In Thailand's refugee camps, shifting attitudes about sexual and reproductive health

MAE SOT, Thailand - Visiting a sexual and reproductive health clinic may seem ordinary for many women. But this is not the case for Saba, 21, who has been living in the Mae La refugee camp along Thailand's border with Myanmar for the last two years.

Covered in a pink and black headscarf, Saba recently paid a visit to one of the camp's health clinics, operated by the Planned Parenthood Association of Thailand (PPAT) with support from UNFPA.

Saba had given birth earlier in the year and was seeking advice on how to delay her second pregnancy.

“I want to have time for myself. I don’t want to have the second child any time soon,” she said through an interpreter.

Access to voluntary family planning is essential to improving the health and lives of women - and in refugee camps it becomes critical. In times of upheaval, many women lose access to family planning services, exposing them to unwanted pregnancies under perilous conditions. Many refugee women and girls also lack basic information about sexual and reproductive health and hygiene.

Thailand is home to one of the largest refugee populations in the world; most of the refugees are from Myanmar. Mae La, with more than 40,000 residents, is Thailand's largest refugee camp.

Traditionally, women in the Mae La camp, most of whom are ethnic Karen, did not openly visit sexual and reproductive health clinics. Social norms and family pressure discouraged them from doing so. Additionally, most of them were married at a young age and did not discuss family planning openly.

But today, the reproductive health centre is teeming with people. Young children run about, and some women even bring their husbands. This would have been an unlikely scene just a few years ago.

Earning and building trust

The positive changes in the Mae La camp are in large part due to the partnership between UNFPA and the PPAT, which provides a variety of services, including counselling on domestic violence.

The partnership also works to educate camp residents about reproductive health. But instead of relying on outside health workers and educators, the programme selected and trained a group of refugees to serve as assistant nurses and peer-educators, helping to build trust within the community.

In a small building with walls made from local jute, Naw Shair Paw, a refugee assistant nurse, spoke to Saba in Burmese. She took her weight and blood pressure before leading her to a private room for a contraceptive implant.

“I can use the needle,” said Naw Shair Paw, who was trained by Thai nurses through the UNFPA-sponsored programme.

Beaming with pride, she lifted another assistant nurse’s arm to show the spot where she had injected a contraceptive implant earlier. “Birth control provides women free time to study, like us, who can be assistant nurses.”

Dispelling myths

Before the clinic gained wide acceptance, many refugees simply did not know about the health benefits of family planning and sexual and reproductive health services. Some even feared the programme would attempt to ‘control’ the refugee population.

– Jeerawat Na Thalang