17 January 2019

Faculty of Nursing

The Faculty of Nursing is working with Ulster University in Northern Ireland on the Birth Across Borders Project funded by the Global Research Challenges Fund of the Research Councils UK. This project is a collaboration between Northern Ireland, Thailand, and Myanmar to address maternal mortality. Dr. Lesley Dornan from Ulster University is leading project activities in Southeast Asia and is working closely with Dr. Nonglak Chaloumsuk and Prof. Dr. Susanha Yimyam from the Faculty of Nursing. The UK research team from Ulster University also includes Professor George Kernohan, Principal Investigator, and Professor Marlene Sinclair a Midwifery specialist; both of whom have many years of experience in this area.

This study is building upon the formative phase of the project which took place from February – April 2017. This phase focused on comparing the differences in maternal policy and practices in Thailand and Myanmar and exploring the effect of universal healthcare coverage on maternal care in Thailand. The formative phase also centered on identifying resources and expertise to build capacity for maternal health in Myanmar. FON was identified as an important partner for Phase II given the Faculty’s expertise in maternal issues and Thailand’s success in dramatically reducing its maternal mortality rate in a relatively short amount of time.

Phase II is a six-month mixed-methods pilot project to identify maternal mortality risk factors in conflict settings. The team is currently designing a framework for working in conflict countries and a 54-item survey and focus group guide. The pilot project will take place in Karen State in Eastern Myanmar. Karen State was chosen because of the identified need for better maternal health services and the existence of key partners that can assist with project implementation. Karen state is very rural and people often have to walk between one to six days to access healthcare facilities, which often have limited supplies. The Karen Department of Health and Welfare gave permission for the study to take place in the Karen State as they are looking to establish local area clinics and study data will provide important information in guiding their process.

The quantitative study is collecting information on the context of maternal health such as maternal healthcare, barriers to healthcare access, community strengths and functions, and basic issues that mothers face on a daily basis. The focus groups will capture women’s lived experiences of birth and maternal health. Women will discuss their experiences of pregnancy, labor, delivery, and the early postpartum period. In total, 16 communities in Karen State will participate with a goal of collecting 260 surveys and conducting 8-10 focus groups. The Karen Department of Health and Welfare will assist with identifying participants. The data collection will be conducted by local development groups, Earth Mission Asia and Partners Relief and Development. Drs. Dornan and Chaloumsuk traveled to Myanmar in February 2018 to meet with local partners and to prepare for data collection training.

Data from this pilot project will be used to apply for funding for a two-year project that will scale up project activities across Myanmar. The government of Myanmar is in the process of reforming its healthcare system and they are considering universal coverage similar to Thailand. The Ministry of Health and Sports recently approved a nationwide Birth Across Borders project focusing on the five main ethnic groups in Myanmar: Burmans, Mon, Kachin, Karen and Shan.

Myanmar has experienced conflict for decades. As a result, many parts of the county are impoverished and the government has a difficult time providing healthcare in remote areas. In 2015, WHO documented that Myanmar had 178 maternal deaths per 100,000 live births. This is well above the Sustainable Development Goal of less than 70 maternal deaths per 100,000. Hopefully the Birth Across Borders project will identify key elements that will improve maternal health Myanmar and assist the government in improving health care for all in Myanmar.