Pimpawun Boonmongkon

Mot Luuk problems in northeast Thailand: why women's own health concerns matter as much as disease rates

In this paper, we consider womens illness experiences, above and beyond the presence of clinically identifiable disease. In Northeast Thailand, epidemiological data suggest that the prevalence of major womens reproductive tract infections is relatively low and not a cause for significant public health attention. Conversely, we found that self-reported rates of gynecological complaints are high and a significant womens health concern in rural Northeast villages. Womens embodied experiences and interpretations of these complaints affect their lives dramatically. Moreover, womens responses to gynecological problems (regardless of diagnosed morbidity) constitute an important health issue in their own right. In this regard, we document the dangers of womens self-treatment practices that rely largely on small doses of medically inappropriate antibiotics, the manner in which family life and sexual relations are disrupted by fears that gynecological problems will progress to cervical cancer, health care seeking patterns and expectations from health staff, and most importantly, how womens concerns about the seriousness of recurrent ailments result in substantial suffering. This study demonstrates why attention to womens own health concerns is as important to address in health programs as rates of disease, and why common gynecological problems and work-related complaints are important to take seriously rather than dismiss as psychological or routine and expected. We argue that there is a strong need to conduct ethnographic research on womens health problems as a complement to, and not merely a support for, epidemiological research. An evidence-based approach to health policy needs to be accompanied by a more humanistic approach to understanding health care needs.

‘She met her (boy)friend online’: negotiating gender identity and sexuality among young Thai women in online space

This paper focuses on the experiences of women 15–24 years old living in one suburban district in Bangkok. Its objectives are to analyse processes of building and negotiating social identity and femininity in online spaces by young women; the ways in which young women express their sexuality using online technologies; connections between the ‘online’ and ‘offline’ worlds in terms of emotions as well as social and sexual networks; and traditional values regarding female sexuality reproduced through online media and how young women negotiate and resist these. Content and narrative analyses were conducted using qualitative data from 9 focus-group discussions and 14 narrative interviews. Findings indicated that the online media serve as tools that help young women develop and express their gender identities. Mobile phones and the Internet facilitate communication in order to express love, responsibility, intimacy and sexual desires. Discourse on womens chastity, which puts pressure on women to maintain their virginity, still influences online and mobile contents, messages and images among young women. However, women also exerted agency in negotiating and expressing their sexuality, both online and offline.

Connections between online harassment and offline violence among youth in Central Thailand

Increasing evidence indicates that face-to-face (offline) youth violence and online harassment are closely interlinked, but evidence from Asian countries remains limited. This study was conducted to quantitatively assess the associations between offline violence and online harassment among youth in Central Thailand. Students and out-of-school youth (n=1,234, age: 15-24 years) residing, studying, and/or working in a district in Central Thailand were surveyed. Participants were asked about their involvement in online harassment and in verbal, physical, sexual, and domestic types of offline violence, as perpetrators, victims, and witnesses within a 1-year period. Multivariable logistic regression was used to assess independent associations between different kinds of involvement in offline violence and online harassment. Perpetration and victimization within the past year were both reported by roughly half of the youth both online and offline. Over three quarters had witnessed violence or harassment. Perpetrating online harassment was independently associated with being a victim online (adjusted odds ratio [AOR]=10.1; 95% CI [7.5, 13.6]), and perpetrating offline violence was independently associated with being a victim offline (AOR=11.1; 95% CI [8.1, 15.0]). Perpetrating online harassment was independently associated with perpetrating offline violence (AOR=2.7; 95% CI [1.9, 3.8]), and being a victim online was likewise independently associated with being a victim offline (AOR=2.6; 95% CI [1.9, 3.6]). Online harassment and offline violence are interlinked among Thai youth, as in other countries studied so far. Interventions to reduce either might best address both together.

Women's Health in Northeast Thailand: Working at the Interface Between the Local and the Global

SUMMARY An important first step in translating global statements about womens right to health into action programs is an assessment of the interface between local health culture and public health/medical practice. In this paper, we present the findings of an ongoing research project focusing on womens sexual and reproductive health in Northeast Thailand. The project is a prototype illustrating how formative research may be used to guide intervention development as well as midcourse correction. Examples are provided which clearly illustrate why cultural understandings of gynecological health are important to consider before introducing womens health programs. One case featured describes how an iatrogenic fear of cervical cancer has emerged from public health messages and screening programs. A hybrid model of cancer has evolved from preexisting local ideas, resulting in an exaggerated sense of risk wherein women fear that a wide range of common problems may potentially transform into this fatal disease. We argue that public health needs to be held accountable for what transpires when health messages are introduced into a community. Monitoring of community response is necessary. In the second half of the paper we describe efforts to increase community understanding of womens health problems, create gender and culturally sensitive health care services, and enhance the technical and communication skills of health staff.

