Understanding the Karen Community: History, Displacement, and Sexual & Reproductive Health Context
The Karen are one of the oldest ethnic groups in the region now known as Burma, with a history that spans more than 3,000 years. Burma is home to over 135 ethnic groups and languages and has a population of more than 53 million people. Eight major ethnic groups are officially recognized: Bamar (Burman), Karen, Shan, Chin, Kachin, Mon, Rakhine, and Karen. The Karen are a distinct people with their own languages, cultures, and governance traditions.
In 1989, the military dictatorship changed the country’s name from Burma to Myanmar. However, many ethnic groups, including the Karen, continue to refer to the country as Burma. The Karen and other ethnic minorities who sided with the British during colonial rule felt betrayed at the end of World War II, as they had been promised sovereignty over their own lands. Instead, political power was transferred to the Burmese majority, leaving ethnic groups marginalized and vulnerable.
In 1962, the Burmese military seized power in a coup and began efforts to eliminate Karen resistance. In 1988, a nationwide pro-democracy uprising occurred, and many Karen villages were declared “free-fire zones.” In the 2020s, the civilian government won elections, but in 2021, the military carried out another coup, leading to another nationwide uprising and the use of airstrikes against civilians.
As a result of decades of violence many Karen people were forced to flee their villages due to the burning of homes, landmines, forced relocations, labor exploitation, the use of children as landmine sweepers and child soldiers, physical abuse, rape, and being used as human shields. Karen and other refugees often had to walk for weeks to reach refugee camps. Today, there are approximately eight long-standing refugee camps along the Thailand–Burma border.
Life in the camps is extremely difficult, with limited resources and few opportunities for work or education. Space is cramped, and independence is restricted. In 2004, the UNHCR began resettling Karen refugees to third countries, including the USA, Australia, Canada, the UK, the Netherlands, Norway, Sweden, Finland, Denmark, New Zealand, South Korea, and Japan.
Sexual and Reproductive Health
Many Karen community members had little or no access to formal education due to decades of conflict and displacement. As a result, literacy levels vary widely, which can make learning and navigating health systems challenging.
Sexual and reproductive health is one of the least discussed health topics within the Karen community. Because these conversations are often avoided, many Karen people lack basic knowledge about the anatomy and physiology of the reproductive system. Many Karen women have never been taught what their internal reproductive organs look like or how they function, and some are unfamiliar with how pregnancy occurs. Similarly, many men have limited understanding of their own reproductive health.
Reproductive responsibility is often placed almost entirely on women, with men traditionally viewed as having a limited role beyond conception. Access to quality maternal and reproductive healthcare was severely limited in both Burma and the refugee camps in Thailand. Many women did not receive consistent prenatal care, skilled birth attendance, or accurate health education.
Understanding this history and context is essential for delivering effective, trauma-informed, and culturally responsive care. Many Karen patients may be navigating healthcare systems for the first time, carrying the impact of displacement, trauma, and limited health education. Providers who approach care with patience, clear explanations, and respect for lived experience can help rebuild trust and improve health outcomes for Karen individuals and families.
Written by:
Hsa Hser, Community Health Worker