Filthy Fertilizer: How Urine-Biochar Could Potentially Help Farmers in Rural Bangladesh

By Dr Ipsita Sutradhar and Sayema Akter

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Farmers producing biochar in a soil pit kiln.

Urine + Biochar = Quality Fertilizer. Biochar is created through burning biomass in an oxygen-limited environment. Biochar is a light and porous material with high adsorptive and water-holding capacity that can be used as fertilizer. The Ithaka Institute in Switzerland invented a low-tech method to produce biochar from crop and wood waste in soil-pit kilns (a type of oven). Studies have also demonstrated that animal (or human!) urine can be a highly efficient fertilizer. Even though it is available free of cost, urine remains underused in the global farming industry because of the bad smell and other associated socio-cultural barriers. However, most are unaware that biochar can actually soak up urine and transform it into an odorless solid organic fertilizer that promotes optimal soil conditions for farmers to grow crops.

Urine-Biochar Fertilizer in Bangladesh. In Bangladesh, the FAARM project promoted home gardening among small-scale farmers to improve their nutritional status. But the home gardens demonstrated low soil fertility and commercial mineral fertilizer was less affordable for the farmers. This is where the BUNCH project played a key role; it tested whether urine-biochar fertilizer could serve as a solution for the farmers to improve their home gardens at a low cost. But the real question was whether the farmers would accept it.

Cow Urine Already Accepted! Since cow dung is widely used in rural Bangladesh as fuel and fertilizer, we found that both Hindu and Muslim farmers under the project quickly accepted the concept of using biochar mixed with cow urine. In fact, they preferred using it because not only are the ingredients easily and freely available, but it is also chemical-free and highly efficient.

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Biochar and urine are mixed together in buckets before it is distributed in the soil.

Yuck! Human Urine is Considered “Impure.” When the study introduced the use of human urine with biochar, farmers from both Hindu and Muslim communities were very hesitant to use it due to their religious and cultural beliefs. Human urine is considered ‘impure’ and ‘unholy’ substance. They are also convinced that human urine is accountable for spreading diseases, although the scientific literature does not support this. Some Hindu farmers were even afraid of social isolation and some Muslim farmers thought that crops produced by using human urine would be religiously forbidden to consume. Only a few individuals were willing to try the human urine-biochar as they thought it was possible to overcome the impurity-related barriers by taking a bath and changing clothes immediately after handling the fertilizer.

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Urine-biochar fertilizer being applied to the soil before planting.

What Next? Since using urine-biochar for crop production is a new concept in Bangladesh, a series of practical demonstrations were very helpful for training farmers to manufacture and use it. At the moment, further testing of the method is underway in the field. The crop yields from urine-biochar will be compared to yields from traditionally used fertilizers and chemical fertilization.

In general, using urine-biochar fertilizer can help increase food security and cropland diversity in areas with severely depleted soils, scarce organic resources, and inadequate water and chemical fertilizer supplies. With wider promotion and use, it will eventually become easier to convince more farmers in Bangladesh to tap into the rich supply of human urine and biochar-based fertilizer.

The authors are both research associates at BRAC School of Public Health.

This blog as written as a result of research funded by LANSA Research Programme Consortium under the Responsive Window 2 opportunity. LANSA is funded by the UK Government. The views expressed in this document do not necessarily reflect the UK Government’s official policies.

Victoria’s Story: When the Student Becomes the Teacher

By Farasha Bashir


Have you ever faced a daunting medical crisis and felt helpless? A hospital wing overflowing with patients with very little you can do to help or cure them? This was the situation Victoria Nankabirwa found herself in 2004 when she was working as an intern doctor at the Department of Paediatrics in Mulago Hospital in Kampala, Uganda. That year, during her internship, there was a measles outbreak in Kampala. Soon the paediatric ward was overflowing with afflicted children who were more likely to succumb to the disease than leave the hospital wing to which they were confined.

