Women oppressed in the daily lives and cultural practices of the akha people, Thailand: how can the situation change?

BACKGROUND: Gender equality is one of the most concerning issues globally. Females lacking equality could lead to several impacts, including health and economic impacts. Gender equality is often present in some minorities, such as the Akha hill tribe people who live in remote areas and have poor educational and economic statuses. This study aimed to understand the patterns and forms of women's oppression through their norms and cultures. METHODS: A qualitative method was used to elicit information from participants in twelve group discussions. The participants were Pha Mee and Ulau Akha people living in six selected villages along the border of Thailand and Myanmar. Twenty-two main questions were used as a guide in the discussions, which were grouped by gender and conducted by a same-gender moderator. The findings were extracted and formed according to a thematic approach. RESULTS: A total of 72 Akha from six villages were invited to participate in the study: 29 males and 43 females. The average age was 47.7 years, 69.4% were married, 63.8% were Buddhist, 47.2% had never attended a school, and 47.2% worked in the agricultural sector. Several forms of Akha women's oppression were identified: oppression through daily life, religious rituals, son preference, novels and cradle songs, naming ceremonies, and work performances. Many factors acted as unorthodox patterns to relieve the oppression of Akha women: religious conversion, educational impact, exposure to people from outside villages, and social and economic roles. Oppressed Akha women moved through four layers: individual, family, community, and external culture and modernization. The combination of culture and globalization was a key factor in gender inequity through these four layers to balance the pressures to oppress and resist. CONCLUSIONS: Akha women have lived under the power of men for several years, and these men have built up common features to control women in their society. Improving gender inequity is important for moving to a better stage of health, quality of life, and social roles, which will increase the power of all people to improve their society in the future.

Influences and patterns of intimate partner violence among married Akha and Lahu women in northern Thailand.

BACKGROUND: Intimate partner violence (IPV) is a major global public health problem. Women are the principal victims of IPV, and some special populations have been particularly impacted. The Akha and Lahu women are vulnerable populations for IPV due to the modernization and changes of their culture and norms. This study aimed to understand premarriage factors related to IPV, including associated factors, influencers, patterns and impacts, in Akha and Lahu women in Thailand. METHODS: A qualitative method was used to gather information among Akha and Lahu women who had experienced IPV in the previous year and were fluent in Thai. Women who had experienced IPV in the previous year and lived in the border area of Thailand and Myanmar were invited to provide information. A thematic analysis was used to extract information from the participants and develop findings. RESULTS: A total of fifty-two married women were recruited into the study: 46.2% were Akha and 53.8% were Lahu. Those married Akha and Lahu women younger than 39 years found their partner through social media, had conditions before getting married, had high self-confidence, and tended to marry people from different tribes. While those aged 40 years and over met their husbands in village activities, were highly compliant with the norms of their culture, and married men from the same tribe. Three factors were detected as associated factors of IPV: cultural differences between partners from different tribes, substance use, and personality. Differences in age between partners, living in poor family economic status, and poor education were also detected as influencers of IPV. Four patterns of IPV were observed among Akha and Lahu married women: neglect, emotional abuse, verbal abuse, and physical abuse. Several patterns of the impacts were presented: children were neglected, especially in the preparation of daily food, having stress, having poor family relationships, and having children with unsuccessful lives in terms of education and getting a good job. Almost all married Akha and Lahu women had no particular expectations in their lives. CONCLUSION: Akha and Lahu women face IPV problems with several key influences and impacts. Effective implementations are required to monitor and reduce the problem in the Akha and Lahu families, especially where the women are younger than 40 years old and married to men from different tribes.

Components of stigma and its impact on maternal and child health service and outcomes: perspective of Akha hill tribe women in Thailand.

