DOCSLIB.ORG

Ellie Hukin Thesis Final Draft Post Viva and Corrections6

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Ellie Hukin Thesis Final Draft Post Viva and Corrections6 London School of Economics and Political Science Contraception in Cambodia Explaining Unmet Need Eleanor Frances Hukin A thesis submitted to the Department of Social Policy at the London School of Economics for the degree of Doctor of Philosophy, London, September, 2012 Declaration of Authorship I certify that the thesis I have presented for examination for the MPhil/PhD degree of the London School of Economics and Political Science is solely my own work other than where I have clearly indicated that it is the work of others (in which case the extent of any work carried out jointly by me and any other person is clearly identified in it). The copyright of this thesis rests with the author. Quotation from it is permitted, provided that full acknowledgement is made. This thesis may not be reproduced without my prior written consent. I warrant that this authorisation does not, to the best of my belief, infringe the rights of any third party. I declare that my thesis consists of 79,756 words. Statement of use of third party for editorial help I can confirm that my thesis was copy edited for conventions of language, spelling and grammar by Janice Hukin. Eleanor Frances Hukin 2 Abstract This thesis aims to explain why there is a high level of unmet need for contraception in Cambodia - a country where effective methods of birth control are cheaply available and morally acceptable. The research design takes a mixed methods approach, initially using data from the Cambodian Demographic and Health Surveys of 2000 and 2005 to assess trends in contraceptive use. Multivariate logistic regression is used to analyse factors associated with, firstly, unmet need, and secondly, use of traditional contraceptive methods. The likelihood of having an unmet need for contraception increased as education and wealth levels decreased; urban or rural residence had no significant effect. However, the likelihood of using traditional methods, rather than modern methods, increased as education and wealth increased. Taking these findings and the questions they raise as a departure point, 21 months of ethnographic fieldwork was conducted in one urban and one rural site in Northwest Cambodia between 2008 and 2010. The study looks at women’s and men’s reproductive decision making with a focus on their experiences of and meanings given to contraception, situating these understandings within the broader social context. Fear of side effects, stemming from both contraceptive experiences and notions of health and the body, was found to be the greatest obstacle to use of modern contraceptives. This related more broadly to the pluralistic medical systems operating simultaneously and the varying levels of medicalization and trust in both biomedicine and the Cambodian health system. Behaviour that seemed counter-intuitive at the outset - not wanting to become pregnant but not using contraception, and wealthy educated women choosing traditional over modern methods – becomes understandable in light of the context and meanings highlighted by the ethnographic data. This thesis provides a unique empirical study which contributes to the emerging field of anthropological demography. By bringing approaches and methods from medical anthropology to the typically demographic phenomenon of unmet need, the study provides a new insight for social policies regarding reproductive health as well as contributing to the body of ethnographic literature on Cambodia. 3 Acknowledgements Janice and Stuart Hukin, Simon Hukin, Phan Sotheavy, Phan Sophearn, Thim Chhorb, Huy Phan, Phan Van Soneng, Phan Somnang, Bonh Te, Ernestina Coast, Rebecca Sear, David Lewis, Melody Mohebi, Emily Freeman, Shaffa Hameed, Alice Goisis, Paul Bouanchaud, Eleri Jones, Dwan Kaoukji, Nisrine Mansour, Gabriella Mejia-Pailles, Nahid Kamal, Ellie Reynolds, Dewi I. Puradiredja, Nina Gosling, the Economic and Social Research Council, the London School of Economics, the Department of Social Policy at LSE, and His Excellency Him Chhem. Most of all, I would like to thank my friends, family and informants in the field without whom this research would not have been possible. 4 Contents Declaration of Authorship ............................................................................................... 2 Abstract ............................................................................................................................. 3 Acknowledgements ........................................................................................................... 4 List of Acronyms and Abbreviations............................................................................ 10 List of Khmer Terms ..................................................................................................... 12 Chapter 1: Introduction ................................................................................................ 13 Defining and measuring unmet need............................................................................ 14 Prior research on contraceptive use in Cambodia ........................................................ 19 Research questions ....................................................................................................... 23 Structure of thesis ......................................................................................................... 23 Chapter 2: Methodology .............................................................................................. 26 Research design ............................................................................................................ 