In 1991, following privatisation of the Nicaraguan industrial sector, local textile factories began to set up in free trade zones. The free trade zones started in the capital Managua and progressively spread to other departments of the Pacific coast and in the north. These textile companies hire young workers, mainly women, who often work in precarious conditions. In addition to work-related health risks, they face many sexual and reproductive health problems as evidenced by high pregnancy rates, increased HIV risk, cervical cancer, and sexual and domestic violence. In July 1998, the United Nations Population Fund (UNFPA) and the Centre for Social Studies and Promotion (CEPS) undertook a joint project to promote sexual and reproductive rights in two free trade zones.

CEPS is an NGO founded in 1990 to improve the living conditions of the most vulnerable populations and strengthen local communities' self-reliance. Since its foundation, CEPS has been active in preventive education projects, especially on HIV/AIDS. In the last four years, it has broadened its work to the field of sexual and reproductive health (SRH). Currently, it is the only organisation with experience in SRH promotion in the textile industry.

The existing provisional health clinics in the free trade zones are characterised by a curative approach. There is a lack of understanding among decision makers in the private sector regarding the importance of reproductive health services as a way to invest in human development. Against this background, CEPS and UNFPA set up a programme aimed at strengthening the textile workers' self-care capacity. CEPS carried out its work in Managua's free trade zone with 12,000 workers, aged 18-26 years, 80% of whom were women. Nearly half (43%) of these women were heads of households and were often single mothers.

Using three strategies, the project sought to strengthen the textile workers' capacity for self-care in the sexual and reproductive health field. The first strategy was to sensitise management of the free trade zone companies through meetings and training workshops. Little by little, as management began to trust CEPS, the interventions started to take off.

The second strategy aimed to strengthen the health services offered to the workers through the free trade zone's provisional medical clinics. The project provided the clinic with training, basic equipment, medical instruments and supplies. Gradually the clinic was able to provide more services to more patients, including sexual and reproductive health services.

The third, fundamental, strategy was the development of voluntary SRH promoter networks to educate company workers. The volunteers worked inside and outside the factories, depending on circumstances.

Principal achievements and difficulties

Over the project's three years, a major achievement was winning the cooperation of company management, especially the human resource departments. CEPS managed to convince the management that it was interested in the workers' sexual and reproductive health, not in undermining their productivity. As a result, the companies permitted CEPS to carry out its work and assisted in programme administration. Initially, however, the companies did not recognise the cost-effectiveness of the SRH services. This perception changed radically when they saw a reduction in the number of pregnancy-related complications among their workers.

Another important achievement was the improvement of the quality of SRH care by the provisional medical clinics, which fall under Nicaraguan Social Security. At the beginning of the project, the high turnover of medical personnel, including nurses, slowed progress. Policy makers and planners decided to stabilise the clinics' personnel situation and offer them training. They also provide the clinics with materials such as gynaecological beds, Pap test materials, IUD insertion devices, contraceptives (oral and injectable), condoms and educational materials. The most innovative elements were the educational videos and SRH counselling services. Audio-visual education materials were shown in waiting rooms, where they discussed domestic violence, gender perspectives, sex education, detection of breast and cervical cancer, HIV/STI prevention and sexual and reproductive rights.

The higher quality of SRH services resulted in an increased demand, which forced CEPS to broaden the range of services at the clinics. Client satisfaction at the clinics has increased as a result of the counselling services and personal attention received in the SRH field. These activities have been increasing in step with the training of voluntary health promoters by CEPS staff, their educational activities and referrals to the clinic workers.

The formation of a network of voluntary promoters to carry out SRH promotion, using both interpersonal methods and educational materials, has been successful. In addition, popular theatre, referral of patients and provision of oral contraceptives and condoms have all helped to improve the knowledge of the workers in the free trade zone.

Key lessons learned

The principal lessons learned during project implementation were the following:

• It is possible to carry out workplace SRH promotion in the textile industry. There is no single intervention model: it has to be dynamic and adapted to local circumstances.
• Sensitising decision makers is a key part of implementing SRH interventions. As a non-profit organisation, CEPS was able to play a facilitating role, creating a space for participation between the private companies and the workers.
• Sexual and reproductive health has to be an integral component of the provisional health clinics' services; it should be a compulsory element of the Social Security's tasks, as one of the biggest problems in the country.
• To meet the increased demand for SRH services, corresponding health services should complement IEC activities for textile workers.
• Experience shows that the SRH approach has favourable win-win effects for all the dimensions of the workplace and workers: health and productivity increase while costs decrease.
• Given textile workers' working conditions, SRH promotion activities should use a wide range of complementary communication channels, prioritising a creative and non-formal educational approach.
• The contents of the SRH promotion activities have to meet the beneficiaries' needs.

Future perspectives

Based on the experiences of this project, CEPS has set some goals for future SRH work in the textile industry:

• Share this SRH promotion experience with other private-sector companies in Nicaragua to show the cost-effectiveness of these kinds of interventions. The earlier exchange of experiences between textile companies in Honduras and Nicaragua, promoted by UNFPA and CEPS, was productive and can be replicated.
• Lobby Social Security authorities to include SRH services as part of the rights of insured workers.
• Replicate the accumulated experience in other CEPS SRH projects in other textile factory companies in the country.