Such was the bleak situation when the government initiated a mass immunisation campaign to tackle the epidemic. The campaign was thorough, leaving no stone unturned and targeting both the sick children and those susceptible to the disease. The results were astonishing. Within a short period of time, the entire wing had dried up; patients were getting better and discharged while no new cases were reported.

Watching the effect of a single, simple intervention 13 years ago that saved so many lives changed Victoria. Erstwhile, she wanted to pursue a career in clinical medicine but her experience working in the paediatric wing and witnessing the utility of public health in helping populations motivated her to change her career track. Around this time, she received a call from one of her professors telling her about a new public health programme in Bangladesh. This programme would incorporate the theoretical approaches from the classroom and apply them practically through field-based learning. It was also taught by renowned faculty from institutions across the world.

Contemplating her future, Victoria was invited to take part in a briefing session, conducted by Jon Rohde and Cole P Dodge – two renowned scholars and practitioners in public health. They described the story of oral rehydration solution (ORS) that was developed in Bangladesh and saved over 40 million lives. This resonated with Victoria as she herself watched how a simple awareness and immunisation campaign had cured so many children. She made her decision to study at this new school of public health; not only was the programme tailored to the scenario in low and middle income countries like her own, but she would gain unprecedented exposure to national and international experts and access to BRAC, the largest and most effective NGO in the world.

“Most of the practical skills I learned and adopted and used in my career, I learned it from here – the BRAC School of Public Health,” said Victoria.

Victoria was one of 25 students in the first batch of the Master of Public Health (MPH) programme at the BRAC School of Public Health (the MPH is currently on its 13th batch). She credits the School for not only providing a strong academic foundation but also teaching her skills vital to her career. She was provided the simple guidance she needed to work in the field, starting from how to ask a question to someone to understanding what entails a “good” question to ask. The practical day-to-day aspects are some of the valued lessons, which she attributes to helping her get to where she is today.

Victoria and her fellow classmates at the MPH orientation session in Savar in 2005. They are joined by Ahmed Mushtaque Raza Chowdhury and Alayne Adams.
Victoria with Jon Rohde in 2015 at the MPH curriculum review workshop for the BRAC School of Public Health.

Since graduating from the School,Victoria has pursued further degrees, including a PhD in International Health from University of Bergen (Norway) and a DrPH in Epidemiology from Columbia University (USA). She has also taught at both universities in various capacities. This year, she will be teaching at the BRAC School of Public Health, taking classes in the Epidemiology module, bringing her journey with the School to a full circle.

“I always wanted to give back. Coming to Bangladesh changed my life and I knew that if I were to give back, the BRAC School of Public Health would be one of the first places I would do so.”

Today, she is a lecturer at Makerere University (the same institution where she completed her Doctor of Medicine) and an avid researcher in her chosen field. She is also a researcher at the center for intervention science in maternal and child health (CISMAC) at the University of Bergen in Norway and also a principle investigator for the BCG study and the cholorhexidine studies in Uganda.

To all those who are currently undertaking a degree in public health or hoping to pursue a career in this field, she advises them to think ahead. The public health arena is ever changing, with non-communicable diseases poised to be the next big threat affecting those in low and middle-income countries. However, the threat of other problems, such as infectious diseases and chronic malnutrition still persists. Thus the need for quality public health practitioners today is more vital than ever with a wide scope of challenges that must be tackled.

The author is a communications and knowledge manager at BRAC School of Public Health.

Bringing a Baby into the World at the Cost of the Mother’s Health

By Dr Nahitun Naher

There are so many special days we celebrate throughout the year that nowadays they do not create enough excitement. But among these plethora of special days, Mother’s Day is unique as it is a reminder to all to acknowledge and honour one’s mother. This should not only be a one day celebration, rather a mantra in our lives. Mother’s Day is the perfect time to talk about motherhood and maternal health and to express love and gratitude to the most unconditional bond between two human beings.

From my personal experience, the day when my son was born there was an overnight shift in all the equations and dimensions of my life. However, the journey towards motherhood is not an easy one to trail; motherhood is difficult and the amount of physical and emotional stress it places on a woman is not an easy one to endure despite that fulfilling experience of bringing a life into the world. 

