Sex workers wait for clients late at night near Wat Phnom in downtown Phnom Penh in 2009. Sovan Philong

Abortions pose hidden risk for Cambodia's sex workers: study

A shocking 40 percent of maternal deaths among Cambodian sex workers were the result of abortions, according to a recent study.

The research, published online last week in peer-reviewed journal BioMed Central Public Health, surveyed 271 female sex workers to ascertain the major causes of death for mothers in the industry and their children.

Study author and Global Health Promise director Brian Willis said his research found that of 194 reported deaths of female sex workers, nearly a quarter, 43, were maternal deaths, meaning women who died either during pregnancy, during childbirth or within six weeks of a termination or childbirth.

Willis said his team chose to focus on 32 of those 43 deaths because they occurred after the 2010 Cambodian Demographic Health Survey; his interviews took place in 2013, before the 2014 demographic survey was released.

A total of 13 women out of the 32 sex workers died from an abortion, while five (16 percent) died of complications related to HIV.

The report hinted that the high proportion of abortion-related deaths could indicate sex workers face barriers to reproductive health, safe abortions and post-abortion care.

“Based on the data we collected, it is unclear why so many of the reported deaths were due to abortion,” Willis said, adding the reasons warranted further research.

Dr Var Chivorn, executive director of the Reproductive Health Association of Cambodia, said despite abortions being a legal procedure in the Kingdom, stigma and shame were still major contributors to pregnant women seeking secret – and sometimes fatal – abortions.

“Because abortion is sensitive and the women don’t want to disclose their pregnancy, sex workers, as the most vulnerable group, tend to go somewhere where they can hide their identity, where it’s cheap. They often go to an unqualified provider,” he said.

He said abortions were the cause of 30 percent of maternal deaths in Cambodia overall, much lower than the study’s 40 percent figure for sex workers.

Chivorn said some women took abortion medication without proper advice, which could lead to complications, while others sought out traditional healers who used a deep massage on the womb.

Chivorn said this sometimes meant the foetus was not completely expelled and could lead to bleeding and infection, often resulting in the death of the woman due to septic shock.

“Abortion is actually very safe if performed by a trained provider,” Chivorn said.

The study found that obstructed labour and suicide each claimed three lives (9 percent each), while two women were killed in accidents and one was murdered.

One woman died of postpartum hemorrhage, and four deaths had unknown causes.

The participants reported a total of 58 children of sex workers had died, with HIV responsible for more than a third of deaths in children under 5.

Willis also pointed to a stark difference between his work and the official statistics from the 2010 CDHS.

That survey identified 40 maternal deaths among the general population through interviews conducted with more than 18,000 women, while his team identified 32 by interviewing “a much smaller sample” of 271 female sex workers in 2013. The 2014 demographic survey reported exactly 32 maternal deaths.

The disparity could suggest “there may be many unrecognized maternal deaths among [female sex workers] in Cambodia”, the report reads.

Sivann Botum, secretary of state with Ministry of Women’s Affairs, was unavailable for comment yesterday, while officials from the Ministry of Health could not be reached.