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Articles by Cambodia

Leaving no one behind
04 December 2018

Leaving no one behind: Universal health coverage and sexual and reproductive health and rights

Universal health coverage means ensuring every person has access to quality, affordable health services and plays a pivotal role in achieving global development targets. Healthy populations can better contribute socially and economically, while poor health is a major driver of poverty. Universal access to sexual and reproductive health care services is identified in the Sustainable Development Goals as an essential contributor to ensuring healthy lives and promoting well-being for all at all ages. IPPF, together with the London School of Hygiene and Tropical Medicine, undertook a literature review looking at progress to date in and challenges to achieving universal access to sexual and reproductive health and rights. The review, Leaving no one behind, is illustrated with case studies on Afghanistan, Cambodia, Kenya and Sudan. Supported by the Japan Trust Fund.

Ny, is pregnant with her first child

“The doctors have also been giving me advice on how to look after myself and the baby"

When garment worker Ny thought she might be pregnant with her first child, a home test kit quickly confirmed her suspicions. But the 23-year-old – who is originally from Takeo province but moved to Phnom Penh to take up a job in the garment industry – did not know where to go to seek prenatal care. After a cousin recommended that she visit a nearby Reproductive Health Association of Cambodia clinic, Ny took her relative’s advice – and has gone back eight times to date. “I come here every month to check on the baby,” she says, cradling her belly. “I had never been before I got pregnant.” During her visits to the medical clinic, Ny says, she has had a raft of standard tests and procedures as part of her prenatal care, including two ultrasounds, blood and urine tests, and vaccinations. “The doctors have also been giving me advice on how to look after myself and the baby [such as] to eat nutritious food and not to carry heavy things,” she says. As well as caring for the health of mother and unborn child, RHAC staff have also offered up valuable family planning information. “I did not know about how to plan to have children before I came to the clinic,” Ny says. “The doctors here told me that there are three different methods of [long-term] contraception: medication, an implant and an IUD.” Ny, who sews winter clothing at a factory while her husband also works in a nearby garment factory, says she was very glad to learn about her options. “This child was unplanned, but I don’t feel any regret because I had already been married for two years. But after having the baby I plan to use birth control, though I don’t know what method I will use,” she says. “I know that I don’t want to have another child straight away. It may be two or three years until I have the next one, as I want to wait until my family’s finances improve.”

Kouch Davy

“When they don’t dare to ask questions about sensitive health topics, they don’t have the information they need"

Female workers, many of them undereducated migrants from rural areas, dominate the garment sector in Cambodia. And Propitious garment factory in Takhmao, a small city that lies just south of the capital Phnom Penh, is no exception. Women make up more than 90 percent of the factory’s workforce. Helping to oversee the 3,700-strong workforce is human resources manager Kouch Davy, who has worked at Propitious since it opened four years ago. Seeing a need to improve the workers’ sexual and reproductive health knowledge, she says she decided to work with the Reproductive Health Association of Cambodia (RHAC) because of its reputation for providing high-quality services. “I raised it in a management meeting, and the board was happy to explore it,” she says. For almost two years, trained staff from RHAC have been visiting the factory twice a month to meet with workers during their lunch break. They answer questions on topics ranging from birth control to STIs and abortion. The organisation has also provided training to the nurses who work in the factory’s on-site medical clinic. Davy says the factory’s female garment workers have changed as a result. “They are more open to asking questions about sexual health and they have also become more informed about the subject,” she says. “When they don’t dare to ask questions about sensitive health topics, they don’t have the information they need, so they tend to exaggerate their problems and ask for sick leave. But when they go to see an RHAC clinic and get proper treatment, there is less sick leave. “Now that they understand about contraception, there are fewer women getting pregnant and taking maternity leave, so that also helps with the workflow. ” Davy says the factory has seen requests for sick leave drop by an average of between 100 to 200 cases a month – and any decrease in absenteeism is a major boon for productivity. “The factory works like a chain: if just one person on the production line takes a day off, it affects the overall productivity,” she says. “And if a worker comes to work sick, they have problems concentrating.” Even Davy says she has gone to RHAC to seek medical care, visiting one of their clinics a few months ago for a breast examination. Meanwhile, the company that owns Propitious has extended its partnership with RHAC to a second factory in Phnom Penh. The firm has even requested that the NGO starts visiting its largest factory, which is situated in a rural province and has 10,000 workers, in the future.

