Home delivery in Southern Lao PDR: Challenges to achieving MDG 4 and 5 targets

@#<p style="text-align: justify;">This study investigated rural Lao PDR village women's views and experiences of recent, or impeding, childbirth to better understand barriers to maternity service usage. Lao PDR has the highest maternal mortality rate (MMR) in the South-East Asian region with very low utilization rates for skilled birth assistance and health sector delivery services. The study site, Sekong, a southern Lao province, was lowest in the country on virtually all indicators of reproductive and maternal health, despite several recent maternal health service interventions. The study's aim was to gain a fuller understanding of barriers to maternity services usage to contribute towards maternity services enhancement, and district and national policy-making for progressing towards 2015 MDG 4 & 5 targets.</p> <p style="text-align: justify;">A descriptive cross-sectional study was used. First, face-to-face questionnaires were used to collect demographic and reproductive health and health care experience data from 166 village woman (120 with a child born in the previous year, and 46 who were currently pregnant). In-depth individual interviews then followed with 23 purposively selected woman, to probe personal experiences and perspectives on why women preferred home birthing.</p> <p style="text-align: justify;">The majority of the woman had given at home, assisted by untrained birth attendants (relatives or neighbours). While seventy percent had accessed some antenatal services, postpartum follow-up attendance was very low (17 percent). Limited finances, lack of access to transport and prior negative health service experiences were important factors influencing women's decision making. Giving birth at home was seen by many, not just as unavoidable, but, as the preferred option.</p> <p style="text-align: justify;">Recent top-down maternal health initiatives have had little impact in this region. Improving maternal and child-health strategies requires much greater community participation and use of participatory action methodologies, to increase women's engagement in policy and planning and subsequent usage of health service developments.</p>

Community participation efforts for strengthening community well-being through conflict management

This participatory action research aimed to enhance a community's potential in strengthening sub-district well-being, a grass-root community of Northeast Thailand. Community Participation had three patterns. The first pattern-involved determining the five community commitments in which the members relied on an honest living, followed a "sufficiency economy" process, practiced local traditions, engaged in community development, and prevented their community from conflicts under the community justice system. The second participation was processed through community meetings with volunteer voting. Three workshops were arranged for volunteer training to develop instruction media for raising consciousness, distributing their knowledge, and resolving any controversies among the community members. The third participation was to advocate human rights among the community members by broadcasting via the local news tower, religious ceremonies, and career meetings. These activities helped encourage generosity among the community members, praised the respectful members , maintained traditions, developed communication, and built careers for the children, handicapped, poor, sick or elderly as well as supporting a community's proactive role in using the justice system to settle conflicts among its members.