“Now I Use Contraception” – Oun Srey Leak’s Story

This is the third blog in a 4-part series sharing personal family planning stories from around the world – presented by CARE and Girls’ Globe in the lead up to the 2018 International Conference on Family Planning. Catch up on the whole series with stories from HawaParmila, and Olive.

Oun Srey Leak, a 26-year-old mother of one, navigates her way to work on a crowded street in Phnom Penh, Cambodia. She has worked in the Gladpeer garment factory for five years.

The garment industry is a huge part of Cambodia’s economy, employing over 700,000 workers. About 90% of these workers are women.

Srey Leak, like many of her colleagues, moved to Phnom Penh from a less populous area of Cambodia in search of job opportunities. She met her husband and shortly after became pregnant with their daughter.

Photo by GMB Films

“After I got married, I heard using contraception could stop us from being able to have children in the future. So, that’s why I decided to have a child soon after I got married. Two months after the wedding, I got pregnant,” Srey Leak explained.

Although half of female garment workers report being sexually active, less than a third of them use modern contraceptives.

Just as soon as Srey Leak became a new mom, she was faced with the demand to return to the garment factory. “After the birth, I needed to get back to work. So, I took my daughter to my mother back in the province. I am now far away from my child because I don’t have time to take care of her.”

Srey Leak’s story is not atypical. Most Cambodian garment factories operate six days a week, eight hours a day, and workers are often paid based on the outputs they produce, rather than the time they put in. Taking time off to go to the doctor may cost them more income than they can afford to lose, and there are limited health providers and pharmacies operating on Sundays when the factories are closed.

For the past five years, CARE has been working in garment factories to help women like Srey Leak make healthy decisions. Chat! is a package of activities that reaches women inside factories, where they spend most of their time. The innovative package includes sessions providing information on various sexual and reproductive health topics.

Srey Leak welcomed the opportunity to take control of her health. “One day, CARE came to invite workers to join a short training. They showed me short films about understanding the different types of contraception, safe abortion, and the ways in which we can avoid unplanned pregnancies.”

The sessions are paired with videos that feature fictional characters, in which the women can relate to and identify real health challenges. There is also an app that provides interactive quizzes and activities that are tailored specifically for garment workers, to facilitate ongoing learning.

After she learnt about the various modern contraceptive methods available to her, Srey Leak decided to start using oral contraceptives.

“I now take the contraceptive pill every day. If I’d known about this method before, I could have used it before falling pregnant,” she shared. “For me, after I joined CARE’s training, it changed my life. Now I use contraception and I have a greater understanding. So, it means I can have enough money for my next child.”

Chat! is supported by the Australian government’s Partnering to Save Lives (PSL) initiative and the Cambodian Ministry of Health in an alliance to reduce maternal and newborn mortality in Cambodia. Workers who participated are twice as likely to use modern family planning methods and health services. Factory managers have reported increased productivity and reduced absenteeism within their workers.

Learn more about CARE Cambodia’s garment factory work here, and read an interview with Chat! co-founders Maly Man and Julia Battle.

“Why should women have all the responsibility for family planning?” – Parmila’s Story

This is the second blog in a 4-part series sharing personal family planning stories from around the world – presented by CARE and Girls’ Globe in the lead up to the 2018 International Conference on Family Planning. Catch up on the whole series with stories from HawaOun Srey Leak, and Olive.

When it comes to family planning, women in India (and in the rest of the world) are expected to do the work. This reality is consistent across the various methods of contraception, but the disparity between the sexes is especially obvious when it comes to permanent contraception, or sterilization. For each man who opted for a vasectomy between 2016-2017 in India, 52 women got tubectomies.

The 1:52 ratio is striking, especially when you consider that vasectomies are cheaper, less invasive, carry a lower risk of infection, and have a quicker healing time than the female equivalent.

In recent decades, the procedure has been improved with the advent of the no-scalpel vasectomy (NSV), which boasts an even quicker healing time and lower risk of infection.

For couples who do not want to have any (or any more) children, the NSV can be a great option, and one frontline health worker in India has made it her personal mission to increase uptake in her community.

Photo by CARE

This is Parmila Devi with her husband, Bigan Sahni.

