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Jillian Gedeon, Saw Nanda Hsue, and Angel M Foster

reported that broader social stigma restricted information and service delivery to adolescent popula-
tions and added to community pressure towards early marriage. Internalized stigma impacted the
ability of unmarried women to ask questions or seek services when needed; a cultural construct often
described as “shyness.” Thus, the majority of women in our study reported that they only learned
about reproductive health issues — including reproductive anatomy and physiology, contraception,
and pregnancy — after getting married, even if they themselves were sexually active before mar-
riage.
Two of our participants shared their abortion experiences during the interviews. In both cases, as
illustrated in Sie Sie’s story (Box 3), the women were unmarried at the time of the pregnancy and
first attempted to terminate the pregnancy through self-induction practices. Both women then went
to a traditional birth attendant and had an unsafe abortion and their stories showcase legal status,
service availability, financial and socio-cultural dynamics shaping reproductive health deci-
sion-making along the border.
4. Discussion

Women’s reproductive health decision-making along the Thailand-Burma border is shaped and in-
fluenced by a multitude of structural, systems, financial, and socio-cultural factors. Our results
are consistent with a larger body of literature that explores reproductive health in crisis, conflict,
emergency, and refugee settings in general, and on the Thailand-Burma border in particular. Migrant
women’s health is affected by pre-departure events (war, trauma, natural disaster, poverty, etc.), the
mode and duration of travel to the new destination, the availability of resources in the host commu-
nity, and discrimination and exploitation associated with relocation (International Organization for
Migration, 2013; López-Acuña, 2008). Along the Thailand-Burma border, access to healthcare ser-
vices such as hospitals or clinics is highly dependent on the person’s place of living combined with
her legal status and financial resources. Combined with socio-cultural taboos and externalized and
internalized stigma, these dynamics blend together to place constraints on women’s autonomy and
self-actualization. The experiences of women in our study make evident the claim that reproductive
health and rights are intertwined with the broader issue of human rights and social justice.
However, in addition to the barriers that women experience, our results also showcase the resil-
ience of women in this protracted conflict setting and suggest that there are a number of ways that
women navigate existing challenges. In order to reduce the chance of being stopped by Thai authori-
ties, women use their bicycles to travel to and from different health services. If and when a clinic is
not nearby, women ask friends and family members for reproductive health advice and support
which often leads them to a traditional birth attendant near their village or community. In desperate
situations, women will find themselves inducing their own abortions, if legal, structural, and/or
socio-cultural barriers stand in the way of much needed abortion care.
That women’s lives are complex and that reproductive health is affected by a range of factors is
hardly surprising. However, the ways in which women in this context experience structural barriers
offers insights into priorities for programming and service delivery. Many of our participants sug-
gested that one of the most important avenues for improving reproductive health along the border is
to increase multi-lingual educational efforts. Our participants’ own lack of knowledge of reproduc-
tive health issues — especially in the period before marriage — certainly signals this need. This
finding is consistent with a larger body of research with women on the border that has documented
the social taboos surrounding sexual and reproductive health among adolescents and unmarried
youth (Oh and van der Stouwe, 2008; Women’s Commission for Refugee Women and Children,
2006).
Yet as is evidenced from the experiences of our participants, increasing awareness, at the individ-
ual, community, and/or health service provider levels, is not a panacea as education alone will not
address the larger structural and systems constraints that women face. Rather, culturally-and con-

International Journal of Population Studies | 2016, Volume 2, Issue 1 85