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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

text-specific educational programs that explicitly acknowledge the confluence of forces shaping de-
cisions and access are likely to have more resonance. Further, identifying and expanding initiatives,
such as the accommodations program at the Mae Tao Clinic, that address the complex challenges
women experience in seeking health services appears warranted.
Finally, our findings showcase that the totality of women’s reproductive health experiences shape
future decisions. A woman’s decision to use contraception is not only made in the context of struc-
tural, economic, and social forces but is also influenced by her earlier reproductive health experi-
ences and those of women in her community. Our findings support an emerging effort to reconceptu-
alise women’s reproductive histories as “reproductive careers,” a sociological construct that recog-
nizes the inter-relatedness of the reproductive health events in an individual woman’s life (Nash,
2014; Bessett, 2010). This can include the utilization of contraception, abortion care, and delivery
services as well as engagement with reproductive health issues such as infertility and sexually
transmitted infections. The woman who has an abortion, the woman who delivers a healthy infant
and parents, the woman who actively prevents pregnancy for a decade, and the woman who experi-
ences perinatal loss, are one and the same. The siloing that has often characterized both rhetoric and
policy in the reproductive health field belies women’s lived experiences.
Because of the qualitative nature of this study, this study is not meant to be representative or gen-
eralizable. Rather this research provides insight into the reproductive decisions and experiences of
migrant, refugee, and cross-border women living in the Mae Sot and Mae La areas of Tak Province.
It is worth noting that this particular region stands out along the entire Thailand-Burma border as it
is home to the Mae Tao Clinic, a well established not-for-profit clinic that provides services
free-of-charge to Burmese migrants and refugees. In conducting a rigorous and credible qualitative
study, we believe that our results have import beyond the small number of women who participated
in the project. However, our participants are also exceptional within this region as all had used an
IUD at some point in their reproductive lives and almost all were current users of the device. Use of
the IUD is rare along the border and, until recently, few health care facilities have offered this mo-
dality of contraception (Hobstetter, Walsh, Leigh et al., 2012). Thus this sub-set of women had
all been able to successfully navigate the myriad barriers to obtain a desired reproductive health ser-
vice from a trained provider. The experiences of women living along the border who are unable to
navigate these barriers or choose not to contracept are not reflected in our study. Additionally, by
recruiting women who are (or were) users of the IUD, our study is limited to the experiences of mar-
ried women. Although women in our study reflected on their previous experiences as unmarried
women, rigorous qualitative research with adolescents and unmarried young adults may reveal dif-
ferent perspectives.
5. Conclusions

Women’s experiences with health services along the Thailand-Burma border suggest that legal,
structural, financial, and socio-cultural barriers play a role in shaping a women’s reproductive health
decision-making and overall health. Educational services and resources that are culturally and con-
text specific can help mitigate these barriers and improving the availability and accessibility of much
needed reproductive health services appears warranted. This study sheds light on the complex, in-
tertwining factors that can shape women’s reproductive health and careers along the Thailand-
Burma border and may provide health care providers with more insight into women’s health in a
protracted conflict and refugee setting. In the last several years, Burma has experienced tremendous
political and economic reform and in 2016 elected its first civilian President in more than five dec-
ades. This transition to democracy opens the way for improved human rights conditions and may
also create an opportunity to improve health services in the eastern part of the country. Understand-
ing and recognizing the importance of women’s lived experiences may help inform these efforts.

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