According to the World Health Organization (WHO), more than 135 million women experience pregnancy and childbirth each year. One of the lesser discussed topic are the issues a woman will face during this experience.

Maternal health refers to a woman’s health during the period of pregnancy, childbirth and postpartum. For many women around the world, it is also associated with ill health and sometimes even life threating complications. Although the global maternal mortality ratio declined 44 per cent from 1990 to 2015 (as per UN inter-agency estimates), 830 women will die every day from pregnancy and child birth related complications. Unsurprisingly, 99 per cent of these deaths take place in developing countries, with a higher rate in rural areas and with an even higher rate among young adolescent mothers. 

The five main causes of maternal mortality are severe bleeding, infection, unsafe abortion, hypertensive, and medical complication in pregnancy. Out of the 135 million women who give birth per year, nearly 20 million of them suffer from various complications even after birth. 

Many of these mortalities and morbidities can be prevented through skilled care and delivery, however shortage of qualified health workers to provide these services remains a major obstacle in ensuring safe motherhood (WHO).

Bangladesh has made significant improvements in maternal health in terms of achieving Goal 5 of the Millennium Development Goals (MDG). As per the United Nations and WHO, the maternal mortality rate in Bangladesh is 176 per 100,000 live births (2015) with an annual rate of 5.9 per cent reduction from 2005 to 2015. Multiple factors contributed to this achievement, primarily the government’s strong commitment to highlight maternal health as a national priority.

Despite the achievement, the number of skilled birth attendants present during delivery is still below the national goal of 55 per cent (it is currently 42 per cent). On the other hand, the high rate of unnecessary Caesarean sections (23 per cent in 2014 despite the WHO recommendation of 10 to 15 per cent) reflects an imbalance in terms of utilisation of maternal health services. The government institutions, private organisations, and NGO’s including BRAC, are producing midwives towards so as to bolster the maternal and new born healthcare services available in Bangladesh. 

However, while the country is making strides in promoting better maternal healthcare services, it is also hampering progress due to the high rate of child marriage and adolescent pregnancy – a new law was recently passed which allowed a marriage to take place between parties under the age of 16 due to “special circumstances”.

Because every single mother matters and deserves care, safe delivery through the presence of skilled birth attendants and ensuring equitable provision of comprehensive reproductive healthcare services, while at the same time working on issues of child marriage and adolescent pregnancy are crucial to accelerate the progress of maternal health in Bangladesh in the coming years.

The author is a senior research associate at BRAC School of Public Health. 


The Needs of the Few: Reflections from PMAC 2017

By Aisha Siddika, Kuhel Islam, and Tasfiyah Jalil


We have entered into the age of sustainable development goals (SDG), and this time is very critical, particularly for our target of making societies inclusive.

The inequalities and financial burdens in health care, which are unfair and unjust, are some of the current concerns of public health professionals. Recognising these ambiguities, more than 900 public health professionals, academics, and representatives from civil society organisations gathered in Bangkok, Thailand to attend the Prince Mahidol Award Conference (PMAC) 2017, a highly prestigious public health experts’ congregation in Asia.

 The conference title was “Assessing the health of vulnerable populations for an inclusive society,” which resonates with the third SDG of ensuring healthy lives and promoting wellbeing for all at all ages.

Incidentally, this year’s theme for the World Health Day on April 7 was depression — an overlooked mental health problem globally and an issue that requires more attention in Bangladesh also. Mental health is inseparably connected with people’s physical health, so we cannot ensure physical well-being of people by excluding their mental wellbeing.

About 14% of the global disease burden is related to neuropsychiatric disorders — mostly depression. According to the WHO, about 6.4 million people are suffering from depressive disorders in Bangladesh, which is a very big number.

Unfortunately in Bangladesh, due to social stigma and lack of awareness, mental health patients are often advised to visit local healers instead of seeking professional help.

Evidence says depression is often a result of social exclusion and discrimination and can lead to sufferers developing suicidal tendencies. Vulnerable populations are more at risk as they frequently face exclusion and discrimination from mainstream society.