26 Quantitative research ................................................................................................ 27 Qualitative research .................................................................................................. 28 Theoretical framework ............................................................................................. 31 Preparation, language, fieldwork ................................................................................. 35 Arriving in Siem Reap ............................................................................................. 36 Language learning .................................................................................................... 37 Research site selection ................................................................................................. 38 Why Siem Reap? ...................................................................................................... 38 Choosing sites .......................................................................................................... 40 Sampling .................................................................................................................. 44 Research methods during fieldwork............................................................................. 46 Participant observation and field notes .................................................................... 46 Interviews ................................................................................................................. 48 Ethical considerations .............................................................................................. 52 Conclusion ................................................................................................................... 54 5 Chapter 3: Setting – The people and the health system ............................................. 55 The demography of Cambodia ..................................................................................... 57 The health system in Cambodia ................................................................................... 61 The public health system: organisation and characteristics ..................................... 63 Health financing and delivery .................................................................................. 66 Private sector health care ......................................................................................... 70 Indigenous health care.............................................................................................. 73 The history of family planning policies in Cambodia .................................................. 79 Conclusion ................................................................................................................... 83 Chapter 4: Khmer reproductive models ...................................................................... 85 Part 1: The number of children .................................................................................... 87 Ideal family size ....................................................................................................... 87 The costs of children ................................................................................................ 90 Big families and power ............................................................................................ 97 Lineage continuation ................................................................................................ 99 Old age dependency ............................................................................................... 101 Child mortality ....................................................................................................... 102 The need to replenish Khmers................................................................................ 105 Part 2: The gender of children ...................................................................................
Load more

Recommended publications
  • Contraceptive Use and Induced Abortion in Cambodia
    Contraceptive Use and Induced Abortion in Cambodia Social and Cultural Context, Perceptions and Decisions made Population Research Centre University of Groningen Netherlands Loes Kendle Supervisors: Prof. Dr. I. Hutter & Dr. F. Janssen Contraceptive Use and Induced Abortion in Cambodia 2 Social and Cultural Context, Perceptions and Decisions made Preface Somewhere half way through the first semester, the mind was pushed into deciding what to do for a master’s thesis. Different ideas popped into mind, but it was soon clear that it had to be something to do with reproductive health, and preferably somewhere abroad. Luck had it that close friends of my family were visiting, Simon and Oie. Here the first suggestion was given that has brought me to Cambodia and back. The idea was very appealing, but there were difficulties to overcome. First of all there were no established contact, so not only did I have to convince my professor, Dr. Inge Hutter, to allow me to go, but I also needed to make contact and find someone there to help me set up my research. The first part was the easiest part. My professor has been a never-ending source of support on my scientific, as well my personal, journey that has lead to this thesis. My ‘big brother’ Simon was my only contact in Cambodia, but it was his friend Bart Jacobs, who brought me into contact with Dr. François Crabbé. With his help I was able to hand in my request to the National Ethical Committee of Cambodia, and did I find a location to do my fieldwork, the Mother and Child Health clinic in Sihanoukville.
