Bangladesh, along with many other developing countries, is rapidly industrialising and growing numbers of young women are moving to urban areas to make use of the new work opportunities in many of these industries where cheaper products are manufactured for export to the Western market. The garment sector, which has become the economy’s main growth engine, is the most notable. With such sudden growth in a sector so reliant on manual labour, a need arose to recruit many low-skilled workers at low pay. This immense need was largely filled by women from lower socioeconomic backgrounds with minimal education and skills who had practically no alternate job opportunities available to them in this country. This very large and growing demographic group finally saw an opportunity to have real jobs with a regular monthly salary. This group was previously employed as domestic workers for urban middle or upperclass families while a few others were working in the strenuous construction sector in urban areas or agriculture sector in rural areas. Women from lower socioeconomic strata in Bangladesh finally found an opportunity to become respectfully and gainfully employed in jobs and become economically independent and started to contribute to their own wellbeing as well as helping their family members and other dependents. They mostly took low-end jobs in these factories which required them to do repetitive and high-paced and tedious for very long hours. All stakeholders gained enormously from this workforce: factory owners found an abundant supply of cheap labour, western buyers found the market to be reliable, cheap, stable and credible, the government was happy seeing massive job growth, NGOs, women’s rights activists, human rights campaigners and public health practitioners saw millions of poor women getting out of extreme poverty.

However, this almost overnight influx of millions of young female workers to urban centres created unique and massive public health issues. Some are typical of women of reproductive age with regard to maternal and sexual health, whereas some are work-related health issues such as back pain, machinery injuries and exposure to physical and chemical hazards. The employers, western companies and policy makers in Bangladesh were not ready to accommodate the needs of this population in already highly crowded urban settings and provided very poor infrastructure with regards to housing, transportation, healthcare, etc. The factory environment was not prepared to address the basic health needs of this large working population as most factories were operating in non-industry grade buildings or located in residential settings. Aside from a wage at the end of the month, no other standard employment-related benefits were provided. Maternal health issues related to pregnancy, childbirth and breastfeeding had unique challenges but unlike stay-at-home mothers, these workers had to balance their work life with family life and most of these factory settings were not prepared to accommodate the needs of women workers of reproductive age.

The industry now employs about four million workers of which about 70 percent are reported to be women. Most are young women (18 – 35 years) who migrate from rural areas to a city like Dhaka- a major urban centre. These women have low education, low income, are malnourished, and rarely seek preventive medical care. Like many other lower middle-income countries, many women in Bangladesh are married at a very young age; 20 percent of girls in urban areas and 37 percent of girls in rural areas are married before the age of 19 and half of these married women will have a child before the age of 19. Garment workers, despite what they liked about their career, usually marry at a fairly young age and give birth to children to keep up with social norms and expectation. These working women, while performing traditional duties as daughters, housewives and mothers now have to balance their work and family life. Staying single for long or delaying marriage and childbirth are not feasible options for them in this society.

A series of major disasters have occurred in the industry in the last decade, including a fire incident that killed 112 workers and a factory building collapse that killed 1,122 workers, leading to pressure on stakeholders. But recent funding and initiatives led by European and North American retailers have almost exclusively focused on fire and building safety ignoring the fact that most of these workers also suffer from a host of acute and chronic health issues. These non-fatal or non-acute health conditions, being non-traumatic in nature, generated very little attention despite numerous newspaper reports and personal anecdotes suggesting that these factory workers in addition to typical workplace injuries (eg, machinery injuries, cuts, burns, slips/falls) also suffer from health issues such as back and shoulder pain, fatigue, vision loss, headache, hearing loss, respiratory problems, etc.

Stakeholders can start addressing some of these critical health issues. While the prevailing health conditions are somewhat reported and known from personal anecdotes and newspaper reports, the absence of any longitudinal follow up study on garment workers the long term health consequences of many of these conditions remains unknown. Studies of poor health on business productivity or economic loss may generate practical interests. In addition to shortening the work lives of people by affecting overall health, wellbeing and quality of life of young reproductive age women, these health conditions may also negatively impact their babies’ health and wellbeing during gestation period and after birth.

Attention has focused so far on their physical safety arising from building conditions and fire hazards while the more common and chronic conditions- many of which can be addressed with known, effective and inexpensive interventions- have been largely ignored by all stakeholders. It would be in the best interest of the western companies, the Bangladesh government, donor countries, aid agencies and consumer groups to provide more support to improve the health of garment workers which will ultimately benefit all stakeholders economically (in terms of productivity and profitability) by creating and preserving a healthy workforce.

Hasanat Alamgirteaches at New York Medical College, New York.

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