Marie Stopes Asia Pacific: Delivering Modern Contraception and High-Quality Family Planning Services in the Asia Pacific Region
Overview
Marie Stopes International Cambodia (MSIC) is one of the leading providers of sexual and reproductive health (SRH) services. MSIC has been supporting women and girls in Cambodia for over twenty years. Since 1998, MSIC has established a network of clinics in the country, with seven clinics in operation. The clinics are situated in Phnom Penh (2), Kandal, Svay Rieng, Kampong Thom, Battambang, and Siem Reap. In addition, the Marie Stopes Ladies network operates in locations where there are no MSIC clinics, bridging the gap of SRH needs. With SRH services such as contraception and reproductive health care information, MSIC focuses on empowering women, girls, and everyone in Cambodia to make their own reproductive choices.
Objective 2: Improved Access to FP/SRH Services for Vulnerable Youth in Phnom Penh, Cambodia
New Clinic in Sen Sok
In addition to raising awareness on SRH, MSIC also ensures young people have access to SRH services through our clinics and MSLs. In November 2020, MSIC opened a new clinic located in Sen Sok, a district of Phnom Penh. The new clinic focused on reaching young, unmarried Cambodians with SRH services. The centre also aims to support MSIC to achieve financial sustainability across the centre network by enabling MSIC to cover the cost of service provision by generating income.
Clinic Reach and Services
During the reporting period, our two clinics located in Phnom Penh reached:
12,821 clients with SRH services, of which 905 were long-term family planning methods.
6,086 services were accessed by young people.
Partnerships and Service Accessibility
As part of the partnerships with NGOs mentioned above, MSIC provided access to quality and affordable SRH services through special discounts for students (young people) and staff associated with our partner NGOs. In addition, we provided mobile services to our partners, to make our services even more accessible. During the reporting period, 100 young women accessed SRH services in our clinics through the service discount initiative and through mobile service provision, where MSIC providers visited NGO facilities/offices to provide services. The services included gynaecological consultations, menstrual hygiene guidance, STI testing, and HPV vaccination provision. However, in 2021, mobile service provision was cancelled due to the Covid-19 pandemic and related government restrictions.
Challenges and Lessons Learned
Impact of Covid-19 Restrictions
The most significant challenge during the reporting period was responding to the Covid-19 context and in particular, the lockdowns in Phnom Penh and Kandal. During the lockdown, most people were not allowed to leave their homes, and businesses, aside from essential businesses, had to close. We were fortunate enough to remain open, but many of our clients could not travel to MSIC clinics to access services. Not only did this decrease the number of services we provided, but it also meant more people had to risk unintended pregnancy or delay getting treatment for their SRH problems.
Commitment of Providers
However, our providers were highly committed to continuing serving clients as they understood how important it is for women to access SRH services. We have also learned to shift our marketing activities from offline to online, facilitating webinars and different virtual discussions so that the conversation surrounding SRHR continues, despite Covid-19. However, we were not able to conduct other sessions with our partners like VCAT because of their availability. Most partners were occupied with responding to the basic needs of their students and families during Covid-19. Through our partnership with three NGOs, we continued to engage with their students and referred them to our clinics should they need SRH services.
Curriculum Development and Online Engagement
The curriculum for SRH adolescent training has been developed but will need to be further reviewed. This has been delayed but will be finalised by the end of August. Although we implemented limited face-to-face interactions, technology has enabled us to continue engaging with young people via video webinars. With online sessions, we can reach more participants at one time and reach clients anywhere in the country. This allows us to reach more people. It also provides a sense of anonymity for participants if they have any questions, they feel too shy to ask as they can simply turn off their camera and/or write the questions in the chat box. We are finding ways to adapt to the Covid-19 world, ensuring that our target groups still get comprehensive information about SRH, as well as access to services.
The Covid-19 Context and MSIC’s Response
Although Cambodia was affected by Covid-19 from March 2020 onwards, the situation worsened towards the end of 2020 with the first official case of Covid-19 community transmission reported in November 2020. Things significantly deteriorated in February 2021 with the first substantial community outbreak which has led to a current daily average of 800-1000 Covid-19 cases.
From February 2021 MSIC operations have had to respond and to adapt to a range of government directives aimed at decreasing the risk of Covid-19. Government restrictions included a highly-policed lockdown in Phnom Penh and Kandal in April 2021, an inter-provincial travel ban, a curfew, and a ban on gatherings. In addition to this, various locations have implemented their own restrictions in response to an increase in Covid-19 cases in their local area. Despite these challenges, all MSIC clinics have remained operational with minimal disruption, in contrast to many other private and public facilities which struggled to operate during these challenging months.
Initiatives Implemented by MSIC
In response to the Covid-19 context, MSIC has implemented a number of initiatives to support staff and clients, including:
Enhanced infection prevention measures at a service delivery point level: This includes checking client’s temperature and asking if clients have any Covid-19 symptoms before they enter facilities, increasing cleaning protocols, implementing social distancing and ensuring staff wear provided personal protective equipment (PPE).
