This is the abstract presentation of Elisa Oreglia and Camille Tijamo, which was made as part of the 10th session of #APCRSHR10 Virtual, on the theme of "Innovations and changing norms around sexual and reproductive health and rights (SRHR) in Asia and the Pacific". C H A I R Dr Eden R Divinagracia Executive Director, Philippine NGO Council on Population, Health and Welfare (PNGOC) P L E N A R Y S P E A K E R Beth Schlachter Executive Director, Family Planning 2020 (FP 2020) "Family planning progress to date and a collective vision for family planning post-2020" A B S T R A C T P R E S E N T A T I O N S Dr Neeta Shrestha | Visiting Service Provider Approach: reaching the unreached with Family Planning services Dr Pramesh C Bhatnagar | Peer lead approach for Promoting change in socio-Cultural Norms in a conservative rural community so as to reduce child marriage and promote youth friendly SRHR: An Intervention from Khalikote Ganjam Rural area of Orissa India Mehrin Shah | Increasing Lady Health Workers’ knowledge of sexual and reproductive health and rights: addressing knowledge gaps and improving linkages within rural communities in Pakistan Elisa Oreglia, Camille Tijamo | Smartphone use and reproductive health in Cambodia: A qualitative, multi-disciplinary exploratory study For more information on the session, please visit www.bit.ly/apcrshr10virtual10 Official conference website: www.apcrshr10cambodia.org Thanks

1. SMARTPHONE USE AND REPRODUCTIVE
HEALTH IN CAMBODIA: A QUALITATIVE, MULTI-
DISCIPLINARY EXPLORATORY STUDY
LSHTM CHRIS SMITH, CAROLINE FREE, MEGAN MCLAREN
KING’S ELISA OREGLIA, GEORGIA WILLOX DUNANT
MSI SOKHEY LY, AMRA OU, CAMILLE TIJAMO
SOAS JUSTIN WATKINS, SANARY KAING, ANUBHA SINGH

2. TABLE OF CONTENTS
▸ RESEARCH QUESTION & METHODS
▸ NEW (MOBILE) INTERNET USERS
▸ SOCIAL MEDIA & REPRODUCTIVE HEALTH INFORMATION
▸ MSI CAMBODIA & SOCIAL MEDIA

3. RESEARCH QUESTIONS &
METHODS

4. BACKGROUND
RESEARCH QUESTIONS
▸ PHASE 1: qualitative, wide-spectrum research with garment factory
workers, with observations (in person and online), informal discussions,
semi-structured interviews on mobile phone use and health in general
▸ PHASE 2: focused, qualitative research with private providers & MA
clients, with interviews with private healthcare providers and clients.
METHODS
▸ How do Cambodian female factory workers use smartphones? Do
they use them to search for health information? How do they
experience reproductive health after MA?
▸ How can we integrate perspectives from medical, cultural, and
information-sharing practices perspectives to improve post MA care?

5. NEW (MOBILE) INTERNET USERS

6. NEW (MOBILE) INTERNET USERS
Source: Hootsuite | We are Social | 2019 https://www.slideshare.net/DataReportal/digital-2019-cambodia-january-2019-v01

7. WHO GOES ONLINE? FACTORY WORKERS!
▸ Irregular / on-off use:
▸ constant churn of phones & numbers, to find best deals
▸ offline use to save airtime, e.g. videos and films downloaded directly to
smartphones from sellers’ computers, rather than purchased online.
▸ Collaborative (and not very private) use:
▸ mobile service providers & relatives set up phones and social media
accounts
▸ very little “privacy” in a Western sense (many people have access to
them or help users set up their accounts, so know their passwords)
NEW (MOBILE) INTERNET USERS

8. WHO GOES ONLINE? FACTORY WORKERS!
▸ Non-text based communication:
▸ Facebook and Youtube commonly and widely used.
Google (and Google search) unknown.
▸ marked preference for videos and non-text based
communication, including in interacting with social
media (so “likes,” “shares,” and emoticons are in effect a
form of engagement with content)
▸ Youtube as a site to experiment with search
NEW (MOBILE) INTERNET USERS

9. “GARMENT WORKERS DO NOT KNOW HOW TO SEARCH FOR VIDEOS OR
SONGS ON YOUTUBE AND FACEBOOK THROUGH THEIR SMARTPHONES.”
“THE GARMENT WORKERS USE FACEBOOK FOR THEIR ENTERTAINMENT. IF
THEY WANT TO KNOW ABOUT CONTRACEPTION, FAMILY PLANNING, THEY
WILL ASK THEIR FRIENDS RATHER THAN GOING TO THE CLINICS OR SEARCH
INFORMATION FROM THE INTERNET.”
Reproductive Health NGO workers
ARE SMARTPHONES USED TO SEARCH FOR HEALTH INFORMATION?
NEW (MOBILE) INTERNET USERS