BACKGROUND: Maternal and child health (MCH) is crucial to the well-being of mothers and children. Stigma regarding access to MCH services is a major challenge, especially for hill tribe people in Thailand. The study aimed to understand the components of stigma and its impact on MCH service and outcomes including experiences and expectations to address the stigma in perspective of Akha hill tribe women in Thailand. METHODS: A phenomenological qualitative approach was used to gather information from Akha women who had attended MCH service one year prior and had an experience with stigma. A validated question guide was used in the study. The interview was conducted in private and confidential rooms in the Akha hill tribe villages between June and September 2021. A thematic analysis was used to extract the major and minor themes and develop the findings. RESULTS: A total of 61 Akha postdelivery participants were recruited to provide information; the average age was 28.9 years, 32.8% had no Thai ID card, and 93.4% were married. Language, traditional clothing, poverty, and name were identified as drivers of stigma, while health care providers' background, gender differences between clients and health care providers, and knowledge gaps facilitated the stigma. Being a member of a hill tribe acted as the stigma marker. Stigma manifestation was presented in the forms of verbal or physical abuse, refusal to provide treatment, and intentional disclosure of personal information to the public. Accepting the situation with no better option, defending oneself to receive better care and services, and using a private care service were experiences in addressing the stigma. Gender matching, active MCH service, mobile emergency clinics, and appropriate, permanent medical equipment in health care facilities located in their villages were the expectations. CONCLUSION: Akha women face a variety of stigmas in access to MCH services, with substantial impacts on health outcomes, especially the rate of services in women and child health. Creating laws to prevent the occurrence of any forms of stigma and implementing gender matching in MCH services should be considered.

Acceptance and accessibility to the early phase COVID-19 vaccination among the healthcare workers and hill tribe population in Thailand.

Coronavirus disease 2019 (COVID-19) is a serious emerging disease and an extreme threat to human life. This study aimed to understand the perceptions of hill tribe people living in the border areas of Thailand-Myanmar and health workers regarding the acceptability and accessibility of the COVID-19 vaccine and health workers' perceptions of the readiness to implement the vaccination program during the early period of national COVID-19 vaccination. A qualitative method was applied to elicit information from key informants who lived in hill tribe villages and the health professionals who served them. The study was conducted in seven hill tribe villages located along the Thailand-Myanmar borders in Mae Fah Luang District, Chiang Rai Province, Thailand. The participants were hill tribe villagers aged 20 years and over; public health care professionals working in village health centers who had primary roles in implementing disease prevention and control measures; and public health care professionals working in districts and provincial public health offices who had primary roles in policy development and implementation. A total of 63 participants (26 men and 37 women) from seven hill tribe villages provided information. Three acceptance choices regarding receiving the COVID-19 vaccine were found among the hill tribes: definite acceptance, likely acceptance, and no preference. Two factors related to obtaining access to the new COVID-19 vaccine were found: Thai citizenship and the level of literacy related to the vaccine. There was no process or protocol in place for implementing the new vaccine among health professionals working at the district, subdistrict, or community levels, but the national expanded immunization program (EPI) system was clearly demonstrated to extend throughout the health service chain in Thailand. During the early period of national COVID-19 vaccine implantation in Thailand, not all members of the hill tribes accepted the vaccine; participant acceptance depended on several factors, including a participant's previous experience with vaccination, whether he or she required more information before making a decision, etc. While acceptance of the vaccine depended on the individual's background, not everyone had an equal opportunity to access the vaccine. The new COVID-19 vaccine should be available at the village level, including in hill tribe villages, to reduce the systemic threat to the country.

Drivers, facilitators, and sources of stigma among Akha and Lahu hill tribe people who used methamphetamine in Thailand: a qualitative approach.

