Female garment factory workers in Laos: Meeting critical sexual and reproductive health needs

by 23rd Apr 2015
A member of the Vientiane Youth Centre team (right) talks to a garment worker during a mobile health clinic visit to the factory A member of the Vientiane Youth Centre team (right) talks to a garment worker during a mobile health clinic visit to the factory

How much does the average high street shopper pay attention to where their clothes come from? If asked, most people wouldn’t think of Laos – but according to a 2012 World Bank report, even though Laos’ production of garments is still modest compared to some of its more competitive neighbours (China, Cambodia, Thailand and Vietnam), garment production is the largest manufacturing sector in the country, with an annual turnover of $200 million. The sector employs more than 20,000 people in over 100 factories, and as with other low-cost garment-producing countries, most of the garment workers in Laos are young (17-25 years old), female (85%) and have migrated from the country’s rural areas. But do the pull factors of rural-urban migration translate into a better life?

Vientiane garment factories: the daily reality

Upon arriving in Vientiane recently, I visited two garment factories that produce a range of clothing for European markets – from industrial work-wear to t-shirts and underwear. Most of the workers in these factories are young men and women who migrated from rural Laos in search of better income opportunities. Separated from their families and social networks, these migrant workers are not adequately prepared to deal with the risks and challenges of living in a capital city. They also face poor working and living conditions with insufficient light and ventilation, unsafe water supplies and unhygienic toilet facilities.

One thing I noticed was how regulated garment workers’ days are – their one-hour lunch break, for example, is initiated every day by a loud alarm that pierces through the searingly hot conditions on the factory floor. It was nearly 40 degrees on the day I was there – just another factor for the workers to deal with over here, and one that would never be tolerated were this a factory in Europe.

Workers’ social lives are also centred around factories, some of which are located in the outskirts of Vientiane, without necessary infrastructure nearby. Factory workers live in crowded on-site dormitories, work long hours (sometimes from 8am until midnight to fulfil large and urgent orders), six days a week, and in most cases do not have access to basic health services or proper nutrition. On average, they make about $90 a month and, just for comparison, a basic drink of coconut water costs $2.

Young girls and women become particularly vulnerable – often suffering unwanted pregnancies and having to deal with physical and sexual violence. They may not have the time, means of transportation or information to access available sexual, reproductive and other health-related services. Compounding this dynamic for workers is the fact that the government health system in Laos currently prioritises maternal and child health issues in rural areas, resulting in lesser focus on the healthcare needs of the urban poor, in particular those of migrant workers.

CARE-GSK project in Laos: bringing critical health services to factories

Last year, to improve the health of female migrant workers in garment factories, CARE International, together with GSK, launched a project in three districts of Vientiane, covering 18 factories with over 7,000 workers. The project focuses on providing outreach sexual and reproductive health services to garment factories, via mobile clinics and training a number of local health educators to assist female garment factory employees to better manage their health and well-being.

The case for CARE and GSK partnership in this area is clear. With over 15 years of experience implementing more than 20 programmes in the majority of the international garment industry’s major sourcing countries, CARE is uniquely positioned to bring companies, suppliers and poor workers together through comprehensive programmes that make a lasting impact on the working conditions and social welfare of garment workers and their communities, whilst improving business practices and sustainability. As a leading pharmaceutical company, GSK sees improving access to healthcare as core for its business, as well as supporting more sustainable and responsible engagements in countries such as Laos. The pharmaceutical industry can play an important and impactful role, particularly in emerging market economies, in terms of the health and well-being of all demographics in society.

Partnership in action

During my visit, I met CARE’s two implementing partners that are delivering these critical services – Vientiane Youth Centre (VYC) and Laopha NGO. VYC’s director, Ms. Dalayvanh, explained to me that their centre is the only place that offers sexual and reproductive health services and advice to young people in the capital and beyond. Doctors and nurses at VYC’s clinic, led by Dr. Ya, offer STI/HIV testing and basic reproductive health treatment, while their trained male and female volunteers staff toll-free health lines.

To better connect with younger audiences, Dr. Ya also offers medical advice on Facebook, which is growing in popularity in Laos. Later, I watched his team during their mobile clinic visit to the factory. Another doctor and two nurses energetically provide birth control, condoms and information materials to the steady flow of female workers, while in a separate office Dr. Ya offers one-to-one clinical counselling, prescribes STI treatment and refers more complicated cases to the hospital. In an hour slot agreed with factory management, Dr. Ya’s team manages to see on average 15-16 young women.

In the afternoon I had an opportunity to observe a training session on nutrition for a class of 10 young workers at another Vientiane garment factory. Enthusiastic health educators from Laopha NGO explain the value of various vitamins and nutritious types of food for overall health and energy levels, which directly affect workers’ productivity. The session is part of CARE’s innovative training curriculum that focuses on various topics, such as sexual and reproductive health, family planning and pregnancy, nutrition and life skills such as personal finance, decision-making, and assertive communication. I ask participants about what difference these training sessions make for them, and they explain how this new knowledge helps them make better health choices on a daily basis. What is also interesting is that each group at the end of the session nominates a peer educator, who in turn will further spread health education and messaging among their friends and colleagues.

Looking forward…

Besides individual gains, there are bigger benefits of this project. Many owners of the garment factories in which CARE works are starting to appreciate that healthy workforces mean less absenteeism, increased productivity and thus, higher profits. As a result, Laopha has been invited back to this factory more frequently (2-3 times a week) because demand for these one-hour training sessions is increasing, and more workers are signing up.

After my visit to Laos, I realise there is an obvious gap in sexual and reproductive health services for garment factory workers and currently this is the only project that targets migrant communities in urban settings. Therefore, to successfully address this gap, CARE and other INGOs need to continue aligning their goals with the Ministry of Health’s priorities for improving the quality of services, increasing the capacity of the health workforce, and reaching out to the most vulnerable populations. To do this requires partnering with local garment industry bodies, factory owners, workers and other stakeholders for a more holistic and comprehensive approach.

This can be a “win-win” situation on several fronts, not just for the garment workers who will be better equipped to cope with the challenges and opportunities of city life, but also factory owners seeking a more satisfied and healthier workforce, and for the various international industry stakeholders who are impacting on Laotian workers and consumers. A healthy and more productive society is one best placed to support responsible and sustainable economic development, and as Laos looks to better position itself on the highly-competitive international labour market, these gains at the factory level can go a long way to creating more mutually beneficial outcomes for all involved.

Svetlana Ancker

Svetlana Ancker was formerly a Senior Account Manager (Health), managing CARE's corporate partnership with GlaxoSmithKline which works to improve maternal and child health in six Asian countries. Svetlana has over 10 years’ experience in international health and HIV/AIDS programme development. Prior to joining CARE International, she worked for UNICEF in New York and Ukraine.

Svetlana has published a number of publications on HIV/AIDS policy-making and holds Masters degrees from the London School of Economics and Georgetown University, as well as a PhD in Public Health and Policy from London School of Hygiene & Tropical Medicine.