Exclusion, cohesion and health ple of a sector pulling a targeted excluded group— young women generally from low-income rural households—into the formal-sector economy. The remittances RMG workers send home can keep the family from slipping into further poverty and even allow some families to develop skills for better live- lihood. Under the Multi-fibre Arrangement (1974-2004), Bangladesh saw massive growth of the garment industry. Ready-made garments are now the lead- ing national export, accounting for an estimated three-quarters of annual gross domestic product and employing an estimated 2.5 million workers, approximately 80% of whom are female. When juxtaposed against women’s employment in non- export industries (estimated to be 7%), the impact that RMG-sector employment is having on wom- en’s active participation in the formal economy be- comes apparent. Traditionally, women in Bangladesh have been ex- cluded from formal employment by the cultural constructs of purdah. The rise of garment man- ufacturing, the decline in the agricultural sector, and high levels of rural poverty have combined to push women to seek work in garment factories. The impact on livelihood of garment workers is mixed. Working conditions are difficult, hours are long, and harassment is common. At the same time, the widespread employment of women in the RMG industry has had a profound impact on the social constructs that limit women’s opportu- nities (43,44). Widespread employment of women in the RMG industry has changed the perception of women from dependents to economic actors who have more say in the direction of their lives (45,46). Compared to other women of the same age, garment workers delay marriage and fertili- ty (47). Finally, women have the opportunity to be employed in the formal sector and earn higher wages than from most other occupations, which provide both an immediate and future economic benefit to the women garment workers, their fami- lies and their communities (43,44). The dramatic growth of women in the garment industry has re- duced the cultural barrier of purdah and opened up economic, social and political options for a broad class of women and made some progressive social changes more likely. In addition to the impact the garment industry has had on individual female employees and the per- ception of women in society, the sometimes strict enforcement of international labour standards and Volume 27 | Number 4 | August 2009 Johnston HB regulations in the garment industry is having an impact within and beyond the garment industry in Bangladesh. In a context in which national employment legislation is weakly enforced, the industry-wide incentive of being competitive in an international market can motivate companies to meet and exceed national legislation. Meeting international standards in the RMG industry can serve to challenge other industries in Bangladesh to also comply with higher standards. In a context in which the state does not tightly enforce labour policies, clearly-articulated and regulated interna- tional standards set, enforced, and rewarded by in- ternational agencies can motivate the local private sector to meet and exceed the nationally-set basic rights of employees. Micro-insurance (48) Access to healthcare is a basic right according to the Bangladesh Constitution. However, in practice, the poor in Bangladesh are largely excluded from public facilities due to lack of money or lack of so- cial connections. It is estimated that out-of-pocket health payments account for as much as 3.8% of the population falling below the poverty-line of US $1 per day annually (49). Poor and rural popula- tions, particularly women, have the most limited access to public-sector health services. Micro-health insurance (MHI) schemes have been developed to address the lack of access to state-run health clinics (50,51). MHI is a nascent strategy to reduce households entering poverty as a result of a health crisis and broadly increase access to and the use of basic healthcare; it also has the benefits of motivating clients to seek licensed healthcare providers as opposed to care from untrained local providers or self-treatment. The MHI programmes in Bangladesh promote ac- cess to and the use of basic healthcare. While the MHI strategy implemented in Bangladesh regard- ing the coverage of basic healthcare is beneficial, it does not cover catastrophic care, and health- care costs still can drive members of MHI schemes deeper into poverty. Examples of expanded MHI in India, on the other hand, aim at improving the quality and reduce the income-impact of second- ary and tertiary healthcare. These schemes address high cost, low-frequency events and pose a strategy for addressing the issue of catastrophic health-costs among the poor. 433