by Anonymous
From the author
INTRODUCTION
Laos today remains one of the most ethnically diverse and geographically complex countries in Southeast Asia. Its government recognizes 160 sub-ethnic groups within 50 main ethnic groups, and around three-quarters of its land is covered in mountains and forested hills (“The Indigenous World 2026: Laos (IWGIA)). That being said, much of Lao PDR is made up of rural villages that inhabit many different ethnic groups, all with their own cultures and traditions. While this diversity is a unique aspect of Laos , it has also contributed to longstanding health inequities, particularly for ethnic minority women.
Prior to the 2000s, Laos was ranked as having one of the highest maternal mortality rates in Asia, having approximately 834 deaths per 100,000 live births as of 1990 (“Lao PDR Maternal Mortality Rate | Historical Chart & Data”). For comparison purposes, the World Health Organization currently states the Sustainable Development Goals aim is to have a global MMR of 70 or less maternal deaths (World Health Organization). Yet, within the last decade, Lao PDR has been considered to be one of the top countries to improve maternal, newborn, and child health – decreasing their maternal mortality rate all the way to 112 maternal deaths per 100,000 live births as of 2023 (“Lao PDR Maternal Mortality Rate | Historical Chart & Data”). These improvements have significantly resulted from expanded healthcare initiatives by the government and international aid efforts to increase maternal healthcare accessibility. However, national progress does not indicate equal progress across Lao PDR. Barriers to accessing care still persist amongst ethnic minority groups in Laos as a result of many overlapping cultural, economical, geographical, and educational factors. Thus, this paper aims to examine maternal health access in Lao PDR through an intersectional lens that analyzes the persisting disparities ethnic minority women experience, despite national improvements made within the last two decades.
Historical Inequities and Injustices
In order to understand the full extent of ethnic inequalities that persist in maternal healthcare today, it is crucial to examine the country’s broader historical injustices through war and colonialism. The Lao People’s Democratic Republic has had a longstanding history of war violence that has severely impacted the health and safety of people in Laos. As a country that lies centrally between Vietnam, Cambodia, Thailand, Myanmar, and China, Laos served as a scapegoat for severing war resources of its surrounding countries. During the U.S.’ war with Vietnam, over two million tons of bombs were dropped on Laos, and is known to be one of the heaviest bombed countries in the world to this day (“Win Without War”). Within these times, there was almost no international attention on the atrocities being committed in Laos. As a result of this “secret war”, approximately 30% of the US bombs failed to explode, killing more than 20,000 people in Laos after the war (Rotondi). Unexploded American bombs still contaminate the countryside of Laos, disproportionately affecting ethnic minorities of Laos, especially those near the Ho Chi Minh trail, where many of the bombs remain (Rotondi).
The long term effects of unexploded bombs extend past just physical risks. Contaminated land and damaged infrastructure creates massive physical barriers to the development of roads and transportation to rural villages, directly hindering those who need maternal health services while living in remote areas. In this aspect, the historical weight that the secret war has on Laos continues to impact all areas of society, including shaping the health disparities amongst minority women.
Colonialism also played a major role in shaping ethnic inequalities today. Upon the emergence of Indochina, France created a comprehensive classification of Lao ethnic groups, distinguishing between the Lao Luom (low lands), Lao Theung (midlands), and Lao Soung (uplands) of Laos “The Indigenous World 2026: Laos (IWGIA). Although these criteria in modern times do not dictate the common language used by people in Laos to describe others, it has been used amongst researchers and the government to differentiate between the main geographical groups of Laos.
In addition, the French became responsible for the group generalization that persists today, referring to those who live in Laos as “Lao” – a term derived after the dominant ethnic group (Silavong). Today in literature and scholarly writing, populations are more commonly referred to through the four main ethnolinguistic categories: Lao-Tai, Mon Khmer, Hmong-Mien, and Chinese-Tibetien “The Indigenous World 2026: Laos (IWGIA). Within these categories exists a plethora of ethnic and indigenous groups, and as a result comes diverse languages, dialects, and cultures. Knowledge of this diversity remains highly relevant today in understanding how geographical, linguistic, and cultural differences can influence whether a ethnic minority woman is able to obtain proper maternal healthcare.
