(formerly IRIN News) Journalism from the heart of crises

Taking reproductive healthcare to remote communities

A trainer supervises a Community Based Distributor (CBD) in injecting a hormone contraceptive. This innovative program to provide contraception and reproductive health services to remote communities has had success in various parts of the world.
Ministry of Health, Lao PDR

In a country where two women die every day from pregnancy-related causes, increasing access to contraceptives and reproductive health services is a priority of the government of the Lao PDR.

"Contraceptives give women the ability to time and limit pregnancies and help reduce abortion-related deaths and disabilities," said Mieko Yabuta, the UN Population Fund (UNFPA) representative in Laos, told IRIN. "In doing so, they can prevent around a third of maternal deaths."

However, many rural villages are cut off for months during the rainy season and the nearest health centre might be a three-to-four-day trek through mountainous, forested terrain where tigers and snakes pose a danger. And even when they make contact with health workers, they are often unable to communicate as there are 82 distinct languages and myriad dialects spoken throughout the country.

For years the government has struggled to bring just the basic health services to remote rural areas. Providing much-needed family planning has proven equally challenging. Yet if it fails, according to health experts, the country will find it difficult to significantly reduce the maternal death rate which is already one of the highest in the region.

Photo: Ministry of Health, Lao PDR
A CBD explains contraceptives and the reproductive system to villagers

Stress of pregnancies

"Early marriage and pregnancy are still the norm in Laos, particularly among rural populations where access to reproductive health services and family planning information is limited. Yet the risk of dying from pregnancy-related causes is five times higher for girls under the age of 15 than for women in their 20s. Young girls' under-developed bodies are not ready to cope with the stresses associated with pregnancy. And no woman's body, irrespective of age, can truly recuperate from the ravages imposed on them by rapid, continuous pregnancies with little interlude between them," said Yabuta.

One promising approach is family planning community-based distributors, or CBDs. Already meeting with success in some African nations, CBDs are relatively new to Southeast Asia. A pilot programme is being introduced in three of Laos's most impoverished and remote provinces.

"Lao community-based distributors are men and women recruited from local ethnic communities," explained Viengkham Phixai, from the Ministry of Health's Mother and Child Health Centre. "They are trained in basic family planning and reproductive health."

The CBDs begin their information sessions with the families of the naibans (village chiefs) and representatives of the Lao Women's Unions. "Villagers are not stupid," said Viengkham. "When they see the naiban's wife, the women's union representative, using it with no side effects, they will be happy to use it."

Viengkham visits the CBDs in the field to monitor their progress and provide support. She was impressed with the results of the pilot programme so far, though she admitted formal results of an evaluation study had yet to be finalised.

"As an example, Kalum District, Sekong Province, is a roadless area and has no health centre because it is so remote. But since the programme was introduced, the contraceptive prevalence rate has gone from zero to 50 percent."

Photo: Ministry of Health, Lao PDR
A villager practices applying a condom under the watchful eye of a UNFPA-supported CBD

Key to success

The reason for its success is fourfold, Viengkham believes. "First and foremost, it's because people are now receiving information. They also understand it because it's in their language and is culturally sensitive," she said. "Second, the service is coming direct to the household. Third, it is free. Finally, the CBDs don't just talk to the woman. They talk to the husband and the entire family. So it's a family decision. It avoids a member who has fears from lack of information overruling the woman if she is the only one with the information."

Seeing the change the programme brings is satisfying, according to the doctor. "In one village I visited at the very start, I held up a condom pack and asked, 'What is this?' The men responded, 'Oil to grease guns?'

"When I returned the next time, they definitely knew what it was for and how to use it!" Viengkham said. "I feel very deeply that the CBD service needs to be extended to all remote provinces. I really believe we can reduce maternal deaths in these areas by bringing information to the people."


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