Considering these issues, it is crucial for Bangladesh to make the health of vulnerable populations (both physical and mental) a priority if we want to achieve our target of an inclusive society.

Everyone has a right to receive the highest attainable standard of health care, as stated at the world health assembly in Alma Ata in 1978. For an inclusive society, we need to ensure quality, and respectful and trust-based care for all, particularly those who are vulnerable.

But, whom should we consider as vulnerable? We have to consider people’s vulnerabilities from our own context. In addition to biological vulnerabilities (eg suffering from infectious diseases like tuberculosis, HIV, etc) and economic vulnerabilities (eg living in poverty), we also have to consider relational vulnerabilities (eg social stigma, class system, etc) while addressing the health needs of populations.

Vulnerable populations (eg women, children, and the elderly, particularly from rural, resource-poor settings, and ethnic communities; migrants displaced because of climate and man-made disasters; people with disabilities, diverse gender identities, and orientations) are often neglected entirely by mainstream health service providers.

However, as the PMAC keynote speaker, Nobel Laureate Amartya Sen, said: “Neglecting the health of some is surely a way to perpetuating social injustice.”

One of the practices discussed at the PMAC was people-centred health care, which refers to putting the particular needs of the patient first. Presenters described successful initiatives where service providers came from the same community as the patients so the patients would trust them more.

Presenters also suggested that patients’ agency and transparency in service provision should receive more attention so as to make the system more equitable and people-friendly.

Better evidence for better interventions is crucial as emphasised by PMAC attendees. If we do not have accurate data on vulnerable groups, they will remain excluded from receiving services and from policy decisions, allowing discrimination and exclusion to persist.

One of the biggest challenges in implementing evidence-based interventions is that factors such as ethnicity, sexual orientation, disability, etc are not considered during data interpretation, thus pushing the vulnerable further to the fringes.

Health care finance was another focal point at the PMAC, underpinned by an understanding that ill-health breeds poverty. Out of pocket expenditure for health is one of the highest in Bangladesh, which can be a major barrier to all our efforts towards an inclusive and equitable society.

Whether to cover everybody with a modest coverage or provide full coverage to selective vulnerable groups is the question. To balance the two, we can consider different health insurance schemes or health benefit packages for different vulnerable groups depending on the nature of their vulnerabilities.

The PMAC emphasised increasing the number of skilled health care providers, in particular skilled mental health first-aiders who can be non-judgmental and neutral in listening to people’s sufferings and can provide primary instructions (eg follow a “self-help” approach or referrals).

We need to reorient our health workforce to motivate them to work in diverse conditions and situations geared towards a rights-based approach rather than focusing only on physical well-being. In order to ensure inclusivity, health care providers need to rise above stigma, exclusion, and preconceived notions, and treat communities based on equity and not just equality.   

Addressing the health needs of vulnerable populations and ensuring quality and respectful care for them is also a matter of social justice, as one of the PMAC panelists, Steve Kraus, director of UNAIDS Regional Support Team for Asia and the Pacific, rightly said.

Vulnerable populations are not asking for any additional rights but the same rights that we are all enjoying. To manifest the changes we want, we first require rigorous political scrutiny and attainable commitments.

We must also put forward human rights and social justice agendas and do everything we can to address the inequalities and unmet needs until we have an inclusive health care system in Bangladesh.

This article was originally posted on Dhaka Tribune. The authors are project coordinators at BRAC School of Public Health. 

How Can Civil Society Help Influence Health Policy?

By Anushka Zafar

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Bangladesh’s health sector has come a long way, reaching several millennium development goals and making foremost improvements in areas of maternal and child health, immunisation coverage and TB control. But the double burden of existing communicable and emerging non-communicable diseases (NCDs) is threatening to undermine the benefits of development and growth that have been achieved over the past four decades.

NCDs are not passed from human to human like many traditionally observed illnesses in tropical countries such as Bangladesh. Instead a person may be genetically predisposed to, or at risk of NCDs from behavioural or environmental factors. The four most common forms of NCDs are cardiovascular diseases (like heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructive pulmonary disease and asthma) and diabetes.

