Hpa-An, Kayin State, Myanmar - Three years ago Ahnaw* collapsed on the floor of her house in a small rural village in eastern Myanmar. When she came to, she realised she was bleeding heavily from what turned out to be a miscarriage.

“I didn’t even know I was pregnant,” the 36-year-old recalls, seated in front of a Buddhist shrine in her living room. “They told me when I got to the hospital. They said I was lucky to survive.”

As a result of her experience, Ahnaw is now part of an International Rescue Committee programme that trains hundreds of women in Myanmar’s Kayin state to become advocates for birth-spacing and safe pregnancies. These “mother support groups” spread their messages in village gatherings or by going door-to-door, targeting families with many children or young families with children born in quick succession.

“It’s now our job to inform women and young girls how to protect themselves from unwanted pregnancies,” Ahnaw says. “And if they are pregnant we inform them about the health services that are available in their community.”

Those services are few and far in between. Myanmar’s health system is in shambles after decades of neglect and fighting between ethnic independence groups and government forces. Most rural hospitals and clinics lack trained health staff and proper equipment.

As a result, the maternal mortality rate in Myanmar is one of the highest in the region, according to a recent United Nations study.

Almost 90 percent of deaths occur in rural areas, where poor infrastructure makes it even harder to reach a clinic. About a quarter of people in Kayin State live below the poverty line and the standards for maternal and child care are among the lowest in the country.

In Kayin, as well as other rural communities in Myanmar, family planning is often frowned upon by conservative community members and religious leaders. Nationwide, the use of condoms and other contraceptives is less than 40 percent, according to government figures. Only 15 percent of married women in Kayin have access to modern family planning services.

“People want large families, but often cannot care for all their children,” says Ralf Thill, the IRC’s Myanmar director. “It makes poor villages even poorer.”

Another problem in rural Myanmar is young mothers. Thill says 18-year-olds with three children are not uncommon.

“We have seen mothers as young as 14,” he says. “In these communities, information is key.”

Abortion is generally illegal in Myanmar, resulting in clandestine, often life-threatening, terminations.

“Because they are performed in secret by unskilled practitioners, we see a lot of complications, including death,” Thill says.

To help, IRC staff helps refer women with post-abortion trauma to hospitals and specialists.

In the village of Yae Kyaw, a group of women has gathered to listen to the local mother support group. One of its members, Daw Aye Than, displays a range of contraceptives, unleashing a barrage of questions from the crowd.

“What are the side-effects from hormonal injections?” one woman asks.

“Is an IUD harmful if you keep it for a long time?” another one demands.

Daw Aye Than says that there are still a lot of unawareness about reproductive biology in the villages where she works.

“Women have never heard of certain contraceptives and some think it is impossible to get pregnant after 40, so they stop protecting themselves,” she says.

Another common problem seldom discussed is uterine prolapse, says Daw Aye Than, referring to a condition where the womb slides out of its normal position after multiple childbirths and heavy lifting.

“These subjects are often taboo, but they are very important” she says. “And someone has to provide the answers.”

Read more about our work in Myanmar here.

*Names were changed to protect the woman's privacy