Making family planning a reality for remote communities in Lao PDR

22 August 2020

Twenty days after safely delivering a baby boy, Phonekham, visited a doctor at her nearest health centre with her son in her arms. Being her first child, Phonekham, like many new mothers, is constantly worried about her baby’s health. At the first sign of minor symptoms like a running nose, she rushed to bring the infant to the health centre which she used to visit often for check-ups during her pregnancy. After the clinic staff assured her the baby was fine, she asked the midwife for family planning advice because she wanted to ensure a two-year gap before having a second child. Phonekham was a very rare visitor, as she is from the Hmong ethnic minority, a community that usually lives in remote and often hilly areas across Laos, Viet Nam, Cambodia, and Thailand. With good education and working as a secondary school teacher in town, Phonekham was confident and aware of postpartum care.


Most women living in the mountains normally would only visit family planning facilities after they have four children already. There are cultural beliefs that good families should have at least 4 sons.  Apart from this, sons are favored because of the nature of work in these rural areas: hunting, farming and other physical work. so families say they prefer sons so that they fully contribute to the daily work.


At the health facility, Phonekham shared with us a story of a mother under 35 years old who has 14children. She was so sad for her: “How can she take care of the health and nutrition of herself and so many kids?” said Phonekham. Living near the town centre, she is worried about the challenging reality of the majority of women in remote communities. 


Barriers blocking women to access family planning services


In remote parts of Laos, it is difficult for couples and women to access health facilities that are few in number and often far away, challenges further compounded by less than optimal roads and hilly or mountainous terrain. 


The health centre where we met Phonekham in Nam Bak district, Luang Prabang province serves about 20,000 people from 15 villages in the Nam Thuam Cluster, a sub-district in Luang Prabang Province in the north of Lao PDR. A number of ethnic groups live in remote and mountainous areas there. Among them, the Hmong people scattered on the highest mountains with limited access to health facilities that are located in suburban low land areas.


The villagers often have to endure long and rough journeys to access health services posed by distance and poor road conditions. Some of them have to travel 25 kilometers to the nearest health centre, mostly on foot and complemented by short motorbike rides when road conditions permit.


Further, women in these largely conservative communities live under traditional and social norms such as sons preference, because families believe sons are the backbone and reputation for the extended family. girls are married very early because parents believe women are weak and need the protection of their husbands. Girls are also deprived of education in rural regions because it is seen as a waste of time and money, while girls can stay at home and contribute to domestic work. All of these practices amongst others reduce opportunities to get the information and services that women and girls need to know to make informed and independent choices on if and when to have children, and how many.


Gender-based violence is high jeopardising their human rights. Families generally prefer to have sons rather than daughters, because they believe sons are the backbone of the extended family and enhance a family’s reputation. Many believe that one family should have at least four sons.


For most women from ethnic minority groups, there is another barrier to overcome. To communicate some of them have to bring a friend or relative, usually a son or daughter, to help translate health workers’ instructions into the Lao language. There are 49 ethnic groups in the country with more than 90 languages, the Hmong is one of them.


Family planning: Everyone’s right wherever they are


Lao PDR has 50 ethnic groups. Two-thirds of its 7.1 million people live in rural areas, and 47 per cent of the total population hails from various ethnic backgrounds. The country has seen remarkable progress in reducing its maternal mortality ratio and expanding family planning services, but disparities remain for people from different ethnicities, education, income, and age groups. 


While the fertility rate which measures the average number of children per woman at the national average stood at 2.7 in 2017, the rate for the ethnic groups remains higher at 4.6. Similarly, while about one in ten Lao girls aged 15-19 has begun childbearing, one in five girls from the Hmong ethnic group is a teenage mother.


Recently, UNFPA and the Ministry of Health invested considerable effort in recruiting and training midwives from different ethnic minority groups. So far, three of the ten main ethnic minority groups are represented in the country’s midwifery cadre. These midwives are now making inroads by supporting their communities. Considerable efforts are deployed to decrease gender discrimination through community-based advocacy and building positive examples of male engagement to support the empowerment of women in terms of making decisions and choices for their lives and health.


“Family planning is a fundamental right for all people. Ensuring universal access to family planning will lead to sustainable benefits to individuals, families, and communities and enable the country to reap the demographic dividend, to make it happen, women need affordable, accessible and suitable supplies, well-trained health workers and positive engagement of their husbands and families,” said Mariam Khan, UNFPA Representative in Lao PDR, who emphasised the importance of equity in closing the gaps in family planning in order to ensure no one is left behind.


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