Informal workers and access to healthcare: a qualitative study of facilitators and barriers to accessing healthcare for beer promoters in the Lao People’s Democratic Republic

Background: Informal workers often face considerable risks and vulnerabilities as a consequence of their work and employment conditions. The purpose of this study was to examine the interplay between the experience of informal work and access to health, using as an example, female beer promoters employed in the informal economy, in the Lao People's Democratic Republic

Determinants of adolescent pregnancy and access to reproductive and sexual health services for married and unmarried adolescents in rural Lao PDR: a qualitative study

Early marriage and pregnancy is a risk factor for poor maternal and child health and socio-economic outcomes. Bokeo and Luang Namtha provinces in northern Lao People's Democratic Republic (PDR) has high rates of teenage pregnancy. The purpose of this research was firstly to explore factors contributing to teenage pregnancy in rural Lao. Secondly, to understand the specific challenges adolescent mothers face in accessing maternal health services.Qualitative interviews were undertaken with adolescent mothers and unmarried adolescents aged 12 to 19\ua0years, living in rural areas, and from different ethnic groups. In total, we undertook six focus group discussions with adolescents aged 13-19\ua0years, twenty in-depth interviews with unmarried/married adolescents aged 12-19\ua0years. In addition, we interviewed husbands of the adolescent mothers (N = 8) and mothers-in-law of both male and female adolescents (N = 9), community leaders and healthcare providers (health providers N = 17 and community leaders N = 12). Thematic analysis was used to analyze the data, based on a conceptual framework identified at the outset of the study.The findings suggest that pre-marital sex, early marriage and pregnancy are the norm in these settings. Determinants of teenage pregnancy included liberal attitudes to teen pre-marital sexual intercourse, early marriage and pregnancy, incomplete knowledge of sexual and reproductive health and limited access to appropriate services.The determinants of teenage pregnancy in this setting are multi-dimensional, and require a range of responses. As some of the determinants are deeply embedded in the system of local values, beliefs and practices, and form part of the logic of what it is to become a healthy woman, these practices are deeply entrenched and may be resistant to new knowledge. The challenge therefore is to find culturally responsive strategies that enable individual and collectively agency

Lifestyles, sexuality and gender: vulnerability to STIs and unplanned pregnancy among female migrant beer promoters in Lao PDR

In Southeast Asia, many young rural female migrants supplement their income by working as beer promoters. This study examined how young, female beer promoters working in Vientiane Capital, Lao PDR, navigate intimate relations and sexual encounters and how their experiences create sexual vulnerabilities. A total of 30 female beer promoters aged 18-24 years old were recruited using snowball sampling. Repeated face-to-face in-depth interviews were undertaken and thematic analysis conducted to identify common themes. Most participants had their first coital experience pre-migration but living in the city introduced them to a larger pool of potential partners. Unprotected sexual intercourse was common, with young women usually deferring to their male partners preference for non-condom use. Working as beer promoters, the sexualised environment of the bar room promoted male ideals of femininity and exposed the young women to sexual harassment. While the young women used various strategies to assert their autonomy, and challenge unequal gender norms, the prevailing male hegemony acted to subvert female sexual agency. Leveraging young urban migrants’ desire to complete education, live independently and postpone motherhood may provide opportunities to examine and challenge gender norms and harmful practices.</p