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Jillian Gedeon, Saw Nanda Hsue, and Angel M Foster

hospital facilities hours away.
The challenges associated with getting to a facility heavily influenced the timing and types of ser-
vices women sought. Many of the women in our study had worked with a traditional birth attendant
or a traditional healer at some point in their reproductive lives. Although some women reported hav-
ing positive experiences with traditional and lay providers, most described use of these systems
as being forged out of necessity. For example, Myia, a 54-year-old who resided in Eastern Burma at
the time of interview, delivered her son in her village in Mon State, Burma in the early 2000s.
She believes that his death was directly tied to her inability to travel to an affordable clinic:

“I delivered my son [in the village] and after 5 days, he was not healthy…And then we tried to get
him some medicine and we also asked some other people to come and check but they could not help
us. They gave us traditional medicine but it wasn’t helpful for my son. He continued to feel better
for 7 days but then after 12 days, he died.”
- Myia, age 54, cross-border

A number of our participants reported that the availability of health facilities also directly influ-
enced their contraceptive decision-making. Our participants who lived in Mae Sot or in the Mae
La camp were overwhelmingly positive about the contraceptive method mix available to them.
However, women who resided in communities outside of Mae Sot or the Mae La camp at some point
in their reproductive lives described significant challenges in accessing ongoing contraceptive
methods and lacked access to long term reversible contraceptive methods. Women explained that
even if they had information about more effective methods, their choices were constrained. Indeed,
almost all of the participants in our study adopted the IUD after having experienced challenges in
accessing or using hormonal contraception consistently and/or having had unintended pregnancies,
as showcased in Khin’s story (Box 2).

Box 2: Khin’s story
Khin got married at the age of 16 when she was still living in Pago, Burma. She became pregnant
with her first child a few months after being married to her husband; she explains that they were
young and did not know about sexual and reproductive health. She later tried to use contraception
to plan her family, but could not afford to take contraception consistently. Reflecting on her expe-
rience, she reports:

“I got pregnant with my young daughter because I could not really afford to buy the pill. When I
had the money, I would use the pill, but when I didn’t have the money, I didn’t use anything. That
is when I became pregnant with her.”

Living in Burma presented many financial hardships and after the birth of her second child, Khin
tried to use oral contraceptive pills again, but they made her dizzy. She sought contracep-
tive counseling and experimented with a variety of methods, all of which came at a cost, while
trying to help her husband support their family. The financial constraints that her family was ex-
periencing motivated their move to Mae Sot, Thailand. Since then, Khin experienced contracep-
tive failure with the pill and had a miscarriage. Her migrant status led her to seek medical advice
from a doctor at the Mae Tao Clinic. Now in her mid-30s, Khin eventually opted for the IUD and
explained that it was particularly useful when living in Thailand because it reduces the need for
many clinic visits, which in turn reduces the risk of getting caught by the police and getting fined
as an undocumented migrant.

3.4 Direct and Indirect Financial Costs of Obtaining Services

Fines or bribes to ensure safe passage to or from a clinic and the costs associated with traveling long

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