Sophorn

"During the pregnancy I was very worried”

Sophorn, a garment worker for the past decade, first visited a Reproductive Health Association of Cambodia (RHAC) clinic when she was pregnant with her first child. She returned for health checks each month until, at five months pregnant, she lost the baby. Her second pregnancy also resulted in a miscarriage, leaving her distraught. Then, she got pregnant a third time, in 2013. “I started to discuss with the doctors how to protect my child,” she says. “They gave me medication to strengthen my cervix, which I took for six months. In the seventh month, I gave birth prematurely.” Doctors told Sophorn that her baby girl was health, but she only weighed in at 1.7 kilograms. The infant was taken to a specialist children’s hospital, where she was cared for an additional two weeks. “During the pregnancy I was very worried,” Sophorn says. “I felt so happy when I finally delivered my child.” Her daughter was born without any complications is now a happy and healthy four years old. In initial stages of her third pregnancy, Sophorn’s friends told her that she would have to undergo surgery on her cervix or have injections to help her carry her baby to term, and doctors at a private clinic confirmed their suggestions. However, she decided to seek a second opinion at RHAC, where doctors instead gave her a prescription to strengthen her cervix. “When I heard I needed to have that surgery I was very scared, so I was relieved when the doctor at RHAC told me to take the medication instead,” she says. “While I was taking the medication I observed my body and any changes to it, so when I felt unwell I would go to the doctors and consult them, so I felt comfortable to continue taking it.” Sophorn also went for appointments at a government-run hospital, but found that their services were also lacking. “I told the doctors about losing my first and second babies, but they only weighed me and measured my stomach. There weren’t any more examinations or very much care,” she says. “When I went to RHAC they did so many examinations and had so many services, so I think it’s really better to go to RHAC for these kinds of services.” She estimates that during her third pregnancy, she had ten appointments at RHAC clinics at a cost of 40,000 to 60,000 riel (£7.40 to £11.15) each time. Compared to just 2,000 riel for an obstetrics appointment at the public hospital, the difference in cost is significant. “It’s expensive for me because my salary is little.” Despite the relatively high prices, Sophorn already knows where she will go for medical care in the future. “I want to have one more child, and I have already planned that when I decide to do it I will go to RHAC to get my cervix checked first,” she says. Until that day comes, Sophorn is taking the oral contraceptive after receiving advice about birth control from RHAC’s clinicians, with a midwife from the NGO making regular visits to the factory.

Pann Chandy

“Just yesterday during the outreach service, a woman asked me why she didn’t get her period after having an abortion..."

Pann Chandy gave her first sexual education lesson when she was still at school as a volunteer youth social worker with the Reproductive Health Association of Cambodia (RHAC). She had no qualms about standing up in front of her classmates to discuss culturally taboo topics when she was just a teenager. Now aged 25 and in possession of a Bachelor degree in midwifery, Chandy has been employed by RHAC for less than a year, working as part of the organisation’s health outreach team. The job is demanding: she is tasked with regularly visiting four karaoke parlours, eight garment factories and 20 villages in Phnom Penh, with plans to expand to two universities imminently. Travelling for hours A round trip to some communities can take two hours or more on her motorcycle, travelling alone into areas that are not always easily accessible. “Sometimes I have the clinic staff with me, but rarely,” Chandy says. “I promote the health services provided by Reproductive Health Association of Cambodia as well. If they are interested in going to a clinic, I give them a referral,” she says. One of the factories on her regular roster is Propitious garment factory in Takhmao, a small city south of Phnom Penh. Chandy spends two days a month at the factory, where she speaks to groups of women or has one-on-one discussions about sensitive topics. Passionate about the job “Just yesterday during the outreach service, a woman asked me why she didn’t get her period after having an abortion. She wanted to know what was wrong,” she says. “It’s common for women to use unsafe abortion methods. Mainly they take medicine from a pharmacy, and the pharmacy doesn’t give them any advice on how to use it. Often they go to cheap, unlicensed clinics near the factories for medical abortions.” Chandy is passionate about her job at Reproductive Health Association of Cambodia, and dreams about one day setting up her own pharmacy where she could provide comprehensive advice to clients. “There are a lot of unlicensed pharmacists in this country,” she says, many of which prescribe the counterfeit medicines that have inundated the market. “I think I may have the capacity to become a licensed one."