In Bangladesh, there has been a slow decline in tobacco use – one of the main reasons for asthma, cancer and chronic obstructive pulmonary diseases. Cardiovascular diseases account for the greatest number (17 per cent) of all NCD-related deaths (WHO 2014), and more than eight per cent of the adult population suffers from diabetes (WHO 2013). Yet the country’s health system and policies still continue to prioritize the needs of children and reproductive-age women with little preparedness and skills to address the emerging epidemic of the NCDs.


Having not been addressed in the previous MDGs, NCDs have now been recognized as a major global health challenge and included in the Sustainable Development Goals. As a result, currently two significant policies are being developed in Bangladesh that includes NCDs – the seventh five-year plan (2016-2020), and the fourth health sector plan (HPNSIP 2016-2021).

“While these documents are being formulated, it is high time to discuss, debate, and strategise approaches and interventions to mainstream preventive NCD interventions in the existing primary healthcare infrastructure in a sustainable manner,” said Dr Syed Masud Ahmed, professor and director of the BRAC School of Public Health’s Centre of Excellence for Universal Health Coverage. The School currently hosts the secretariat of Bangladesh Health Watch (BHW), a civil society initiative comprised of multiple stakeholders.

Since 2006, BHW has been monitoring the health sector agenda and programmes, while advocating for the improvement of the country’s health system. The group’s members have joined forces to carefully review health policies and recommend appropriate actions for change that will have a lasting impact on the lives of Bangladeshi people.

The collective is comprised of several key public and private sectors players including high-ranking representatives from BRAC, EngenderHealth, and WaterAid. Others include individuals who were previously holding prominent positions at the National Institute of Population Research and Training, WHO, and government ministries including Health and Family Welfare. BHW also includes members from research hospitals such as the Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), think tanks such as Centre for Policy Dialogue, academicians from BRAC University and Dhaka University, as well as members of the media and activist groups. Including a wide range of perspectives and expertise provides BHW with the legitimacy that allows for access to those who directly inform and formulate policy change.

Civil society has already been active in monitoring the country’s progress in various sectors, such as education, with the Education Watch having been established in the late 1990s. Reports released annually by Education Watch have been widely considered a credible source of information used to inform national policy and programming. Similarly, BHW has also been playing a part in influencing the national health agenda through its series of reports. The first report published focused on the theme of health equity (2006), followed by health workforce (2007), health governance (2009), universal health coverage (2011), and urban health challenges (2014).

As a result of its continuous efforts, BHW has become a credible source for instigating policy changes at the top level. For instance, based on findings from the health governance report, governance and stewardship were included as legislative priorities in the next Health, Nutrition and Population Strategic Investment Plan 2016-2021. Additionally, recommendations from the report on health workforce stated the need to restart recruitment and training of additional medical assistants and family welfare visitors as a matter of urgency. Subsequently this was reflected in the Health Workforce Strategy 2008, stating special attention would be placed on improving the production capacity of the institutes responsible for production of nurses, health technologists, medical assistants, family welfare visitors and skilled birth attendants.

This year, the collective has decided to focus on the theme of tackling emerging NCDs. With both the five-year plan and next health sector plan already on its way to being drafted, the BHW group believes it is imperative to release a report and give recommendations to be included in the final policies and operational plans. With already low spending in health resources, along with the rise of NCDs, findings have shown that NCDs can have a catastrophic impact on spending and impoverishment caused by large out-of-pocket expenditures for treatment. Thus one of the recommendations made by BHW is that the government must urgently focus on mainstreaming NCD care in primary healthcare facilities, emphasize prevention over treatment, screening and appropriate referral for early diagnosis and treatment. This will help provide population-based and cost effective services.

However, these recommendations are not a silver bullet, but rather a catalysing force comprised of civil society members capable of aiding greater action and influencing lasting solutions. Much work is still left to be addressed in order to continue the sustainable development of the national health system. NCDs include a large spectrum of illnesses, including mental health and road accidents, which will not be included in the most recent BHW report. However the collective agree that the significance of these problems in Bangladesh are deserving of their own reports as policies continue to evolve to include these immediate and emerging health sector issues.

