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Premarital Family Planning and Reproductive Health Counseling in Bangladesh

Helping Youth Make Informed Life Choices

Bangladesh has the highest rate of child marriage in Asia. Early marriage leads to a poorer quality of life for girls. It is detrimental to their agency and ability to obtain or continue education. So, in order to improve young couples’ quality of life and encourage them to make informed decisions, the Bangladesh Center for Communication Programs (BCCP) collaborated with the Directorate General of Family Planning to introduce a national Premarital Counseling (PMC) Guidebook.

Bangladesh has the highest rate of child marriage in Asia and the fourth-highest rate globally with 51% of young women marrying before the age of 18. There are 38 million child brides in Bangladesh, 13 million of which married before they were 16. Child marriage is the cause of at least 75% of births before a girl turns 18. A girl married at 13 will also have 26% more children over her lifetime than a girl married at 18 or later. This high child marriage rate has contributed to Bangladesh’s stalled fertility rate, which has remained at 2.3 for the past 10 years.

Early marriage also leads to a poorer quality of life. Girls who marry early have less decision-making power and are more likely to be illiterate or have dropped out of school. They have lower labor force participation and earnings, less control over household assets, and less agency in their sexual and reproductive lives. Thirty-one percent of these young girls are married to men who are 10 or more years older than they are. They are at high risk of violence, exploitation, and abuse. Girls who are married earlier experience higher rates of malnutrition, isolation, depression, abandonment, and domestic violence, all of which fuel higher maternal mortality and morbidity rates than girls who marry after age 18.

“Early marriage also leads to a poorer quality of life. Girls who marry early have less decision-making power and are more likely to be illiterate or have dropped out of school.”

In order to improve the quality of life among young couples and encourage them to make informed decisions about pregnancy, the Bangladesh Center for Communication Programs (BCCP) collaborated with the Directorate General of Family Planning to introduce a national Premarital Counseling (PMC) Guidebook.

The Premarital Counseling Guidebook for Youth

The Directorate General of Family Planning introduced the PMC Guidebook to reduce misconceptions among youth planning to marry. The Guidebook, whose audience is unmarried adolescents between ages 17 and 18, teaches both boys and girls how to integrate family planning and reproductive health (FP/RH) principles into their lives.

PMC Guidebook Cover Page

PMC Guidebook Cover Page

The PMC guidebook aims to increase the age of marriage and empower couples to make informed decisions to delay early pregnancy and space their pregnancies safely, following healthy timing and spacing guidelines.

The guide emphasizes healthy spousal communication to help couples resolve misunderstandings and potential conflicts about FP/RH using proper knowledge of reproductive health. Other benefits of stronger communication skills include healthier conflict-resolution skills, reduced rates of domestic violence, and a happier conjugal life overall. The ultimate goal of the initiative is to reduce maternal and child mortality by reducing unmet need for FP/RH services, thereby lowering fertility rates.

The guidebook itself will be used to train frontline workers and service providers who engage youth on various aspects of premarital counseling.

Youth seeking services will be reached for PMC through three main touchpoints: in the community (30%), at colleges and universities (60–70%), and at service sites (10%).

  • Group work presentation during the PMC guidebook first batch ToT attended by district and sub-district level GoB officials. Credit: BCCP

    Credit: BCCP

    At the community level, a Family Welfare Assistant (FWA) will counsel youth who are planning to get married by inviting them and their families to attend a group premarital counseling meeting in a communal courtyard. After the session, youth are also encouraged to visit their service facility for more information and services.

  • Upazila-level (sub-district) officials will arrange a series of four interrelated sessions at each college or university in their Upazila to provide information on premarital issues. They will also encourage students to come to their local service facility for more information and services.
  • At service sites, a Family Welfare Visitor (FWV) and Sub-Assistant Community Medical Officer (SACMO) will counsel youth who seek PMC guidance.

Progress to Date

To date, the guidebook has been introduced in the Mymensingh division (comprising several districts). Mymensingh was chosen because it has the highest level of early pregnancy. With funding from the Government of Bangladesh, the Bangladesh Center for Communication Programs and the USAID-funded Ujjiban Social and Behavior Change Communication (SBCC) Project have instructed 75 trainers of trainers in Mymensingh, who in turn have trained 750 frontline workers and service providers.

