Providing ante-natal care in remote areas of Lao PDR

Women stories

22 June 2018

From the sky, Savannakhet province in southern Lao PDR exudes an idyllic beauty. Roughly translated as ‘Land of Fertility’ or ‘Golden Land’, Savannakhet appears as a glorious mosaic of rice paddies, rivers and dirt roads which crisscross dense woodland-like strands of rust-coloured cotton thread. Yet down below, on the ground, those tiny lines reveal themselves as something else entirely. Muddy tracks, potholed, crevassed and treacherous.

“Just lie still and relax. Breathe slowly. That’s it”. Kneeling on the floor of a rickety stilt house, midwife Khoun Keobouttavong presses a small wooden horn known as a ‘pinard’ into a pregnant belly. In front of her lies Out, 30 years old and six months pregnant.

“The heart is beating well,” Khoun tells Out, smiling. “Now let’s do some measurements”. Practicing for just two years, Khoun is the sole midwife for the entire Thapangthong District, an administrative area inside Savannakhet province, which includes eight villages, one tiny clinic, 32 pregnant women and several newborns. Khoun provides contraceptive and reproductive health services to hundreds of others both inside the clinic and at home. That is, if the state of the roads allows.

“For women who live in the main village, they can visit the clinic, but for those outside there are obstacles,” Khoun notes. “The roads are not good and they need to tend to rice crops and take care of children. Also, there is a perception that ante-natal care is not essential. The previous generation gave birth at home, most often with the help of a traditional birth attendant. So sometimes they simply do not come”.

Like Khoun, there are now 1,700 trained midwives working in remote areas across Lao PDR, via an initiative begun by the Lao government in 2012 to meet the acute needs of rural women. Since then, over just three years the country’s Maternal Mortality Ratio has gone from 357/100,000 live births to 206/100,000 in 2015, “a significant reduction” says UNFPA Representative in Lao PDR, Frederika Meijer. But still, there are challenges. As well as access, Lao PDR is home to over 49 different ethnic groups, each 

with their own language and customs, making it difficult, at times, for the midwives to communicate. Intergenerational poverty and low education levels mean that both women and men face limited opportunities to break the cycle.

Readjusting her garments after her checkup, Out looks exhausted. This afternoon she must return to the rice fields to work with her husband, while her two young children, 5 and 2, wait out the day in a tiny shelter nearby. Herself one of twelve children, Out never attended school and apart from working the fields, forages in the forests and streams daily to feed her family. “I catch fish or frogs to eat or cut some bamboo, as we do not have money to buy food,” Out says.

Like Out, Khamkong, 21 and seven months pregnant, is one of many children, who missed schooling to help her parents who were rice farmers and illiterate. Now recently married and excited about the future, Khamkong says she is grateful for the midwifery service and hopes she will be able to deliver safely.


“I do feel very nervous because it is my first baby and in the village where I am from, one woman died. But I feel good having the midwife close by. I know she will take good care of me,” says Khamkong shyly.

Back at the clinic in Savannakhet, Khoun says that although there are times she is overwhelmed with her workload, she is happy to see an increase in women seeking her services, and she gets inspiration from the example she herself is able to set for the next generation. Revealing only later that she too grew up in this village and is the only woman to ever graduate from secondary school, her presence – and accomplishments - cannot be overstated.

“I have some girls who want to talk to me about my education and some of the parents see that maybe it’s good for their daughters to stay in school,” Khoun says. “People see what I have done and so they have begun to think ‘Maybe I can do that too’. So, I have become a kind of role model.”