Sociocultural Barriers
Cultural traditions and rigid gender roles within ethnic communities in Lao PDR significantly influence the nature of, and access to, maternal healthcare. Expectations surrounding marriage, labor, and women’s social responsibilities considerably impact the amount of educational opportunities and awareness they receive regarding reproductive risks. Consequently, high adolescent pregnancy rates continue to disproportionately affect ethnic minority groups from a lack of knowledge surrounding safe sex and reproductive risks. Data provided from a Lao Social Indicator Survey displays adolescent pregnancy being more common amongst young women who come from “rural areas, have lower level of education, and belong to lower wealth quintiles” (Habito et al.) – all factors associated with higher levels of maternal mortality as well as lesser access to maternal healthcare. Adolescent pregnancy is both its own interdisciplinary issue and a major maternal health concern, one that is pushed by cultural expectations and labor needs. A 2024 qualitative study covering adolescent pregnancy in girls throughout Vientiane Capital, Vientiane Province, and Luang Namtha notes parental expectation of marriage following pregnancy in the majority of the girls they investigated. Motivations of early marriage and childbirth often stem from economic and social pressures, and reinforce the expectation that young ethnic minority women should assume domestic responsibilities even at an age that poses higher risk of maternal complications.
In many rural regions, agricultural work is often a primary source of income, and serves as a central priority for ethnic minority families. Under this framework, many parents believe that sending their daughters to school is less valuable, and overall unproductive compared to the work they could be doing at home (“Teenage Pregnancy Is Way of Life in Remote Laotian Villages”). By devaluing education of young ethnic minority women, communities inadvertently decrease awareness and information regarding proper maternal health and reproductive complications.
These societal expectations are further emphasized by continuing gender stereotypes. The International Labor Organization (ILO) notes that according to social norms in Lao PDR, women are advised to “focus on childcare and domestic chores” and also help with the “farm and family business”. While in Lao PDR 76% of women in agriculture are considered to be contributing family workers, their labor is often uncompensated (“Voices of Change: Amplifying Gender Equality in Rural Lao People’s Democratic Republic”). This expectation that these women are to continue heavy labor while serving as primary child-bearers leaves very little room for becoming educated. As girls are increasingly less encouraged to go to school, it results in a lack of knowledge surrounding safe sex and how to properly manage pregnancy-related complications. These sociocultural systems extend into the birthing labor itself, where traditional beliefs of ethnic indigenous communities often supersede official health services. United Nations Population Fund (UNFPA) features the story of Tod, a woman who lives in a rural Savannahkhet community. At 15 years old, Tod gave birth to her first child in the forest, a cultural practice amongst some ethnic groups residing in the Savannakhet district, such as the Bru, Khao, and Katang. Research examining the birth practices of the Katang indigenous group explains how women are expected to “go into the forest and give birth alone or with the support of older women and/or family members” (Chithtalath, 100). This is primarily done in order to avoid any cursing of the mother and her child, as it is believed the house spirits may eat the blood of the woman and result in death. While these beliefs are deeply rooted in generational practices, villages like these have since pushed for improvement in their communities that still allow for tradition but recognize the needed improvement of health protocols. Within Katang and other ethnic groups, birthing practices have begun to change over the last decade, implementing training of traditional birth attendants (TBAs) and building local health clinics (Helin, 5). In highlighting these specific experiences, it pushes for strategy improvement amongst maternal health and mortality rates in Laos as a whole, one that acknowledges the presence of cultural practices while simultaneously providing community support for these women.
Geographical Marginalization and Infrastructure
With over 60 percent of Lao PDR living in rural villages, geographical marginalization and proper infrastructure remain as some of the largest barriers to improving maternal health for ethnic minority women. Rural communities, including Hmong and Khmu villages, remain relatively isolated and often have insufficient infrastructure and unreliable transportation to access urban health centers. For example, the journey from Luangprabang to a Khmu village is around 136 miles, but has been documented to take “almost eight hours without stops” (Dunlop). In the case of an emergency, delays caused by travel time and limited transportation to healthcare services pose serious risk of maternal complications or mortality. Even routine healthcare checkups for mothers can be a struggle if community resources are limited and require traveling to more urban areas. Data from a journal covering delivery health service utilization shows that of their participants, 74.9% are from rural areas and around 7% of that population have no road access at all. Even amongst the rural women who have road access, more than 25% of them did not pursue official health services (Amaliah et al.). This finding suggests that even in cases where women may have the physical road access to maternal health services, it does not guarantee meaningful access.