The gradual introduction of the PMC guidebook is included in the government’s five-year sector development plan; it will be introduced in the remaining seven divisions in 2022. Registered users can access the PMC guidebook in Bangla on the BCCP eLearning website https://www.bdsbcc.org/.

Mymensingh division PMC guidebook TOT inauguration by the Director-FP. Credit: BCCP
Credit: BCCP
Group work during the PMC guidebook TOT 1st batch. Credit: BCCP
Credit: BCCP

Advocacy Strategies that Led to the Government Endorsing and Owning the Initiative

The Ujjiban project consistently advocated the importance of reaching Bangladeshi youth before marriage to better prepare them to plan their families and improve their quality of life. In conversations with government leaders, the project raised the issues of stagnant rates of fertility, contraceptive prevalence, and unmet need, demonstrating how addressing youth needs would help increase the minimum age of marriage—delaying marriage and first pregnancies.

It was helpful that BCCP, through the Ujjiban project, was part of the SBCC capacity system strengthening of the Bangladeshi government and was already working closely with them. BCCP helped form five levels of committees to manage, implement and monitor SBCC activities, and were able to motivate central/directorate level authorities to develop and approve the PMC guidebook initiative. BCCP was also able to help the government design an integrated health, population, and nutrition school curriculum. The school curriculum and the PMC guidebook are part of a larger push to address adolescent and youth sexual and reproductive health needs in Bangladesh.

Reaching Youth and Managing Quality of Life

Although not related to the PMC Guidebook, a new national curriculum will provide adolescents with basic information to help them understand PMC more easily.

Unveiling of the cover of school health curriculum (SHPNE package) by the Director Generals, Additional Secretaries and USAID-OPHNE’s Deputy Team Lead. Credit: BCCP

Credit: BCCP

In January 2022, the Ministry of Health and Family Welfare inaugurated a comprehensive, integrated school curriculum on health, population, and nutrition. This new curriculum will be used simultaneously by the Health, Family Planning, and Nutrition departments and among non-governmental organizations across Bangladesh.

The curriculum consists of 23 sessions on health, population, and nutrition for students in secondary school ranging from 11 to 15 years old, who will participate as part of their extra-curricular activities.

Key Takeaways

It is critical to identify the needs of youth and match them to doable initiatives that have shown success in other contexts. Being prepared with evidence is important to make a strong argument that successful behavior change is possible. Close collaboration with key government divisions and focal centers, as well as understanding the larger needs of a nation and its leadership, are helpful in designing initiatives that will result in buy-in. Persistence is necessary; it takes time and continuous engagement to draw attention to child marriage and other issues experienced by youth and the interventions that address them. It is vital to integrate these interventions into a larger effort, thereby adding to and enhancing the existing system and endeavors.

For more on how to meet the FP/RH needs of youth, check out the Connecting Conversations series.

Pranab Rajbhandari

Country Manager, Breakthrough ACTION Nepal, and and Regional Knowledge Management Advisor with Knowledge SUCCESS, Johns Hopkins Center for Communications Programs

Pranab Rajbhandari is the Country Manager/Sr. Social Behavior Change (SBC) Advisor for Breakthrough ACTION project in Nepal. He is also the Regional Knowledge Management Advisor-Asia for Knowledge SUCCESS. He is a Social Behavior Change (SBC) practitioner with more than two decades of public health work experience. He has grounded field experience starting as a program officer and has in the past decade led projects and country teams. He has also consulted independently nationally and internationally for USAID, UN, GIZ projects. He holds a Master’s in Public Health (MPH) from Mahidol University, Bangkok, a Master’s (MA) in Sociology from Michigan State University, Michigan and is an Ohio Wesleyan University alumnus.

A. K. Shafiqur Rahman

Project Integration Adviser, Bangladesh Center for Communications Programs (BCCP)

Mr. Shafiqur Rahman is a seasoned behavior change communications (BCC) expert, with over 30 years of progressively senior level experience in conceptualizing, designing, implementing, coordinating and monitoring of strategic communication, community mobilization and SBCC capacity building interventions for international and national development agencies in Bangladesh. Presently working with Bangladesh Center for Communications Programs, Mr. Rahman has been responsible for strategic planning and guidance to project teams, GoB level TA and NGO partners in the fields of public health, education and good governance, with special expertise in family planning/reproductive health and other programs targeting women, girls and youth.