PHNOM PENH (Khmer Times) – Fear of social reprisal may be causing Phnom Penh’s sex workers to seek abortions in the privacy of unregistered private clinics or at home.
But they pay a high price for confidentiality. These abortions are dangerous, unregulated, and sometimes the mother dies in the process. Despite the danger, a new study shows that 90 percent of sex workers choose to terminate their pregnancy at home or at private clinics in order to escape public shaming.
Researchers from NGO KHANA and the Center for Global Health Research interviewed 667 sex workers for this study, released July 31. Many of the workers come to Phnom Penh from the provinces seeking work at a garment factory, but poor work conditions, low wages, and long overtime hours sent them into the sex trade. Working in karaoke bars and massage parlors, and without knowledge of safe-sex practices or access to sexual-health services, many contract sexually transmitted infections, or unwanted pregnancies.
Almost half – 46 percent – of Cambodian female sex workers have reported having an abortion, according to the KHANA study. And the majority of this vulnerable group chose unsafe places for the abortions, despite the wide availability and easy access to safe abortions at public hospitals or NGOs.
These public hospitals and NGOs provide professional care for women seeking to terminate a pregnancy.
“Free and friendly sexual and reproductive health services are currently available through government and NGO providers to [sex workers],” the study said. Yet women only use these places for 10 percent of abortions.
Almost half of the women surveyed reported seeking abortions at private clinics, followed by 41 percent who chose to do home abortions using over-the-counter medication. Meanwhile, the study found that only 10 percent of women chose the safest option – abortion at a public hospital or NGO with formally trained staff.
“The majority of induced abortions were not carried out in public health or NGO facilities considered to be the safest place equipped with formally trained abortion care providers,” the study said.
Why do so many women choose to get abortions at home or at unregistered private clinics?
The study’s authors say that many sex workers feel that they are social outcasts, and worry that an abortion would only alienate them further from society.
“They aren’t really accepted into society,” said Dr. Siyan Yi, who co-authored the study. “Many women choose private clinics because they are more confidential, and they can protect themselves from the eyes of other people. So they choose these back-alley options.”
The “back-alley options” often employ unlicensed, untrained workers who lack even basic knowledge of reproductive health. The risks of the mother dying during the procedure are higher than at clinics with trained staff.
Home abortions are another popular choice, with roughly 40 percent of sex workers choosing to end the pregnancy at home with over-the-counter medication from the pharmacy.
This method also comes with its risks, since medication causes intense contractions of the uterus, and may cause severe internal bleeding, in severe cases leading to death, Dr. Siyan Yi warned.
Out of the Shadows
Cambodian law allows abortions until the 12th week of pregnancy, but many women are unaware of their legal standing and worry they will face jail time if they seek an abortion, said Dr. Yi.
The topic of abortion continues to be taboo, so many women lack basic information about how to safely and legally terminate a pregnancy. “We need to decrease the stigma, so women will feel more welcome to discuss it,” Dr. Yi said.
He added that abortion needs to be brought out of the shadows in order for more women to choose the safer option to end their pregnancies. “We need to talk more openly in public,” Dr. Yi said. “We know this is an issue, and we need to work together to end it. Female sex workers are very vulnerable. The most important thing is to make these women safe.”