Stories

Lisiane Messine is a CIFWA youth volunteer and formally the CIFWA Youth Representative for the East South East Asia and Oceania (ESEAOR) region of IPPF. She is also the Senior Probation Officer for the Cook Islands Government. Originally from the outer island of Aitutaki, she moved to New Zealand to complete her undergraduate studies. On return to Cook Islands, she became a CIFWA Youth Volunteer, and went on to become the first Cook Islands youth representative to gain a position on the ESEAOR Youth Executive Committee.  For International Volunteer Day, we are sharing part of Lisiane's story, in her own words. “I was born in Rarotonga (the main island of the Cook Islands) but raised in Aitutaki (a small outer island). I was raised by my auntie and uncle. I was given to them after they lost two of their children, one was an infant when it died, and one was a miscarriage due to my aunt’s job harvesting in the plantation the chemicals she was exposed to doing that. My biological mother was only 17 years old when she had me, so they decided that my auntie would raise me, and I am grateful and blessed she made that decision. I feel blessed to have two sets of parents. It’s quite normal in the Pacific for this practice to happen. We call them our ‘feeding family’.   Neither of my parents made it to university, they are both self-employed and sell vegetables for a living. My dad funded my university (Bachelor in Applied Social Worker) in New Zealand himself, all from selling vegetables. I’m just grateful. Living in NZ opened my eyes to talking openly about abuse in the family, sexual and reproductive health, relationships. My views changed.   I ran my first workshop for CIFWA at 15 years old. They had come to Aitutaki to run a Comprehensive Sexuality Education (CSE) workshop and I thought ‘Oh my gosh all these things I am not allowed to talk about with my parents’ so as soon as I moved to Rarotonga, I visited CIFWA to see how I could get involved. Now I am seeing the young ones I have seen growing up since they were in nappies having a different experience to me.   I have friends who experienced things that I didn’t know how to deal with, so I thought if I were to learn how to help, I can help my younger friends, family and children not deal with these things and be safer. I was always the ‘go-to’ person for my friends to talk about things so I wanted to learn how to approach it with them.   In 2018, after I became the Youth Rep for CIFWA, we travelled to Malaysia with the other youth reps from around the Pacific, some of whom had never travelled that far before. I took on the role of unofficial ‘mama’ for the group and taking care of the group. It was my first time travelling that far too, but my English was better, so I wanted to take on the responsibility to make sure they were okay. I miss all the other Youth Reps!   During this trip in 2018, we held an election, where nine of the youth reps were elected to the ESEAOR Youth Executive Committee, and I was elected. I felt privileged because I was new, just a girl from Cook Islands, and it made me feel good. I had doubts because I come from a small nation and doubted my experience in SRH and being a youth rep. But after talking to my fellow Pacific Island youth reps, I thought this is a perfect opportunity to put the Pacific on the map in IPPF. The top two positions were both awarded to Pacific Youth Representatives, and I was voted in as Deputy Chairman for the period of three years.   I admired the other youth reps from SE Asia so much, they were so vocal and outspoken. Over my three years in this position, we recommended that those of us that age over 25 should become mentors to the younger youth reps who come in. Our next trip was to the IPPF General Assembly in India, and I remember thinking ‘this is big, this is really big. There must be something that people recognise in me that I don’t even see in myself.’   That experience built my confidence and leadership skills so much’.  

It’s a scene like many others around the world: a loving family pour over childhood photos, giggling and reminiscing about the memories. This particular scene takes place amongst the swaying palm trees and soft breeze rolling over the island of Rarotonga in the Cook Islands, and the child they are cooing over – then named Nathanial – is now a beautiful transgender woman, Natalia.   Born in New Zealand to Cook Islanders parents, 36-year-old Natalia (Talia) Lajpold, says she has always known she was female. Talia grew up in Australia and began her transitioning process at the age of 15. In the last year of her schooling, Talia decided to wear the girl’s uniform to school but was met with disapproval from the school authorities.   “A lot of people think [being transgender] is a choice but if I had a choice, I would choose for things to be normal, the way I was born. Because it’s really hard. High school was hard,” Talia recalls.

The Cook Islands has removed a law that criminalizes homosexuality, in a huge victory for the local LGBTI+ community.  Our local Member Association, the Cook Islands Family Welfare Association (CIFWA), has been integral to the advocacy around this law reform, which has faced many hurdles since the movement kicked off in 2017. Staff and volunteers at CIFWA have worked in step with Pride Cook Islands and the Te Tiare Association (TTA), two of the biggest LGBTI+ advocacy organizations in the country, to end discrimination and promote human rights. Meet some of the inspiring people behind this historic movement.

On the island of Rarotonga, the main island of the Cook Islands in the South Pacific, a little white van makes its rounds on the palm-tree lined circular road. The van, run by the Cook Islands Family Welfare Association (CIFWA), stops off at condom distribution points along the way, refilling the condom stock.  Dean Tangata, a 26-year-old humanitarian focal point for CIFWA and a registered nurse, is behind the wheel.  "Our condom dispensers get emptied so quickly!” said Dean. “We refill them twice a week.”   On Rarotonga, the locals refer to a system called ‘coconut wireless’ - a local phrase meaning to communicate quickly by word-of-mouth. This means that discretion is key to encourage people to practise safe sex and use condoms.  According to the Cook Islands Ministry of Health 2014, sexually transmitted infections (STIs) are common in the Cook Islands. A study conducted in 2006 showed a 22% prevalence rate of chlamydia; 46% of these cases were in people between the ages of 15 and 29 years. After a robust intervention campaign, a repeat survey in 2012 showed a 50% decrease in prevalence. This is why CIFWA instigated a condom dispenser system, placing handmade dispensers (that an industrious staff member made from cutting holes in piping) inside bathrooms in restaurants around the island. “We’re the ‘sex people’ - the ‘sex workers’ who roll up in our condom car,” says Dean, smiling.

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.”

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, 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 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."

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.”