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Thai-Burma Border Reproductive Health Assessment Thai-Burma Border Reproductive Health Assessment Women's Commission for Refugee Women and Children Women’s Commission for Refugee Women and Children 122 East 42nd Street New York, NY 10168-1289 tel: 212.551.3111 fax: 212.551.3180 [email protected] www.womenscommission.org © April 2006 by Women’s Commission for Refugee Women and Children All rights reserved. Printed in the United States of America MISSION STATEMENT The Women’s Commission for Refugee Women and Children works to improve the lives and defend the rights of refugee and internally displaced women, children and adolescents. We advocate for their inclusion and participation in programs of humanitarian assistance and protection. We provide technical expertise and policy advice to donors and organizations that work with refugees and the displaced. We make recommendations to policymakers based on rigorous research and information gathered on fact- finding missions. We join with refugee women, children and adolescents to ensure that their voices are heard from the community level to the highest councils of government and international organizations. We do this in the conviction that their empowerment is the surest route to the greater well-being of all forcibly displaced people. Founded in 1989, the Women’s Commission is an independent affiliate of the International Rescue Committee. ACKNOWLEDGMENTS This report was authored by Sally Girvin, consultant, Sandra Krause, director, reproductive health program and Julia Matthews, former senior technical advisor, Women’s Commission for Refugee Women and Children. It was reviewed by Kristen Graham, American Refugee Committee, Dr. Cynthia Maung, Mae Tao Clinic, and Dr. Rose McGready, Shoklo Malaria Research Unit. It was edited by Diana Quick, director of communications, Sarah Chynoweth, program manager, reproductive health program, and Megan McKenna, senior coordinator, media and communications. The Women’s Commission would like to thank the refugees, forced migrants and others living in refugee- like circumstances, representatives of the Committee for the Coordination of Services to Displaced Persons particularly the health subcommittee and other international and local nongovernmental organizations working with displaced populations on the Thai-Burma border, without whose support this report would not be possible. Cover photo: Sandra Krause Acronyms AIMBP HIV/AIDS Initiative for Mobile and Border Populations AMI Aide Medicale Internationale ANC Antenatal care ARC American Refugee Committee ARCM Asian Research Center for Migration ARHNG Adolescent Reproductive Health Networking Group ASRH Adolescent Sexual and Reproductive Health AZT Zidovudine BBC Burma Border Consortium BBG Burma Border Guidelines BHPC Border Health Projects Committee BMA Burmese Medical Association BPHWT Backpack health worker teams CBO Community-based organization CCMH Coordinating Center for Migration Health CCSDPT Committee for the Coordination of Displaced Persons CDC Centers for Disease Control and Prevention CEDAW Convention on the Elimination of All Forms of Discrimination against Women CHE Community health educator COERR Catholic Office for Emergency Relief and Refugees CPR Contraceptive Prevalence Rate CRC Convention on the Rights of the Child CSW Commercial sex worker DOW Doctors of the World EC Emergency contraception EmOC Emergency obstetric care FHI Family Health International FSW Female sex worker GAATW Global Alliance Against Trafficking in Women GBV Gender-based violence HI Handicap International HRW Human Rights Watch HV Home visitors ICBL International Campaign to Ban Landmines ICCPR International Covenant on Civil and Political Rights ICRC International Committee of the Red Cross IDP Internally displaced person IDU Injecting drug user IEC Information, education and communication IMPACT Implementing AIDS Prevention and CARE IOM International Organization for Migrations IPPA International Planned Parenthood Association IPPCR International Convention on Civil and Political Rights IRC International Rescue Committee IUD Intrauterine device JAP Joint action plan JRS Jesuit Refugee Service KAP Knowledge attitude practice KEWG Karen HIV/AIDS Education Working Group KnED Karenni National Education Department KnHD Karenni National Health Department KnRC Karenni National Refugee Committee KNU Karen National Union KnWO Karenni National Women’s Organization KnYO Karenni National Youth Organization KRC Karen Refugee Committee KRCH Kwai River Christian Hospital i KRWDG Karen Refugee Camps Women’s Development Group KWO Karen Women’s Organization KYO Karen Youth Organization MAP Migrant Action Program MCH Maternal and Child Health MHD Malteser Germany MHP Migrant Health Project MISP Minimum Initial Service Package of reproductive health MMR Maternal mortality rate MOI Ministry of Interior MOPH Ministry of Public Health MSF Médecins San Frontières MSM Men who have sex with men MTCT Mother-to-child transmission MVA Manual vacuum aspiration NGO Nongovernmental organization NHEC National Health and Education Committee NLD National League for Democracy PAC Post-abortion care PATH Program for Appropriate Technology in Health PE Peer educator PHC Primary health care PHO Provincial health officer PID Pelvic inflammatory disease PLWHA People living with HIV/AIDS PMTCT Prevention of mother-to-child transmission PPAT Planned Parenthood Association of Thailand RCH Reproductive and community health RH Reproductive health RI Refugees International RHRC Reproductive Health Response in Conflict Consortium SAW Social Action for Women SLORC State Law and Order Restoration Council SMRU Shoklo Malaria Research Unit SPDC State Peace and Development Council STIs Sexually transmitted infections SWAN Shan Women’s Action Network TA Technical advisor TALC Teaching Aid Low Cost TB Tuberculosis TBA Traditional birth attendant TYAP Thai Youth AIDS Prevention Project UN United Nations UNFPA United Nations Population Fund UNHCR United Nations High Commissioner for Refugees UNICEF United Nations Children’s Fund USAID US Agency for International Development USCRI United States Committee for Refugees and Immigrants VCT Voluntary counseling and testing VHV Village health volunteer WEAVE Women’s Education for Advancement & Empowerment WLB Women’s League of Burma WV World Vision ZOA Dutch for Zuid (South) Oost (East) Azie (Asia), ii CONTENTS Acronyms i Executive Summary 1 Key Recommendations ...................................................................................................3 Background 6 Burmese Refugees..........................................................................................................7 Life in Thailand: The Host Country Context ....................................................................8 Human Rights Instruments..............................................................................................8 The Role of UN Agencies................................................................................................9 Migrants.........................................................................................................................11 The General Health Context 13 Burma ............................................................................................................................13 Thailand.........................................................................................................................14 Burmese Living in Thailand ...........................................................................................17 Coordinating Assistance................................................................................................20 The Reproductive Health Context on the Thai-Burma Border 22 Assessment Methodology .............................................................................................22 Key RH Indicators for Burma and Thailand...................................................................23 Reproductive Health Services in General .....................................................................25 Safe Motherhood...........................................................................................................25 Family Planning.............................................................................................................28 STI/HIV/AIDS.................................................................................................................29 Gender-based Violence.................................................................................................31 Adolescent reproductive health.....................................................................................35 Reproductive Health Response on the Thai-Burma Border 37 Chiang Mai and Mae Hong Son Provinces ...................................................................37 Mae Hong Son...............................................................................................................42 Mae Kong Kha (Site 3) and Mae Ra Ma Luang (Site 4)................................................47 Tak and Umphang Provinces ........................................................................................49 Samutsakorn Province ..................................................................................................68 Kanchnaburi Province ...................................................................................................71 Ratchaburi Province ......................................................................................................76
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