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

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

Webberetal.GlobalizationandHealth2012,8:21 /content/8/1/21 RESEARCH OpenAccess Facilitatorsandbarrierstoaccessingreproductive healthcareformigrantbeerpromotersin Cambodia,Laos,ThailandandVietnam:Amixed methodsstudy GailWebber1*,DeniseSpitzer2,RatanaSomrongthong3,TruongCongDat4andSomphoneKounnavongsa5 Abstract Background:Thepurposeoftheresearchwastoassessaccesstosexualandreproductivehealthservicesfor migrantwomenwhoworkasbeerpromoters.ThismixedmethodsresearchwasconductedinPhnomPenh, Cambodia,Bangkok,Thailand,Vientiane,Laos,andHanoi,Vietnamduring2010to2011. Methods:Focusgroupswereheldwithbeerpromotersandseparatefocusgroupsorinterviewswithkey informantstoexplorethefactorsaffectingbeerpromoters’accesstohealthcareinstitutionsforreproductivehealth care.Thefindingsofthefocusgroupswereusedtodevelopasurveyforbeerpromoters.Thissurveywas conductedinpopularhealthinstitutionsforthesewomenineachofthefourAsiancities. Results:Severalcommonthemeswereevident.Workdemandspreventedbeerpromotersfromaccessinghealth care.Institutionalfactorsaffectingcareincludedcost,location,environmentalfactors(e.g.waitingtimes,cleanliness andconfidentiality)andservicefactors(e.g.staffattitudes,clinichours,andavailabilityofmedications).Personal factorsaffectingaccesswereshynessandfear,lackofknowledge,andsupportfromfamilyandfriends. Thesurveyofthebeerpromotersconfirmedthatcost,locationandbothenvironmentalandservicefactorsimpact onaccesstohealthcareservicesforbeerpromoters.Manybeerpromotersaresexuallyactive,andasignificant proportionofthosesurveyedrelyonsexworktosupplementtheirincome.Manyalsodrinkwiththeirclients. Despiteafewdifferencesamongstthesurveyedpopulation,thefindingswereremarkablysimilaracrossthefour researchsites. Conclusions:Recommendationsfromtheresearchincludetheprovisionofeveningandweekendclinichoursto facilitateaccess,freeorlowcostclinics,andhealthinsurancethroughemployerorgovernmentplanswhichare easytoaccessformigrants.Otherimprovementsthatwouldfacilitatetheaccessofbeerpromoterstothese ser