Additionally, Laos’ rough terrain and irregular seasons can make access considerably more challenging. Occurring between the months of May to October, monsoon season severely hinders travel and access to maternal healthcare services. The tropical monsoon season is only predicted to get worse as climate change intensifies, disproportionately affecting low-income and rural communities due to insufficient infrastructure (Myren). This environmental unpredictability is precisely what transforms geographical distance into a form of involuntary exclusion. Struggles of transportation mentioned by Dunlop only worsen when considering how different rural villages may be affected by extreme weather patterns.
As a result of these obstacles, geographical distance becomes a form of both physical inaccessibility and structural exclusion from maternal health services when factoring environmental and institutional aspects . However, in doing so, it effectively highlights the importance of implementing localized healthcare strategies. Rather than trying to overcome distance, working within the communities themselves may help reduce the effects of geographical marginalization.
Maternal Health Literacy and Educational Gaps
Maternal health literacy (MHL) continues to be a significant barrier for ethnic minority women in Lao PDR because of its direct influence on the understanding and utilization of healthcare services. A 2025 study done on incomplete antenatal care of those experiencing geographic and sociocultural barriers in Laos found that only 10% of the study’s participants received all thirteen antenatal care components that the Ministry of Health outlines (Kim et al.). Although many maternal mortality cases occur post-pregnancy, antenatal care remains crucial in identifying health risks early on before they become fatal during or after birth. More importantly, was the substantial gap in health education these women received. The study presented five main categories of danger signs in pregnancy – headache, high or chronic fever, severe abdominal pain, blood or amniotic fluid coming out of the vagina, and convulsions. Results showed a disproportional effect, with at least 40 percent of ethnic minority participants across categories reporting not receiving information on these given danger signs (Kim et al.). Informing minority women on how to recognize warning signs and respond to an emergency is vital to progress, as it directly affects the woman’s autonomy in being able to make her own informed decisions regarding her pregnancy.
Research on levels of maternal health literacy further exhibits its reliance on many differing factors. A recent study looking at maternal health literacy on mother and child health care in southern provinces of Laos found that 80% of mothers had either inadequate or problematic maternal health literacy (Phommachanh et al.). With MHL score indexes remaining significantly higher in urban areas, complex aspects are of course involved. Factors impacting these results include, but are not limited to, “mothers who speak the Lao language, who have high income and who frequently visited ANC” (Phommachanh et al.). In acknowledging these linguistic and economic issues that can limit informational opportunities, it brings awareness to the fact that access does not just mean physical proximity to educational centers. Improving maternal health literacy requires that education is both physically and culturally accessible – meaning that it is in a language they can speak, and in a form that is comprehensible and affordable.
National Governance
In response to maternal health and maternal mortality rates over the last two decades, governmental and global efforts have made significant strides in prioritizing women’s health. The World Health Organization (WHO) notes the implementation of a five year “National Strategy and Action Plan” that aims to address antenatal care, maternal care during childbirth, early essential newborn care, routine assessments of the mother and child, as well as strengthening local governance to improve their health systems. Response to the urgency of maternal health care rose following the COVID-19 pandemic, as widespread clinic closure and restrictive policies significantly decreased access. In response, the nationwide deployment of
CONNECT (Community Network Engagement for Essential Health Care and COVID-19
Responses through Trust) became a pivotal role in progress of relations amongst health centers and the ethnic minority patients. Beyond just the expansion of healthcare centers throughout rural areas, strategies in technology are advancing as well. The United Nations Children’s Fund notes the implementation of electronic immunization records into health systems. Dr. Bouapao, who is head of immunization at the Van Vieng District hospital, discusses the advantages of the new electronic registry system in its more individualized care because patient data is able to be processed more efficiently. This has allowed for a shift in focus on delivering immunization and antenatal care by motorbike – allowing for mobility even in areas with rough terrain (“Devoted to Maternal and Child Health”). By learning to address problems within the healthcare systems themselves, it allows for recognition and focus to be put on those who cannot physically access healthcare centers.
