Rural Women Face High Maternal Mortality

Lack of access to medical facilities leaves Laotian women at risk of death during childbirth.

Women in the outlying areas of Laos face some of the highest risk in Asia of dying in pregnancy or childbirth, largely due to simple complications that could be avoided with access to adequate medical assistance, according to an official.

An official from the Lao National Commission for Mothers and Children told RFA that most pregnant women in the country’s remote mountainous regions die because doctors or midwives cannot reach them for lack of local infrastructure.

“Sometimes midwives are unavailable and a mother is forced to give birth by herself because of inaccessible roads,” the official said, citing particularly a remote area of western Xayaburi province which has one of the highest maternal mortality rates in the nation.

“Many mothers die in Xayasatan district because it is in mountainous area,” she said.

According to the official, 120 of every 100,000 mothers died during childbirth in Xayasatan in 2011, mostly due to post-partum bleeding and lack of medical care. She cited a lack of access roads as the main obstacle to overcoming the problem.

And despite a government pledge to provide medical assistance to pregnant women and children under the age of five in the Xayaburi districts of Paklai, Hongsa and Boten, which also suffer from high mortality rates due to inaccessibility, the official said plans have not yet been implemented. There is also no medical care plan for mothers and children in Xayasatan to date.

Natural births common

Natural births are a way of life for women in rural areas without access to professional health care during pregnancy, who are often forced to carry out the delivery process by themselves, according to the director of the National Commission for Mothers and Children in northwestern Bokeo province.

“In some culture, women cut the umbilical cord of their newborn babies by themselves using a piece of bamboo sharpened by hand,” the director, identified only as Suphen said.

“Many newborns are at a high risk of contracting tetanus.”

As a consequence, he said, Laos faces some of the highest infant and maternal mortality rates in Asia.

A 2010 report by the United Nations Development Program said that the likelihood of a skilled health worker attending childbirth in Laos was largely based on a family’s income and area of residence.

It said that between the years 2006 and 2010, the country’s wealthiest 20 percent of women had an attendant during childbirth 81 percent of the time, while the poorest 20 percent were only assisted during three percent of births.

The report also showed that 68 percent of births were attended by skilled health workers in urban areas, while only 11 percent of births were attended in rural areas. Urban dwellers made up only 6.2 percent of the country’s population between 2006 and 2010.

Millennium goals

In 2000, with help from NGOs like the U.N. Population Fund, the World Health Organization (WHO) and the World Bank, the Lao government established new millennium goals which aimed to reduce by more than half its rate of 790 maternal deaths per 100,000 childbirths that year—to 300 by 2015.

In order to realize those goals, the Lao government and related NGOs set up a midwifery program to train local women in basic medical procedures in the hope that they would assist in delivering babies in remote areas.

Suphen said that the program had achieved some success in Bokeo province.

“In areas where there are midwives, like in some villages in Bokeo province, new and expectant mothers are receiving important training,” he said.

“For example, midwives advise mothers to fully clean their nipples before breastfeeding their babies.”

But overall, few Lao women have shown interest in being midwives because they would work without receiving any salary, leaving many areas of Laos, particularly those in remote regions, without any skilled health personnel.

And while in 2009, the maternal mortality rate in Laos dropped to 500 mothers for every 100,000, according to the United Nations Development Program, down from 580 the previous year, Lao officials reported to the U.N. last year that the country is unlikely to achieve its millennium goals.

Other reasons cited by the World Bank for high maternal mortality rates among rural women in Laos include high fertility rates amongst adolescent women, who face higher health risks for themselves and their infants, and malnutrition, which leads to higher rates of anemia in pregnant women.

It said that human resources for maternal health in the country are also limited with only 0.35 physicians per 1,000 population. Nurses and midwives are slightly more common at 0.97 per 1,000 population.

Reported by Manichanh Phimphachanh for RFA’s Lao service. Translated by Bounchanh Mouangkham and Max Avary. Written in English by Joshua Lipes.