    [Show full text]
  • Joint Cambodian Ngoreport on Torture and Other Cruel, Inhuman
    Joint Cambodian NGO Report on Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment in the Kingdom of Cambodia Presented to the UN Committee Against Torture (CAT) prior to Cambodia’s second periodic report at the 45th session of CAT, held in Geneva from 1 to 19 November 2010 October 2010 Jointly prepared by Cambodian Human Rights and Development Association (ADHOC), Cambodian Defenders Projects (CDP), Cambodian League for the Promotion and Defense of Human Rights (LICADHO), Transcultural Psychosocial Organization (TPO), Cambodian Human Rights Action Committee (CHRAC), and endorsed by Asian Human Rights Commission (AHRC); Cambodian Center for Human Rights (CCHR); Coordination of Action Research on AIDS and Mobility (CARAM Cambodia); Community Legal Education Center (CLEC); Cambodian Women in Crisis Center (CWCC); Khmer Institute of Democracy (KID); Khmer Youth Association (KYA); Legal Aid of Cambodia (LAC); People’s Center for Development and Peace (PDP); Protection of Juvenile Justice (PJJ); Human Rights Vigilance of Cambodia (VIGILANCE) Table of Contents Abbreviations ...............................................................................................................3 I. Executive Summary ………………………………………………………………………………………………4‐5 II. Summary Recommendations ………………………………………………………………………………6‐7 III. Introduction ………………………………………………………………………………………………………….8 IV. Comments on the Cambodia Report and Replies to the List of Issues ……………….9‐43 V. Recommendations ………………………………………………………………………………………….44‐46 Annex 2 Abbreviations
    [Show full text]
  • Commodifying Karma: Abortion Discourses and Kaekam Practices in Thai Society
    COMMODIFYING KARMA: ABORTION DISCOURSES AND KAEKAM PRACTICES IN THAI SOCIETY A Thesis Presented to the Faculty of the Graduate School of Cornell University In Partial Fulfillment of the Requirements for the Degree of Master of Arts by Moodjalin Sudcharoen May 2013 © 2013 Moodjalin Sudcharoen ABSTRACT In Thailand, abortion received little attention until the 1980s, when some social activists introduced legal reforms that would have legalized the practice, but they failed to achieve their goals. From the 1990s to the present, abortion became a topic of popular discourses as Buddhism became increasingly commodified. Entrepreneurs introduced ways for women who have had abortions to pay for services that would ameliorate their bad karma; this is known as the trend of kaekam. While the dominant discourse has long depicted abortion as a life-destroying act from a Buddhist perspective, the emphasis on embodied karma in the form of vengeful child ghosts, the ability to change one’s karma through certain rituals, and confessions by those involved in abortions is all recent. I argue that these phenomena not only dominate public discussions and perpetuate abortion stigma, but also allow some groups to gain economic benefit from the fear of the negative effects of the karma incurred through various forms of the karma business. BIOGRAPHICAL SKETCH Moodjalin Sudcharoen, nicknamed Mood, was born in Bangkok, Thailand, in February 1988. From 1994 to 2006, she studied at Assumption Convent School, Bangkok. Afterwards, she spent four years as an Honors Program student of the Department of Thai, Faculty of Arts, Chulalongkorn University, Bangkok, and received a Bachelor’s degree (1st class honors) in March 2010.
