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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

distances to clinics are but a few of the financial considerations that our respondents described as
shaping their reproductive health decision-making. Most of our participants described the costs of
obtaining reproductive health services — particularly contraceptive supplies and delivery care — as
prohibitively expensive. This was especially true for cross-border women, as family planning ser-
vices are often not subsidized and facility-based deliveries often require payment in Burma. In com-
paring services in Thailand to those in Burma, Lwin explained, “Here, [in Thailand] even if you have
no money, they just provide a free service for us.”
Many women in our study explained that financial costs not only influenced their decision to con-
sistently use a particular method of contraception but also served as a major factor in the decision to
adopt any method of contraception. Women who engaged in small-scale income generating activities,
owned small shops and businesses, and worked in factories along the border, all struggle to make
ends meet. Women explained that having (in all but one case) additional children would impede their
ability to give their existing children as many opportunities as possible. Further, many women in our
study described demanding workloads and daily exhaustion that influenced their decisions about the
timing of pregnancies and parenting. As one 30-year-old factory worker explained, “[Each week I
have one] day off, on Sunday. We usually start at 8 am and [go] until 10 pm or sometimes…they
keep us working until 12 midnight.” Sie Sie’s story (Box 3) reflects this dynamic.

Box 3: Sie Sie’s story
Sie Sie is a 27 year old married woman with one child. She currently works in Mae Sot in a cotton
factory with her husband. During her late teens, she found out she was pregnant after having un-
protected sexual intercourse with her partner. Sie Sie struggled to find abortion services in Mae
Sot and she eventually travelled across the friendship bridge to Myawaddy, Burma to consult with
a traditional birth attendant. She was initially given a red powder to ingest and later endured a
pummel massage, both of which made her feel very sick and uncomfortable.

“I deliberately aborted my pregnancy because I didn’t want it and I [didn’t] want to get married.
When I tried to abort my pregnancy [myself] it didn’t work…So I went to a woman in Myawaddy
and she treated me with a medicine…After 15 and 20 days the foetus was not totally aborted and
it really hurt me. She pressed and squeezed my stomach with her body and treated me with herbal
medicine but I was still really hurt and uncomfortable. I was scared and became thinner.
I couldn’t eat any more and then I worried that something would happen [to me]”

Sie Sie and her partner were not convinced that the abortion had worked. Thus they decided to get
married immediately because of the cultural stigma associated with pre-marital sex. They found
out a couple of days after the wedding that the unsafe abortion had been successful.

After a few years of using the oral contraceptive pill provided to her by her employer, Sie Sie and
her husband decided to have a child. But after their daughter was born it became clear that the
long and exhausting hours at the factory and the costs associated with caring for a child made
raising her in Thailand impossible. Sie Sie ultimately sent her daughter to Yangon to be cared
for by extended family members. Sie Sie and her husband continue to live and work in Mae Sot;
they hope to eventually be able to obtain enough financial security to be reunited with their child.

3.5 Socio-cultural Stigma Associated with Sex Before Marriage

Irrespective of women’s ethnic or religious identification, the majority of participants in our study
referenced that sex before marriage was considered a major social taboo. The stigma associated with
premarital sexual activity was cited as a major factor influencing women’s reproductive health
knowledge and decision-making by cross-border, migrant, and refugee participants. These women

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