“My only wish is to bring my child into a safe world" - A safe delivery against all odds: UNFPA’s support in collaboration with partners for maternal care in conflict-affected Rakhine

In the shadow of the ongoing conflict in Rakhine State, Myanmar, Mi Mi’s story of resilience and overcoming her fears echoes through the disrupted lives of many. At seven months pregnant, Mi Mi, a 32-year-old woman from a township ravaged by conflict, faces uncertainties that concern her health and the safety of her soon-to-be-born baby. "I was working various jobs to support my family, even as a mason. But now, due to my pregnancy and the escalating conflict, I worry about delivering my baby safely in these harsh conditions," she shares, her voice a mixture of hope and anxiety.

The escalating conflict in Rakhine has not only shattered the economy but has also devastated the healthcare infrastructure and services crucial for pregnant women, lactating mothers, and girls. Facilities that once offered health care are now inaccessible due to the ongoing conflict. In the townships affected by armed conflict like Maungdaw, Pauktaw, Kyauktaw, and Sittwe etc., the lack of access to essential healthcare creates a life-threatening threat for women, particularly pregnant women living in those areas.

Despite the challenging context in Rakhine, the Myanmar Medical Association (MMA) and Relief International (RI), with the support of UNFPA, strive against the odds to deliver sexual and reproductive health (SRH) services through static and mobile clinics for those in urgent need. These clinics, particularly the mobile units, have become lifelines to those affected by the conflict, reaching out to vulnerable areas to ensure that essential SRH services are not just a privilege but a right that is upheld even in the most dire situations. Their work is vital, offering everything from prenatal check-ups to emergency obstetric care, proving indispensable in a landscape where people, including displaced persons, cannot access local healthcare facilities amid the armed clashes.

The situation for Mi Mi is dire. "I always worry about my health and my baby. Without access to medical facilities, it feels like we are abandoned," she says.

Amidst the turmoil, stories of gratitude in the face of desperation surface from the women affected. Hnin Yu Lwin, who recently gave birth, credits the antenatal care she received at MMA’s clinic, which saved her and her baby’s life. "Without the support from the clinic, I cannot imagine how my child and I could have survived," she reflects. Reflecting on her experience, she continues, " Receiving healthcare from professional health workers is so important. Without their care, we (pregnant women) would have been left to face the uncertainty and health-related risks alone. Their effort saves many of our lives in the community."  

Nuha Mina, from a village in Sittwe township, voices the collective fears of her community, "Many women here in my community are giving birth at home, without any professional care and assistance, facing life-threatening complications. I am lucky that I have connected with this service. I do not want my regular visits to the clinic to be interrupted due to the conflict. That’s my constant worry everyday."

The conflict has not only disrupted healthcare facilities but has also severely restricted the transportation and distribution of essential reproductive health commodities. Supplies such as contraceptives and maternal health products, once readily available at the UNFPA-supported clinics, have become difficult to deliver due to logistical challenges and travel restrictions.

Sanitary pads, categorized as medical items in Rakhine, are also in short supply. With logistical constraints impeding distribution, countless women and girls have been deprived of access to menstrual hygiene products, compromising their dignity and well-being. "Not having sanitary products is more than just an inconvenience," says Myaa, a woman with disability from the internally displaced camp in Sittwe. "It affects our health, confidence, and basic rights."

Dr. Myo Aung Hlaing of MMA explained the immense challenges faced by the mobile clinic teams: "Travel authorisations are difficult to obtain in this security context. It is a significant challenge for mobile service delivery. As an alternative, MMA provides transportation costs for women of some IDP camps so they can come to our static clinic in Sittwe to receive health care. This arrangement is to help those in need access our services in this difficult time.” This support does not completely solve all the issues faced by people in the community. The scarcity of medicines, travel restrictions, banking issues, and price fluctuations of basic household items are all worsening the situation in Rakhine. Dr. Myo added, “Previously, we had 500 patients per month, but in the last two months, we’ve only seen 200. This gap in access to life-saving SRH services will negatively impact the well-being of women and girls."

For women like Nuha Mina, this support is invaluable. "The conflict has taken so much from us—jobs, security, peace. But the transportation help from MMA has been a lifeline. It's not just healthcare; they recognise our struggles and make sure we can get there. I don’t have to choose between healthcare and other essentials for my family. Their support has lifted a huge weight," she says.

MMA’s initiative, with UNFPA support, is more than just about healthcare—it’s about ensuring that women in conflict-affected areas can access the care they deserve without added burdens. Through this holistic approach, MMA is not only improving health outcomes but also restoring a sense of dignity to women in Rakhine.

The United Nations sexual and reproductive health agency (UNFPA) and its partners are tirelessly working to provide essential health care and support to those affected by the conflict. The mobile and static clinics, in particular, are a testament to the commitment to providing life-saving SRH services amid the deteriorated situation in Rakhine, overcoming logistical challenges to reach those most in need. In 2023, MMA provided sexual and reproductive health services such as antenatal care, postnatal care, emergency maternal referral, and family planning services to 25,000 women in Sittwe township, while 14,000 among them received maternal healthcare services. RI, through their mobile clinics, provided sexual and reproductive health services for 5,000 women in four townships of Rakhine. 3,000 pregnant women received maternal healthcare, and 2,000 women received family planning services.

Despite these efforts, the needs continue to outpace the services available, not only in Rakhine but also in different states and regions across the country affected by the conflict. There are significant gaps in healthcare access, especially in remote and conflict-affected areas where security and mobility issues complicate service delivery. UNFPA and its partners are actively working to bridge these gaps by strengthening local partnerships to expand reach. However, there is still much to be done to meet the healthcare needs of women and girls, including persons with disabilities. Each step forward is crucial in ensuring that no one is left behind.

As the echoes of conflict continue to reverberate through Rakhine, the words of a community woman resonate deeply, underscoring the dire need for sustained support: "We, in the community, do not expect much for our lives, but to hold our hands, keep us safe, and treat us with dignity. The mobile clinics are the places we don't want to disappear." In these words lies a powerful plea for humanity—a call to ensure that amidst the deterioration, the essential lifelines of health and dignity are preserved. These clinics are more than just medical facilities; they are beacons of hope and resilience to women and girls affected by the conflict.

*This story was originally published on the UNFPA Myanmar website.