Situations and Factors Related to Home Birth among Women from a Subgroup of the Karen Ethnic Group in Remote Thai-Myanmar Border Areas

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Abstract

Globally, maternal and infant mortality rates are problems that are influenced by access to services and the quality of the maternal and newborn service system. In Thailand, some pregnant women in border areas and other rural areas still labor at home. They often have no choice of where to give birth because of several factors. Maternal and child deaths can be a consequence of unsafe delivery services, such as the use of traditional birth attendants and insufficient availability of maternity supplies.                The aim of this cross-sectional study was to: 1) explore the situation of birth at home and 2) examine the factors associated with home delivery among pregnant women from a subgroup of the Karen ethnic group. The sample was selected by multistage randomization with 110 pregnant women who had experienced a home birth and hospital birth. Data were collected with a questionnaire from 4 January to 20 February 2021 along the Thai-Myanmar border districts of Tak Province, Thailand. Demographic data for maternal delivery were analyzed by descriptive statistics and a relationship factor analysis by Chi-square test.                The results revealed that 55 pregnant women (11%) gave birth at home. They were aged between 14 and 45 years (  = 26.2 ± 6.2). For 74.5% of the women, it was their second or more pregnancy, however, it was a first pregnancy for 25.5% of the women. 60% of the women had received no formal education or only compulsory level (elementary) education, and 56.4% had a low economic status. For 69.1% of the women, antenatal care did not meet the quality criteria and 61.8 % had experience birthing at home.  Also, exploration of the reasons why women gave birth at home revealed that 52.7% had intended to give birth at home due to several reasons. 40% of the women were unable to go to the hospital. 7.3% delivered their infant on the way to the hospital. 92.7% of the deliveries were carried out by traditional birth attendants. 50.9% of the infants had a birth weight between 2,500-3,000g. The lowest and highest birth weights were 1,200g and 3,980g, respectively. The factors related to home birth were education level, economic status, birth history, antenatal care, knowledge, family support, values, ​​ traditions, and environment (p<0.05). A first pregnancy and a newborn weight of 3,980g can prolong labor, increasing the risk for the mother. In contrast, low birth weight may put the infant at risk of respiratory distress syndrome and even death. Most families had a low economic status. Their rural residences were located far from a hospital and transportation was inconvenient. These results suggest that primary health care should train traditional birth attendants and health agencies, in addition to providing proactive antenatal care services, birth planning, and having a referral system to support these communities. Finally, systems should be developed in conjunction with the government sector, to ensure safe motherhood and baby-friendly hospitals, in order to reduce disparities in access to services.