10. SOCIAL MEDIA & REPRODUCTIVE
HEALTH INFORMATION

11. WHO GOES ONLINE? AN EXPERIMENT ON YOUTUBE
▸ We searched in Khmer for a variety of terms and FAQ
related to MA and other reproductive health questions
that we gathered from MSI and other NGOs in Cambodia.
▸ None of the videos we found have been posted by an
NGO or a government source.
▸ Such videos exist, because they appear when searching in
English - they’re optimized for an English-speaking and
English-searching audience.
SOCIAL MEDIA & REPRODUCTIVE HEALTH INFORMATION

12. WHO POSTS HEALTH-RELATED VIDEOS?
▸ Videos are mostly uploaded by private health clinics,
media outlets, and people trying to figure out what gets
viewers on YouTube to monetize videos.
▸ Production values are very low, but videos are easy to
follow and often instructional
▸ Content producers often answers viewers’ questions in the
comments
SOCIAL MEDIA & REPRODUCTIVE HEALTH INFORMATION

13. WHO COMMENTS ON HEALTH-RELATED VIDEOS?
▸ Public postings on Youtube or Facebook might be done
with users’ real name, but this doesn’t mean that they don’t
value their privacy! We see that in their actual behavior
(e.g. going for MA to pharmacies far away from where they
live)
▸ People value their privacy also online, but it can be difficult
to see how it works, or to do anything about it.
SOCIAL MEDIA & REPRODUCTIVE HEALTH INFORMATION

14. IMPLICATIONS
▸ For health providers, the biggest challenges to operate on
social media are privacy, people’s need to feel that they are
connecting with a human, and the work required to keep on top
of ever-expanding multi-channel outputs.
▸ Web pages/ video descriptions/ FB posts / keywords should
reflect different types of language used for searches (medical,
popular, slang) to make content findable.
▸ Instructional videos/content that is accurate, accessible,
actionable, in local languages and optimized for Youtube and
web searches is an easy first step.
SOCIAL MEDIA & REPRODUCTIVE HEALTH INFORMATION

15. MSI CAMBODIA & SOCIAL
MEDIA

16. MSI CAMBODIA & SOCIAL MEDIA
▸ 87k followers
▸ 52% of followers are
young people
▸ 300 messages/month
▸ content about safe
abortion,
contraception, other
SRH, empowerment,
stigma, inclusion
CONTACT CENTRE
▸ 1,200 calls/month
▸ 300 referrals/month
▸ 23% of callers are
young
▸ appointment
booking
▸ friendly counseling
over the phone,
email, messages
INSTRUCTIONAL
VIDEOS
FACEBOOK
▸ 59k views in FB as of
date (25.9k views in 2
weeks
▸ 2k engagement in FB
▸ 4.3k views in YouTube
▸ 82% from YouTube
searches mostly
medical abortion pills
How to use medical abortion?

17. FACEBOOK & ONLINE INFORMATION
▸ Multi-channel communication provides new opportunities to reach people who are otherwise
hard to reach, but there are complex challenges:
▸ the privacy of responses sent through Facebook/Messenger/Line is predicated on
women having their own phone and number, but especially in rural areas women do
not have their own phone/they use their husbands, they change number and FB profile
often.
▸ online work in giving information is invisible when not followed by referrals; it’s
‘wasted’ work from a budget viewpoint, and not sustainable in the long term.
▸ little awareness of public versus private communication on the part of users
▸ little knowledge of who the users are on the part of information/healthcare providers,
unless these digital encounters turn into referral and users becoming clients.
▸ large amount of repetitive answers to common questions that have already been
answered - the personalization of the response, though, is key to reaching users.
MSI CAMBODIA & SOCIAL MEDIA

18. LSHTM CHRIS SMITH, CAROLINE FREE, MEGAN MCLAREN
KING’S ELISA OREGLIA, GEORGIA WILLOX DUNANT
MSI SOKHEY LY, AMRA OU, CAMILLE TIJAMO
SOAS JUSTIN WATKINS, SANARY KAING, ANUBHA SINGH
THIS RESEARCH WAS SUPPORTED BY THE ARTS & HUMANITIES RESEARCH COUNCIL THROUGH GRANT AH/R006091/1
ELISA OREGLIA: ELISA.OREGLIA@KCL.AC.UK
CAMILLE TIJAMO: CAMILLE.TIJAMO@MARIESTOPES.ORG.KH