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カンボジアの衣料品工場で働く女性たち

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Bringing sexual and reproductive healthcare to garment factory workers in Cambodia

The garment manufacturing industry in Cambodia employs roughly 700,000 people, the majority of which are women.

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It’s lunchtime at Propitious garment factory in Takhmao, and thousands of workers in neon headscarves are gathered around as Khmer pop music rings out across the expansive canteen.As the song dies down, they melt into the crowd and Dr. Veth Sreng takes to the stage, which is adorned with banners promoting the Reproductive Health Association of Cambodia (RHAC).

“Do you know how HIV gets transmitted? Who can get infected?” the community health specialist calls out, undaunted by the sea of women staring back at him. This concert, peppered with such health-related questions (and answers), is typical of the inventive ways RHAC is working with some of Cambodia’s most vulnerable women to improve their sexual and reproductive health outcomes.

About 700,000 people work in Cambodia’s garment factories, many of them migrant women from rural areas who typically possess low levels of education. According to Dr. Sreng, not only do these women often lack crucial health knowledge, but they tend not to trust health providers or know where to access medical care. Meanwhile, “there are private clinics and pharmacies that factory workers sometimes access, but they unpredictably vary in quality and cost,” he says.

 

Health with pop: Talking sex education with Cambodia’s female garment workers

About 700,000 people work in Cambodia’s garment factories, many of them migrant women from rural areas who typically possess low levels of education. According to Dr. Sreng, not only do these women often lack crucial health knowledge, but they tend not to trust health providers or know where to access medical care. 

RHAC, which first took its health outreach programme into garment factories in 1998, now operates in 82 factories that employ a combined total of 130,429 workers. Nearly 28,000 of them have taken part in RHAC-led group discussions and more than 67,000 have attended targeted health days like the one at Propitious.

Photography © IPPF/Omar Havana
Clinic Supervisor Dr. Roeun Neardey has been working at RHAC for five years. For her, family planning is an essential part of her passion for her job.
RHAC midwife Nuth Sopheak checks 28 year-old Choeun's blood pressure during a first-time medical check-up at the RHAC clinic. Recommend by her hairdresser, Choeun is very impressed with the care and cleanliness of the RHAC clinic.
23-year-old Ny garment worker is 8 months pregnant with her first child. She has been receiving monthly care at the RHAC clinic throughout her pregnancy. She didn't know anything about family planning until RHAC staff discussed it with her, and she plans to use birth control after she gives birth.
29-year-old Borin receives a Hepatitis B vaccination during a check-up at the RHAC clinic. While most of the patients attending RHAC clinics are women, there has been an increase in the number of young men seeking treatment and consultation.
RHAC midwife team leader Chan Vanna has been working for RHAC for 24 years and is passionate about helping young women. Many of Vanna's clients are female garment workers who have migrated from the countryside in search of work.
Garment worker Doung Sreynith, 22, after her check-up with midwife, Chan Vanna. She is two months pregnant. Sreynith is attending the RHAC clinic for the first time after her sister recommended the clinic. She had heard positive things about RHAC doctors paying more attention to their patients than in other clinics. Sreynith did not know anything about reproductive health before but feels confident to share her opinions with friends and family.
A group of garment workers work on the production line inside the Propitious garment factory in Krong Ta Khmau city. The factory employs more than 3,500 workers and specializes in children's clothes, but also produces a variety of men and women's clothes. The factory has seen a rise in productivity and a reduction in staff taking sick days since RHACs' health outreach programme has been introduced.
Garment workers sit inside the Propitious Cambodia garment factory during their lunch break in Krong Ta Khmau city.
Chenda, 29, first attended one of the RHAC clinics held at the Propitious garment factory in 2014 after her baby was born. Since then, she has been taking birth control measures as advised by doctors at the clinic and she feels very happy with the care.
RHAC’s work is having an impact. According to a survey of garment workers it carried earlier this year, 36% had visited a RHAC clinic before.
Garment worker Sek Sophorn, 34, shares a photo of her with her 4-year-old daughter Kanika during a break.
25-year-old RHAC midwife, Chandy, gives information leaflets to a group of garment workers on their lunch break during a health event held in the Propitious garment factory. Many of the women would have left school at an early age and little or no knowledge of reproductive health.
Chandy has been working as a midwife for RHAC for five months but she previously worked as a volunteer for them while studying in high school. Chandy would like to be a gynaecologist.
"The understanding of contraception methods since we started to work with RHAC has made workers understand how not to have many babies because it leads to a poorer quality of life. There has been a reduction of approximately 20% in sick days which has led the factory to increase significantly the productivity over the last years," says Propitious Human Resources Manager, Kouch Davy.
Employees gather to enjoy a music concert during a health day event organized by RHAC at the Propitious garment factory.
39-year-old garment worker Theary receives a consultation at the Propitious garment factory. RHAC provides training to some of the nurses working in the factories as part of their programmes, so that garment workers can seek advice during working days about reproductive health issues.
Human resources manager Vong Ratha at the Dewhirst Garment Factory library. Ratha has been working for Dewhirst for four years. He says that access to reproductive health care has had a positive impact on the workers at the factory; they have seen a considerable reduction in workers' absenteeism, which then has had a positive impact on the factory's production line.
RHAC hotline counsellor, Ing Samnang, speaks to a garment worker during her lunch break inside the canteen of the Dewhirst Garment Factory.
Ing Samnang's is constantly juggling mobile phones. "I take 30 calls a day on average," she says. Samnang is RHAC's only hotline counsellor. "I feel good when I help people solve their problems."
28 year old Ry Sineang works in the trousers production line ward at the Dewhirst Garment Factory on the outskirts of Phnom Penh. Sineang originally attended the RHAC clinic after suffering from a Reproductive Tract Infection (RTI). Since then, she has been seeking fertility treatment; after two years of trying to conceive. Following a month of treatment, she finally became pregnant. She is happy to recommend RHAC services to friends and colleagues.
Savoeurt, 27, works in the jackets and waistcoats production line at the Dewhirst Garment Factory. Savoeurt has been receiving treatment from RHAC since July. She had been having problems since giving birth three years ago, but she feels that since receiving treatment from RHAC, her health has improved significantly.
RHAC demand generation officer, Sophal Im, speaks to a group of garment workers during a group discussion. Im has been working for RHAC for the last year and received four training sessions; she now feels very confident about speaking to other women about reproductive health.
23 year-old Srey Pov received advice from a RHAC midwife about contraception options after she had been experiencing problems with IUD fitted in by another health provider.
Chanmey Noerun, is an office administrator at the Dewhirst Garment Factory. Noerun is 8 months pregnant. After hearing about RHAC services from RHAC's outreach staff, she has been attending RHAC clinics for pregnancy health checks for the past five months.
RHAC staff and a group of garment workers outside the recreation room of the Dewhirst Garment Factory following a group discussion. RHAC organizes participatory events with garment workers, which are very popular.
RHAC organizes health events where famous actors and singers are invited to offer entertainment while RHAC staff provides health messages and run sexual reproductive health games.
The Dewhirst Garment Factory employs 2,800 workers; 85% are women. Dewhirst has been working with RHAC for the last two years. They have seen a positive impact on a reduction in absenteeism among employees as a result of providing access to quality health care. 75% of the factory production is by Marks & Spencer, a company that organizes health programmes for workers four times a year in the factory.
Garment workers exit one of the production line wards at the end of their shift at the Dewhirst Garment Factory.
Pregnant garment workers head home after finishing their shift at the Dewhirst Garment Factory. Pregnant employees are not required to wear their uniform during their working shift and are allowed to finish their shift several minutes ahead of the rest of the workers.