Sineang

“I was very happy when my daughter was born”

After three years of marriage, Cambodian garment worker Sineang had started to wonder why she hadn’t yet become pregnant. Still in her early 20s, she and her husband wanted to have a baby and were not using contraception. In late 2011 or early 2012, Sineang visited a Reproductive Health Association of Cambodia clinic to seek treatment after she noticed some vaginal discharge. During the appointment, her doctor asked her more details about her sexual and reproductive health history: the issue of infertility soon came up. “I had been wanting to have a child for three years, since I was married,” she says. “I felt down about myself, but my husband gave me encouragement and told me it was okay that I was not pregnant yet.” During the initial examination, Sineang says, she was tested for cervical cancer as well as other reproductive health issues that can interfere with pregnancy. RHAC staff prescribed medication to treat her fertility problems, which she continued taking until they confirmed she was pregnant. “At first, I wasn’t really convinced that there was any relation between the discharge and not having a baby, but later I started to think that there was a connection,” she says. Throughout the whole period, Sineang went to RHAC each month – switching from infertility treatment to prenatal care – until she gave birth to a baby girl in 2013. “I was very happy when my daughter was born,” she says. “She’s healthy.” At the time, RHAC offered a discount to garment workers, which Sineang says was a big help. It’s no longer on offer, but she is an enthusiastic supporter of a plan RHAC is hoping to implement soon – a partnership with the National Social Security Fund that would allow them to visit RHAC clinics for free through the fund. “It would be really great if they could, because having a baby is expensive,” she says. “The clinic at RHAC has better service than the public hospitals. When I had my first baby, I wanted to have good service, because I had this problem with discharge [in the past].” Sineang, who is originally from Kandal province and works at Dewhirst garment factory in Phnom Penh, said she was pleased to see RHAC midwives doing regular outreach sessions at the factory. “It’s good for women to know more about these issues,” she says. And not only that, but Sineang is also an active ambassador for RHAC, spreading the word about the NGO’s services to friends and colleagues who have also struggled to have a baby. “I referred a friend to RHAC after she saw that I finally got pregnant. Now my friend, who didn’t have a baby, has two children,” she says. “I also referred another colleague who is having the same problem, and she is going to go on Sunday.”

カンボジアの衣料品工場で働く女性たち
16 November 2017

Bringing sexual and reproductive healthcare to garment factory workers in Cambodia

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.   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.

衣料品工場「デワースト」の建物の外にいるバン・サーヴェンさん(23)
08 November 2017

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

Reproductive Health Association of Cambodia (RHAC)

Established in 1996, Reproductive Health Association of Cambodia (RHAC) is a non-profit organization, and an accredited member of IPPF.

Our vision:
RHAC is a centre of excellence for women and sexual and reproductive health.

Our mission:
RHAC aspires to consistent high standards of quality, cost-effectiveness, and client satisfaction. We seek to provide our employees with every opportunity to advance their expertise; we will improve the health of the communities we serve, by delivering, with sensitivity to individual needs, reproductive health information and services to a wide range of our clients.

RHAC is one of the largest and well-respected NGOs in health sector and we continue to play the leading role in the areas of sexual and reproductive health. Currently, we continue to expand its coverage to 19 out of 25 provinces in Cambodia. RHAC has had and will continue its focus on SRHR, including:

  • research and advocacy for SRHR
  • comprehensive sexual and gender based violence (SGBV) services;
  • collaboration with the ministry of education youth and sports in the areas of sexuality education for in-school students;
  • advocacy through building core activist groups of youth, women groups, and transgender people;
  • partnership with local civil society organizations;
  • demand generation activities to reach factory workers, university students, and selected villages.
  • utilization of digital health interventions to promote access to health information and services, including self-care practices.

We have been collaborating with a number of associated networks including clinics and government health facilities to enable services, in addition to direct service provision through its mobile outreach teams. In 2020, RHAC had partnership with 15 associated clinics in eight provinces, and 64 government health facilities in four provinces; and it managed 10 mobile outreach teams in 10 provinces.

We devote our effort to increasing access to SRH information and services among target populations, especially the vulnerable groups. It focuses on integrated package of essential services. From 2018-2020, RHAC provide an average of 3,240,000 services per year.

