By Josephine Kyi and Nicha Wachpanich 

KARENNI STATE // Reproductive health and family planning are more difficult than ever as the intensifying civil war enters its third year. With fear and the threat of persecution ever-present, groups of local women are coordinating healthcare and promoting women’s rights as best they can.

According to the UN, Myanmar has long had high pregnancy rates among adolescents due to a lack of sex education.

“Do not have kids in this current period. Even we, adults, feel that fear, so young people would fear worse than us,” said Daw Anna*, a 40-year old devoted Roman Catholic believer. She raises her three children in Karenni State, the smallest state in eastern Myanmar bordering northern Thailand. Like many Karenni Christians, Daw Anna did not previously use birth control. Now, against this backdrop of civil unrest, ongoing conflict, and extreme economic hardship, she utilizes birth control and encourages other women to do so.

“There are religious concerns against taking birth control and abortion in our communities.” explained Maw Pray Myar, secretary of the Karenni National Women’s Organization (KNWO). Members of Christian and Muslim faiths, both prevalent in ethnic minority communities, nor the majority Buddhist population feel comfortable discussing these issues. Military crackdowns, ongoing conflict, disrupted supply chains and a flagging economy have resulted in a de-prioritization, intended or not, of sexual and reproductive health care and rights. Despite this, the reality of prolonged conflict and resulting hardship serves to make the need for reproductive rights all the more imperative.

Prior to the coup, prophylactics could be transported to Karenni State from Yangon or across the Thai border. Birth control pills were accessible via local pharmacies, hospitals and clinics, with only conservative mindsets the predominant barrier to access. After the coup, transportation difficulties and struggling pharmacies mean that birth control options, when available, are limited to emergency pills and condoms. Any service requiring the advice of a doctor of gynecologist, such as implants and intrauterine devices (IUDs), is no longer available. 

Lack of medical supplies

Being pregnant in times of conflict is not easy. Ma Ye Ye*, 22, fled from Demoso in northwestern Karenni. Without documents, she crossed the Thai border in order to deliver her firstborn. Her hometown, Kone Thar village, became a battlefield between the Local Defence Forces (LDF) and Myanmar military junta in the first year of the coup d’Etat in late 2021. The young woman sought shelter in a relative’s house in a safer village, an option she chose over staying in a makeshift refugee camp. A year into marriage, Ma Ye Ye got pregnant in 2023. She had previously taken the contraceptive pill, but discontinued this after hearing from her relatives that it could alter the uterus during the first pregnancy, with the risk of not being able to have children in the future – a widespread misunderstanding.

Early in her pregnancy, Ye Ye went to the clinic in a refugee camp near her village for vitamin supplements and vaccines, but the support didn’t last long. “I regularly went there in the first and second months of pregnancy. In the third month, they told me that the vaccines were out of stock and I was told the same again the following month,” said Ye Ye.

Transportation has become a major obstacle in supplying conflict-ridden communities with necessary medical supplies, especially vaccines reliant upon cold chains to maintain specific temperatures. The electricity shortage throughout Myanmar has exacerbated difficulties in the process. “After the 2021 coup, it is hard to send vaccines into Karenni state. The closest we can reach is the Thai-Karenni border,” said Maw Pray Myar from KNWO. The KNWO, a local women’s organization based in Karenni and in the nearest Thai border town of Mae Hong Son, has been supplying their communities with necessities, ranging from groceries and birth control to vaccines.

Ye Ye’s story comes as no surprise to Maw Pray Myar. The Karenni women’s rights advocate explains they have encountered many cases of women with unplanned pregnancies due to expired birth control pills; women who reluctantly aborted pregnancies as a result of food scarcity; and of married women who have been physically abused by their husbands for refusing to have sex.

Crossing the border for births

In late 2023, Ye Ye took on a risky path, decamping from the clinic at the refugee camp and disembarking on the journey to the state capital of Loikaw. There, she could get the 3-in-1 vaccination recommended during the early months of pregnancy. According to the American College of Obstetricians and Gynecologists (ACOG), guideline obstetric care providers should administer the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine to all pregnant patients during each pregnancy, as early in the 27–36-weeks-of-gestation window as possible, in addition to COVID and inactivated influenza.

At roughly the same time (on November 11th), the Karenni anti-regime armed forces successfully seized Loikaw in an offensive dubbed ‘Operation 1111’. Once the centre of state administrative control, the city was transformed into a heavy battlezone, with the number of displaced people reaching 35,000 – that is, one person in every ten. Ye Ye was again forced into movement. Five months pregnant, and without identifying documents, she made the journey into Thailand. In April 2024, the young woman safely welcomed a baby girl in a hospital in Chiang Mai, “I wouldn’t have come here if this hadn’t been my first pregnancy. I only left Karenni state because the political situation was so bad.” 450 kilometres away from home, Ye Ye was luckily able to rely on a cousin already living there.