BACKGROUND: The stigma related to drug use has several impacts, including effects on users' physical and mental health. Methamphetamine is a major drug that is used among hill tribes living in the border areas of Thailand and Myanmar. This study aimed to understand the drivers, facilitators, sources and outcomes of the stigma surrounding drug use, including the expectations among Akha and Lau hill tribe people who use methamphetamine in Thailand. METHODS: Qualitative data were used to elicit information from key informants and members of the hill tribes who used methamphetamine. The questionnaire was developed from a literature review and tested for validity before use. In-depth interviews were used to confidentially gather information from the participants in private rooms in villages. Each interview lasted 45 min, and a thematic analysis was conducted to examine the findings. RESULTS: A total of 46 participants were recruited to provide information; 95.7% were male, and 50.0% were aged 15-34 years. The majority were married (47.8%), 76.1% were Christian, and 45.7% graduated high school. Six drivers of stigma were detected: being poor, illiterate, unemployed, working aged, female, and married. Culture and tribe acted as facilitators of the stigma attached to methamphetamine use. Four sources of stigma were found: self, family members, peers, and community members. Three outcomes of stigma were determined: poor physical health, mental health, and relationships with others. There were four levels of expectations: no expectations, expectations for themselves, expectations for their family members, and expectations for their community members. CONCLUSIONS: Many personal traits, people living nearby, and socioeconomic factors, including culture and tribes, act as drivers, facilitators, and sources of stigma among hill tribe people who use methamphetamine. A program to reduce methamphetamine use among hill tribes should be implemented, which could eventually minimize stigma.

Status of the stateless population in Thailand: How does stigma matter in their life?

BACKGROUND: The stateless population in Thailand live by accessing all public services, including the health care system. Stigma is a crucial factor impacting these individuals' lives and their access to medical care. This study aimed to understand the experience of the stateless population in Thailand and how they overcome the problem of stigma. METHODS: A qualitative method was used to elicit information from key informants who were members of the stateless population, which was classified as those who did not hold Thai identification cards (IDs). A questionnaire was used to guide the interview, which was conducted in a private and confidential room. The interviews were conducted after voluntary agreement was obtained from the participants; each interview was held in August 2021 and lasted for approximately 45 minutes. RESULTS: Fifty-one people participated in the study; 68.6% were females, 86.3% were married, and 90.2% were Akha or Lahu. The stateless population in Thailand reported four types of perceived stigma: having a lower ability to request that their needs be met, not being equal to others, not being able to qualify for health care services and being ranked below other hill tribe people who have IDs. The phrase "life is nothing" was presented by the participants, who reported that they felt like an invisible population in Thailand. Some participants reported that other hill tribe people who have IDs act as stigma perpetuators among members of the stateless population who do not have IDs. Maintaining their privacy within their village, trying to obtain a Thai ID, and practicing the Thai language were the main ways of avoiding the stigma reported by the stateless population. Obtaining a Thai ID was detected as the top goal in their aim to overcome the stigma problem. CONCLUSIONS: The stateless population in Thailand live as an invisible population and are negatively treated via various patterns from others. Accessing Thai IDs and education are argued to be the most effective procedures for addressing the problem under the implementation schemes of the relevant organizations.

Experiences and expectations regarding COVID-19 prevention and control measures among the hill tribe population of northern Thailand: a qualitative study.

BACKGROUND: COVID-19 has been a major human threat for a year. A large number of people have been infected and killed globally, including hill tribe people living in remote and border areas between Thailand and Myanmar. Different expectations of and experiences with the implemented disease prevention and control measures by local, national and international organizations have been widely reported. This study aimed to understand the experiences and expectations regarding the disease prevention and control measures that were implemented among hill tribe people in Thailand. METHODS: Qualitative data were collected from participants aged 20 and older who belonged to the hill tribes living on the border of northern Thailand and Myanmar. A semistructured questionnaire was used to guide interviews. Information was extracted for thematic analysis by the NVivo program. RESULTS: Fifty-seven participants (36 female, 21 male) were interviewed; 27 participants were Thai Yai, 14 participants were Yunnan Chinese, 8 participants were Akha, and 8 participants were from other tribes. The average age was 45.8 years (min = 20 years, max = 90 years). Thirty participants had never attended school, and the other 27 participants had received education at different levels, from primary school to higher education. Forty participants were unemployed, 13 worked as agriculturists, and the other 4 were attending school. Both positive experiences, such as improving personal hygiene practices, maintaining close contact and increasing relationships among family members and demonstrating the leadership of the villager leaders, and negative experiences, including interruption of social interactions, family financial problems, poor access to medical care services, and invisible people to the government, were found. Different expectations were observed regarding organizations at the local, national, and international levels. Expectations at the local level included villagers and community leaders taking action to strongly contribute to prevention and control measures and to prevent unscreened people from entering the village. Obtaining accurate information about the disease and being financially supported were expectations at the national level, while closing borders to protect cases from overflowing into their villages was an international-level expectation. CONCLUSION: Although hill tribes reside in very remote rural areas, they experience both positive and negative effects of the disease prevention and control measures implemented by organizations. Their expectations are formally and informally voiced to policy makers at the local, national and international levels.