Leaving no one behind
04 December 2018

Leaving no one behind: Universal health coverage and sexual and reproductive health and rights

Universal health coverage means ensuring every person has access to quality, affordable health services and plays a pivotal role in achieving global development targets. Healthy populations can better contribute socially and economically, while poor health is a major driver of poverty. Universal access to sexual and reproductive health care services is identified in the Sustainable Development Goals as an essential contributor to ensuring healthy lives and promoting well-being for all at all ages. IPPF, together with the London School of Hygiene and Tropical Medicine, undertook a literature review looking at progress to date in and challenges to achieving universal access to sexual and reproductive health and rights. The review, Leaving no one behind, is illustrated with case studies on Afghanistan, Cambodia, Kenya and Sudan. Supported by the Japan Trust Fund.

Ny, is pregnant with her first child

“The doctors have also been giving me advice on how to look after myself and the baby"

When garment worker Ny thought she might be pregnant with her first child, a home test kit quickly confirmed her suspicions. But the 23-year-old – who is originally from Takeo province but moved to Phnom Penh to take up a job in the garment industry – did not know where to go to seek prenatal care. After a cousin recommended that she visit a nearby Reproductive Health Association of Cambodia clinic, Ny took her relative’s advice – and has gone back eight times to date. “I come here every month to check on the baby,” she says, cradling her belly. “I had never been before I got pregnant.” During her visits to the medical clinic, Ny says, she has had a raft of standard tests and procedures as part of her prenatal care, including two ultrasounds, blood and urine tests, and vaccinations. “The doctors have also been giving me advice on how to look after myself and the baby [such as] to eat nutritious food and not to carry heavy things,” she says. As well as caring for the health of mother and unborn child, RHAC staff have also offered up valuable family planning information. “I did not know about how to plan to have children before I came to the clinic,” Ny says. “The doctors here told me that there are three different methods of [long-term] contraception: medication, an implant and an IUD.” Ny, who sews winter clothing at a factory while her husband also works in a nearby garment factory, says she was very glad to learn about her options. “This child was unplanned, but I don’t feel any regret because I had already been married for two years. But after having the baby I plan to use birth control, though I don’t know what method I will use,” she says. “I know that I don’t want to have another child straight away. It may be two or three years until I have the next one, as I want to wait until my family’s finances improve.”

Kouch Davy

“When they don’t dare to ask questions about sensitive health topics, they don’t have the information they need"

Female workers, many of them undereducated migrants from rural areas, dominate the garment sector in Cambodia. And Propitious garment factory in Takhmao, a small city that lies just south of the capital Phnom Penh, is no exception. Women make up more than 90 percent of the factory’s workforce. Helping to oversee the 3,700-strong workforce is human resources manager Kouch Davy, who has worked at Propitious since it opened four years ago. Seeing a need to improve the workers’ sexual and reproductive health knowledge, she says she decided to work with the Reproductive Health Association of Cambodia (RHAC) because of its reputation for providing high-quality services. “I raised it in a management meeting, and the board was happy to explore it,” she says. For almost two years, trained staff from RHAC have been visiting the factory twice a month to meet with workers during their lunch break. They answer questions on topics ranging from birth control to STIs and abortion. The organisation has also provided training to the nurses who work in the factory’s on-site medical clinic. Davy says the factory’s female garment workers have changed as a result. “They are more open to asking questions about sexual health and they have also become more informed about the subject,” she says. “When they don’t dare to ask questions about sensitive health topics, they don’t have the information they need, so they tend to exaggerate their problems and ask for sick leave. But when they go to see an RHAC clinic and get proper treatment, there is less sick leave. “Now that they understand about contraception, there are fewer women getting pregnant and taking maternity leave, so that also helps with the workflow. ” Davy says the factory has seen requests for sick leave drop by an average of between 100 to 200 cases a month – and any decrease in absenteeism is a major boon for productivity. “The factory works like a chain: if just one person on the production line takes a day off, it affects the overall productivity,” she says. “And if a worker comes to work sick, they have problems concentrating.” Even Davy says she has gone to RHAC to seek medical care, visiting one of their clinics a few months ago for a breast examination. Meanwhile, the company that owns Propitious has extended its partnership with RHAC to a second factory in Phnom Penh. The firm has even requested that the NGO starts visiting its largest factory, which is situated in a rural province and has 10,000 workers, in the future.