Investigating online harassment and offline violence among young people in Thailand: methodological approaches, lessons learned

Violence in the physical (offline) world is a well-documented health and social issue among young people worldwide. In Southeast Asia, online harassment (defined as intentional behaviours to harm others through the Internet or through mobile devices) is less well documented. In this paper, we describe and critically discuss the mixed-methods data collection approach we used to build a contextualised understanding of offline violence and online harassment among 15- to 24-year-old students and out-of-school youth in Central Thailand. We mapped linkages between offline violence and online harassment, and with their possible correlates including gender, sexuality, and mobile media or Internet use. Data collection methods included in-depth interviews, focus group discussions and a custom-built, self-administered computerised survey. Using mixed methods enabled us to collect holistic qualitative/quantitative data from both students and out-of-school youth. In our discussion, we focus on gender, sexuality, class and ethnicity issues in recruiting out-of-school youth; definition and measurement issues; technical issues in using a computerised survey; ethical issues surrounding data collection from minors as well as privacy and confidentiality concerns in collecting data in both in-school and out-of-school settings; and the general implications of using mixed methods.

Consent Challenges for Participation of Young Men Who Have Sex With Men in HIV Prevention Research in Thailand

Young men who have sex with men (YMSM) younger than 18 years are often excluded from HIV prevention research in Thailand due to cultural attitudes toward youth sexuality, social stigma, and difficulties obtaining guardian permission. Culturally sensitive focus group discussions conducted with parents and YMSM in Bangkok, Thailand, identified barriers and facilitators related to minors’ participation in HIV prevention research. Although gender and class differences emerged, mothers and fathers were generally accepting of research to reduce HIV risk but not in favor of waiver. Youth’s positive attitude toward parental permission was tempered by concerns about harms posed by disclosing same-sex attraction through permission forms.

‘It's an ordinary matter’: perceptions of cyberbullying in Thai youth culture

ABSTRACT This qualitative study focuses on youth perceptions of cyberbullying (definition, causes, consequences, and management). We also articulate how perceptions of cyberbullying among Thai youth are influenced by Thai culture, including Thai youth culture. Data were collected from 15 to 24 year-olds in Central Thailand through 22 focus group discussions (FGDs) with 4–6 participants each, as well as 26 in-depth interviews (IDIs), totaling 136 participants. These youth defined cyberbullying as harming others through mobile phones and the Internet. To count as cyberbullying, actions had to cause real harm or annoyance and be committed with malicious intent. The relationship between the parties involved also mattered: close friends were unlikely to be considered cyberbullies. Participants thought that the anonymity of cyberspace is a key cause of cyberbullying but also that cyberbullying often results from previous offline incidents of violence. In their view, cyberbullying impacts individuals and their social interactions. Participants tended to manage the problem by themselves and not consult their parents. Alarmingly, participants viewed cyberbullying as ‘an ordinary matter’. To raise awareness that cyberbullying is a societal problem with serious consequences, state agencies and educational institutions need to play active roles in preventing it and responding to it constructively when it occurs.

Yauk gyar mann yin (Be a man!): masculinity and betel quid chewing among men in Mandalay, Myanmar

Abstract Betel quid chewing is associated with various oral cancers and other health concerns, including reproductive health issues. Nevertheless, the practice is widespread in Myanmar, especially among men. This qualitative study elucidates the gendered aspects of betel quid chewing by examining how it links with masculine ideology among male betel quid chewers in Mandalay, Myanmar. Data were collected through in-depth interviews, focus-group discussions, key-informant interviews and participant observation. The thematic content analysis was guided by Connell’s concept of hegemonic masculinity and Butler’s notion of gender performativity. The findings indicated that young Mandalay men were drawn to betel quid chewing by the value they gave to satisfying their curiosity, power competition, risk-taking and a display of manliness. Thus, the practice of betel quid chewing, as defined by our participants, was perceived as manly, trendy, stylish and sexually attractive. For adult men, betel quid chewing was a social lubricant that assisted them in talking with clients and co-workers, thus enhancing their economic opportunities with other men. It also helped working-class men to work harder. Betel quid chewing harm-reduction programmes therefore need to be mindful of masculinity issues as well as the economic aspects of betel quid chewing.