Characteristics of the study participants
A total of twenty women were interviewed. Out of the twenty women, six of them were pregnant and reported that they had developed health problems, including hypertensive disorders, during pregnancy. They reported that the doctors at the factory clinic had explained these health issues. These women were aged between 20 and 35. None of them had completed primary education (up to grade five). Three of them were working as sewing machine operators: a job that requires sitting constantly in one position on a small stool to run a machine. Three of them worked as a helper, restricted to one position, either sitting or standing, to cut the thread of the fabric. Our interviews with the female workers revealed that the women had migrated from their villages due to poverty to work in the ready-made garment factory. This job created an opportunity for these women to generate income to support their families.
Health services available to female workers
Female workers can access factory clinics for health care services. The clinics are open from 8 am to 9 pm every day except weekends. They are staffed by nurses and doctors but doctors are available for half days in the afternoon. The female workers explained that they receive painkillers for headache, oral saline for stomach problems, and treatment for injuries (needle puncture, small burn injuries, and cuts from scissors). They indicated that they visit the factory clinics when they get sick from colds or cough, fever and injuries. The clinics also provide ante-natal and post-natal check-ups for pregnant workers.
The women reported that they do not visit the factory doctor for an ante-natal check-up when they first suspect that they are pregnant because they feel they need to hide their pregnancy from their supervisors. The women need to meet a production quota of one hundred pieces per hour. If they lag behind the quota due to their pregnancy, their supervisors will encourage them to leave the job. They will also not be assigned to do overtime to earn extra money. They only go to the factory clinic for a check-up during pregnancy when their pregnancy becomes visible. They also do not go to the private clinics because of the cost.
The women also reported that they cannot go to the government hospital because of their long working hours: “We enter in the factory at 8:00 am in the morning. We return home at night. We work 10–12 hours per day and sometime 7 days in a week. We need to meet production quota, 100 pieces per hour. I could do it but after getting pregnant I cannot meet my production quota. First few months of my pregnancy, I did not feel well; I felt all time nausea, headache, and fatigue. I took more small breaks and I became slow to meet my daily quota. I did not go to the factory doctor for check-up because my supervisor will know that I am pregnant and would encourage me to leave the job as I was falling behind to meet the target due to my pregnancy.”
Factory work, pregnancy and vulnerability
Our interviews with pregnant female workers revealed different perspectives about their health during pregnancy. They reported that the doctor of the factory told them they had a hypertensive disorder, and that “stress” was the “cause” of their health problems. The female workers reported that they didn’t know if there was a relation between stress, work and illness. They reported that getting pregnant is a ‘normal’ experience that ‘every’ woman goes through, but the experience of pregnancy made them less able to cope with their work due to the pressure and the nature of the job.
The following stories of two pregnant women who work in the ready-made garment industry explore how the nature of their job, and work practices at home and in the work place affect their health. The narratives are from two women, “Afia” and “Morium” (both pseudonyms), who had developed hypertensive disorders during their pregnancy as described to them by the factory doctor. Participant quotes are presented to support findings.
Afia’s story
Afia was a twenty year-old woman from Gaibandha district in the northern part of Bangladesh. She came to Dhaka for a job at the garment factory with another woman who lives in the same village. The woman helped her to get a job as a machine operator. She has been working in the factory for the last three years. At the time of the interview, she was seven months pregnant. Her husband is a driver. She was married three years earlier and she had been experiencing pressure from her in-laws family to have a child. Three years work in the garment factory taught her to avoid getting pregnant, as the cost of pregnancy would be losing her job. According to her, she got pregnant accidently and she wanted to have an abortion but her husband said that if she had an abortion he would divorce her. She continued with her pregnancy. She said that around the fourth month of her pregnancy, one day she got so sick, that she couldn’t work, and she couldn’t talk, so her co-workers took her to the factory clinic. The doctor of the factory clinic said that she was suffering from high blood pressure. He advised her to take a rest during work and that she shouldn’t work for long hours and she also needed to sleep well. On that day she wanted to have some time off but her supervisor refused her request for time off as a large order of shirts had to be finished in fourteen days. She needed to complete 100 shirts per hour, for 12 hours a day, until the order was complete. In her seventh month, she informed her line manager that she would apply for maternity leave as her blood pressure was always high and she always felt sick. Her supervisor suggested that she leave the job and come back to work after the delivery.
This job is her only source of income. She needed the money, so she spent sleepless nights worrying: “This work created an opportunity for me to earn money. I could support my family financially but now I am pregnant. When we get pregnant we don’t disclose it to our supervisors. We try to keep it secret as long as we can because if we become slow to meet our production quota due to pregnancy we will lose our job. We become more vulnerable physically and mentally due to all these types of stress.”
Morium’s story
Morium is a 28 year-old woman who developed a hypertensive disorder during pregnancy. She always experienced headache, nausea and dizziness. She did not go to a doctor as she believed that these symptoms were normal during pregnancy. After a few weeks she started to feel sicker and couldn’t sit for work and couldn’t sleep well. She then went to the factory clinic to see the nurse. The nurse informed her that her blood pressure was high. The nurse also told her not to work and that she should go home. After three days she visited the clinic again and she was able to see the factory doctor. The doctor advised her not to eat salt or beef and that she needed to sleep more. The doctor recommended that she take medical leave for three days with some medication. She was granted sick leave for just one day. After two days she returned to her work but she always felt unwell. At five months pregnancy, her legs and face become swollen (oedema). She constantly feels tired, short of breath and pain in her shoulders. Still she wants to continue her job as long as she can. She will apply for maternity leave. If the leave is granted with payment she will continue the job after delivery, if not she will leave the job and will look for a new job when the child is 6 months old.
