Pa-O migrant women's accessibility and acquisition of family planning knowledge, and its impacts on their choice of method and practice in Chiang Mai, Northern Thailand

Abstract

The social exclusion, culture gaps, and language barrier alienate migrants from accessing knowledge of family planning methods and comprehensive consultation services for an informed choice of decision. Myanmar migrants’ high contraceptive utilization rate does not represent the knowledge adequacy of the methods they are using. Inadequate knowledge and lack of informed choice to practice Family Planning (FP) methods increase the risk of unmet needs and method failures in family planning, which could result in unplanned pregnancies and induced abortions. Among the Myanmar migrant ethnic groups in Chiang Mai, Pa-O ethnic migrants have a higher vulnerability to health information gaps from limited language applicability in migrated settings and the scarcer relational informational resources from smaller social networks compared to Burmese and Shan ethnic groups. Along with the increasing demand for family planning methods for the Pa-O migrants, the accessibility to quality family planning information and counseling for them is questionable. The research aims to explore the influencing factors on Pa-O migrants’ accessibility and acquisition of knowledge of family planning methods in Chiang Mai and to identify the effect of Pa-O migrant women's knowledge of family planning methods on their decision choice of methods in the context of migration.

A qualitative research based on Wilson’s Information Behaviour model and Giddens’ Structuration theory was conducted among Pa-O migrants in the metropolitan area of Chiang Mai, Northern Thailand. Non-probability sampling methods were applied with 16 in-depth interviews (IDIs), 3 focus group discussions (FGDs), and 7 key informant interviews. Inclusion criteria for IDIs and FGDs were Pa-O ethnic migrants who had lived in Thailand for at least 2 years and were aged 18–49 years. Snowball sampling was applied to identify the research participants following a two-month participant observation at Wat Nong Kham temple in Chiang Mai. The findings are presented in two chapters focusing on the influencing factors of Pa-O migrants’ family planning knowledge development and the impacts of knowledge on decision choice and practice of family planning methods. It was found that the sexual and marital-related cultural norms constrained Pa-O migrants' family planning knowledge acquisition. The limited accessibility to public and private health promotion resources contributed to Pa-O migrants’ family planning knowledge gaps. The language barriers, the negative communication experiences with health care providers, and situational barriers inhibited the Pa-O migrant agency from seeking knowledge and informed choices of the decision of family planning methods. Pa-O migrant applied their agency on identifying alternative sources of information to fulfill their need of family planning, it is informal information sources including kinship and social networks. Although the information from informal sources could not be granted for its quality, but it is based on individual experiences and knowledge within the same social status and cultural influences. It has a strong influential power upon Pa-O migrants’ decision choices of family planning methods. Accessibility to informed choice of decisions by health care personnels was found during post-partum family planning counselling, apart from that, many made decision choices of contraceptive methods with the information they obtained from informal networks. The Pa-O migrants’ family planning methods are limited to easily available short-term effect methods rather than reaching a wide variety of methods. The study analyzed the structural and agency factors on Pa-O migrant information behavior to understand the influencing factors on Pa-O migrant family planning knowledge access to and acquisition and the reasons behind their decision choice of methods. Limited resources of migrant-friendly health education programmes adversely affect migrant family planning information behaviour. Reproductive health education programs, including quality family planning counselling services, should be accessible for marginalised migrants to ensure their choices of family planning are well-informed.