Parmila is an ASHA (Accredited Social Health Activist) in Bihar, one of the most populous states in India. She learned about NSVs as part of the ASHA family planning training, and she immediately decided it was the best option for her family.

“Why should women have all the responsibility for family planning?” she wondered.

“The first thing I did after becoming an ASHA worker was to convince my husband to undergo a vasectomy,” said Parmila. Bigan “thought she had lost her senses” at first, but eventually came around to the idea.

The procedure was a success, and Parmila began to tell her clients about her husband’s experience. She attempted to address concerns and correct myths and misconceptions prevalent in the community.

“Some men think [a vasectomy] would affect their sex drive or their ability to enjoy sex. Some also feel it would make them physically weak, which is not the case,” one state health official explained. Many women shared the same fears for their husbands.

ASHAs typically work most closely with women and children, but because Parmila wanted men in her community to understand the benefits of NSV, she talked to them as well.

“‘Ab ee mardo ken a chori!’ (She will not even leave the men alone!) the people in the households I visited in the early days would say.”

Bigan supports his wife’s efforts, and occasionally they make house calls together and he counsels the husband while Parmila talks to the wife. Gradually, people in her community have become more accepting of NSV as a viable method of permanent contraception.

Parmila received an award from the health minister of Bihar, Mangal Pandi, for motivating 43 men to get NSVs in 2017. Her goal for 2018 is to increase that number to 100, and so far, she’s over halfway there.

Given the volume of accurate information and quality family planning methods available now to individuals, we should be working to ensure this information and these services reach women and men.

There is no reason women should have to bear all of the burden for family planning and contraception in this day and age. Fortunately, there are activists like Parmila in this world to remind us of that, and to push us to be better.

Learn more about CARE’s work in Bihar here.

This case study was collected by Gaurav Masih, MPH candidate at Indian Institute of Public Health – Gandhinagar.

“All men should let their wives start family planning” – Hawa’s Story

This is the first blog in a 4-part series sharing personal family planning stories from around the world – presented by CARE and Girls’ Globe in the lead up to the 2018 International Conference on Family Planning. Catch up on the whole series with stories from Parmila, Oun Srey Leak, and Olive.

Under the hot sun of Maiduguri, Nigeria, 23-year-old Hawa Ngoma is fanning herself with the end of her black hijab (a full head-and-body cloak that most Nigerian Muslim women wear) while sitting under the shade of a tree outside of a health clinic.

Hawa is married and has a five-year-old daughter and a two-year-old son. Her husband, Ali, is an ambulance driver for a United Nations project. Hawa came to this particular clinic after Ali learned about family planning from a midwife who works with him and heard that CARE was offering it here for free. “When my husband heard and saw the benefits of the family planning from his work, he asked me to start family planning and get counseled by this particular midwife.”

CARE Nigeria is providing much needed facility and outreach-based models of sexual and reproductive health service delivery in the most hard-to-reach areas in Northeast Nigeria. Over 250,000 women and girls most severely affected by the crisis have been reached with services including pre- and post-natal care, family planning, HIV testing, health education and post- abortion care.

“When I came to the health center, the midwife explained all the different contraceptive methods to me and how to use them, the good parts and the bad.” Hawa shared. When I came to the clinic, she was really welcoming and warm and took all her time to explain everything to me and gave me the chance to ask as many questions as I wanted and did not feel annoyed at all. This made me want to come back and visit again when the time to change the implant had
come.”

Hawa wanted to find the right method that fit her body and lifestyle, and something Ali would like as well. “I wanted to go for the pill, but my husband told me it makes you grow fat and he loves the way I am already, so I tried the shots. I loved the shots, but I decided to go for the implant because it lasts three years and this will help me rest and not worry about it for that period of time.”

Although Ali now understands the benefits of family planning and supports Hawa using contraceptives, that was not always the case. “After our first daughter was born, he refused to let me start family planning.” At this time, Ali lived in a different town from Hawa for his work. “My husband did not want to hear about family planning and since he was not living with us, it
was easy not to get pregnant. After we started living together, I got pregnant right away and gave birth to a baby girl who died a few days later. Then, because I was not using contraceptives, I got pregnant 40 days after the death of my baby.”

