Migration motherhood and maternity care in Thailand : an ethnographic study of the experiences and practices of Burmese women and maternity staff

Background: The transition to motherhood can be difficult. For some women, it can be a distressing time, especially those who do not have social support. Studies indicate migrant women demonstrate higher levels of distress and perinatal depression. Migrant women primarily attribute their feelings and experiences to separation from family and usual support systems, financial hardship, poor working conditions and difficulties in adapting to life in a new country where traditions and culture are different. Experiences can also be affected by less-than-optimal care and poor engagement with health services. Most research on migrant mothers has been conducted among those living in high-income countries, with few studies of women who begin their lives as mothers having migrated from a low-income country to another low-income country or middle-income country. Recently, there has been a dramatic increase in the number of migrant workers coming from Burma to Thailand; over time, many become parents. However, little is known about their experience of motherhood and perceptions of maternity services. Understanding the experiences and challenges that Burmese women encounter when seeking maternity care in Thailand is important because receiving inadequate care is linked to increased rates of morbidity and mortality. Study aims: This study aimed to explore Burmese migrant women’s perceptions of becoming a mother and their health care and support needs. It also aimed to examine their perceptions of maternity services, including access to and use of Burmese interpreters. The research also examined the experiences of Burmese interpreters and Thai health professionals caring for Burmese migrant women. The social-ecological model is used as a framework to conceptualise the multiple factors influencing the experiences of Burmese women and to identify implications for service delivery. Methods: Ethnography informed the study design. Between May and December 2015, data were gathered through individual interviews with three participant groups. These included 10 Burmese migrant women, four Burmese interpreters and nine Thai health professionals. Observations of the interactions among participants of the study occurred in two antenatal and postnatal settings in Ranong, southern Thailand. General observations of the activities and interactions in the clinics were also conducted in the villages of some participants. The data were analysed using thematic analysis. Results: All women in this study who migrated to Thailand came for employment and all held legal status with a work permit. They lived in a tight Burmese community but their living and working conditions were difficult. Becoming a mother was important to them; however, they had to juggle work and care for young children. Most realised that once their child was school age, the children would be sent to Burma to live with relatives. The women valued Thai antenatal care, but they combined this with traditional practices, particularly cultural practices, that they believed would protect their baby in pregnancy and after birth. Due to poverty, many women could not afford a nutritious diet and were at risk of gestational diabetes and anaemia. The women were well supported by their families and social networks during pregnancy and following the birth of their babies. Although Thai health professionals spoke positively about the Burmese women they cared for, they were also critical of certain cultural practices and became irritated when Burmese women did not follow their advice (e.g., taking iron and folate, and agreeing to sterilisation once they had two children). The theme ‘being processed’ captured the numerous barriers to accessing antenatal care while ‘being cared for’ provided insights into the care and support from professionals that women found helpful. The final results chapter examines the role and experiences of Burmese interpreters (lam in Thai) identifying their dual role as interpreter and healthcare worker. Key challenges included lack of clarity around role boundaries and low remuneration. Implications: The findings contribute to a conceptual understanding of Burmese migrant mothers in their journey towards motherhood. Participants, including the interpreters, indicated that they required service providers to be culturally competent and compassionate. The findings could be used to guide Thai nurse-midwives and other health providers in providing care for migrant women. Health care provision in Thailand needs to be supplemented by an understanding and awareness of the needs of migrant women. This is particularly important to facilitate health services for migrant women, who are in unstable circumstances and have to balance their responsibilities as mothers and migrant workers