Family planning and contraception
By Shiv Fray
Becoming a mother can be one of the most monumental and life-changing events to happen in a woman’s life. But imagine going through this transitional journey without any medical or emotional support, entering this new chapter with limited accessible information. It is widely recognised that there is a lack of accurate and informative sex education available within the public-school curriculum, only being lightly included within biology in grades 10-12. This poses many problems, as a high percentage of impoverished children drop out of school before they reach grade 10. For those that remain in school, due to cultural beliefs that sex should not be spoken about openly, many teachers feel uncomfortable delivering this lesson, and as such, young adults do not have access to important sex education which can heavily impact the future of young women.
With a lack of education, limited skilled maternity health care workers, and high costs linked to medical care, more than 50% of women in Cambodia receive no health care during their pregnancy. For the wealthiest 20% of the population, 9 out of 10 births are assisted by skilled personnel, while for the poorest 20%, only 1 in 5 births are assisted by a skilled attendant.
Sadly, Cambodia still has one of the highest maternity mortality rates in SE Asia. The cost of a bus fare could be the difference between a woman giving birth safely in a hospital, and both mother and baby being at significant risk during a home delivery, in an unsterile environment with no medical support.
These attributing factors promote a direct correlation between poverty and large families. Many families are unaware of contraception methods, and if they were, would not be able to afford them. Subsequently, they are unable to choose the spacing between their children. With more mouths to feed, the addition of children to large families affects the economic well-being of lower-income families, perpetuating the poverty cycle and increasing the vulnerability of all family members. According to ADB, poverty assessments by household size and type show that families with children under the age of 15 are suffering from the highest levels of poverty. This is linked to the costs of keeping children within the education system having to afford uniforms and school supplies. It is reported that these children are at a huge risk of suffering lifetime consequences from detrimental coping strategies. These strategies involve cutting back on food, eating food of lower nutritional quality, sending children to work rather than school, giving them up to exploitative orphanages, and selling them to human traffickers.
One of our enrolled families in our Cambodian's children charity.
With education at the forefront of REACH’s programs, the team spent the past few months building partnerships with medical professionals to be able to provide women and mothers in the community with the support they have previously gone without. Through the team’s research, we have recognised that family planning and maternity care are an immediate need and as a result, the outreach team have established two primary goals:
- Ongoing workshops on contraception and access to free contraception
- Supporting women through their pregnancies
Access to long term contraception solutions:
Since REACH was founded, our team have been in discussions with Marie Stopes, a healthcare provider specifically for contraception and sexual/reproductive health services. It was important that our outreach team knew of a safe and confidential clinic for the women in the community to attend when they needed to.
After the restrictions lifted, on 1st December, we invited Marie Stope’s clinic manager and her assistant to host workshops at REACH to teach our guardians all about family planning. The outreach team contacted our families and asked who would be interested in attending and we were happy to host the workshop for 13 brave women. The workshop covered many topics including what is family planning and birth control, and the different types of contraceptives available (short-term, long-term, and permanent measures). The women who attended this workshop were eager to learn about this taboo subject and participated in a great Q & A session at the end.
Marie Stopes contraception talk for our enrolled mothers.
Most of the women explained that they wanted contraception, but they did not know what options were available, how they worked or if they would be able to afford the cost of them. By joining this workshop, the women were able to ask trained medical professionals about what the best individual option would be for them personally. The women left the workshop with free condoms courtesy of A Place to Be Yourself and an informative flyer.
They then went home to discuss options with their partners to decide if they would like ongoing contraception, and if so, which method would be most suitable. Our outreach team then followed up with the women who wanted the services to facilitate their trip to the clinic. Since the workshop was held, REACH has helped 4 women to access long-term contraception methods.
As it is still a sensitive topic, the attendance of this workshop is hosted only to women who express their interest. On a quarterly basis, we aim to continue delivering this workshop to small groups of REACH guardians who want contraception. Each 5-year implant bar costs approximately $40 and each woman requires individual follow up, monitoring and care. With limited human resources to carry out the project, we are rolling this out slowly, with the goal to eventually provide this service to all guardians who want it.
Free contraception talks to all REACH mothers as part of our Cambodia charity work.
Child-Birth Support & Baby Baskets
With a lack of antenatal services available in Cambodia, many women instead follow generational traditions during pregnancy and postpartum. The Ministry of Health estimates that 40-50% of the population still follow traditional medicine. Many believe that after giving birth, the body in a state of fragility and women must follow these particular processes to prevent chronic illness. It is thought that the act of giving birth can lead to the body temperature becoming unbalanced, and postpartum, the mother must warm up her body. There are many different methods to do this, from eating spicy food, wearing knitted beanie hats, to lying on a raised bed with a fire burning beneath her for 3 to 5 days. Thankfully, Siem Reap is home to multiple free hospitals where women can give birth, however, there is still a huge lack of medical and emotional support for new mothers.
To combat this, the second part to this family planning project is to support REACH’s guardians through their pregnancies.
We were recently inspired by a volunteer mid-wife who came to REACH to host childbirth training workshop to 10 of our female staff members. In this workshop, she discussed the female body and its changes during pregnancy, birth stages, signs of labour, and specific exercises that women can do to feel more comfortable when their pregnancy is at an advanced stage. The workshop ended with an interactive group quiz where our team were able to share their own personal experiences and ask questions. Our team felt empowered that they were able to talk openly, without judgement, about a subject which is rarely discussed and still seen as taboo.
REACH female staff sharing life experiences during the Childbirth workshop.
We wanted to have options for women to be supported no matter what stage they are at, including contraception, pregnancy and birth. Inspired by our friends at Heartprint, we replicated their beautiful idea of baby baskets for our community too. The baby baskets will be given to expecting mothers in our community. Each baby basket costs approximately $30USD and includes a basket, two beanie hats for the mother, two sarongs for the mother, a large towel, a baby mosquito net, a pack of nappies, baby shampoo and powder, baby gloves, hats and socks. We will also gift the mother with donated clothing to help as her baby grows. So far, we have gifted 2 pregnant women their baby baskets and they were so grateful for this small gesture. Each woman has since successfully given birth and are all healthy, they do however know, that we are here for them at any time if they need us.
Clothes and blankets as part of "REACH Baby Baskets."
And this is just the beginning!
Now that we have broached these sensitive topics, which were welcomed by the community, we are looking forward to developing these much-needed initiatives.
We have some exciting things lined up in the pipeline and will be continuing our work in supporting women through childbirth. We are working with local NGOs to host a childbirth workshop and aim to have these facilitated every 6 months to all pregnant women at REACH, while also providing them with a baby basket so that they are readily prepared for their labour and birth.
We will also continue hosting quarterly workshops on contraception to women in small numbers and will be providing those interested with access to long-term contraception treatments.
Our Outreach team believes that by extending these small offerings, we will be able help REACH mothers and families feel supported with the choices they make.