Knowledge of and attitudes towards abortion among adolescents in Lao PDR.

BACKGROUND: Adolescents are at high risk of unintended pregnancy and consequent unsafe abortion. Evidence from Lao PDR suggests a high but underreported prevalence of induced abortion, especially amongst adolescents. Research suggests adolescents are less likely to have an unsafe abortion when they have accurate knowledge about abortion and hold positive attitudes towards abortion. OBJECTIVE: The purpose of this study was to investigate awareness and attitudes towards abortion and associated factors in Lao PDR. METHODS: This study used a descriptive, cross-sectional design. The study was conducted between January and May 2019 in two different provinces within Lao PDR, namely, Khammouane and Champasack provinces. Participants included in- and out-of-school male and female adolescents (n = 800). Data were collected using a structured questionnaire and entered into the EPI Data version 3.1. All analysis was undertaken using STATA v.13. Univariate analysis and frequency distributions were used to study the pattern of responses and bivariate descriptive analysis to report attitudes and knowledge by participant characteristics. The association between participant characteristics and overall scores of attitudes towards abortion was evaluated using multiple logistic regression. FINDINGS: Most respondents (78.8%) were aware of the processes and potential consequences of becoming pregnant at a young age. One-third of respondents (31.5%), were aware of induced abortion. Of those, only 12.1% held positive attitudes towards induced abortion. Factors associated with positive attitudes towards abortion were ethnicity, mother's education and ever having had sex. CONCLUSION: In the case of unintended or unwanted pregnancy, adolescents must also have adequate knowledge and access to safe abortion and associated counselling services. This study suggests a need to increase sexual and reproductive health literacy including information about safe abortion. This requires a holistic approach to sexual education and needs the support and involvement of adolescents themselves as well as parents, community members and healthcare workers.

Perceptions and understandings of pregnancy, antenatal care and postpartum care among rural Lao women and their families.

BACKGROUND: Lao People's Democratic Republic (Lao PDR) has the highest maternal mortality rate (MMR) and infant mortality rate (IMR) due to traditional practice and beliefs on pregnancy, delivery and postpartum. The objective of this study was to get a better understanding of cultural beliefs and practices surrounding pregnancy, ANC and postpartum care among rural women in Lao PDR. METHODS: Eight focus group discussions and 52 interviews were carried out with delivered women, husbands, mothers, traditional birth attendants, head villagers, Lao Women's Union members and healthcare workers, in Khammouane and Champasack provinces in Lao PDR. In order to accurately grasp participants' perceptions and understandings, content analysis was used to analyze the transcripts. RESULTS: Most women in the study claimed to have attended ANC, but participants also explained that it was unnecessary to attend ANC and give birth at a clinic if the woman felt healthy. Factors that discouraged ANC attendance and giving birth at clinics included: time and money constraints; the perceived necessity of giving birth on a "hot bed"; the need for "mother-roasting" after giving birth; the belief that preparing for a birth was a bad omen for the birth; the belief that colostrum is unhealthy for the newborn child; and the preference for cutting the umbilical cord with a piece of sharpened bamboo. CONCLUSIONS: Harmful cultural practices such as discarding colostrum should be discouraged; beneficial practices such as family involvement in birthing and keeping a mother warm after birth could be integrated into biomedical practice. Given the prevalence and importance of the cultural understandings we have described in this study, it is clear that proposed changes in cultural practices need to be addressed with sensitivity and that community stakeholders and trusted leaders will need to be involved.

Informal workers and access to healthcare: a qualitative study of facilitators and barriers to accessing healthcare for beer promoters in the Lao People's Democratic Republic.

BACKGROUND: Informal workers often face considerable risks and vulnerabilities as a consequence of their work and employment conditions. The purpose of this study was to examine the interplay between the experience of informal work and access to health, using as an example, female beer promoters employed in the informal economy, in the Lao People's Democratic Republic. METHODS: In-depth interviews were undertaken with 24 female beer promoters working in beer shops, restaurants and entertainment venues in Vientiane City. The recruitment strategy of snowball sampling was used. Interviews explored the beer promoter's experience of the organization of work, perceived healthcare needs, access to healthcare and insurance, and health seeking practices. The data was analysed thematically and subsequently using Bourdieu's concepts of habitus, capital and field. RESULTS: Most of the beer promoters included in the study were 18 years of age, single, had worked as beer promoters for more than one year and just over half were working to support their higher education. The beer promoters demonstrated a holistic view of health, also viewing good health as contributing to being beautiful - an important attribute in their work. Many reported that their work conditions, including the noisy environment, exposure to second-hand tobacco smoke, long hours on their feet and sexual harassment negatively affected their physical and mental health. Only four participants had any form of health insurance with access to healthcare constrained by individual characteristics, health system factors and the conditions of their informal employment. CONCLUSIONS: Drawing on the work of Bourdieu, the study shows how both employment and illness are linked to habitus embodied in everyday practices, access to capital and the position the female beer promoters hold in the social hierarchy in the field of employment.

Reasons rural Laotians choose home deliveries over delivery at health facilities: a qualitative study.

BACKGROUND: Maternal mortality among poor rural women in the Lao People's Democratic Republic (Lao PDR) is among the highest in Southeast Asia, in part because only 15% give birth at health facilities. This study explored why women and their families prefer home deliveries to deliveries at health facilities. METHODS: A qualitative study was conducted from December 2008 to February 2009 in two provinces of Lao PDR. Data was collected through eight focus group discussions (FGD) as well as through in-depth interviews with 12 mothers who delivered at home during the last year, eight husbands and eight grandmothers, involving a total of 71 respondents. Content analysis was used to analyze the FGD and interview transcripts. RESULTS: Obstacles to giving birth at health facilities included: (1) Distance to the health facilities and difficulties and costs of getting there; (2) Attitudes, quality of care, and care practices at the health facilities, including a horizontal birth position, episiotomies, lack of privacy, and the presence of male staff; (3) The wish to have family members nearby and the need for women to be close to their other children and the housework; and (4) The wish to follow traditional birth practices such as giving birth in a squatting position and lying on a "hot bed" after delivery. The decision about where to give birth was commonly made by the woman's husband, mother, mother-in-law or other relatives in consultation with the woman herself. CONCLUSION: This study suggests that the preference in rural Laos for giving birth at home is due to convenience, cost, comfort and tradition. In order to assure safer births and reduce rural Lao PDR's high maternal mortality rate, health centers could consider accommodating the wishes and traditional practices of many rural Laotians: allowing family in the birthing rooms; allowing traditional practices; and improving attitudes among staff. Traditional birth attendants, women, and their families could be taught and encouraged to recognize the signs of at-risk pregnancies so as to be able to reach health facilities on time.