A version of this article was originally published in the Dhaka Tribune. The author is Communications and Knowledge Manager, BRAC School of Public Health

The Hidden Problem: Shadows of Mental Stress Over Urban Adolescents

By Seama Mowri

Photo Credit: Allison Joyce 2015

“He had a bottle of poison in his hands and told me he would drink it if I didn’t agree to marry him.” 
– A 16-year-old girl living in a Dhaka slum explaining the circumstances that led her to consent to marriage.

Whilst this might read like teenage melodrama, the girl’s story is not unusual. During the last six months of our research (a project funded by IDRC and led by Professor Sabina F Rashid) in urban slums the research team encountered several stories of manipulative suicide threats and evidence of mental angst among both male and female adolescents and young people. Initially, a love interest may spark such incidents of dramatic behaviour but these are symptomatic of much deeper troubles. The rapid hormonal, physical and mental changes brought by puberty are difficult for any adolescent to navigate but these challenges are intensified when they are experienced simultaneously with the social, economic and structural instability of surviving in poverty in Bangladesh’s dense urban slum communities, where adult responsibilities are imposed on children before they are ready.

The multiple stressors experienced by adolescents in these settings are little discussed but include: fathers abandoning families, parents remarrying, children being forced to drop out of school, unemployment, abusive gossip and rumours about girls’ characters and “morality”, bullying, daily sexual harassment, physical abuse for dowry, taunts regarding dark skin from in-laws, and entrenched gender norms that place unachievable expectations on girls and boys. Any one of these factors – including the dynamics of the overcrowded slums they navigate, living out of cramped one-room households – can have debilitating effects on a person’s mental well-being.

Our research also highlights a complex interplay of age and identity. Amongst the slum dwellers, there is an embedded assumption that ‘married’ implies ‘adult’, and most of these married ‘adults’ are 15-16 years old. In other words, there’s almost no sense of transition about the stages of adulthood that they go through. As we’ve noted, most of the early married adolescent girls face the challenge of forming their adult identity at the same time as they are required to assume the duties of a wife and a mother which can create a great deal of mental stress. But who do they turn to?

“I have nowhere to go, no one to seek help from. I see my nonod (sister-in-law, who is only eight months younger than me) roaming around with her friends, gossiping, going to fairs… but I can’t do any of that. I am ghorer bou (bride of the house). I have to take permission from my husband and my father-in-law before stepping out of the house. The only guidance I get from relatives and programme interventions is related to family planning,” shares Ayesha about her experience after marriage.

The WHO constitution states: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” An important implication of this definition is that mental health is more than just the absence of mental disorders or disabilities. Mental health is defined as a state of well-being in which an individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community.

In Bangladesh, there is a dearth of knowledge around systematically-collected data on mental disorders and so the extent of the problem remains unknown. A recent systematic review (by Hossain et al.) suggests that females are more vulnerable to mental disorders in both rural and urban settings compared to males. These findings are consistent with another rural study (Ara et al. 2001) which reported that social stigma inhibits women from seeking medical treatment for their mental problems.

The BRAC School of Public Health has undertaken a number of research projects that focus on exploring mental health issues among adolescents. One of the projects is trying to understand how early marriages change the life opportunities and well-being of girls in urban slums, and their coping strategies in coerced marriages. Qualitative cases pertaining to sexual coercion in early marriages have provided some insight into the challenges faced by adolescent females living in a society fraught with gender disparities. Another research study funded by NWO-WOTRO – “Psychodrama as Transformative Intervention in the SRH of Young Men in Urban Slums” – aims to identify the spectrum of risks and health issues affecting young men. “Sexual and reproductive health (SRH) education for young men, particularly those from vulnerable communities like urban slums, is a neglected issue,” says Dr Malabika Sarker (Professor and Director of Research at James P Grant School of Public Health) who is leading the study.

