Birth across the Borders: exploring contextual education as a catalyst for improved maternal health.

Families that lose a mother in pregnancy or childbirth face many challenges. They are left with a gap that can lead to a loss of income and poverty. It can cause a lot of family pressures, especially for girls are left to care for younger children and are not able to go to school. Many of these families come from communities that are already poor, with very little infrastructure and limited access to decent healthcare. This can cause a much higher risk of death, both for mothers and babies, especially in poor countries. Opportunities are more limited because families lack money and education.
Myanmar is a South East Asian country that has had many years of tension and conflict between the different people groups. Many of these groups live in remote mountainous areas where basic resources and infrastructure such as electricity are limited. There is often little healthcare in these areas with very few doctors, nurses or midwives to care for mothers and their families. One in 23 women in Eastern Myanmar either die or come close to death during pregnancy or childbirth. These challenges are all very typical in developing countries across the world today, but a lot can be changed with education that makes sense to mothers and families in their situations.

Working together with our local partners we intend to learn more about the specific challenges facing families in four regions of Myanmar. From this we will co-develop three education programmes which will be especially adapted for each region. One of these programmes will help families and communities understand the processes of pregnancy and birth, recognise what is normal, what is unusual and what is dangerous and to know what to do and where to go to get help. Our second programme will further train health workers to understand the different signs and symptoms that are dangerous in pregnancy and birth and find ways to help mothers in time to prevent complications. Poverty is very high in parts of Myanmar, so our third programme is for community leaders and local people to support them to start and grow businesses. This way families can afford to eat well and get good healthcare when they need it. Our project will focus on remote regions in Myanmar and together we plan to learn how to find ways to overcome the legacy of many years of poverty and conflict. This project will include staff from our universities in Northern Ireland and Thailand as well as local partners who come from or have been working in the region for many years.

Through this project we hope to help support the work of all our partners and improve education for mothers, families and communities. A key part of our project is making sure that the education they receive makes sense in their situations and includes their beliefs and customs leading to improved health, social and economic opportunities and accessible healthcare. We plan to share what we do with other organisations working in Myanmar who may also benefit from our research. Finally, it is hoped that our research will contribute to current policies and practices in partnership with the government of Myanmar and the ethnic health organisations.

This maternal health education project is co-developed with local, national and international partners representing all beneficiary groups. It builds on partnerships consolidated over 5 years of international networking and research: a workshop with health professionals from Thailand and Myanmar, data collection from Karen State, Myanmar, and community and policy consultations. The project addresses maternal mortality and morbidity in remote, rural communities in Myanmar, with embedded sustainability, and potential for scale-up nation-wide and in other LMICS. Mode of delivery of educational interventions will be community and stakeholder led to ensure maximum benefits, with training of local members and support to promote learning and skills retention. The beneficiaries will be women, families, and communities in rural Myanmar and beyond, and the government departments, policy makers and organisations with responsibility for maternal health care.
Impact will effect: Women of childbearing age through enhanced pregnancy, birth and post-partum care; increased knowledge of pregnancy, birth (what's normal, what's unusual and what's dangerous); access to culturally relevant maternal health education; access to healthcare; decreased risk of pregnancy and birth-related illness and death; enhanced social and economic opportunity. Pathway: targeted educational interventions will lead to improved maternal health. Cascade benefit to siblings, families and communities challenging generational and gendered patterns of inequality. Fathers: increased support to equip fathers in their role in pregnancy, childbirth and parenting; skills to respond to obstetric emergencies; social and economic benefit and participation in sustainable community development. Pathway: timely antenatal and community education interventions. Siblings and Families: less educational disruption caused by caring responsibilities for younger siblings; increased access to education leading to increased life opportunities, lower risk of early motherhood and maternal complications; improved life choices, more equitable opportunity to engage in social and economic development. Pathway: timely maternal and community education interventions for parents and carers with local community members trained for sustainability. Community leaders:Increased understanding of maternal health; leadership development and enhanced understanding of models of social enterprise and sustainable community development. Pathway: educational interventions in maternal health and social enterprise at village tract level. Timely implementation for leadership with support from trainers on social enterprise strategies. Rural communities: enhanced contribution of women to sustainable community development; reduced social and economic burden, maximisation of community resources and realisation of social and economic potential; enhanced social cohesion; improved general health and well-being. Pathway: all educational interventions. Health workers in rural communities: Improved ability to enhance maternal health; recognition of their role within communities; challenge to potential gender discrimination associated with this mainly female role. Pathway: Community education and EMOC programme. Ministry of Health, Ethnic Health Organisations, Local NGOs: evidence of the barriers, risks and implications/realities of maternal health in rural areas. Greater awareness of effective interventions and their potential for roll-out/scale-up. A set of educational packages to promote maternal health. A template for effective practice, and evaluation. Pathways: reports for ethnic health organisations. Workshops to develop transferable skills to design and deliver further culturally and contextually relevant education packages to address health and development challenges/promote sustainable development in diverse ethnic populations in Myanmar. Delivery of interventions through regional training teams beyond project lifetime.