Sophorn

"During the pregnancy I was very worried”

Sophorn, a garment worker for the past decade, first visited a Reproductive Health Association of Cambodia (RHAC) clinic when she was pregnant with her first child. She returned for health checks each month until, at five months pregnant, she lost the baby. Her second pregnancy also resulted in a miscarriage, leaving her distraught. Then, she got pregnant a third time, in 2013. “I started to discuss with the doctors how to protect my child,” she says. “They gave me medication to strengthen my cervix, which I took for six months. In the seventh month, I gave birth prematurely.” Doctors told Sophorn that her baby girl was health, but she only weighed in at 1.7 kilograms. The infant was taken to a specialist children’s hospital, where she was cared for an additional two weeks. “During the pregnancy I was very worried,” Sophorn says. “I felt so happy when I finally delivered my child.” Her daughter was born without any complications is now a happy and healthy four years old. In initial stages of her third pregnancy, Sophorn’s friends told her that she would have to undergo surgery on her cervix or have injections to help her carry her baby to term, and doctors at a private clinic confirmed their suggestions. However, she decided to seek a second opinion at RHAC, where doctors instead gave her a prescription to strengthen her cervix. “When I heard I needed to have that surgery I was very scared, so I was relieved when the doctor at RHAC told me to take the medication instead,” she says. “While I was taking the medication I observed my body and any changes to it, so when I felt unwell I would go to the doctors and consult them, so I felt comfortable to continue taking it.” Sophorn also went for appointments at a government-run hospital, but found that their services were also lacking. “I told the doctors about losing my first and second babies, but they only weighed me and measured my stomach. There weren’t any more examinations or very much care,” she says. “When I went to RHAC they did so many examinations and had so many services, so I think it’s really better to go to RHAC for these kinds of services.” She estimates that during her third pregnancy, she had ten appointments at RHAC clinics at a cost of 40,000 to 60,000 riel (£7.40 to £11.15) each time. Compared to just 2,000 riel for an obstetrics appointment at the public hospital, the difference in cost is significant. “It’s expensive for me because my salary is little.” Despite the relatively high prices, Sophorn already knows where she will go for medical care in the future. “I want to have one more child, and I have already planned that when I decide to do it I will go to RHAC to get my cervix checked first,” she says. Until that day comes, Sophorn is taking the oral contraceptive after receiving advice about birth control from RHAC’s clinicians, with a midwife from the NGO making regular visits to the factory.

Pann Chandy

“Just yesterday during the outreach service, a woman asked me why she didn’t get her period after having an abortion..."

Pann Chandy gave her first sexual education lesson when she was still at school as a volunteer youth social worker with the Reproductive Health Association of Cambodia (RHAC). She had no qualms about standing up in front of her classmates to discuss culturally taboo topics when she was just a teenager. Now aged 25 and in possession of a Bachelor degree in midwifery, Chandy has been employed by RHAC for less than a year, working as part of the organisation’s health outreach team. The job is demanding: she is tasked with regularly visiting four karaoke parlours, eight garment factories and 20 villages in Phnom Penh, with plans to expand to two universities imminently. Travelling for hours A round trip to some communities can take two hours or more on her motorcycle, travelling alone into areas that are not always easily accessible. “Sometimes I have the clinic staff with me, but rarely,” Chandy says. “I promote the health services provided by Reproductive Health Association of Cambodia as well. If they are interested in going to a clinic, I give them a referral,” she says. One of the factories on her regular roster is Propitious garment factory in Takhmao, a small city south of Phnom Penh. Chandy spends two days a month at the factory, where she speaks to groups of women or has one-on-one discussions about sensitive topics. Passionate about the job “Just yesterday during the outreach service, a woman asked me why she didn’t get her period after having an abortion. She wanted to know what was wrong,” she says. “It’s common for women to use unsafe abortion methods. Mainly they take medicine from a pharmacy, and the pharmacy doesn’t give them any advice on how to use it. Often they go to cheap, unlicensed clinics near the factories for medical abortions.” Chandy is passionate about her job at Reproductive Health Association of Cambodia, and dreams about one day setting up her own pharmacy where she could provide comprehensive advice to clients. “There are a lot of unlicensed pharmacists in this country,” she says, many of which prescribe the counterfeit medicines that have inundated the market. “I think I may have the capacity to become a licensed one."

