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“I came by the bicycle so we can avoid the police”: factors shaping reproductive health decision-making on the Thailand-Burma border

accurate and inaccurate information about the oral contraceptive pill, the Depo-Provera shot, and
the IUD. She explained that trying to seek medical care for her sexual health is chall-
enging both because of the lack of time in her daily schedule and the risk of being stopped by the
police on the way to the clinic. She is now an IUD user and hopes to one day be in a position
where she can afford to grow her family.

Undocumented migrants like Lwin and cross-border residents “visiting” Thailand are at risk of
deportation and are vulnerable to the demands of Thai police who may levy onerous “fines.”
Women’s legal status (or lack thereof) becomes an important part of the calculus of where to go and
when and how to travel, thus impacting freedom of movement. Women explained that these dynam-
ics shape their decisions about whether and when to seek reproductive health services.

“On the way [to the clinic] we have to worry about the police, so if I take the pill, I will forget to
take it regularly and for the depo [injection] I would have to [try to] come to the clinic quarterly.
But if I insert the IUD, then I don’t need to worry about anything for 5 years”
- Khin, age 33, migrant

Women are aware of these risks and some developed strategies to navigate them. As Lwin ex-
plained, “It’s not hard to get to the Mae Tao Clinic. In the past, I used to come by car. But later on
I came by the bicycle so we can avoid the police.” Other participants reported, traveling to Mae Tao
Clinic at times of the day when encounters with police would be less likely.
The issue of freedom of movement also emerged in our interviews with refugee women. Women
living in the Mae La camp are generally able to move freely within the designated borders of
the camp itself. However, in the absence of an identification card or travel papers, movement outside
of the camp is severely limited and women who leave the confines of the camp without authorization
risk confrontation with Thai authorities. Most of the refugee women we spoke with reported that
learning about, let alone accessing, reproductive health services outside of the refugee camp
was challenging. As Bway Paw, age 47, explained, “It’s difficult to survive in this camp because
we cannot go out. And we don’t have any ID, including UN ID, Thai ID, and Burma ID.” Although
many women in our study had positive experiences with clinics in the camp, women who require or
desire reproductive health services that are not available within the camp borders and those who
would prefer to access services outside of the gaze of their immediate community are severely re-
stricted in being able to do so.

3.3 Availability and Accessibility of Services

“…some of the women are far away from the hospital and they believe that they can rely on [child]
delivery by their own [peers] in their village at home. However, when they get a serious condition
and they go to the hospital, it is [often] too late.”
- May Ta, age 28, refugee

The lack of availability of comprehensive services, particularly for those women who live in rural
and more remote areas, was consistently raised by our participants as a major factor in their repro-
ductive health decision-making. Beyond the legal risks undocumented women incur in traveling long
distances, many women reported that the costs associated with travel shaped their options and influ-
enced decision-making. The Mae Tao Clinic has established accommodations for women and their
families who require multiple days of treatment or who have travelled extensively. However, some
of our respondents explained that space was limited and often filled to capacity. Women in Mae
La camp generally had ready access to primary reproductive health services in the camp itself, but
tertiary services (for high risk pregnancies or complicated deliveries, for example) require transfer to

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