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Cambodia

Related Member Association

Reproductive Health Association of Cambodia, which first took its health outreach programme into garment factories in 1998, now operates in 82 factories that employ a combined total of 130,429 workers. Nearly 28,000 of them have taken part in RHAC-led group discussions and more than 67,000 have attended targeted health days like the one at Propitious.

The clinics work is having an impact. According to a survey of garment workers it carried earlier this year, 36% had visited a Reproductive Health Association of Cambodia (RHAC) clinic before. Factory workers who attended health days were twice as likely to turn to RHAC for their sexual and reproductive health needs. A further 16% of workers said they had sought an abortion in the past, with RHAC the most well-known place to access safe abortions – an encouraging finding given that female garment workers are known to be at risk of unsafe abortions.

Despite these positive results, Dr Sreng said it was often difficult to convince factories to work with RHAC, even after explaining the benefits of free health education for their staff. “They are often afraid that letting NGOs or unions into the factories will create problems such as mobilising and inspiring the workers to advocate for better conditions,” he says. “When they do agree, we can only operate during their lunch time so that we do not disturb their working hours: health services are not usually a priority for them.”

Nonetheless, the bottom line often proves convincing: factories such as Propitious report that allowing RHAC to provide health outreach to workers has helped to reduce absenteeism. As a result, the production chain is broken less often and productivity improves.“Sometimes, after a while, they hear from other nearby factories about the work RHAC does, and then they ask RHAC to come back,” Dr. Sreng says.

RHAC is looking at ways to better reach garment workers who struggle to afford private health services, according to executive director Dr. Var Chivorn. While the NGO’s pricing is on a par with or cheaper than other private clinics or hospitals, government-run hospitals tend to be much cheaper – although the standard of care is usually low. “To improve access to the services among factory workers, RHAC is now working with the National Social Security Fund so that the NSSF will purchase services for the workers,” Dr. Chivorn says.

If the deal goes ahead, all workers under the scheme – which is compulsory in the garment sector – would have full access to RHAC’s clinic healthcare.

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country

Cambodia

Related Member Association