Strategies to Improve Reproductive Health Services for Adolescents in the Public Sector

Funded by: USAID

Recent surveys on adolescents conducted by ICDDR,B and other organizations in Bangladesh have found that adolescents have poor levels of knowledge regarding reproductive health (RH) issues.   Furthermore, what is known is often incorrect.  The limited knowledge they have is derived from their friends or other social contacts, who are equally unknowledgeable.  In Bangladesh traditional beliefs and practices restrict the discussion and flow of accurate RH information to adolescents.   Accurate information on key RH issues, such as sexuality, family planning, and STDs are severely restricted.  Sexual activity among adolescents, outside of marriage, is generally believed to be uncommon.  This was put to question by a survey completed by Population Council in Bangladesh that reported adolescent, premarital sex is not uncommon.  A report by Bangladesh Government (2001) indicates over 50% of STD cases occur in persons under 25 years of age.

Considering this situation ICDDR,B has recently completed studies in three settings: communities, schools and garment factories.  Strategies tested included community sensitization, booklets, and peer groups.  The interventions were tested in rural and urban sites of Bangladesh. The school based intervention was conducted in Abhoynagar and Mirsarai, two ICDDR,B field sites.  The students of class 8, 9, 10 of selected schools were included in this intervention.   As part of this intervention, three booklets Nijeke Jano (Puberty, Marriage and Family Health and STI/HIV/AIDS) were tested.  The objective of the research was to determine the effectiveness of these booklets which combine the sensitization of communities (Parents, teachers, community leaders and service providers) and the distribution of booklets addressing puberty, reproduction and STDs/AIDS.  The content of the booklets is based on a study entitled Frequently Asked Questions conducted by ICDDR,B.  From this study a databank was created with questions raised by the adolescents and answers were developed with the help of an Adolescent Working Group (members from BCCP, ICDDR,B, NSDP, UNICEF, UNFPA, Marie Stopes, SMC, BRAC and USAID).

The results of the school-based study indicate that students did increase knowledge on different RH issues; all the booklets had greater impact on boys than girls.   The focus of this study was largely on knowledge and very limited reproductive health behaviors were assessed, for example, health care utilization and TT immunization.  In a country like Bangladesh unmarried adolescents face important barriers to information, they experience providers bias and limited access to services.  Booklets, alone, are not enough.  There is a need to adopt multiple information and service strategies.  This study provides valuable information on the process of implementing a culturally sensitive intervention.