Though sexual and reproductive health and rights (SRHR) are fundamental rights for youth, in Bangladesh it remains a difficult topic to discuss openly, particularly among adolescents and despite its importance in this stage of their life.
Bangladesh has the highest adolescent fertility rate in South Asia; 1 girl in 10 has a child before the age of 15, and 1 in 3 adolescents becomes a mother or pregnant by the age of 19 (UNDP 2016). About 31% of adolescent girls have begun childbearing before the age of 20, one in four have given birth and 6% are pregnant with their first child (BDHS 2014). Only 47% of adolescent married girls between 15-19 years have access to contraceptive methods in Bangladesh (Family Planning Department 2013).
This research was undertaken from July-September 2020 by a team of researchers from SERAC to understand how out-of-school adolescent girls who live in the slum areas in Dhaka city access comprehensive sex education (CSE) and SRH services. A total of 58 out-of-school adolescent girls aged 13 –19 living in the Rupnagar slum in the Mirpur area of Dhaka took part in this research. The objective was not to ‘test’ respondent’s knowledge, nor to ask personal questions about their own behavior or decisions, but to understand their experience of accessing CSE including what types of information they have been given and what additional information they need, and how easy it is for young/unmarried women to access SRH services in the area.
Data Collection
Primary data was collected from 50 out-of-school adolescent girls through in-depth interviews. Both qualitative and quantitative data was collected. For quantitative data a structured (close-ended) questionnaire was developed, whereas the qualitative data was collected through a semi-structured (open and close-ended) questionnaire.
A group of 8 out-of-school adolescent girls took part in a focus group discussion (FGD) and shared their experiences around accessibility and affordability of CSE and the information they had received, and their needs of SRH services. This qualitative research focused on gathering their perceptions, attitudes, beliefs, opinions and ideas.
Data Analysis
To analyse the collected information, relevant statistical techniques were used through a univariate analysis such as frequency distribution table. The key results were presented through pie charts and bar graphs along with an interpretation of the findings.
Findings
The finding from this mini-pilot study show an urgent need to provide and improve access to youth-friendly health services, including for SRH, that are confidential, non-judgmental, non- discriminatory, and are affordable. Sexual and reproductive health services, information and education must also include access to contraception, safe menstrual regulation, and reproductive cancer prevention. Programs need to be based on a human rights framework, including the right to be free from discrimination, sexual harassment, coercion, and violence, as well as on principles of bodily integrity, dignity, equality, respect for diversity, and affirmative sexuality. Adolescents must be provided safe space for discussing their needs and challenges including gender based violence and mental health problems.
Access to SRHR and HIV services There is a lack of SRH understanding and information on HIV/AIDS prevention practices, and adolescent girls are not comfortable to talk about their relationship and health issues with their parents, and they have a low voice in the communities on decisions related to SRHR
Privacy issues and superstitions held many back from visiting nearby health facilities. Overall, the majority of the adolescent girls living in the Dhaka slums lag behind with inadequate access to information and friendly services. It is important to encourage young people through awareness and knowledge building opportunities to empower and give voice to their concerns.
Comprehensive Sexuality Education Most of the participants of this study lacked access to CSE. This limits their awareness of choices regarding SRH, and in addition, the avenues they are currently accessing are not age appropriate. Teachers, including the formal and non-formal (religious leaders and madrasa’s teachers), should be provided with CSE facilitation skills training to help address this. It is also important to introduce CSE to all young people through formal and informal channels, in community and workplace settings, to challenge harmful gender and cultural norms and barriers such as early and child forced marriage.