Karenni communities have lived in Northern Thailand for generations. Since the 2021 coup in Naypyitaw, they have had many newly arrived relatives to shelter. While on the one hand there is the possibility of access to medical care, fear of deportation and the shame of being a burden upon the community make for a difficult balancing act. According to the Karenni women’s organisation, many women in the villages have become midwives to help deliver babies. Local health officers have also picked up tasks they were not trained for due to the lack of functioning medical facilities in remote rural areas.

“Sometimes I think back to a woman I befriended when we were getting our vaccines in Loikaw,” recalls Ye Ye, highlighting the lack of continuity in the day-to-day. “She must have delivered her baby by now and I only hope she is okay.”

 

Changing perspectives

According to the 2023 Myanmar Household Welfare Survey, Karenni is one of the poorest and least accessible states in Myanmar. Women’s health has been a neglected issue since long before the current political unrest began. Nowadays, difficulties have increased because of worsening living conditions.

The situation is similar in Sagaing, a state in central Myanmar. “The locals, especially the older generation in the countryside, like to have as many kids as possible. Having six children in a family is common,” said Ko Yay Chan, a doctor in Depayin township. “But after 2021, people changed tack and went into survival mode. Young married couples now understand the necessity of birth control.”

Due to limited options, many of those who are sexually active rely on contraceptive pills, to be taken orally by women. Three years on, however, doctor Ko Yay Chan is noticing a changing trend, with some couples now deciding to plan for babies anyway, due to the end of the war appearing so distant.

Before the coup, there was little previous conflict in middle Burma. Yet in the two years between 2021 and 2023 nearly 60,000 civilian houses in Sagaing were destroyed by the Myanmar military (Data for Myanmar). Nowadays, without the existence of established networks and refugee camps, those displaced by conflict are forced to seek refuge where they can, often ending up in forests, at risk of exposure to nature, the elements, and poisonous snake bites. According to our reporter, however, the healthcare situation in Sagaing still seems better than in the regions situated on hills such as Karenni, Karen and Kachin states.

New spaces for women’s participation?

Karenni state has long been viewed by the broader Myanmar public as one of the least developed regions. Now, in a progressive political move, the establishment of the Karenni State Interim Executive Council (IEC), has surprised many people. The KSIEC came into being in June 2023 as an initiative of the Karenni State Consultative Council (KSCC) which is the ethnic/federal member organisation of the National Unity Consultative Council (NUCC). The chair and vice-chairpersons of this administration are the president of Karenni National Progressive Party (KNPP) and the leader of Karenni Nationalities Defence Force (KNDF).

In contrast to many other EAOs in Myanmar who have vied for self-determination amid decades of civil war, the KSIEC has announced that its goal is to obtain recognition for the Karenni state within Myanmar’s future federal democracy, instead of steering for total independence and autonomy. The KSIEC enjoys support from the Karenni National Women’s Organization (KNWO) in addition to 19 other Karenni civil society organisations. The consortium is calling for a minimum 30% quota of womens’ participation in interim governance arrangements, in addition to demands for increased focus by the interim government and armed forces upon human rights issues in the community, and the prevention of all forms of violence against women and children.

“While it is not easy to talk about sexual health in Karenni state, just talking about gender equality is also still viewed as improper,” said Maw Pray Myar. In August 2023, the KSIEC configured its first departments, with women’s and children’s affairs among them.
“The official from the Women’s and Children’s Department has received reports related to women’s issues and aims to address them in collaboration with the department of justice of KSIEC, Karenni State Police and women-related organisations,” said Daw Ye Ye Myint, the deputy head of the department. “We still did not receive reports embracing the issues which would require legal processes,” she continued. For now, issues reported are reliant upon processes of community justice, such as agreements between persons who have experienced harm, and those who have caused it, including issues which require legal action such as rape or murder.

Karenni had a strong community legal system before the coup. According to the area and the group controlling it, KNWO followed the rule of the village community or the legal system of KNPP / Myanmar government before the coup. The women’s organisation is trying to implement the new legal system of KSIEC but Maw Pray Myar emphasizes the difficulty in reaching large and unknown sectors of the demographic amid the ongoing instability.

The KNWO secretary hopes the new administration can help bring justice against the prevalence of violence against women. Her calls are echoed by the more than ten ethnic women’s organizations working for their communities in this land of adversity and diversity.