Author: Jasmyn J. Tang, MPH
September 26, 2023
Part 5: Sexual and Reproductive Health in Bangladesh
Bangladesh has one of the fastest-growing economies in the world today. As one of the few Asian economies to have grown during COVID-19, the country is currently outpacing peers like India, Indonesia, and the Philippines[7]. This substantial increase in recent years is providing a solid path for the future of Bangladesh’s young generation. But, even so, limitations show the long-standing presence of increased gender barriers, especially for the sexual and reproductive health (SRH) of women and girls. Adolescents make up 1/5 of the population at 32 million; however, adolescent sexual and reproductive health (ASRH) was not formally introduced until 2017 in the National Strategy of Adolescent Health[12]. This policy may be late, but it has slowly closed the gap in another issue this South Asian country faces: child brides.
Child brides are defined as the marriage of a girl before the age of 18. This traditional practice prevents young girls from continuing their education and current lifestyle by isolating them from their families and putting pressure on them to fulfill traditional gender norms. According to UNICEF[5], “Bangladesh has the highest prevalence of child marriage in South Asia and the eighth highest prevalence in the world. Approximately 38 million women in Bangladesh were married before they turned 18 and over 13 million women were married before they turned 15.” Over the past decade, the average age of marriage has slowly increased; between 2011 and 2022, the proportion of women aged 20–24 marrying before age 18 declined from 65% to 50%[8]. This in part is thanks to the hard-working interventions and coalitions from multiple stakeholders and global nonprofits like Girls Not Brides, participation in the UNICEF-UNFPA Global Programme to Accelerate Action to End Child Marriage, and increased awareness from USAID’s child marriage petition to Fazilatun Nessa Indira, the state minister for Women and Children Affairs in Bangladesh[3][4].
According to a report on adolescent sexual and reproductive health, many sexual and reproductive health (SRH) programs focus more on women of reproductive age (15-49) instead of adolescents (10-19), even though more than 4 out of 5 adolescents have never been married[1][9]. Since adolescents are more likely to face both health and social challenges, a lack of adequate and transparent knowledge and skills for protection places adolescents at a higher risk of unwanted pregnancy, unsafe abortion, and sexually transmitted infections, including HIV/AIDS[11]. This report[1] identifies gaps in SRH with unevenly distributed programs and a community of school-based awareness campaigns having little to no evaluation of behavioral change and cultural acceptance among adolescents. Interventions also lack coordination between stakeholders and the government, with much success based on the cooperation and sustainability of these programs. Though most services focus on married adolescents or child brides, health facilities play a major role in SRH with services ranging from family planning methods, menstrual management, and treatments for sexual reproductive tract infections. But, even with this concern, the distribution of SRH programs and advocacy is becoming more effective, as 99% of married girls knew at least one method of contraception, with 61% using modern forms of contraception in the slums of Bangladesh’s capital Dhaka[2]. During COVID-19, an assessment further showed that 83% of girls and 94% of women received the health services they sought with only 10% of men and 3% of women reporting financial difficulties in accessing any type of SRH service and product[6].
Making improvements, Bangladesh is a country with growing gender equality and sexual education, though progress is slow and obstructed by traditional cultural standards. As expressed in the United Nations SDG 2023 report, Bangladesh is ranked 106 out of 166 countries with significant challenges remaining in good health and well-being, quality education, and gender equality[10]. An up-and-coming country, Bangladesh still has prominent concerns that need to be addressed; however, improvements have been made, and one can only hope that they will continue.
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Sources
[1] Ainul, Sigma, Ashish Bajracharya, Laura Reichenbach, and Kate Gilles. (2017). Adolescents in Bangladesh: A situation analysis of programmatic approaches to sexual and reproductive health education and services, Situation Analysis Report. Washington, DC and Dhaka: Population Council, The Evidence Project. https://knowledgecommons.popcouncil.org/cgi/viewcontent.cgi?article=1577&context=departments_sbsr-rh
[2] Cortez, Rafael A.; Hinson, Laura; Petroni, Suzanne. Adolescent sexual and reproductive health in Dhaka's slums, Bangladesh (English). (2014). Health, nutrition and population global practice knowledge brief Washington, D.C.: World Bank Group. http://documents.worldbank.org/curated/en/712551468014450655/Adolescent-sexual-and-reproductive-health-in-Dhakas-slums-Bangladesh
[3] Desmon, S. (2022, August 24). One Million Signatures to end child marriage in Bangladesh - johns hopkins center for communication programs. Johns Hopkins Center for Communication Programs. https://ccp.jhu.edu/2022/08/24/marriage-child-bangladesh-pledge/
[4] Girls Not Brides. (n.d.). Bangladesh. Girls Not Brides. https://www.girlsnotbrides.org/learning-resources/child-marriage-atlas/regions-and-countries/bangladesh/
[5] Global polycrisis creating uphill battle to end child marriage. UNICEF. (2023, May 3). https://www.unicef.org/bangladesh/en/press-releases/global-polycrisis-creating-uphill-battle-end-child-marriage-unicef#:~:text=Bangladesh%20has%20the%20highest%20prevalence,Children%20should%20not%20be%20married.
[6] International Rescue Committee. (2022, May). Access to sexual and reproductive health services during the COVID-19 pandemic. International Rescue Committee. https://www.rescue.org/sites/default/files/document/6817/srh-bangladesh.pdf
[7] Munir, Z., Chakraborty, S., & Ishtiaque, T. (2023, April 28). Bangladesh’s economy is growing, and so are its emerging champions. BCG Global. https://www.bcg.com/publications/2023/bangladesh-grows-economy-with-emerging-champions
[8] National Institute of Population Research and Training (NIPORT) and ICF. (2023). Bangladesh Demographic and Health Survey 2022: Key Indicators Report. Dhaka, Bangladesh, and Rockville, Maryland, USA: NIPORT and ICF.
[9] Population Reference Bureau. (n.d.). Ensuring all Bangladeshi youth have access to sexual and reproductive health information and services. Population Reference Bureau. https://www.prb.org/resources/ensuring-all-bangladeshi-youth-have-access-to-sexual-and-reproductive-health-information-and-services/#:~:text=Young%20people%20in%20Bangladesh%20lack,their%20last%20pregnancy%20was%20unintended.
[10] United Nations. (2020). Bangladesh. Sustainable Development Report 2023. https://dashboards.sdgindex.org/profiles/bangladesh
[11] World Health Organization. (n.d.). Adolescent sexual reproductive health. World Health Organization. https://www.who.int/southeastasia/activities/adolescent-sexual-reproductive-health#:~:text=Sexual%20Reproductive%20Health-,Overview,transmitted%20infections%20including%20HIV%2FAIDS.
[12] Williams, A., Hasan, A. S., Hussain, M. M., Ruwanpura, E., Doraiswamy, S., Crosbie, C., Zaman, S. B., & Hoque, D. M. (2022). What we know and don’t know: A mapping review of available evidence, and evidence gaps, on adolescent sexual and reproductive health in Bangladesh. Sexual and Reproductive Health Matters, 29(2). https://doi.org/10.1080/26410397.2022.2083813