    [Show full text]
  • Abortion and the Law in New
    NSW PARLIAMENTARY LIBRARY RESEARCH SERVICE Abortion and the law in New South Wales by Talina Drabsch Briefing Paper No 9/05 ISSN 1325-4456 ISBN 0 7313 1784 X August 2005 © 2005 Except to the extent of the uses permitted under the Copyright Act 1968, no part of this document may be reproduced or transmitted in any form or by any means including information storage and retrieval systems, without the prior written consent from the Librarian, New South Wales Parliamentary Library, other than by Members of the New South Wales Parliament in the course of their official duties. Abortion and the law in New South Wales by Talina Drabsch NSW PARLIAMENTARY LIBRARY RESEARCH SERVICE David Clune (MA, PhD, Dip Lib), Manager..............................................(02) 9230 2484 Gareth Griffith (BSc (Econ) (Hons), LLB (Hons), PhD), Senior Research Officer, Politics and Government / Law .........................(02) 9230 2356 Talina Drabsch (BA, LLB (Hons)), Research Officer, Law ......................(02) 9230 2768 Lenny Roth (BCom, LLB), Research Officer, Law ...................................(02) 9230 3085 Stewart Smith (BSc (Hons), MELGL), Research Officer, Environment ...(02) 9230 2798 John Wilkinson (MA, PhD), Research Officer, Economics.......................(02) 9230 2006 Should Members or their staff require further information about this publication please contact the author. Information about Research Publications can be found on the Internet at: www.parliament.nsw.gov.au/WEB_FEED/PHWebContent.nsf/PHPages/LibraryPublications Advice on
    [Show full text]
  • 1. Entry Into Reproductive Life
    United Nations E/CN.9/2002/2 Distr.: General Economic and Social Council Original: English Commission on Population and Development Thirty-fifth session 1-5 April 2002 Item 3 of the provisional agenda∗ Follow-up actions to the recommendations of the International Conference on Population and Development Concise report on world population monitoring, 2002: reproductive rights and reproductive health with special reference to HIV/AIDS Report of the Secretary-General Summary The present report has been prepared in accordance with the terms of reference of the Commission on Population and Development and its topic-oriented prioritized multi-year work programme, which was endorsed by the Economic and Social Council in its resolution 1995/55. The Commission, in its decision 2000/1 decided that the theme for the Commission at its thirty-fifth session in the year 2002 should be “Reproductive rights and reproductive health, with special reference to human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS)”. The report provides a summary of recent information on selected aspects of reproductive rights and reproductive health and covers topics such as entry into reproductive life; reproductive behaviour; family planning; abortion; maternal mortality and morbidity; sexually transmitted infections; human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS); and policy issues related to reproductive rights. The preliminary, unedited version of the full report is available as a working paper in document ESA/P/WP.171. The report was prepared by the Population Division of the Department of Economic and Social Affairs with contributions by the World Health Organization and the Joint United Nations Programme on Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) (UNAIDS).