Transitioning offline community engagement activities to online community engagement: Using social media and online adverts to reach women with messaging on the importance of accessing SRH services during the Covid-19 pandemic.
Implementing support to staff to ensure they feel safe and secure working for MSIC: This includes providing support and equipment for staff to work from home where possible, as well as providing online sessions for staff to support their well-being.
Objective 1: Increased Understanding of FP/SRH Amongst Vulnerable Youth in Phnom Penh, Cambodia
Reaching Young People Through Partnerships
During the reporting period, MSIC partnered with three NGOs working with vulnerable youth in Phnom Penh: Happy Chandara (Toutes à l’école Luxembourg), Enfants D’Asie, and AusCam Freedom Project. Happy Chandara is a local organisation that works with more than 1,300 vulnerable girls by providing free education, food, and medical monitoring. Happy Chandara students are mostly vivacious, eager, and smart women who strive to become future leaders, decision-makers and influencers in their communities. Enfants D’Asie is a French organisation, established in Cambodia since 2001, that works to support about 1,000 young people with education, career, and moral support. AusCam Freedom Project engages with 145 young girls as part of their scholarship program.
Face-to-Face Discussions and Information Sessions
Through these partnerships, MSIC has reached 195 young people, 74 aged 15-19 years old and 121 aged 20-24 years old with comprehensive SRH information and education through face-to-face discussions. We provided seven information sessions to the students of NGO partners. The sessions were focused on topics ranging from puberty, menstruation, contraception, and safe sex. To stimulate a lively discussion, we used games and videos to engage with the students. Face-to-face sessions were stopped at the start of 2021 because of Covid-19 related restrictions.
Participation in SRHR Sessions
In November 2020, MSIC was invited to participate in the Introduction to Sexual and Reproductive Health and Rights session organised by Dosslarb. Dosslarb is a multi-media platform founded by young women who want to promote youth wellbeing, especially on SRH. 25 young women from various youth organisations attended the event. Representatives from MSIC gave a speech on the importance of SRH education and access to services among young people. Our centre midwife also provided free consultations for the participants in case they had any concerns or questions about their own SRH.
Surveys and Knowledge Improvement
Before each of our engagement sessions, a pre-session survey is conducted to gauge participants’ current understanding and knowledge of SRH topics. From these results, we can address the gaps and focus on their SRH needs. At the end of the reporting period, MSIC did a post-session survey to compare young people’s understanding of SRH before and after the sessions. A total of 79 participants answered the post-test survey, lower than the pre-test because of the students’ unavailability.
After the training, knowledge about SRH including contraception increased. Their attitudes on access to contraception by young, unmarried women improved compared to before the session and they agreed that a woman should have the right to use contraception even if her partner doesn't want her to. Realising the importance of understanding SRHR, the respondents showed high commitment to further learn about SRH either by themselves (96%) as well as encourage their close friends and/or family members to do so too (86%).
Distribution of “Let’s Talk About It” Kits
A total of 276 “Let’s Talk About It” Kits were distributed to NGO partners. Packed in a nice pink bag, our kit contains a card game (which is a bundle of questions and answers about SRH, including contraception, which we have used to play Q&A games during group discussions and other marketing activities), a condom, and an emergency contraceptive pill. The objective of the distribution is to normalise conversation about SRH and encouraging young people to talk openly about contraception, whereas the card game is designed as a fun way to test their knowledge about SRH and providing them with accurate information through the answers.
Engaging Young People Online
Using Social Media to Reach Young People with Information
In response to Covid-19 and government guidelines on limitations on gatherings and social distancing, MSIC moved many of our community engagement activities online, to ensure that young people still received messaging on SRH and accessed services despite the Covid-19 pandemic. In particular, MSIC used its presence on Facebook (Marie Stopes Cambodia) to reach potential clients with messages. Facebook serves as an important tool to reach young people due to the number of young people using it in Cambodia, especially during Covid-19 as they remain at home and engaged in e-learning. Our Facebook page has more than 94,000 followers, 29% (27,000) of whom are women under 24. During the reporting period, our content achieved an 11,506,102 reach (the number of times people have seen the content) with 346,253 engagements (reactions, comments, and shares).
Our content is designed to raise awareness on SRH topics, empower people to make choices over their body, while remaining as inclusive and sensitive to everyone, ensuring members of marginalised groups feel seen and able to access SRH services. Content topics included consent, teenage pregnancy, menstruation, masturbation, vaginal discharge, SRH services available for LGBTIQ+ people, and Pride Month celebrations. We make sure that our content is representative by including images of same-sex couples, wheelchair users, and people with disabilities. For Women’s Day celebration, we produced a video telling the inspiring story of a blind woman who owns a massage therapy centre. The video has been viewed over 15,000 times.
