Reaching “forgotten” Rohingya in Myanmar cut off from basic maternal care

DAR PAING, Myanmar – A deadly tropical storm, the first of the 2018 monsoon season, descended on Myanmar at the end of May, tearing apart hundreds of homes along the coast. As the storm pounded on her small shelter in Sittwe Township, 19-year-old Phu Tu Nee gave birth to her first baby. 

Without access to reliable health services, she delivered under the care of a traditional birth attendant, a person without modern resources or training. But it was not only the storm that had cut Phu Tu Nee off from proper health care – she is also part of the Rohingya ethnic minority in Myanmar. 

Over 700,000 Rohingya have fled Myanmar to Bangladesh since the community’s long-running crisis erupted into horrific violence last August. But Phu Tu Nee is one of an estimated 300,000 “forgotten” Rohingya who remain confined to camps and villages in the central part of Rakhine State.

Their freedom of movement has long been severely restricted, as has their access to basic services such as health care.

A clean blade 

Yet even under these circumstances, Phu Tu Nee was – in some ways – fortunate. 

Although her small village and the adjoining camp lack professionally trained midwives and health facilities, there are some services available in the form of a mobile clinic and health volunteers, both supported by UNFPA. 

During her pregnancy, Phu Tu Nee was able to visit the mobile clinic, which makes weekly visits to her area. There, she received crucial antenatal care, as well as a clean delivery kit to bring home to the small hut she shares with her husband and 10 in-laws.

The clean delivery kit contains a sterile plastic sheet to lie on, soap and sterile gloves for the delivery attendant, as well as a clean razor blade and clamps for the umbilical cord. It also includes clean cotton towels for mother and baby, and a plastic bag for the placenta. 

These materials are essential in crisis settings, where birth attendants often lack access to sterilized equipment. Some even lack knives to cut the umbilical cord, resorting instead to using sharpened bamboo or stones, creating serious infection risks.

When Phu Tu Nee’s labour began, she gave the clean delivery kit to her traditional birth attendant, ensuring a safer delivery. 

A reassuring hand

The day after the birth, as the sun came out, Phu Tu Nee rested with her newborn son. She was exhausted and happy.

And she was nervous. 

“My milk has not come in yet,” she said. “It has been 24 hours since I gave birth. Is it normal? Is my baby OK?”

Phyu Phyu Thant, a UNFPA-supported health volunteer, reassured her. 

“Make sure you drink plenty of water. Just keep putting the baby to your breast and the milk will come,” she said. 

Phyu Phyu Thant had heard about the dramatic mid-storm birth and come to pay a visit. “Take the vitamins and the iron tablets that you received from the mobile clinic,” she advised while admiring the baby.  

She also asked Phu Tu Nee to visit the mobile clinic when it returns the following week. There, she can receive a medical check-up, additional vitamins, and information on the health benefits of birth spacing.

Community care

Recruited and trained by UNFPA, in partnership with the Myanmar Medical Association, health volunteers are an important source of advice and information. 

They are themselves Rohingya, living in the camps and adjoining villages. Because they are from the community, they have intimate knowledge of the specific sexual and reproductive health needs of women and girls. 

“The mobile clinic can only come once a week – they have to visit so many camps,” explained Phyu Phyu Thant. “But in between clinics, because I live here, I can keep an eye on the women that I worry for.”

Getting women to visit the mobile clinic is an important part of her work. “I always do the rounds before clinic time to make sure the women come to get skilled medical care from real doctors and real midwives,” she said.

The mobile clinic covers five Rohingya camps and the surrounding villages. Another mobile clinic serves two camps and 35 villages where the residents are ethnically Rakhine. Both are operated by the Myanmar Medical Association with funding from UNFPA and support from the Myanmar Humanitarian Fund.

In 2017, UNFPA distributed 4,200 clean delivery kits to pregnant women in conflict- and crisis-affected areas in Myanmar, including Rakhine, Kachin and Shan states. While access to the camps in Rakhine has been severely limited since last August, UNFPA is continuing its clean delivery kit distribution and other assistance in camps and surrounding villages in Rakhine.