    [Show full text]
  • Abortion in Cambodia Country Report
    Abortion in Cambodia Country Report Dr. Chhun Long Ms. Neang Ren Expanding Access: Midlevel Provider s in Menstrual Regulation and Elective Abortion Care 3 – 6 December, 2001 South Africa 1 Abbreviations: CDHS Cambodia Demography Health Survey KAP Survey Knowledge Attitude and Practice survey MOH Ministry of Health MOP Ministry of Planning MMR Maternal Mortality Rate NMCHC National Mother Child Health Center SESC Socio-Economic Survey of Cambodia TBAs Traditional Births attendents HC Health Center I. Country background Cambodia, situated in the Mekong Sub-Region, bordered by Thailand in the west and north, Laos in the north, Vietnam in the east and southeast and the Gulf of Thailand in the south-west, is one of the poorest and least developed countries in South East Asia. The total population is over 11 million people, living on an area of 180.000 square kilometers of which more than 40 percent is covered by forest. The capital city, Phnom Penh, lies at the confluence of the Mekong, Tonle Sap and Tonle Bassac Rivers. The country is divided into 24 provinces and 183 districts. Districts vary greatly in total land area and in number of people, the smallest having as few as 3.000 people, the largest more than 150.000. Cambodia has suffered a long period of war from 1970. During the period of 1975-1979, more than 2 millions people, mostly men and including many medical professionals, lost their lives, leaving a large number of widow women to head their family and raise their children. The health care system was almost totally destroyed in that period.
    [Show full text]
  • Ghazaleh Samandari, Phd MPH Adjunct Assistant Professor, University of North Carolina at Chapel Hill [email protected] • 202-277-3495
    Dr. Ghazaleh Samandari, PhD MPH Adjunct Assistant Professor, University of North Carolina at Chapel Hill [email protected] • 202-277-3495 EDUCATION: The University of North Carolina – Chapel Hill 2010 School of Public Health Degree: PhD in Public Health Minor: Health Behavior and Health Education The George Washington University, Washington, D.C. 2005 School of Public Health and Health Services Degree: Master of Public Health Boston College, Chestnut Hill, MA 2002 School of Arts and Sciences Degree: Bachelor of Arts SKILLS: - Design, implementation and analysis of operations research and project monitoring & evaluation - Development and execution of complex statistical analyses - Quantitative and qualitative research in health communication, health behavior and social marketing - Focus group and in-depth interview design and administration - Knowledgeable in SAS, SPSS, STATA, MPLUS, EXCEL and ACCESS software applications - Topical expertise in Adolescent Sexual and Reproductive Health, Domestic Violence, HIV/AIDS, Malaria, Sexual and Reproductive Health, Human Resources for Health - Proficient in Farsi, conversational in Spanish and French - Professional experience working in multiple international and domestic settings, working effectively both in groups and independently - Highly organized, detail-oriented, flexible, self-motivated - Excellent written and oral communication skills PROFESSIONAL EXPERIENCE: JOHN SNOW, INC. (KMS PROJECT) Washington, DC - Senior Research Analyst 2013-present • Supporting USAID’s seven Element teams:
    [Show full text]
  • Development of an Intervention to Support Reproductive Health of Garment Factory Workers in Cambodia
    Development of an Intervention to Support Reproductive Health of Garment Factory Workers in Cambodia Chris Smith ( [email protected] ) London School of Hygiene and Tropical Medicine https://orcid.org/0000-0001-9238-3202 Ly Sokhey Marie Stopes International Cambodia Camille Tijamo Marie Stopes International Cambodia Megan McLaren Marie Stopes International Caroline Free London School of Hygiene and Tropical Medicine Department of Population Health Justin Watkins School of Oriental and African Studies London: SOAS University of London Ou Amra Marie Stopes International Cambodia Chisato Masuda School of Tropical Medicine and Global Health, Nagasaki University Amy Williamson Marie Stopes International Cambodia Elisa Oreglia King's College London Research Keywords: Family planning, contraception, abortion, Cambodia, garment factory workers, intervention development, intervention mapping, videos, behaviour change Posted Date: October 22nd, 2020 DOI: https://doi.org/10.21203/rs.3.rs-94573/v1 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Page 1/20 Abstract Background: Garment factory workers in Cambodia are potentially a vulnerable population in terms of support for reproductive health issues and access to services, as the majority are young women aged under 30 years who have migrated from rural areas away from their family and community support. The aim of this paper was to describe the development of an intervention to support the reproductive health of garment factory workers in Cambodia. Methods: The research was conducted by a multidisciplinary team with backgrounds in public health, linguistics, digital cultures and service delivery in a suburb of Phnom Penh where many garment factories cluster.
    [Show full text]
  • Forest Crimes in Cambodia
    RESEARCH REPORT FOREST CRIMES IN CAMBODIA Rings of illegality in Prey Lang Wildlife Sanctuary MARCH 2021 FOREST CRIMES IN CAMBODIA Rings of illegality in Prey Lang Wildlife Sanctuary ww March 2021 ACKNOWLEDGEMENTS While there are many individuals who deserve recognition for their support and participation in this report, none can be named owing to the security threat and potential reprisals driven by increasing restrictions in Cambodia on the freedom of expression, civic interaction and par- ticipation. As such, our deepest gratitude goes to the participants who contributed to the report in the face of these risks. Many thanks to the Cambodian scholars and practitioners who contributed to this report and who worked under extremely challenging conditions to tackle issues caused by organized illegal logging in the Prey Lang Wildlife Sanctuary. It has been a privilege to see the work and dedication of the field prac- titioners, who put their lives on the line to protect one of the last intact forest landscapes in the country. Our gratitude goes to the reviewers who made invaluable suggestions and comments that greatly improved the strength of the report. Bruno Manser Fonds is kindly acknowledged for their critical support to the authors in the preparation of the report. We are extremely thankful for the support from the team at the Global Initiative Against Transnational Organized Crime, whose engagement, funding and great editorial work have made this report possible. AUTHORS’ NOTE The authors’ credentials include many years’ experience and research in Cambodia, and they have a deep understanding of Cambodian politics and society from extensive fieldwork in the country.
