 Self-Care & Health Care: How migrant women in the Greater Mekong Subregion take care of their health Presented by Mekong Migration Network (MMN)

Overview: Why do we do this research?  Migrants often pay out much more than nationals of their health cost, for instance in Cambodia hospitals often charge foreigner double.  In GMS countries’s healthcare system require healthcare user pay a percentage of their health cost themselves i.e. Myanmar 80%, Thailand 14%, Vietnam 56%, China 35%.  Investment in Health systems is low.  Myanmay spent 2% of GDP on health care, 3 physicians per 10,000 people. 2.8% of GDP in Lao dedicated on health care and 1.9 physicians per 10,000 people. Thailand is the main destination country in the region, however, health care expenditure is 4.1 % of GDP, and 3 physicians per 10,000 people.(UNDP, 2014).  For many migrant women, formal health care facilities are a last resort.  “How do migrant women take care of themselves?”

How Migrant Women Take Care of Themselves?

“We don’t get information because we don’t go out, and we don’t know anybody.” Burmese returnee who worked as a domestic worker in Thailand “I was afraid to go to doctors as I was undocumented, and I also didn’t know how to find a doctor in any case.” Cambodian returnee who worked in Thailand

What factors affecting migrant women’s health rights? Migrant women Self-Care  Living and working condition: sanitation insufficient, stress/nerves from long arduous work, isolated living and working places,.  Information on Health: source of information, access to education, inadequate health information and care at pre-departure training  Time: long working hours, day off/sick leave, housework  Money: lower wages/under minimum wages, household expenses, remittance or migration broker’s fee Access to Doctors and Hospital  Documentation: fear of arrest/detention/deportation, no original copy of ID card/work permit  Isolation: workplace location, restricted movement, communication ability  Language: explaining health conditions/symptoms to health care providers, specific vocabulary  Complicated procedures, long queues/waiting times in hospitals and cost  Discrimination  Workplace Policies: documentation status, Pregnancy and Maternity Leave

Sexual and Reproductive Health Issues Migrant Women face in the GMS  Contraceptives: methods-ease of use, price, relationship with her sex partner.  Abortion (unplanned pregnancy): unsafe methods, unsafe, unregistered and unhygenic clinics, legal abortion  Pregnancy & Birth: forced sterilisation, possible risk of home births, access antenatal care  HIV/AIDS: testing, confidential, treatment, HIV and AIDS education  Other Sexually Transmitted Infection: treatment, STI information  Gender – Based Violence (GBV): mental and physical health, sexual abuse by family members or employers

Policies VS Gaps on Migrants Health Care in the GMS  Limited access: specific who or what illnesses are covered. Informal sector and undocumented migrants often are excluded  No long – term policy relevant to migrant health, and both healthcare and immigration policy change often  Mental health and sexual and reproductive health, as well as preventive health care are often unavailable.  HIV/AIDS care remains inadequate such as referral system full antiretroviral therapy (ART)  Social Security  Health Insurance  Labour Laws  Policies and systems for Departing Migrants

Recommendations  Ensure universal access to comprehensive, affordable, quality, gender-sensitive health services at all stages and across all locations, in part by removing discriminatory policies, to achieve the highest standard of sexual and reproductive health;  Enhance cooperation and integration between government and NGO services;  Provide information on health, health services, rights and policies relevant to migrant women;  Promote and enforce proper compliance of maternity and sick leave policies;  Provide information to support migrant women’s self-care practices

Mekong Migration Network (MMN) is a subregional network of 39 of the CSOs and research institutes in the GMS working for the promotion of the welfare, well-being, dignity and human rights of migrants in the GMS. Thank You!