Melbourne School of Population and Global Health - Theses
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ItemBorders of fertility: unwanted pregnancy and fertility management by Burmese women in Thailand( 2005-05)In this thesis, I describe how women who are forced to migrate from Burma into Thailand manage their fertility, unwanted pregnancy and pregnancy loss. The study was initiated by Dr Cynthia Maung, a Burmese medical doctor, herself a stateless person who coordinates a refugee-led primary health service five kilometres inside Thailand. Unsafe abortion is a common problem and much time and resources are taken with the care of women suffering haemorrhage, infection and pain after self-induced abortion in both Thai and Burmese-led health facilities. The thesis examines the characteristics of Burmese women admitted to health facilities with post-abortion complications and their chosen methods of self-induced abortion. Local meanings of abortion and post-abortion care are explored. Lay midwives play a central role in fertility management and some are abortionists. Men’s role in the management of fertility is also presented. The women are generally married with children. Considered illegal migrants, they are employed and work in Thailand without work permits. Many women have a history of escaping human rights abuses and entrenched poverty in Burma. At least a third of women admitted into care with post-abortion complications had induced their abortion with oral herbal preparations, pummelling manipulations or stick abortions. Most of the abortion services were provided by Burmese lay midwives. Reasons for terminating the pregnancy include: poverty, gender-based violence and the local illness of ‘weakness’. In addition, low sexual health knowledge, and difficult access to reproductive health services play a part in mistimed pregnancy. There is no commonly agreed definition of abortion between formal, informal health workers or women. Most people considered it against cultural lore and in some cases judicial law but still felt it was necessary. Women’s perceptions of the viability of their pregnancy and its outcome prevailed. Men played a limited role in fertility management. I argue that a lack of rights to work and earn a fair wage; to move without fear, a lack of sexual health information, and the ability to safely control fertility increases women’s risk of unsafe abortion. Furthermore, violence perpetrated at the individual and state level contributes to unsafe abortion. Burmese women’s mortality and morbidity associated with unsafe abortion is largely unrecorded by Thai processes and unknown to the Burmese military government. Unwanted and mistimed pregnancy can be avoided through reproductive technologies, education programmes, and access to modern contraceptives. To safely terminate unwanted pregnancies and to treat the complications of pregnancy loss is not only possible but a woman’s right as delineated in the international treaty CEDAW, to which Burma and Thailand are signatories. Yet Burmese women continue to suffer: become sterile, socially vilified, unemployed or repatriated against their will due to their reproductive status. Their sickness and deaths are secondary to the economic imperatives of Burma and Thailand and their human rights continue to be violated.....