Bangladesh has actually done exceptionally well in increasing contraceptive use by more than 50% in the last 40 years. Yet it still has the highest rate of adolescent pregnancy (31%) in all of South Asia. In a society where child marriage remains common practice, tackling adolescent pregnancy can be an uphill battle.
But a recent study conducted about decision-making and contraception use among married girls in Bangladesh has helped shed more light on how to address this issue. Findings revealed that approaching husbands and mothers-in-law through targeted interventions may serve as an effective method to encourage more use of contraception.
The study took place in Rangpur district, which has the country’s highest number of adolescent pregnancies. Conducted by a research team including JPGSPH’s very own Malabika Sarker, the study followed 35 married adolescent girls for a year through interviews about their maternal healthcare-seeking behaviour.
The aim was to understand the girls’ rationales for using or not using contraception. The most common reason they gave for having a child right after marriage was the expectation to bear a child from their husbands and mothers-in-law. They also conveyed a mistrust and fear about the quality and usage of contraception. Further apprehension is caused by misconceptions from other women in the family or neighbourhood, who become the primary sources of information for girls after marriage.
In rural Bangladesh, husbands and mothers-in-law act as the main decision makers in all matters related to childbearing. As the main breadwinners, men ultimately get to make all household decisions regarding health care. But because family planning is still considered a “woman’s issue,” mothers-in-law are also given authority to make decisions.
Thus by creating interventions that target husbands and their mothers and educating them about the benefits of contraception use and the severe detrimental effects associated with adolescent pregnancy, several of the barriers keeping girls from making these decisions can be lifted.
Child marriage cannot be expected to end overnight, but public health practitioners and policymakers need to start considering the matters at hand. Community health workers with the most exposure to these populations must also be trained in order to provide accurate information so that people fully trust and understand why and how to use contraceptives.
However, these findings are not a means to an end; it is now imperative that the wider community and societal actors begin implementing programmes to increase the uptake of contraception to delay pregnancy among adolescent girls. Only then can further policy formulation and implication lead towards decreasing the rate of adolescent pregnancy in Bangladesh.
To find out more about the study, read it here.
This blog was written by Anushka Zafar, a communications and knowledge manager at BRAC School of Public Health.