Facilitators and barriers to accessing reproductive health care for migrant beer promoters in Cambodia, Laos, Thailand and Vietnam: A mixed methods study

Abstract

BackgroundThe purpose of the research was to assess access to sexual and reproductive health services for migrant women who work as beer promoters. This mixed methods research was conducted in Phnom Penh, Cambodia, Bangkok, Thailand, Vientiane, Laos, and Hanoi, Vietnam during 2010 to 2011.MethodsFocus groups were held with beer promoters and separate focus groups or interviews with key informants to explore the factors affecting beer promoters’ access to health care institutions for reproductive health care. The findings of the focus groups were used to develop a survey for beer promoters. This survey was conducted in popular health institutions for these women in each of the four Asian cities.ResultsSeveral common themes were evident. Work demands prevented beer promoters from accessing health care. Institutional factors affecting care included cost, location, environmental factors (e.g. waiting times, cleanliness and confidentiality) and service factors (e.g. staff attitudes, clinic hours, and availability of medications). Personal factors affecting access were shyness and fear, lack of knowledge, and support from family and friends.The survey of the beer promoters confirmed that cost, location and both environmental and service factors impact on access to health care services for beer promoters. Many beer promoters are sexually active, and a significant proportion of those surveyed rely on sex work to supplement their income. Many also drink with their clients. Despite a few differences amongst the surveyed population, the findings were remarkably similar across the four research sites.ConclusionsRecommendations from the research include the provision of evening and weekend clinic hours to facilitate access, free or low cost clinics, and health insurance through employer or government plans which are easy to access for migrants. Other improvements that would facilitate the access of beer promoters to these services include increased funding to hire more staff (reducing waiting times) and to stock more needed medications, mobile clinics to come to the workplace or free transportation for beer promoters to the clinics, improved training to reduce health care provider stigma against beer promoters, and public education about the importance of reproductive health care, including preventative services.

Sex in the city

“…Based on the sexual experience of the group, 45.2 percent had sexual intercourse with three or more people during their lifetime which was consistent to H. Yang et al's study [19]. Furthermore, the majority of respondents never had sex with their clients neither voluntarily nor beneficially that was similar to Webber study and H. Yang et al study [19,20]. There were 25.2 percent respondents who did not use a condom as a protection which consistent with 2011 Cambodia STI survey among female beer promoters [21] In terms of attitude levels toward using a condom, 72.8 percent of female beer promoters had a neutral attitude about using condom, while 19.6 percent of them had a negative attitude.…”

“…The study showed that most participants worked as part-time beer promoters (78.3 percent) which was inconsistent with Webber et al's study [20], while majority of respondents worked as full-time beer promoters (83 percent). This difference might be related to different study areas.…”

“…Most common workplace among beer promoters was restaurants (47.8 percent) and many respondents also used to drink with their clients (48.4 percent). Despite a few differences between studies, Webber's study reported that 42.0 percent of Thai respondents ever had drunk with clients which is consistent [20].…”

Men on the move and the wives left behind: the impact of migration on family planning in Nepal

“…18 This is further complicated by limited access to sexual and reproductive health services for wives left behind. 19 Positive impacts of husbands' migration include increased accrual of money and material items and improvement in women's decision-making power, particularly for the management of resources and household affairs. 20 Unfortunately, these benefits can also complicate familial relationships and may place a greater burden on women's wellbeing.…”

Accessibility to health services among migrant workers in the Northeast of Thailand

“…However, in 2015 the Thai government attempted to solve these problems by allowing foreigners and migrant workers to purchase a health insurance card with different coverage periods and extended the coverage to the foreign workers. Even a migrant worker who is legally registered with the Ministry of Labour has numerous difficulties in using a government health insurance card, for example the employer confiscates the health card from the workers, or the workers prefer private clinics due to inadequate attention in public hospitals 6 . This obstructs migrant workers from having access to good healthcare.…”