Between borders and barriers: disability prevalence, pregnancy outcomes and maternal care access on the Thai-Myanmar border, a mixed methods study.

Abstract

Introduction: Research on the intersection of displacement, disability, and pregnancy remains scarce globally. At the Thai-Myanmar border tens of thousands of displaced individuals including over 12,000 refugees with documented disabilities reside. The objective of this analysis is to assess the prevalence of pregnant People With Disabilities (PWD) among displaced populations and to explore perspectives on disability and barriers to accessing maternal care in this setting.

Methods: This mixed-methods study included a retrospective analysis of 49,038 clinical records of refugees and migrants who gave birth or received antenatal care at clinics operated by the Shoklo Malaria Research Unit. Logistic regression was used to compare pregnancy outcomes between pregnant people with and without disabilities. The qualitative component included five in-depth interviews with migrant PWD and five focus group discussions with healthcare staff and migrant community health volunteers providing maternal care. Deductive and inductive thematic analyses were conducted to examine experiences of accessing, receiving, and providing care.

Results: Documented prevalence of pregnant PWD was low at 0.62% (305/49,038; 95% CI 0.55-0.70). Women with disabilities reported barriers including stigma, transportation difficulties, financial constraints, and reliance on accompaniment to attend clinics. Those who accessed care described respectful communication and supportive interactions with staff. Healthcare providers expressed strong commitment to equitable care. Quantitative findings included higher antenatal care attendance and lower loss to follow-up among women with disabilities.

Discussion: The low documented prevalence of disability may reflect underrepresentation or underreporting of pregnant PWD in maternal services or a healthy migrant effect. Quantitative results reported favourable ANC use and perinatal outcomes, which aligned with accounts of respectful communication, equal treatment, and participation in decision-making. Future research should use standard tools, disaggregate findings by disability type, severity, and ethnicity to uncover specific needs.