Alone in a village far from medical professionals, with no medication and only a knife shaped from a bamboo stem to cut her baby’s umbilical cord – that is the experience of childbirth for most rural women in Laos.
With one of the highest maternal mortality rates in the Asia-Pacific region, the Laotian expression that compares pregnancy to “waiting for death” is notoriously accurate for the many women who die due to childbirth complications each year.
Research by the University of Health Sciences in Vientiane reveals that nearly 90 percent of rural women deliver their babies without the aid of a trained attendant. Dr. Alongkone Phengsavanh, Director of the University’s Collaborating Centre of Postgraduate Training in Obstetrics and Gynaecology, said most rural women did not give birth in hospitals because they could not afford the medical fees, could not reach health services and feared medical procedures. Traditional beliefs about giving birth at home also played a role.
Dr. Phengsavanh, who conducted in-depth interviews with rural women, said the remote, mountainous terrain of northern Laos made it difficult for women to reach health facilities.
“We need to motivate them to go to hospitals and understand the importance of antenatal care and delivery with trained birth attendants,”Dr. Phengsavanh said, adding that mobile health workers needed to be trained to care for those who could not reach clinics.
Many rural women do not receive vital antenatal care, which may affect the health of their babies as well as mothers. Although some NGOs provide antenatal care at a subsidised cost, Dr. Phengsavanh urged the government to provide free services. “Because they are so poor they can’t afford even the minimal cost of antenatal care,” he said.
Teenage pregnancy is also a major concern among rural communities, where girls as young as 13 sometimes give birth. Dr. Phengsavanh said young girls were at greater risk of maternal death because their bodies had not yet fully developed.
He said traditional beliefs about childbirth could also affect a woman’s and new born’s health, such as the custom that a woman does not eat meat for a week after the birth. He said a woman’s husband, parents or in-laws often decided where the woman gave birth, and more often than not, it is at home without skilled birth attendants. Women and their relatives needed more information to ensure that women can make an informed decision about where they deliver. Dr. Phengsavanh added that women who planned to deliver at home needed more information about the need to access a trained birth attendant.
The University of Health Sciences’ research is part of the International Conference on Population and Development +15 project, a monitoring and research project coordinated by the Asian-Pacific Resource and Research Centre for Women (ARROW) which assesses progress on women’s health in 12 countries. ARROW is a women’s regional NGO committed to promoting and protecting women’s health rights and needs, particularly in the area of women’s sexuality and reproductive health.