Maternal and Child Health System for the Hill Tribe in Northern Thailand: Outcomes and Barriers

Abstract

Background: Maternal and child healthcare (MCH) services are a very significant health service for the safety of women and children during pregnancy, which is a standard and basic service for all people including the hill tribe and stateless populations lived in Thailand. This study aimed to investigate the health performance, health outcomes, and barriers to accessing MCH clinics from two district hospitals accessible to the hill tribe and stateless population in Chiang Rai, Thailand. Methods: Retrospective data collection and group discussions were performed to extract information to understand the situation and barriers to accessing MCH clinics among the hill tribe and stateless populations living in Mae Suai and Mae Fah Luang districts, Chiang Rai, Thailand.  Data were collected from July to August 2021. Results: A number of child deliveries were performed by the Mae Suai district hospital every year; a high proportion with preterm delivery and low birth weight, less than 50.0% of pregnant women had early and complete access to antenatal clinics (ANC); more than 15.0% of pregnant hill tribe women were pregnant before age of 20 years. Only a few children were on the right developmental track, according to the standard development assessment tools.  Several poor outcomes were detected among pregnant women and child births in Mae Fah Laung District; a low number  of pregnant women visited the antenatal clinic and postpartum clinic, a large proportion had a high risk for pregnancy, 17.9% of children aged 6-12 months of age  were diagnosed with anemia, 31.2% experienced asphyxia problems during delivery, and poor development among children had asphyxia and birth weight less than 2,500 g. Several challenges and barriers were detected in healthcare providers, such as poor attendance rate of early ANC due to their belief, poor personal hygiene related to postpartum care, substance use among pregnant women, and multiple pregnancies from poor rate family planning. In the clients’ aspects, distance, lack of family and community support, and financial problems were major barriers. Conclusion: There is an urgent need to strengthen the current MCH system to improve the health and safety of the hill tribe and stateless populations by focusing on linking health information among institutes, improving professional skills to health care providers, and engaging community members in the system, including improvement of individual socioeconomic characteristics.