Akhi (L) is a young wife and pregnant mother living in the most remote locations of southwest Bangladesh. Mili (R), a community nutrition volunteer working with USAID’s Nobo Jatra Project implemented by World Vision in Bangladesh, visits pregnant women like Akhi and counsels families through courtyard sessions. Photo Credit: Mehzabin Rupa, World Vision
Shahin Sheikh and Nusrat Akter, which are not their real names, embarked on a journey driven by young love.. Shahin (a 10th-grader) and Nusrat (an 8th-grader) defied societal norms and left their homes, leaving their parents deeply concerned.
In the bustling streets of Dhaka, the capital city of Bangladesh, Shahin and Nusrat sought refuge in a cramped rented room, taking up odd jobs to make ends meet. Back in their hometown, their families initiated a frantic search, seeking help from local authorities and community leaders.
Months passed, and the harsh reality of urban life began to weigh on them. Shahin became a rickshaw peddler, while Nusrat worked as a housemaid. They soon realized that love, while powerful, couldn’t provide the stability they each craved.
With heavy hearts and a newfound perspective, Shahin and Nusrat decided to return home, where they were met with a mix of relief, joy, and concern. However, as they had already lived together, people from their surroundings were forcing their families get married, otherwise, they might have been excluded from society over societal stigmas of adultery. So both families agreed to have them married. This decision altered their lives dramatically, with Nusrat assuming the role of a homemaker and Shahin seeking additional sources of income.
Within months, Nusrat gave birth to a baby girl at the hands of a local midwife who had no formal training. Due to the lack of knowledge about health and nutrition, their infant was under weight and malnourished. They ended up visiting the local sorcery, religious, or ‘kabiraj’ for treatment instead of their local healthcare provider.
This story, though unique in its details, is emblematic of the larger issues surrounding youth access to family planning and AYSRH services in Bangladesh. Adolescent marriage like Shahin and Nusrat’s case shows a typical challenge for family planning and sexual reproductive health in Bangladesh. The country has the 8th highest prevalence of adolescent marriage in the world, and the highest prevalence in Asia, according to UNICEF.
Approximately, 38 million women and girls get married before they reach 18. And of them, 24 percent give birth before the age of 18.
In a society deeply rooted in traditional family customs, it is not common for low-and middle-income families who live with their parents and siblings together to discuss family planning and reproductive health (FP/RH) practices. It remains a taboo. Young people, particularly teenage girls, often struggle to assert their opinions to make difficult FP/RH decisions about their bodies.
Even when youth have the autonomy to choose their partners, societal norms often dictate when and how they should conceive, predetermining the expectations of their reproductive health and pregnancy.
Many educated young wives make FP/RH decisions after discussing matters with their peer groups. Other brides-to-be often have to drop out of their studies and sacrifice their dreams of a good career and financial freedom right after they choose their male partners.
Gender-based violence remains another significant obstacle in Bangladesh for addressing sexual rights and reproductive health (SRHR), particularly for girls. More than half (54.2 per cent) of Bangladeshi women face physical and/or sexual violence in their lifetime and nearly 27 per cent in the last 12 months, according to the Bangladesh Bureau of Statistics data. Shockingly, 25% of Bangladeshi women aged 15-49 believe that husbands are justified in hitting or beating their wives, according to a UNICEF survey.
Rural and marginalized communities often face these cultural and socio-economic barriers to accessing family planning and SRHR services, further limiting the reach of interventions.
These simple but significant societal challenges tell the sorrowful state of women’s participation in family planning and sexual reproductive health in Bangladesh. This trend not only has serious health implications for both young mothers and their children but also affects young women’s health and their ability to make informed choices about family planning.
SRHR education has been a part of the curriculum since 2013. Moreover, studies have found that a lack of comprehensive sexuality education (CSE) in schools and communities largely affects the sexual reproductive health issues for youth.
Research findings further demonstrate that the substantial obstacles and associated stigma, related to cultural norms and taboos, feelings of shame and the associated stigma, and religious constraints hinder the dissemination of information on sexuality within secondary and higher secondary schools in Bangladesh. According to a 2018 study conducted by the BRAC James P. Grant School of Public Health, both educators and students experience discomfort when broaching SRHR topics. However, efforts to provide CSE have increased, as initiatives are driven by organizations like UNFPA and WHO.
The United Nations’ Sustainable Development Goals (SDGs), particularly, Goal Number 3.7, emphasizes universal access to sexual and reproductive health-care services, family planning, information, education, and integration into national strategies. Despite these challenges, Bangladesh has made significant strides in improving family planning and reproductive health services. The reduction in the average fertility rate from 6.3 children per woman in the 1970s to around 2.1 today is a testament to these efforts.
The utilization of contraceptives among young people has also increased, with the modern contraceptive prevalence rate among married women aged 15-49 rising to 65.6% in 2021.
At the heart of the country’s FP/RH programming lies an essential cadre of healthcare professionals known as Family Welfare Assistants (FWAs). The FWA program represents a critical component of the healthcare system, catering to the unique needs of the youthful population and addressing the various challenges that young mothers and families face.
Youth-friendly health services have played a pivotal role in engaging young people in SRHR and family planning activities. These services create a comfortable and non-judgmental environment where young individuals can seek advice, counseling, and contraceptives.
Peer education and advocacy programs, driven by organizations like the Bangladesh Family Planning Association (BFPA), have been working to empower young people to raise awareness and disseminate information within their communities. These initiatives have helped reduce stigma and promote healthier behaviors. Grassroots strategies like the Jiggasha (asking) program engaged communities. Various national and international organizations developed support materials and tools for family planning programs, including reproductive health awareness. Capacity-building activities and research studies were also conducted to enhance program effectiveness.
The government of Bangladesh, in collaboration with international organizations and NGOs, have demonstrated its commitment to engaging young people in SRHR and family planning. Initiatives like the National Adolescent Health Strategy and Action Plan (2017-2030) and the Youth-Friendly Health Service Guideline prioritize youth participation and involvement.
In a country where a significant portion of the population comprises young people, youth engagement in family planning and SRHR activities are paramount. Comprehensive SRHR information not only promotes education but also reduces healthcare costs, promotes gender equality, and fosters economic growth. Addressing the challenges and barriers faced by Bangladeshi youths in family planning and SRHR is crucial for the well-being and prosperity of the nation. As the nation progresses, advocacy leaders must ensure that the voices of its youth are heard, and their choices and rights are respected, enabling them to make informed decisions about their sexual and reproductive health.