For 33-year-old Ayesa Akter Asha and many other women like her, a major shift in Bangladesh’s ready-made garment industry proves that workplace health is central to national resilience.
Seven years ago, Ayesa’s life was torn apart when the relentless river erosion in her native Chandpur, a disaster-prone coastal area of Bangladesh, swallowed the only home she had ever known. A climate migrant, she fled with her husband, child, and mother-in-law, carrying little more than grief. They found shelter with Ayesa’s sister in the overwhelming urban sprawl of Savar, on the outskirts of the capital, Dhaka. Driven by the desperate need to feed her family, Ayesa found work at the Vision Garments Ltd. factory, which makes ready-made garments (RMG). She started as a helper, slowly climbing her way up to sewing operator. Trapped in the daily grind of survival with family members depending on her, caring for her own health felt like an impossible, selfish fantasy.
Ayesa is not alone. Much of Bangladesh's economic growth is powered by its ready-made garment industry and its predominantly female workforce. It’s estimated that around 4 million people are employed by the industry, 80% of whom are women. This workforce is also at the nexus of two of the nation's most significant challenges: rapid urbanization and climate vulnerability. Bangladesh ranks ninth on the 2024 World Risk Index of countries vulnerable to extreme weather and other climate impacts. It ranks second-highest in flood risk.
As climate pressures increasingly drive migration from rural areas, urban centers swell. Approximately 400,000 low-income migrants, just like Ayesa and her family, arrive in Dhaka every year. Many are forced to settle in densely populated urban slums with poor sanitation and unhygienic living conditions. This rapid urbanization, compounded by gender-based health disparities, often leaves women disconnected from the traditional health systems they once knew and their health needs are often deprioritized due to work, family, and mobility constraints.
This gap does not just impact individuals; it weakens the entire public health infrastructure, making it less resilient to shocks—from climate disasters to disease epidemics. In this environment, preventable diseases, including life-threatening ones like cervical cancer, can take hold.
A truly resilient, epidemic-ready primary health care system must therefore be agile, gender-responsive, and meet people where they are.
Recognizing this, Jhpiego, with support from the United Nations Population Fund (UNFPA) and in collaboration with the Government of Bangladesh, pioneered a new model that redefined primary health care in the country. Instead of asking women to leave their jobs and risk their wages to find a distant clinic, the project brought the clinic to the factory floor. By leveraging existing factory medical officers, paramedics, and service providers at Dhaka Medical College Hospital, it embedded life-saving services directly into the workplace.
Some of the services provided included:
The results from just the first 12 clinics across five garment factories revealed a staggering, unmet need. More than 2,100 women received comprehensive cervical cancer screening services, many for the first time. Screening identified early cervical abnormalities in over 6% of women, enabling immediate, on-site treatment for approximately half of these early lesions and timely referral for further diagnostic evaluation where needed. Follow-up and continuity of care were supported through partner coordination.
This impact extended beyond the numbers. Over 90% of workers actively joined health education sessions that broke stigma and empowered them with knowledge.
"I never considered getting a screening before, even though I had been struggling with health issues,” said a 31-year-old worker who tested positive for pre-cancerous lesions and received care. “The doctor explained everything, and now I feel more at ease. I'm grateful for the opportunity to address my health problems early."
Leadership at garment factories and national health leaders recognized the importance of this systems-level thinking. "Hosting this camp showed us how much our workers value their health,” said the Human Resources Manager of Vision Garments Ltd. “It inspired the entire management team.”
“As rapid urbanization and climate disruptions strain access to facility-based services, workplace sexual and reproductive health and rights models like Jhpiego’s ensure women receive timely screening and referral without losing a day’s wage or a safe route to care,” said Dr. Abu Hussain Md. Moinul Ahsan, Hospital Director of the Directorate General of Health Services (DGHS). “This is smart public health—and smart for Bangladesh’s economy.”
For Ayesa Akter Asha, this initiative was more than just a health service—it brought with it a sense of empowerment and control.
"I can finally work and care for my children without this constant worry about my health,” she said, smiling. “I feel heard. I feel respected. That is what truly matters."
Thahina Zaman is a Program Officer for Urban Health for Jhpiego Bangladesh. Indrani Kashyap, Associate Director for Regional Communications also contributed to this article.
