- Training health workers and health volunteers living in villages in Shan State; so that where clinics and doctors don’t exist, local women trained in midwifery and curative care are on call for their communities
- Community health surveys: collection and analysis of data from 66 village cluster in remote Shan State
- Community awareness-raising and outreach on health issues, such as - Basic health care, with a focus on prevention - Reproductive health,
- Maternal and child care
- HIV/AIDS: support and counselling
- School-aged specific nutrition, health and hygiene workshops
- Regular de-worming for community members
- Health services, through a community health centre on the Thai-Burma border, and through outreach in rural areas of Shan State
- Providing basic health care, focusing on mothers and children
Women’s Crisis Support
- Running accommodation centres for women and children in crisis: one on the border in Fang and one in Chiang Mai
- Provision of emergency health assistance to women and children in crisis
- Networking with other local organisations to provide legal and other support for emergency cases
- Providing counselling and psychological healing
SWAN’s Women’s Wellbeing Program has been providing women and children in remote and rural areas of Shan State with vital education and health services. The SWAN-supported health project is community managed and includes education and service delivery as well as a training course for Shan women. The training effectively expands and updates the knowledge and skills of the courageous young women, who are already actively working in their communities and are interested in becoming a part of the broader SWAN reproductive health service delivery network. Quite often SWAN’s health workers are the only health workers providing targeted services to women and children in rural and remote villages in Shan State. SWAN’s project has been successful in improving the maternal health status and wellbeing of women and children. SWAN will expand this project in 2017 and continue to build community capacity through participatory health interventions and empower communities through education and training in rural and remote Shan State.
Reproductive Health Awareness and Data Collection Training Course 2016
SWAN has been running the reproductive health awareness and data collection training course annually since 2011 and in September 2016 we held our sixth consecutive course. This important and modern training course is targeted toward young women who have had some form of prior health worker training or experience and need to expand or update their knowledge and skills. The content of the course primarily focuses on reproductive health, family planning, maternal and child health. The course also consisted of a special segment on Maternal and Child Health Care conducted by a public health specialist and a training team from the Chiang Mai Rajabhat University Department of Public Health; the team has frequently delivered special segments in SWAN’s reproductive health training courses since 2011. SWAN aims to provide young women with the skills they need so that they may reach more communities in rural and remote areas of Shan State, where there is a severe lack of women’s health services which has resulted in extremely low health outcomes, especially for women.
Summary of Village Household Demographic-Family Planning-Vital Events Surveys (2015)
As mentioned above, SWAN-sponsored health workers routinely collect demographic, vital events and health related data in their villages to ensure that the health status of their communities is kept up to date. The health workers also itemise and organise the information into report format to make it available to the program staff to easily assess and monitor. The Annual Village Household Demographic-Family Planning-Vital Events Survey was conducted in January 2016, which covers the period from 1 January-31 December 2015. The vital events, collected for this survey exercise, cover the catchment area Mong Hsu, Kesi, and Kunhing Townships in northern Shan State; 61 villages in total.
The surveys found that overall the total number of women, married and unmarried of reproductive age in these 61 villages is 26.7% which is slightly higher than average in Burma (22-25%) and the family planning acceptance is very high in most of the 61 villages with a Contraception Prevalence Rate (CPR) at 78.1%. The high CPR is unusual for women to be using a modern family planning method in remote areas where there is a lack of state government health service provision. The rate is more than double that of the whole of Burma. This is an outcome of SWAN’s health workers, who have been actively working in these catchment areas for between 5 to 10 years, providing women with vital reproductive education as well as some direct services.
The vital events surveys were administered by the SWAN health team in Mong Hsu, Kesi and Kunhing to record all births, deaths and foetal events including natural abortions/miscarriages, induced abortions and stillborns. The results from these vital events surveys will be discussed below.
The overall crude birth rate was low at 15.0, which was expected considering the high contraceptive prevalence rate of these rural and remote communities. The SWAN health team performed at least 55 of the 148 (37.2%) deliveries that took place in the calendar year of 2015. 70 deaths were recorded in 2015, and therefore the CDR was 7.1, which is in the moderate range and what is expected in rural/remote areas of Burma. It is similar to the rest of Burma, which is 8.1, as well as other neighbouring countries including Thailand, where the CDR is 7.4. Similarly, in a region with low CBR and moderate CDR, the overall population growth rate is classified as in the low range at 0.79%. Some villages had more deaths than births and others had an equal number of births and deaths.
There was one natural abortion/miscarriage, 5 induced abortions and 0 stillbirths, which is a small percentage compared to all possible births (3.9%). In total there were 5 infant deaths, resulting in a moderate-high IMR. One of the reasons why the IMR is relatively high is that the total number of live births was much lower than one would expect to find. As such, the percentage of newborn infants dying within the first year of life (5 of 148 or 3.4%) was high and results in an IMR of 33.8 per 1,000 live births. There was only 1 early childhood death, and thus the overall Early Childhood Mortality Rate (CMR) for these 61 villages was very low (6.8), which is somewhat unusual for remote/rural communities in Burma.
There was one maternal death in the 61 villages during 2015. This resulted in a high MMR rate at 676. The reason it was so high was due to the relatively few births and a lack of emergency obstetric care in rural and remote communities. This means that if a woman has complications during her pregnancy it is a very long distance to travel to the hospital to access emergency care. During a special workshop in July 2015 SWAN provided a review of the recommendations for health workers regarding maternal deaths and how to reduce and prevent them from occurring.
Please refer to the tables below for detailed household demographic- family planning and vital events information.