    [Show full text]
  • Everyday Experiences of Genocide Survivors in Landscapes of Violence in Cambodia
    EVERYDAY EXPERIENCES OF GENOCIDE SURVIVORS IN LANDSCAPES OF VIOLENCE IN CAMBODIA A thesis submitted to Kent StAte University in partial fulfillment of the requirements for the degree of MAster of Arts by Savina Sirik December, 2015 © Copyright All rights reserved Except for previously published mAteriAls Thesis written by Savina Sirik B.A., The RoyAl University of Fine Arts, 2004 M.A., Coventry University, 2007 M.A., Kent StAte University, 2015 Approved by James Tyner, Professor, Ph.D., Advisor Scott Sheridan, Professor, Ph.D., Chair, DepArtment of GeogrAphy James L. Blank, Ph.D., DeAn, College of Arts And Sciences Table of Contents List of Figures ...................................................................................................................................................... iv Acknowledgments ................................................................................................................................................ v Chapter One: Introduction ............................................................................................................................... 1 HistoricAl BAckground of the DemocrAtic KampucheA Regime (1975-1979) ............................................ 5 Zone and Regional Variations .......................................................................................................................................... 7 MemoriAlizing LAndscApes of Violence during the PRK Period ........................................................................ 9 OrgAnizAtion
    [Show full text]
  • The Intersection of Abortion and Gun Rights , 50 Rutgers L
    Fordham Law School FLASH: The Fordham Law Archive of Scholarship and History Faculty Scholarship 1997 Principles and Passions: The nI tersection of Abortion and Gun Rights Nicholas J. Johnson Fordham University School of Law, [email protected] Follow this and additional works at: http://ir.lawnet.fordham.edu/faculty_scholarship Part of the Constitutional Law Commons, Health Law Commons, Second Amendment Commons, and the Women Commons Recommended Citation Nicholas J. Johnson, Principles and Passions: The Intersection of Abortion and Gun Rights , 50 Rutgers L. Rev. 97 (1997-1998) Available at: http://ir.lawnet.fordham.edu/faculty_scholarship/437 This Article is brought to you for free and open access by FLASH: The orF dham Law Archive of Scholarship and History. It has been accepted for inclusion in Faculty Scholarship by an authorized administrator of FLASH: The orF dham Law Archive of Scholarship and History. For more information, please contact [email protected]. PRINCIPLES AND PASSIONS: THE INTERSECTION OF ABORTION AND GUN RIGHTs* Nicholas J. Johnson** In this article, Professor Nicholas J. Johnson explores the paral- lels between the right of armed self-defense and the woman's right to abortion. ProfessorJohnson demonstrates that the theories and prin-, ciples advanced to support the abortion right intersect substantially with an individual's right to armed self-defense. Professor Johnson uncovers common ground between the gun and abortion rights-two rights that have come to symbolize society's deepest social and cultur- al divisions-divisions that prompt many to embrace the abortion right while summarily rejecting the gun right. Unreflective dispar- agement of the gun right, he argues, threatens the vitality of the abortion choice theories with which gun-rights arguments intersect and suggests that society's most difficult questions are settled not on principle, but by people's passions.
    [Show full text]
  • CHRONOS the History Journal of Yeshiva University
    CHRONOS The History Journal of Yeshiva University 2018-2019 Editor-in-Chief Shana Adler Editors Hadassah Penn Dani Ritholtz ZaCk Rynhold Scott Weissman Yeshiva University, New York, NY TABLE OF CONTENTS WelCome Letter Tziona Kamara, Patriotism: Barbeques or Bravery?…………………...…………………………………………........7 Dena Katz, Before and After Jone v. Hallahan: Gender Roles in Marriage Defined and Redefined…………….………….…….………18 Dani Ritholtz, The Effects of Museums In Depicting Atrocities Around the World..………………………...………………….......28 ZaCk Rynhold, Identifying Subjectivity: The Power of Bias and Narrative in Historical Writing.………………….……………41 Elianna Sharvit, The Evolution of Tchaikovsky’s NutCraCker..………………...……..………………………………….55 Liora Steinberg, Liberty Weekend: July 4, 1986.……………….. ……………………………..……………………………70 Faculty Contribution Professor William Stenhouse, Scribbles, Supplements and Strike-throughs: Early Modern Readers and The Epigrammata Antiquae Urbis.………………....….…81 Dear Reader, WelCome to the 2018-19 edition of Chronos: The History Journal of Yeshiva University. For over a deCade, Chronos has served as a forum dediCated to the dissemination of student research on a broad range of subjeCts within the realm of history. We would like to aCknowledge the authors of these papers for working with us to prepare their submissions for publiCation. The artiCles in this issue are diverse, innovative, and interesting, and they stand as a testament to the high Caliber of students’ work at Yeshiva University. We would also like to thank Professor William Stenhouse for Contributing his artiCle as the faCulty submission for this issue. Additionally, we are grateful to the Dean’s OffiCe of Yeshiva University for their enthusiastiC support of the Chronos, both aCademiCally and financially. Finally, we extend our sincere gratitude to our faCulty adviser, Dr.
    [Show full text]