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.”

“When I was about to give birth, we called for an ambulance or a vehicle to help but even after five hours of calling, no vehicle arrived,” recalls 32-year-old Mona Shrestha. “The birth was difficult. For five hours I had to suffer from delivery complications.” Mona’s story is a familiar one for women in rural Nepal. Like thousands of women across the country, she lives in a small, remote village, at the end of a winding, potholed road. There are no permanent medical facilities or staff based in the village of Bakultar: medical camps occasionally arrive to dispense services, but they are few and far between. Life here is tough. The main livelihood is farming: both men and women toil in the fields during the day, and in the mornings and evenings, women take care of their children and carry out household chores. The nearest birthing centre is an hour’s drive away. Few families can afford to rent a seat in a car, and so are forced to do the journey on foot. For pregnant women walking in the searing heat, this journey can be arduous, even life-threatening. “Fifteen years ago, there was a woman who helped women give birth here, but she’s no longer here,” Mona says. “It’s difficult for women.” Giving birth without medical help can cause severe problems for women and babies, and even death. Infant mortality remains a major problem in Nepal, and maternal mortality is one of the leading causes of death among women. Only 36% of births are attended by a doctor, nurse or midwife.  A traumatic birth can cause long-term physical, psychological, social and economic problems from which women might never recover. Access to contraception and other family planning services, too, involves walking miles to the nearest health clinic. Mona says she used to use the contraceptive injection, but now uses an intrauterine device. Like many villages in Nepal, Bakultar is awash with myths and gossip about the side-effects of contraception. “There are so many side effects to these devices – I’ve heard the coil can cause cancer,” Mona says. “This is why we want to have permanent family planning like sterilisation, for both men and women.” These complaints heard frequently in villages like Bakultar. As well as access to facilities and contraception, people here desperately need access to education on contraception and sexual health and reproductive rights. Misinformation as well as a lack of information are both major problems. “It would be really helpful to have family planning services nearby,” says Mona. Stories Read more stories from Nepal Ask for universal access to contraception!

The Safe Abortion Action Fund (SAAF) which is hosted by IPPF was set up in 2006 in order to support grass-roots organisations to increase access to safe abortion. One such organisation which received support under the last round of funding is called Lady Mermaid's Bureau. I am Pretty Lynn, aged 25. I am a sex worker but I went to university. I graduated with a Bachelor's Degree in Tourism in 2013. But now, during the day I’m sleeping and during the night I’m working. That is how my day goes every day. I got into sex work through friends. Okay it is not good but I am earning.  I tried to get a job when I graduated. I have been applying since I graduated in 2013. I’m still applying but I’m not getting anywhere. You know to get jobs in Uganda; you have to know someone there and no one knows me there. To be a sex worker is like a curse. People look at you like, I don’t know, as someone that has no use in society. People look at you in a bad way. They even don’t consider why you are selling. They just see you as the worst thing that can happen in the society. So it is not comfortable, it is really hard but we try and survive. The fact sex working is illegal means you have to hide yourself when you are selling so that police cannot take you. And then you get diseases, men don’t want to pay. When the police come and take us, sometimes they even use us and don’t pay. So it is really hard. They want a free service. Like if they come and take you and pay that would be fair. But they say it is illegal to sell yourself. But they still use you yet they are saying it is illegal. You can’t report the police because there is no evidence.  Abortion and unwanted pregnancies are really common because men don’t want to use condoms and female condoms are really rare and they are expensive. Though at times we get female condoms from Lady Marmaid’s Bureau (LMB) because there are so many of us they can’t keep on giving you them all the time. At times when we get pregnant we use local methods. You can go and use local herbs but it is not safe. One time I used local herbs and I was successful. Then the other time I used Omo washing powder and tea leaves but it was really hard for me. I almost died. I had a friend who died last year from this. But the good thing is that LMB taught us about safe abortion. I have had a safe abortion too. There are some tabs they are called Miso (misoprostol). It costs about fifty thousand shillings (£10 pounds or $20.) It is a lot of money. But if I’m working and I know I’m pregnant, I can say, "this week I’m working for my safe abortion". So if I’m working for twenty thousand, by the end of the week I will have the money. It is expensive compared to Omo at five hundred shillings but that is risky. So if I say I will work this whole week for Miso (misoprostol) it is better. But I'm working and I'm not eating. A project like this one from Lady Mermaid's can help young girls and women. But to take us from sex work, it would really be hard. They would not have enough money to cater for all of us. So what they have to do is to teach us how to protect ourselves, how to defend ourselves. Safe abortion yes. They will just have to sensitise us more about our lives, protection, female condoms and all that. I don't have a boyfriend but maybe when I get money and leave this job I will. But for now, no man would like a woman who sells. No man will bear the wife selling herself. And that will happen only if I get funds, settle somewhere else and become responsible woman. I don’t want this job. I don’t want to be in this business of sex work all the time. I want be married, with my children happily, not selling myself. Stories Read more stories about the amazing success of SAAF in Uganda