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Abortion Baseline Report.Indd Solidarity for the Right to Safe Abortion Alliance & the partner organizations National Baseline Research Claiming the Right to Safe Abortion: Strategic Partnerships in Asia Abortion related Stigma and Discrimination in Cambodia Solidarity for the Right to Safe Abortion Alliance & the partner organizations National Baseline Research Claiming the Right to Safe Abortion: Strategic Partnerships in Asia Abortion related stigma and discrimination in Cambodia 2 VERSO PAGE The verso page includes the ISBN number, publishers (contact information of partner organisation and ARROW), publication team, and cover photo credits. 3 TABLE OF CONTENTS VERSO PAGE ................................................................................................................. 3 TABLE OF CONTENTS .................................................................................................... 4 ACKNOWLEDGEMENTS ................................................................................................ 5 LIST OF ACRONYMS AND ABBREVIATIONS ................................................................... 5 LIST OF TABLES ............................................................................................................. 6 LIST OF FIGURES ........................................................................................................... 6 EXECUTIVE SUMMARY .................................................................................................. 7 1. Introduction .................................................................................................................9 2. Country profile: Socio-economic and political context ........................................16 3. Profiling Cambodia: SRHR ........................................................................................16 4. Abortion: Country Situation, Critical Issues and Attempts to Ensure the Right to Safe Abortion ....................................................................................................................... 17 5. Abortion: Gaps in Understanding the Issues and Addressal of the Issues ........17 6. Baseline Research Findings ......................................................................................18 7. Conclusions.......................................................................................................51 8. Recommendations ...................................................................................................53 9. List of references .......................................................................................................54 10. APPENDICES ................................................................................................................55 4 ACKNOWLEDGEMENTS This project is a collaboration between Angkor Research and Consulting, the Reproductive Health Association of Cambodia (RHAC), and the Asian-Pacific Resource and Research Centre for Women (ARROW). The project was led at RHAC by Mrs. Sek Sisokhom, and overseen at ARROW by Ms. Azra Abdul Cader, both of whom provided inputs into the research design, instruments, data collection, and analysis of results. RHAC provided the national context and background included in the introduction. At Angkor Research, Mr. John Nicewinter and Mrs. Saing Ratanaksophea managed the project together. John drafted the instruments, selected the sample, conducted analysis and wrote the draft report. Ratanaksophea tested and revised the instruments, conducted field staff training, managed the data collection and supervised the transcription and translation of all qualitative data. Mr. Ian Ramage, Chief Technical Officer, oversaw the project. LIST OF ACRONYMS AND ABBREVIATIONS ARROW Asian-Pacific Resource and Research Centre for Women CAC Comprehensive abortion care CAPI Computer-assisted personal interview CDHS Cambodia Demographic and Health Survey CSES Cambodia Socio-Economic Survey HH Household IDI In-depth interview ILAS Individual Level Abortion Stigma Scale IUD Intrauterine device NCDD National Committee for Sub-National Democratic Development PPS Probability proportional to size RHAC Reproductive Health Association of Cambodia SABAS Stigmatizing Attitudes, Beliefs and Actions Scale SRHR Sexual and reproductive health and rights STI Sexually transmitted infection TOR Terms of reference TV Television 5 LIST OF TABLES Table 1: Qualitative sample description. .................................................................... 12 Table 2: Sample selection probabilities and weights, by province. ............................ 13 Table 3: Quantitative respondent sociodemographic characteristics, by province. ... 19 Table 4: Qualitative respondent characteristics, by province. .................................... 20 Table 5: Household income in the last 12 months, by province. ................................ 20 Table 6: Respondent income in the last 12 months, by province. .............................. 21 Table 7: Wealth groups, by province. ......................................................................... 22 Table 8: Respondent mobile phone and media access. .............................................. 23 Table 9: Sexual and reproductive health knowledge, by province. ............................ 24 Table 10: Use of contraception, by province. ............................................................. 25 Table 11: Contraceptive decision-making, by province. ............................................. 26 Table 12: Sexual decision-making, by province. ......................................................... 27 Table 13: Primary person responsible for women’s contraceptive, reproductive and overall health care decision-making, by province. ...................................... 28 Table 14: Knowledge of abortion legality in Cambodia, by province. ......................... 32 Table 15: SABAS scores, by province. ......................................................................... 37 Table 16: Individual SABAS questions, by province. ................................................... 37 Table 17: Attitudes toward abortion providers, by province. ..................................... 41 Table 18: ILAS scores, by province. ............................................................................. 42 Table 19: ILAS individual questions, mean scores by province. .................................. 43 Table 20: Experience with abortion, by province. ...................................................... 46 Table 21: Abortion characteristics, by abortion (n=73). ............................................. 48 Table 22: Post-abortion follow-up and contraceptive use. ......................................... 49 LIST OF FIGURES Figure 1: Primary household income source, by household wealth group. ............... 22 Figure 2: Sources of reproductive health information for women, from most important (1) to least important (10), by province. .................................... 23 Figure 3: Contraceptive methods known by women that know of any contraceptive method, by province (multiple response; answers do not total to 100%). ........ 25 Figure 4: Use of contraceptive methods, among women that had ever used any contraceptive, by province (multiple response). ......................................... 26 Figure 5: Women’s overall decision-making ability for their own health. .................. 29 Figure 6: Abortion decision-making, among women who would consider having an abortion. ................................................................................................ 30 Figure 7: Knowledge of abortion legality in specific situations, by province (only among women that reported knowing of abortion laws; n=283). .............. 33 Figure 8: Likelihood of arrest for women having (L) and medical staff performing (R) abortions in Cambodia........................................................ 34 Figure 9: Abortion providers, as identified by women (multiple response). .............. 35 Figure 10: Primary reason for most recent abortion, among women that ever had an abortion, by province. ..................................................................... 46 Figure 11: Person that women discussed their abortion with before/after the most recent abortion (multiple response; unweighted n). ....................... 47 Figure 12: Contraceptive use after each abortion where women started using contraception (multipleesponse; r n=35). .................................................. 50 6 EXECUTIVE SUMMARY Lack of information about how women and their communities understand and perceive abortions, women who have abortions, and abortion service providers has resulted in limited knowledge on how women’s lives change after an abortion. Despite the fact that abortion was legalized in Cambodia in 1997, available information demonstrates that women greatly hesitate to access safe abortion services, and even when they access them, they are strongly stigmatized within their community after having an abortion. Therefore, the current study was undertaken to measure the awareness of abortion legality and the levels of stigma and discrimination around abortion in Cambodia. The mixed methods study involved a quantitative survey of 300 women of reproductive age (WRA; 15-49 years old), which is weighted to ensure proportional representation of WRA in the target provinces of Siem Reap and Kampot. As well, 26 in-depth interviews (IDIs) with community leaders and six separate focus group discussions (FGDs) with WRA, their husbands/partners,
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