Impacts of and survival adaptations to the COVID-19 pandemic among the hill tribe population of northern Thailand: A qualitative study.

BACKGROUND: COVID-19 has exerted a variety of impacts on people, particularly people with limited education living in poor economic settings. This study investigates the impacts of and adaptations to COVID-19 among the hill tribe people of northern Thailand. METHODS: A qualitative method was used to elicit information from key informants who lived in a hill tribe village in Mae Fah Laung district, Chiang Rai Province, Thailand. Fourteen questions on two issues were used to gather information, and an NVivo program was used to extract the findings. RESULTS: A total of 57 hill tribe villagers participated, including 36 females and 21 males (mean age of 50.1 years, min = 20 and max = 90). Twenty-seven individuals were Thai Yai, 14 were Yunan Chinese, eight were Akha, and eight were members of other minor tribes. Regarding education and occupation, 30 individuals were illiterate, while 27 had attended different levels of primary school; 40 individuals were unemployed, 13 were employed as daily wage workers and farmers, and the other 4 were attending school. Three age categories were used to assess the impacts of the COVID-19 pandemic: impact of access to the educational system among the young, loss of jobs and family financial problems among the working, and access to medical care for the elderly. Six adaptation stages in response to the COVID-19 crisis were observed among the hill tribe people: shock stage with no prior experience, looking for help from health and other agencies, considering the national lockdown policy, complying with prevention and control measures, reducing stressful situations and following the new normal approach, and addressing suffering points at home and elsewhere. CONCLUSIONS: The COVID-19 pandemic has exerted different impacts on different age categories among the hill tribe population living in remote and border areas. Effective adaptations have been implemented to address the new normal life under the disease, and six adaptation stages have been identified that have helped them survive the greatest threat to humankind today.

Knowledge, attitudes and preparedness to respond to COVID-19 among the border population of northern Thailand in the early period of the pandemic: a cross-sectional study.

Background: Chiang Rai province in northern Thailand is a site of many people travelling among nearby countries and areas, including Yunnan province, China. In February 2020, there was concern about the population's vulnerability to coronavirus disease 2019 (COVID-19). Methods: A cross-sectional study was conducted in 15 villages less than 10 km from a border. A questionnaire was developed and tested for reliability and validity; 48 questions covered participant characteristics, plus knowledge about, attitudes to and preparedness for COVID-19. Chi-squared tests were used to detect any significant association between variables. Unadjusted and adjusted odds ratios with 95% confidence intervals (CIs) were calculated to assess the possible association of various factors with participants' level of reported knowledge, attitudes and preparedness. Results: A total of 520 participants were recruited of whom 320 (61.5%) were women. The age range was 18-90 years; the average age was 45.2 years. Variables with an association with good to moderate preparedness for COVID-19 prevention and control that remained after adjustment were: women were better prepared than men (adjusted odds ratio (ORadj) = 2.52; 95% CI = 1.36-4.68); those aged 18-30 years (ORadj = 4.26; 95% CI = 1.18-15.30), 31-45 years (ORadj = 4.60; 95% CI = 1.59-13.32) or 46-60 years (ORadj = 2.69; 95% CI = 1.16-6.26) were better prepared than those aged 60-90 years; and, compared with those with no formal education, those educated to primary school level (ORadj = 2.43; 95% CI = 1.09-5.43) or to university level (ORadj = 3.18; 95% CI = 1.06-9.51) were better prepared. Conclusion: Effective communication of essential, accurate and up-to-date information regarding COVID-19 prevention and control is essential in this population - especially for men, older age groups and those lacking formal education.

Associations of childhood experiences and methamphetamine use among Akha and Lahu hill tribe youths in northern Thailand: A cross-sectional study.