Hawa’s second and third pregnancies were difficult. “For my last two pregnancies, I lost a lot of blood and lost consciousness. After the second one, I had a blood pressure issue,” Hawa explained. “After my second pregnancy, I was introduced to family planning but my husband was against it. I guess the difficulties and challenges we faced during my third pregnancy made him realize it was a mistake not to space births.”

Although acceptance of family planning is growing in her community, many men still do not approve of it. Hawa sees that as a problem. “I’d like to tell men that they should let their wives start family planning as it reduces the risk of suffering and allows them to give birth to healthy babies. It gives you the time to rest and to give a better upbringing to your children instead of having a baby sucking on your breast, one on your back and the other one bothering you for being hungry or because they have messed their pants!”

Hawa hopes to be able to go back to school, find a job, and be financially independent. She wants to grow as a woman and give her children a better education and to raise them to be good people who will help others.

Learn more about CARE’s work in Nigeria here.

The Integration Hypothesis: Let’s Empower Women and Girls

The challenges women and girls experience around the world are interlinked and multi-dimensional. Addressing and developing effective solutions to empower women, girls and communities requires a coordinated global and local response. Last month, Girls’ Globe had the opportunity to be a part of FHI 360’s Integration Hypothesis event in New York City. The event gathered organizations, thought leaders and those working at a community level to discuss the importance of creating sustainable integrated solutions to effectively address issues such as education, violence against women, health and poverty. Creating successful and sustainable integrated development programs for women, girls and communities is not a new conversation. For years, development practitioners, advocates, governments, organizations and communities have sought to address global  issues through talking about the need for more integrated and holistic approaches.

Last week, FHI 360 and Girls’ Globe hosted an interactive Google+ hangout to continue the conversation on the importance of integrated development for women and girls. The live discussion was a continuation of FHI 360’s Integration Hypothesis series. A diverse group of panelists took the “virtual stage” in what was an engaging and robust discussion. All panelists agreed there is no better time than the present to begin to turn the integration discussion into effective international development solutions.

Greg Beck, Director of Integrated Development for FHI 360, began the conversation by defining integrated development as a coordinated response across sectors to create an amplified impact for communities. FHI 360 is committed to building the evidence needed to show where integration and development solutions can be most effective and sustainable. Through a four million dollar FHI 360 Foundation grant, FHI 360 has launched a new integrated development initiative which utilizes their research and technical expertise as well as experience in international gender programming to produce evidence-based integrated solutions. Greg emphasized the importance of awareness and education among the donor community and private sector as essential elements to the process of advancing successful integrated development outcomes.

The Google+ Hangout panelists included: Greg Beck, Director of Integrated Development at FHI 360; Rose Wilcher, Director of Research Utilization at FHI 360; Katja Iversen, CEO of Women Deliver; Joyce Adolwa Head of Girls’ Education, Empowerment and Programming at CARE; and Catalina Escobar, CEO of the Juan Felipe Gomez Escobar Foundation. The panelists shared their experiences as well as the challenges and opportunities to implementing integrated solutions for women and girls at both a macro and micro level.

Creating lasting opportunities for women and girls requires a multi-prong approach. Katja Iversen emphasized the importance of continued advocacy for women and girls. Clear messaging and advocacy are critical components to building successful integrated solutions. Katja stated, “We need to make it so delicious for governments and others to invest in girls and women.” Evidence  is the foundation while advocacy and messaging are powerful vehicles for creating change and moving the conversation into effective action for women, girls and communities.

Joyce Adolwa spoke of the importance of listening to and involving communities in the process of integration. Women, girls and communities must be at the center and thoroughly involved in the change making process. Joyce emphasized, “Societies change because people change.” Sustainability can not occur unless we involve communities and people in the change-making process.

Simply put, integrated development solutions for women, girls and communities must meet people where they are. We all have a responsibility to carry this conversation forward. Integrated solutions and decision making must both come from the grassroots community level as well as involve donors and those at an international decision making level. Let’s continue to think critically about how we are investing time and resources into holistic solutions for empowering women and girls.

Watch the recorded hangout and continue to share your thoughts at #IntegratedDev

Read our Storify recap to learn more.