Flowers, tablets, sticks, and falls: Documenting women's abortion experiences on the Thailand-burma border

Background: The ongoing conflict in Burma and the consequent population dislocation, disruption of services, and shortage of trained health service personnel has had a significant impact on reproductive health outcomes. The risk of unintended pregnancy and subsequent unsafe abortion among women in Eastern Burma and refugees and migrants in Thailand is considerable. The Mae Tao Clinic (MTC) operates one of the largest and most comprehensive post-abortion care (PAC) services along the Thailand-Burma border. This study aimed to document PAC clients' abortion and contraceptive experiences, identify barriers to the adoption of post-abortion contraception, particularly the IUD, and explore ways in which reproductive health service delivery could be improved along the border. Methods: In 2011-2012, we completed 24 in-depth interviews with women who had received PAC services at MTC. Interviews were conducted in either Burmese or Karen and completed immediately after discharge. We conducted content and thematic analyses of the interviews using a combination of pre-determined codes and inductive techniques to identify emergent themes and findings. Results: Participants in the study presented for PAC services after both induced and spontaneous abortions. Women reported a range of induction practices, including insertion of sticks, tablets, traditional medicines, and flowers, physical exertion, and falls. Participants' knowledge of the full range of contraceptive methods was limited and few PAC clients were offered an IUD during contraceptive counseling. Conclusion: Unsafe abortion practices were widespread among our participants. The findings informed the development of a clinic-based intervention to train 20 health workers in IUD counseling, insertion, and removal.