Sineang

“I was very happy when my daughter was born”

After three years of marriage, Cambodian garment worker Sineang had started to wonder why she hadn’t yet become pregnant. Still in her early 20s, she and her husband wanted to have a baby and were not using contraception. In late 2011 or early 2012, Sineang visited a Reproductive Health Association of Cambodia clinic to seek treatment after she noticed some vaginal discharge. During the appointment, her doctor asked her more details about her sexual and reproductive health history: the issue of infertility soon came up. “I had been wanting to have a child for three years, since I was married,” she says. “I felt down about myself, but my husband gave me encouragement and told me it was okay that I was not pregnant yet.” During the initial examination, Sineang says, she was tested for cervical cancer as well as other reproductive health issues that can interfere with pregnancy. RHAC staff prescribed medication to treat her fertility problems, which she continued taking until they confirmed she was pregnant. “At first, I wasn’t really convinced that there was any relation between the discharge and not having a baby, but later I started to think that there was a connection,” she says. Throughout the whole period, Sineang went to RHAC each month – switching from infertility treatment to prenatal care – until she gave birth to a baby girl in 2013. “I was very happy when my daughter was born,” she says. “She’s healthy.” At the time, RHAC offered a discount to garment workers, which Sineang says was a big help. It’s no longer on offer, but she is an enthusiastic supporter of a plan RHAC is hoping to implement soon – a partnership with the National Social Security Fund that would allow them to visit RHAC clinics for free through the fund. “It would be really great if they could, because having a baby is expensive,” she says. “The clinic at RHAC has better service than the public hospitals. When I had my first baby, I wanted to have good service, because I had this problem with discharge [in the past].” Sineang, who is originally from Kandal province and works at Dewhirst garment factory in Phnom Penh, said she was pleased to see RHAC midwives doing regular outreach sessions at the factory. “It’s good for women to know more about these issues,” she says. And not only that, but Sineang is also an active ambassador for RHAC, spreading the word about the NGO’s services to friends and colleagues who have also struggled to have a baby. “I referred a friend to RHAC after she saw that I finally got pregnant. Now my friend, who didn’t have a baby, has two children,” she says. “I also referred another colleague who is having the same problem, and she is going to go on Sunday.”

カンボジアの衣料品工場で働く女性たち
16 November 2017

Bringing sexual and reproductive healthcare to garment factory workers in Cambodia

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.   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.

衣料品工場「デワースト」の建物の外にいるバン・サーヴェンさん(23)
08 November 2017

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

Reproductive Health Association of Cambodia (RHAC)

Established in 1996, Reproductive Health Association of Cambodia (RHAC) is a non-profit organization, and an accredited member of IPPF.

Our vision:
RHAC is a centre of excellence for women and sexual and reproductive health.

Our mission:
RHAC aspires to consistent high standards of quality, cost-effectiveness, and client satisfaction. We seek to provide our employees with every opportunity to advance their expertise; we will improve the health of the communities we serve, by delivering, with sensitivity to individual needs, reproductive health information and services to a wide range of our clients.

RHAC is one of the largest and well-respected NGOs in health sector and we continue to play the leading role in the areas of sexual and reproductive health. Currently, we continue to expand its coverage to 19 out of 25 provinces in Cambodia. RHAC has had and will continue its focus on SRHR, including:

  • research and advocacy for SRHR
  • comprehensive sexual and gender based violence (SGBV) services;
  • collaboration with the ministry of education youth and sports in the areas of sexuality education for in-school students;
  • advocacy through building core activist groups of youth, women groups, and transgender people;
  • partnership with local civil society organizations;
  • demand generation activities to reach factory workers, university students, and selected villages.
  • utilization of digital health interventions to promote access to health information and services, including self-care practices.

We have been collaborating with a number of associated networks including clinics and government health facilities to enable services, in addition to direct service provision through its mobile outreach teams. In 2020, RHAC had partnership with 15 associated clinics in eight provinces, and 64 government health facilities in four provinces; and it managed 10 mobile outreach teams in 10 provinces.

We devote our effort to increasing access to SRH information and services among target populations, especially the vulnerable groups. It focuses on integrated package of essential services. From 2018-2020, RHAC provide an average of 3,240,000 services per year.