Accessing Maternal Health Services in Eastern Burma

Burma is a country that has endured decades of war and civil conflict. The State Peace and Development Council, the current military regime that has governed the country for decades, has had ongoing conflicts with ethnic minority groups. Specific policies of the State Peace and Development Council have resulted in forced labor, forced relocation, torture, killings, and deliberate destruction of food supplies [1–3], largely targeted at ethnic minorities within the country [4]. Over one million Burmese are estimated to have been displaced since 1996 [5], and about half have been unable to resettle or return to their homes. The eastern border of the country bears the largest burden of internally displaced persons in the country [5]. Accurate measures of health are critical to address the high morbidity and mortality in this vulnerable population. However, there is a wide variation in reported estimates of health indicators. For example, the World Health Organization reports a maternal mortality ratio of 360 per 100,000 live births [6]; in 2006 UNICEF reported an under-five mortality rate of 104 per 1,000 live births and an infant mortality rate of 74 per 1,000 live births [7]. In contrast, surveys conducted by the Back Pack Health Worker Team—a community-based organization providing health care to internally displaced persons in active conflict zones (“black zones”)—give very different results. The team’s surveys estimate maternal mortality as 1,000–1,200 per 100,000 live births [4] and infant mortality and under-five mortality as 91 per 1,000 live births and 221 per 1,000 live births, respectively [4]. A New Study