Cost of Health Education to Increase STD Awareness in Female Garment Workers in Bangladesh

Article excerpt

Introduction

Female garment workers in Bangladesh develop a social sub-group as they live away from their families, usually by themselves in a metropolitan city like Dhaka. (1) Consequently, they make decisions about their lives and daily activities that do not conform to traditional beliefs, e.g., choosing a sexual life style, marrying at an older age, working alongside and competing with men. (1) Mo st female workers start working at the garment industries while single during their adolescent years, (2) a time of transition that involves sexual development. (3) These workers grow into their adulthood as they work in the garment industry, a very different environment than what their mothers experienced at the same age. (1) The very adolescent characteristics with "formation of one's individuality, expressions of intimacy, and the defining of experiences within a sexual and romantic framework" (3) make these female workers especially vulnerable to undue social consequences including risk of acquiring sexually transmitted diseases (STDs). Risk of STDs, e.g., multiple sex partners, lack of knowledge about safe sex practice and having an STD without the knowledge of having it, have been documented in Bangladeshi garment workers. (4-5) Social disapproval of sexual activity and limited access to information about safe sex in unmarried women in Bangladesh make it harder for the female workers to talk about sexuality related health problems. (6) The obvious need for health education to increase awareness with a goal of prevention of STDs in these workers has also been emphasized in the past. (5) However, no information on any formal health education program on STDs in the female garment workers in Bangladesh is available.

Bangladesh garment industry exports were US $14110.8 million in fiscal year 2007-2008. (7) About ninety percent of the garment workers are women. (1) Personal, family and aggregate economic impacts of these garment industry jobs in Bangladesh are important and there is a need for addressing the health status of female garment workers at the comprehensive policy level. A healthy workforce is not only a step toward empowering a business, but also in empowering the economy by decreasing the burden of health care costs. Given limited available resources, cost-effectiveness evaluation helps inform public health decision makers to determine the health education programs with the greatest benefit. (8-10) Lack of information on STD awareness health education programs among garment workers prevents determination of cost-effectiveness for such a program in Bangladesh.

Peer group education among sex workers in Chad has been found to be very cost-effective in preventing STDs. (11) An intervention to prevent HIV/AIDS was more acceptable when demonstrated with its cost-effectiveness in decreasing "negative health outcomes", e.g., reducing the incidence of new STD infection among the African American and Latino clients attending STD clinics in the USA. (12) This method may also work to motivate garment factory employers in Bangladesh to support groups of female workers in being educated to reduce preventable health problems, e.g., STDs.

Purpose of Study

This study provided a cost-effectiveness analysis of a formal health education program and reported on differences in knowledge and awareness about STDs and their risk factors among the female garment factory workers with and without exposure to the health education program.

Methods

Health Education Program and Selection of Factories for Participation

A convenience sample of 41 female workers from six garment factories in Dhaka, Bangladesh was interviewed with a semi-structured open-ended questionnaire. Factories engaged in similar work were selected as they either did or did not offer health education classes. A physician at a local Family Planning and Reproductive Health clinic designed a curriculum addressing issues of personal and reproductive health with an emphasis on STDs. …