BACKGROUND: Methamphetamine (MA) is a commonly used substance among youths, particularly those who are living in poor economic conditions with low levels of education and who have had bad childhood experiences. The Akha and Lahu hill tribe youths living on the Thailand-Myanmar-Laos border are identified as the group most vulnerable to MA use in Thailand. The study aimed to estimate the prevalence of MA use and determine its associations with childhood experiences among Akha and Lahu youths aged 15-24 years in northern Thailand. METHODS: A cross-sectional study was performed. Validated and sealed questionnaires were used to gather information from participants after obtaining the informed consent form. Questionnaires were completed by participants and their parents at home. Logistic regression was used to identify the associations between variables at the α = 0.05 level. RESULTS: A total of 710 participants participated in the study: 54.2% were Akha, 52.5% were females, 50.6% were aged 15-17 years, and 11.4% did not have Thai identification card (ID) cards. The overall prevalence of MA use at least once among Akha and Lahu youths was 14.5%. After controlling for all potential confounding factors, 8 variables were found to be associated with MA use. Males had a greater chance of MA use than females (AOR = 4.75; 95% CI = 2.27-9.95). Participants aged 21-24 years had a greater chance of MA use than those aged 15-17 years (AOR = 2.51; 95% CI = 1.11-5.71). Those who had a family member who used MA had a greater chance of MA use than those who did not (AOR = 5.04; 95% CI = 1.66-15.32). Those who had been physically assaulted by a family member while aged 0-5 years had a greater chance of MA use than those who had not (AOR = 2.29; 95% CI = 1.02-5.12). Those who had been physically assaulted by a family member while aged 6-14 years had a greater chance of MA use than those who had not (AOR = 3.15; 95% CI = 1.32-7.54). Those who had a close friend who used alcohol had a greater chance of MA use than those who did not (AOR = 2.24; 95% CI = 1.24-4.72). Those who had a highly confident personality had a greater chance of MA use than those who did not (AOR = 2.35; 95% CI = 1.17-4.69), and those who smoked had a greater chance of MA use than those who did not (AOR = 8.27; 95% CI = 4.42-15.46). CONCLUSIONS: All relevant government and nongovernment agencies together with the Ministry of Public Health Thailand should address MA use among Akha and Lahu youths by properly developing a community health intervention that lowers risk of MA use by addressing family relationships, male youth behaviors, and focused on those individuals with a highly confident personality.

Perceived factors influencing the initiation of methamphetamine use among Akha and Lahu youths: a qualitative approach.

BACKGROUND: Methamphetamine use not only impacts health and the economy but also causes social impairment, particularly among the poorly educated and underprivileged young populations among the hill tribes in northern Thailand. Youths are the most vulnerable population for methamphetamine use due to various factors, including parenting styles, childhood exposure, and location of the village. This qualitative approach aimed to investigate the perceived factors influencing the initiation of methamphetamine use among the Akha and Lahu youths in northern Thailand. METHODS: A qualitative approach was used to elicit the information from key informants of Akha and Lahu youths who lived in villages in Chiang Rai province. A sixteen-question guideline was developed and examined for quality by three experts in the field and piloted before use. In-depth interviews were conducted among 19 Akha and 22 Lahu youths, serving as key informants from four villages, in a private and confidential room in their villages between June and August 2018. Each interview lasted approximately an hour. A thematic analysis was performed to evaluate the information. RESULTS: In total, 41 participants (19 Akha and 22 Lahu) from 4 villages participated in the study. According to the context and content obtained, four major perceived factors (low self-esteem, family member use, positive expectation regarding methamphetamine use, and availability), and five supportive factors (social norm perception, school dropout, family level problems, poor economic, and no Thai citizenship) were found to contribute to the initiation of methamphetamine use among the Akha and Lahu youths in northern Thailand. CONCLUSIONS: Akha and Lahu youths are initiating methamphetamine use due to several factors, including living in a poor family and in a remote area. All relevant government agencies with a mission to prevent and protect against methamphetamine use should consider the perceived factors influencing the initiation of methamphetamine use in these populations in order to develop a powerful program to stop methamphetamine use.