In June 2021, we arranged an online quiz on Facebook, asking people to share their experience using FP. We received 63 comments from people talking about which FP they’re using along with their personal anecdotes. Many of them said they’re using an IUD or implant, mostly because it’s convenient, effective for a long time, and it helps ease their concern over unintended pregnancy.
Online Sessions: “Let’s Talk About It”
Starting from April, we have started an online series called “Let’s Talk About It”, a monthly webinar live-streamed on Facebook featuring an MSIC provider discussing different SRH topics. Three webinars have been conducted covering the topics of menstruation, vaginal discharge and cervical cancer, and modern contraception. They were conducted on Zoom while also live-streamed on Facebook. A total of 376 participants registered for the webinars through our partner NGOs: Happy Chandara (Toutes à l’école Luxembourg), Enfants D’Asie, and AusCam Freedom Project. All three webinars have been viewed 3,758 times on Facebook.
Webinar Topics and Engagement
Tes Vechny, clinic Senior Midwife, was the guest speaker for the webinar on modern contraception. During the session, Vechny discussed the different types of contraceptive methods as well as dispelling any misconceptions that people might have, which is one of the biggest barriers to women accessing contraception. 109 people registered for the session. They asked questions such as, “Can you lift heavyweights if you’re using an implant?”, “Which method is the best contraceptive method?”, “Does using a contraceptive method for too long cause infertility?” and “Can breastfeeding women use a contraceptive method?”
We had two rounds of quizzes at the end of the session. The participants had to answer 10 questions and the people with the highest score won an MSIC branded water bottle. In the first attempt, 54 participants joined the quiz, earning a total response accuracy of 67% with one of the questions that stumped them the most being “How long are implants effective for?”. In the second round, 47 participants took part, earning 80% accuracy.
The students and participants from NGO partners were very active and engaged during the webinars, asking many questions about the topics, especially the topics of menstruation and vaginal discharge.
Positive Feedback
The directors from Enfants d'Asie said the students were very happy with the training and they learned many things, especially during the menstruation session. They outlined that their students had learned how to take care of their body and reproductive health better after the sessions, as well as saying that after Covid-19 is no longer a concern, we should conduct offline sessions at their schools so that the students will be able to learn even more.
For Menstrual Hygiene Day, AusCam Freedom Project invited MSIC as a guest speaker on their virtual discussion, focusing on the topic of menstruation. The discussion was live-streamed on Facebook, joined by their students and the public. The live video has been viewed 1,600 times.
The MSIC Contact Centre
The MSIC Contact Centre is the central point where people in Cambodia can access non-judgmental and confidential SRH information and advice. The Contact Centre also refers them to access SRH services at MSIC clinics and MS Ladies. From July 2020 to June 2021, the Contact Centre achieved the following:
25,431 total calls handled, of which 10,894 (43%) were calls from Phnom Penh.
5,867 (25% of the total calls) calls were from young people.
4,512 social media messages received.
8,821 referrals were made to MSIC service delivery points (centres and MS Ladies), of which 2,127 were young people.
Case Studies
H. C. Rith, Implant Client from CCA
H. C. Rith is a 22-year-old with two children. She has a small shop at home and her husband works at a publishing house. Before, she was using contraceptive pills, but because she was afraid that she’d forget, she decided to use implants after going to Marie Stopes Clinic Chba Ampov as she heard it would be more convenient. She discussed it with her partner and he didn’t say anything, simply asking if she experienced any pain or discomfort, which she hasn’t. She said, “I think it’s very important that women have access to contraception. Had I not used it, I might get unintended pregnancy.”
She heard about Marie Stopes from her in-law. She continued, “The service is good. Before going in, I had to spray alcohol to clean my hands. The waiting time wasn’t too long. The provider explained well and when I had any questions, her response was easy to understand.”
A. Heang, IUD Client
A. Heang is a 29-year-old mother with two children. Her husband is a construction worker. She recently got an IUD from a Marie Stopes clinic. “I decided to use an IUD because I didn’t want to use contraceptive pills. I was afraid I would forget. Plus, I don’t want to become pregnant again. Using an IUD is very convenient, so I opted for that,” she said. “It’s essential for women who don’t want to get pregnant.” “People in my village talk about contraception openly. I learned about Marie Stopes from my sister as she had gone there, too.”
P.K Pisey, Implant Client
Pisey is a 30-year-old office staff with one child. She went to MSIC clinic in July to get an implant because she didn’t want to have another child yet. She said, “My partner and I are working, and living with my parents, so we’re unable to take care of any more children.” She said she hasn’t experienced any side effects from the implant. Before getting an implant, she told her husband about it, and he agreed. “It was during Covid and we talked about how difficult it would be. If I had another child, getting into any hospital for a check-up is hard. We’d have to get tested every time,” she said. “I might wait for another year or two.” “Some pregnant women are infected with Covid-19. That’s incredibly difficult. We can see women getting pregnant this year during Covid-19 and they face many challenges.”
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