Their living environment: Opportunities to rest at home and work
The houses of the female workers were observed in two study areas. After walking through a narrow lane, the researcher entered a one level brick and tin building with twenty single rooms (one family, two persons in each room, the size of the room is 30–40 square feet), one shared kitchen with some stoves for cooking (Fig. 1), and four toilets for twenty families. The furniture includes a double bed which occupies most of the space of the room. The clothes are hung on a rope; cooking utensils are piled under the beds. The rooms do not have window, only a door to let in air and light. The female garment workers start their day around 4:00 am to avoid queues in the kitchen and toilets. They need to finish cooking for themselves and their family members, cleaning and other household chores before they go to the factory. The women’s living environment also worsens their health condition because shared accommodation does not allow them to have enough sleep or rest at home.
In this regard one female worker said, “My doctor said to me to sleep more. How could I sleep more? I work for long hours and have little time to prepare meals. I return home tired every day. I just eat rice with some vegetables, dal and salt before I go to sleep. I cook fish and meat sometimes but that I keep for my husband.”
They work hard at home in the morning and walk to the factory as fast as they can to enter the factory by 8:00 am. They get a one-hour break for lunch. The pregnant workers consume food very quickly as to take a small nap during lunch break (Fig. 2) to energize them for the rest of the workday.
Reflecting on the experience of pregnancy and work, another pregnant worker noted:
“Pregnancy is the most joyful event for a woman. [But] if you work as a factory worker, it will be the most painful event of your life. Working in one position for long hours, running to meet the production target and having no guarantee to have maternity leave with payment makes us sick. If you are pregnant you may have to lose your job. Supervisors will not be happy with you as you will be slow to meet the daily quota. You will be encouraged to leave the job. You will not receive support from your boss to continue the job as a pregnant woman. The doctor will advise you to take rest but you will not have an opportunity to take rest due to work at home and workplace.”
Factors that influence the development of health problems during pregnancy
The factory doctors reported that the work stress and prolonged working hours contributed to hypertensive disorders and diabetes among the pregnant workers. Others factors such as biological condition and lifestyle also contribute to making women sick: “the female garment workers work for long hours and they always need to work to meet their daily production quota. When women get pregnant it is difficult for them to meet the production quota. They always feel stress because if they cannot meet the production quota they will lose their job, which definitely contributes to increasing their blood pressure.”
Another doctor said, “If you look at their lifestyle they do not have time to rest. They work in the factory 10–12 hours per day 6 days in a week. Most of the female workers develop hypertensive disorders during pregnancy. Apart from hypertensive disorders, they also suffer from other health problems such as malnutrition and anaemia. They couldn’t eat well due to poverty. We always advise them to eat an egg and not to take any extra salt with rice. They cannot continue their job during pregnancy because this is a physically intensive job. They take a break for one to two years after the delivery, and then when the child grows up they again start a new job with a new factory.”
Business, profit and workers’ health
Discussion was held with the employers of the ready-made garment industry to explore their views on the health problems including hypertensive disorders among the pregnant workers. They reported that pregnancy makes the women more vulnerable in this sector due to the nature of the job. They stated that they always try to allow more breaks for pregnant women, but they cannot always ensure maternity leave with payment.
In this regard one supervisor said, “We do business. We need to ensure profit. If we cannot make profit, we will not be able to pay the workers. We have hundreds of workers working on the production floor. If we allow maternity leave with payment, hundreds of them will get pregnant. How will the factory run? It does not mean that we do not provide maternity leave with payment. We approve maternity leave with payment. [But] in some cases we also cannot approve leave with payment. Because many of these women they go to their village for delivery. They take the money from us but they do not return to work after their leave. In these cases we encourage women to leave the job but if they want to return to their work after delivery, we accept them again in the work.”
Issues of inadequate reporting and non-compliance with maternity legislation
Interviews with government officials from the Ministry of Labour and Employment revealed that they do not have enough reliable data about the health and injury related problems of the factory workers because they are short of skilled staff to collect data on occupational health and safety issues. They also indicated that the factories do not report pregnancy or pregnancy-related health problems to them for fear of being followed up by government factory inspectors.
In this regard one respondent said, “When our factory inspectors visit factories they always request the factory management to assign light work for the pregnant workers. They also instruct them to approve maternity leave with payment. According to the Maternity Act of Bangladesh, if any worker is found to be pregnant, the factory should report that to us, but the factories do not report because they need to approve their maternity leave with payment. As they do not pay them, so they do not report to us about the pregnancy. We cannot tell you about the health problems of these women. We lack reliable data.”
Another respondent raised the important challenge of non-compliance with existing legislation and the concerns expressed by women about this lack of compliance: “We receive many complaints of disputes about maternity benefit. The factories do not want to approve maternity leave with payment for pregnant women. According to law, they need to pay 60 days leave before delivery and the rest of the leave after delivery. In most of the cases they approve leave without payment. In some cases they approve leave with maternity benefit for 6o days but they do not pay for the other sixty days.”