A mixed-methods evaluation of outreach service provision by the “Strengthening Migrant Access to Reproductive Health in Thailand” Initiative, 2020–2024

Abstract

Introduction – Despite considerable progress, pregnancy-related health outcomes are still below Sustainable Development Goal targets for many low-to-middle-income countries. This study evaluated the Strengthening Migrant Access to Reproductive Health in Thailand (SMARH-T) Initiative that included an outreach service provision (2020–2024) to address upstream determinants of prenatal care and a family planning service provision for undocumented migrant women and newborns along the Thailand–Myanmar border. Methods – This study employed a sequential explanatory mixed-methods design with a quantitative survey followed by qualitative interviews and focus group discussions. Participants were asked about their experiences with the initiative and its delivery of prenatal and family planning services. Implementation outcome frameworks were used to understand the acceptability, end-user satisfaction, appropriateness, feasibility, reach, and sustainability of the initiative. Results – A total of 407 migrant women were surveyed and 17 interviews and discussions with health providers, staff, and stakeholders (n = 98) were conducted. The outreach service provision allowed for comparable convenience (p < 0.001), travel time (<30 min, p < 0.001), and costs (<USD 2.75, p < 0.001) to reach care compared with women receiving services at fixed clinics. A thematic analysis of qualitative data demonstrates the acceptability, appropriateness, and improved reach due to the outreach service provision, despite the logistical and management burden involved. Improved organizational processes for program logistics and administration helped enhance the sustainability of the initiative. Discussion – This mixed-methods evaluation of the SMARH-T Initiative demonstrated high service utilization, satisfaction, and reach for migrant women along the Thailand–Myanmar border. The multipronged approach incorporated reparative strategies to address this particularly vulnerable population in this context.