Responses like such reflect the nation’s growing efforts to strengthen healthcare systems in Lao PDR, however, access continues to depend on how effectively these services can reach the rural ethnic communities.
Communal and Local Efforts
While national healthcare strategies and improvements provide the proper framework for reform, it is vital to acknowledge the work being done by local women of Laos in their efforts through midwifery, community support, and local governance to ensure an environment that is both accessible and affordable. More than 3,000 midwives have graduated from medical training since 2010 (Phoummalaysith, 4), and continue to make a lasting impact on the experiences of marginalized ethnic women in Laos. Posing undeniable struggles to proper care, infrastructural issues and unreliable transportation to urban provinces of Laos create a situation where midwives are crucial to monitoring a mother’s health before, during, and after birth. Alongside midwives, traditional birth attendants (TBAs) remain vital in order to tackle language and cultural barriers that would come with bringing in outside healthcare services. While traditional birth attendants are not professionally trained in the medical sense, their role is integral in sustaining the holistic elements of a village’s birthing practices. TBAs are commonly older women who are either self taught or have been taught by other TBAs (Garces et al.). Consequently, these traditional birth attendants provide a bridge between official healthcare systems of Lao PDR and community engagement – often the preferred option by many rural ethnic women because of the communal knowledge that these attendants hold.
Local efforts made by Laotian communities also ensure that trust is just as valued alongside adequate healthcare. A recent study in 2025 looked at the effect of trust in village health care workers and volunteers (VHVs/VHWs) on women receiving postnatal care services, looking particularly at the Sepone and Vilabouly districts to collect data (Ahissou et al.). Within their findings, women’s trust of VHV’s and VHW’s appeared to have a significant effect on how likely they were to go to facility-based follow ups. This furthers the importance of bridging healthcare access first through community that ensures trust, before attending a larger facility that might pose worry about linguistic and cultural barriers. Ultimately, this suggests that the gaps still remaining in maternal healthcare pose as more than just a physical challenge of geographic distance to access. Instead, receiving maternal care requires a certain level of trust and perhaps a cultural connection amongst ethnic minority women. Consequently, the village volunteer workers and midwives serve as vital connections in translating urban healthcare to rural villages in a safe and healthy manner.
CONCLUSION
Despite the recognition of advancements in Lao PDR maternal health and mortality rates, a closer examination shows the uneven path to progress. While the national maternal mortality rate has decreased by over 80% in the last two decades – with numbers reaching as low as 112 maternal deaths per 100,000 live births (“Lao PDR Maternal Mortality Rate | Historical Chart & Data”) – this data often fails to recognize the persistent gap in maternal healthcare for rural and ethnic women. Laos’ ethnolinguistic diversity and geographic vastness is simultaneously what makes the country so breathtaking while also posing a series of obstacles to equitable healthcare. In framing this issue as fundamentally intersectional, it becomes clear that maternal healthcare is a primary indicator of a nation’s overall development.
Prioritizing the health of ethnic minority women demonstrates a necessary kind of shift towards the women who are essential to the economical and sociocultural fabric of Laos. Not only are these women responsible for being childbearers, but in rural communities, they are a driving force behind agricultural labor. Yet, this dual expectation of ethnic minority women is exactly what poses them at risk for maternal health complications. While labor work may not directly correlate to birthing and post-natal complications, it certainly can worsen the effects of an existing condition. Options for maternal care become vastly different when these women are no longer prioritized due to cultural, financial, and geographical background.
For these reasons, providing communal care is vital in closing the gap between who receives access and who does not. With an increase being seen in the training of birth attendants and midwives, local women are becoming the forefront of change in maternal healthcare accessibility. In rural communities, trust and lived experience are equally as valued as professional training, with many rural women choosing to give birth at home despite potential risks. Communal maternal healthcare not only exposes issues within institutional access, but also serves as a dependable option because of its proximity and cultural familiarity. Overall, addressing remaining gaps in maternal healthcare access requires a comprehensive understanding of how experiences differ among ethnic minority groups in Laos, as well as the recognition that
maternal experiences can be profoundly individual, even within the same community.
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