How to curb high maternal mortality in south?

Maternal mortality is much higher in Thailand’s Muslim majority southern provinces than elsewhere in the country, Health Ministry records show.

From October 2007 to June 2008 the maternal mortality rate (MMR) in Pattani, Yala, Narathiwat, Satun, and Songkhla provinces was 42.4 per 100,000 live births.

In 2007 that number stood at 39.5, according to Health Ministry figures, as opposed to 17.7 nationwide.

However, Banchong Withayametha, assistant professor of Sinidhorn College of Public Health in Yala Province, speaking at the November launch of the UN Population Fund’s (UNFPA’s) State of the World Population Report 2008, said making further progress will be difficult.

In 2008 the ministry’s goal was to keep the MMR to fewer than 18 deaths per 100,000 live births nationwide, but it exempted the five southern provinces, setting a target of 36 or less. "We couldn't even meet this standard," Banchong said.

Cultural challenge

The primary explanation for the difference in MMR in the south and the rest of the country is cultural, he said.

We can't tell them to stop getting pregnant. It contradicts their culture and they won't do it.

Most of the area’s 3.4 million inhabitants are Muslim. In the southern border provinces (not including Songkhla) the number of Muslims is close to 80 percent. It is the only area which has a Muslim majority in Thailand and where contraception is largely frowned upon.

"With many feeling contraception is prohibited, family planning is difficult," Banchong said.

Muslim women whose families oppose contraception usually become pregnant too early or too late, and have too many pregnancies, he explained.

"We can't tell them to stop getting pregnant. It contradicts their culture and they won't do it. In some areas, like the southern provinces, and where religious issues are extremely sensitive, we have to adopt a culturally sensitive approach," he said.

The UN's Millennium Development Goals (MDGs) call for a 75 percent reduction in MMR globally between 1990 and 2015. Despite this, the number of women dying worldwide as a consequence of pregnancy and childbirth remains largely unchanged since the 1980s - some 536,000 deaths per year.

UNFPA says Thailand is one of the few countries to have significantly reduced MMR since 1990, but it is concerned about the situation in the south.

"In the overall picture, Thailand has shown a very impressive and significant change. But we've found that in some areas, some pockets, like the south, the problem is still very concerning," Garimella Giridhar, the UNFPA representative in Thailand, told IRIN.

UNFPA, in collaboration with the Ministry of Health, local NGOs and community groups, has taken a number of initiatives to raise awareness of contraception issues in line with Islamic practices.

Conflict

Meanwhile, Nurihah Waesama-ae, an official at Yala's provincial public health office, said the ongoing insurgency between Muslim and government forces was exacerbating the situation, sometimes preventing pregnant women from accessing proper medical treatment.

Another problem was the belief by many Muslims that traditional home births were better for the children.

Muslim couples’ unwillingness to practice contraception undermined family planning: "It's a very complicated issue and it requires cultural fluency and sensitivity,” Nurihah said, noting however that younger people in Yala were becoming more open to the idea of birth control.

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