As Dhaka transitions into being the sixth largest megacity by 2030, the urban challenges of structural poverty and inequalities, steep social gradients, risky environment, deprived living conditions, entrenched and changing social and gender norms will start to have serious impacts on the well-being of the population at large. What does that mean in terms of the stress resilience of an increasingly urban population? What are the health consequences of higher social stress exposure and vulnerability of urban-dwellers, given that stress is the most likely cause of many mental disorders, particularly depression? And from a policy perspective, what actions can be taken to protect people living under dense metropolitan conditions from urban stressors and their negative mental impact? With this article I wish to stimulate a conversation in the hope of facilitating a more nuanced understanding of how urban living conditions impact our mental health. And it is imperative that we start the conversation sooner rather than later.

This article was first published in The Daily Star on World Health Day. The writer is a project manager at the Centre for Gender and Sexual and Reproductive Health Rights, James P Grant School of Public Health. 

Psychodrama as a New Form of Health Education for Young Men in Dhaka’s Urban Slums

By Rafee Muhammad Tamjid


Shujon* is a 19-year-old man living with his mother in Bhashantek, an urban slum in Mirpur, Dhaka. His father left his mother when he was a child, leaving him with too many responsibilities and unable to cope. He feels depressed because of the expectations projected on him by his family and peers. Recently he broke up with his girlfriend, because her parents wanted her to get married, but Shujon was not ready. “If I married her now, I would have to be a rickshaw puller, and that won’t make us enough money.” He admits that sometimes he feels confused and doesn’t have anyone to talk to, which takes a toll on his mental health.

To our surprise, when we explained to Shujon that the research project we were conducting would examine the physical and mental wellbeing of young men just like himself, he was immediately interested to speak to us. His eagerness was probably a reflection of the fact that in Bangladesh there is little to no attention given to mental health education, particularly related to sexual and reproductive health (SRH).

Due to shame and stigma, there is a lack of comprehensive SRH education in Bangladesh. Although several successful interventions exist around family planning for married couples, SRH education is still limited for others, particularly the target group for this research project: young vulnerable men who live in urban slums and engage in risky sexual behavior. While this study will also detect exactly which types of behavior are involved, similar studies in Africa show that risky behavior is influenced by one’s social environment.

Currently Dhaka is one of the fastest growing megacities in the world. By 2025, the UN predicts Dhaka will be home to more than 20 million people. As the population of the city grows, so will the population and size of the slums. Thus it is very important to make sure the wellbeing, including health of men in these slums are attended to just as much as women and adolescents. Generally, SRH knowledge of slum dwellers in Bangladesh is very low and they have a higher probability of being confronted with early marriage, drugs and violence.

This research project aims to identify the spectrum of risks and health issues affecting other young men like Shujon living in urban slum. Psychodrama (a group psychotherapy method) would then be used as a “transformative intervention” to help participants discover alternatives to the choices they would usually make. Psychodrama uses role-playing, dramatisation, and self-presentation to explore and gain insight into one’s life, incorporating theatre and conducted in groups under a licensed trainer, educator and practitioner.

Young men living in Bhashantek slum. Photo Credit: Rafee Tamjid

Since psychodrama is a very new concept in Bangladesh, we want to adapt this therapeutic approach and create an innovative and interactive educational tool to see if it can be used as new form of health education. It will engage young men to explore existing and alternative attitudes towards their own and their peer’s health and relationships. The hope is to use psychodrama can help these young men evaluate their decision-making process so as to decrease the risky-behaviors they engage in which may adversely affect their health.

“SRH education for young men, particularly those from vulnerable communities like urban slums, is a neglected issue,” said Dr Malabika Sarker (Professor and Director of Research at JPGSPH) who is leading the study. “An innovative approach that blends traditional methods of mental health counseling and SRH education with a more humane touch like psychodrama could help reach this population more effectively.”

*Note: Name has been changed for anonymity purposes.

Rafee Muhammad Tamjid is a research assistant at the James P Grant School of Public Health.

Stay tuned on #VitalSigns for more updates from this project!