The recent reforms undertaken by Burma’s “former” military government have been met with cautious, yet encouraging support from the global community. In light of the political and economic “opening up” of the once pariah nation, foreign governments, particularly those of the West, have shifted their respective approaches to ones of direct engagement and dialogue, with the normalisation of diplomatic ties, easing of economic sanctions, and the authorization of bilateral aid donorship.
Whilst these steps taken by the Burmese government and the respective international responses represent hopes of future peace, progress and prosperity for the peoples of Burma, the question must be asked: what does this all mean for those that remain displaced outside the state’s borders?
Anyone who is familiar with Burma’s recent history will know that the authoritarian State Peace and Development Council (formerly the SLORC) has been responsible, and globally condemned, for the constant and systematic abuse and deprivation of its peoples’ rights since its rise to military dictatorship in the late 1980s. One of the most important and incapacitating of these rights denials has been that of health. The Burmese government has spent the lowest percentage of GDP on health care of any government in the world, leading to widespread poor health outcomes of HIV/AIDS, malaria, tuberculosis and infant and maternal mortality, among others.
Therefore it is not surprising that more than an estimated two million predominantly ethnic minority Burmese have made their way, both legally and illegally, across the border into neighbouring Thailand in search of safety, employment and a better quality of life.
However, many have argued that the search for these basic human rights within Thailand has not been met with overall success, particularly with regards to the provision of sexual health information and services.
In Thailand, the provision of sexual health services and education for those Burmese (particularly women) living, working and seeking refuge continue to be determined and, more importantly limited, by a series of powerful social, political and economic actors. These include existing cultural stigmatism and intolerance within local ethnic Burmese communities, the Thai legal and health systems and coercive employer-employee relations.
Whilst the Thai public health system includes extensive family planning and sexual and reproductive health programs, access to and usage of these services is dependant on legal or Thai citizenship status, thus excluding those residing in ‘temporary shelters’ (refugee camps) and those working in Thailand without legal documentation. Furthermore, a lack of information and cultural suitability of the programs as well as a continued fear of arrest or deportation prevents many of those who are actually entitled to such provisions from utilising them.
A similar legal restriction that is placed on the sexual health of Burmese women living in Thailand is the illegal status of abortion (except in cases of threat to the mother’s life, rape and incest). This has become the source of considerable controversy, with a documented rise in the number of Burmese women undergoing alternative illegal and often incredibly dangerous procedures to end unwanted pregnancies. This is seen not only as a result of insufficient sexual health knowledge and practice in Burma prior to relocation to Thailand but also due to the continued obstacles to access imposed by the Thai public health system and the aforementioned industrial power relations between Burmese migrant workers and their Thai employers; with pressure and threats of dismissal from employers provided as a reason by many Burmese women taking these measures.
Therefore in the face of these sexual health deficits generated by the legal and economic powers at be, the responsibility of providing sexual health education and services to Burmese residing in Thailand has fallen largely on local and foreign NGOs.
A number of reports detailing the sexual health obstacles and outcomes of Burmese border communities in Thailand such as those conducted by the Women’s Commission for Refugee Women and Children and Dr Suzanne Belton have praised organisations such as the Mae Tao Clinic and the Adolescent Reproductive Health Network (ARHN) for filling the gap in the provision of this important and much needed health care and education.
Organisations such as Mae Tao Clinic and the ARHN are not only playing a vital role in the provision of services and dissemination of information pertaining to these sexual health issues, but are also prioritising them as important health issues, deviating from their usual oversight in broader public health and aid agenda setting.
The Mae Tao Clinic has developed an extensive and commendable sexual health program including in-house family planning consultations (as well as local outreach programs to factories and community groups), contraceptive advice and provision, blood testing for HIV and STIs as well as post-abortion care. The ARHN has become the principal source of sexual health education and contraceptives within the nine refugee camps situated along the border, and have overcome significant cultural obstacles to empower the Burmese youth within these camps to uphold and safeguard their own sexual health.
However, organisations such as these largely (if not solely) rely on foreign donations and sponsorship to carry out and continue these important programs and services. Therefore the already precious efforts of organisations and community groups such as Mae Tao Clinic and the Adolescent Reproductive Health Network stand to be undermined by prospective shifts in focus and in funds on the part of foreign governments to projects based within Burma following the recent reforms. Mae Tao Clinic has already launched an emergency funding appeal this year following a 10 million THB decline in funds between 2011 and 2012. It has reported that despite changes in Burma, their patient load has not decreased and is not expected to in the coming years with the situation within Burma to inevitably remain precarious, and a significant number of the Burmese they treat in Thailand having no legal rights in either of the neighbouring nations.
Therefore the implications of the recent reforms in Burma and the respective responses of foreign governments, aid organisations and donors are substantial and far-reaching. The expected (and already occurring) shift has the potential to unknowingly impact upon the limited sexual health provisions of thousands of Burmese living in Thailand, introducing a series of additional bodies of power that could ultimately result in a further state of denial and deprivation.