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Jillian Gedeon, Saw Nanda Hsue, and Angel M Foster

of economic development have resulted in the displacement of millions of people both within East-
ern Burma and to neighbouring Thailand (Sietstra, 2012; New Internationalist, 1996). Those who
have been internally displaced and those living in conflict-affected areas of Eastern Burma
are commonly referred to as “cross-border populations” as they are often provided with services and
support from organizations operating in Thailand (Hobstetter, Walsh, Leigh, et al., 2012). Popula-
tions from Burma residing in Thailand are comprised of two primary groups — refugees who reside
in one of the nine “unofficial” refugee camps in Northern Thailand and migrants, most of whom are
2
undocumented and do not have legal status.
Consistent with conflict-affected populations around the world, the overall situation has impacted
women’s reproductive health. Cross-border populations are at significant risk of dying during preg-
nancy and childbirth, lack consistent access to contraception, and face high rates of unintended
pregnancy (Burma Medical Association, National Health and Education Committee, Back Pack
Health Worker Team, 2010; Back Pack Health Worker Team, 2006). Burma’s abortion law is one of
the most restrictive in the world and is narrowly interpreted. As a consequence, unsafe abortion
is common and is a leading cause of maternal mortality in Eastern states (Ba-Thike, 1997). Women
in Burma residing in Thailand — as either refugees or migrants — also face tremendous challenges
to obtaining high quality, comprehensive reproductive health services and are at heightened risk of
sexual exploitation and violence (Mullany, Lee, Yone et al., 2008; Crawford, 2005; Maung and Bel-

ton, 2005; Belton and Maung, 2004). The efforts of a large number of international non-go -
vernmental organizations (NGOs) and community based organizations (CBOs) have not been suffi-
cient to meet the overwhelming needs of women on both sides of the border (Hobstetter, Sietstra,
Walsh, et al., 2015; Gedeon, Hsue, Walsh, et al., 2015; Sietstra, 2012; Hobstetter, Walsh, Leigh et al.,
2012; Lee, Mullany, Richards et al., 2006).
That women in this context face structural, systems, legal, policy, and socio-cultural barriers to
accessing desired health services has been well documented (Hobstetter, Sietstra, Walsh et al., 2015;
Sietstra, 2012; Hobstetter, Walsh, Leigh et al, 2012; Mullany, Lee, Yone et al., 2008; Maung and
Belton, 2005; Belton and Maung, 2004). However, far less research has been dedicated to exploring
how women experience those barriers and identifying ways that women navigate these multi-fac-
eted constraints. Drawing from interviews we conducted in Tak province, Thailand with migrant and
refugee women from Burma, this article explores women’s lived experiences and the ways that com-
plex, overlapping barriers impact women’s reproductive health decision-making at different points in
their reproductive lives.
2. Methods

In the summer of 2013, we conducted a qualitative study dedicated to understanding women’s ex-
periences with the intrauterine device (IUD) on the Thailand-Burma border, a rarely used technology
in this setting at the time. This effort was part of a larger project focused on identifying and address-
ing barriers to expanding access to long-acting reversible contraception and involved a multi-stage,
multi-year collaboration between researchers and service providers in the US, Canada, and Thailand.
We have reported on the IUD-related findings elsewhere (Gedeon, Hsue, Walsh et al., 2015).
However, our semi-structured interviews with 31 women from Burma explored a range of is-
sues beyond the IUD and our initial study questions. Participants provided extraordinarily detailed
accounts of their lives, including reflections on major reproductive health-related decisions and
events. In this article, we use the same dataset to delve into women’s experiences along the border
and focus on the structural, systems, financial, and socio-cultural factors that influence deci-
sion-making and access to services.

2 Thailand is not a signatory to the 1951 Refugee Convention nor to the 1967 Protocol Relating to the Status of Refugees, and thus
does not officially recognize the camps (Women’s Commission for Refugee Women and Children, 2006).

International Journal of Population Studies | 2016, Volume 2, Issue 1 79