Findings of an evaluation of a sexual and reproductive health programme in a humanitarian setting for the forcibly displaced Myanmar nationals in Cox's Bazar, Bangladesh.

Background: Since August 2017, around 940 000 forcibly displaced Myanmar nationals (FDMN), mostly women and children, have fled persecution in Myanmar and arrived in the refugee camps across the border in Cox's Bazar, Bangladesh. This large-scale humanitarian crisis created an urgency for sexual and reproductive healthcare-related services among many of the sexually assaulted FDMN women and girls. Ipas, an international non-governmental organisation (NGO) that has been working on expanding access to safe menstrual regulation, post-abortion care, and family planning services in Bangladesh since 2011, initiated an emergency humanitarian response programme in the refugee camps in Cox's Bazar in 2017 for the victim FDMN women and girls who were in desperate need of care. To understand the implementation process and the scope of sustainability and scale-up of Ipas's programme in the current humanitarian settings, icddr,b, a Bangladesh-based international health research institution, conducted an evaluation study. Methods: Due to the emergency crisis situation, Ipas could not collect baseline data while initiating its humanitarian response programme in 2017. Only a post-evaluation was carried out by icddr,b from August to December 2022 based on a desk review, health facility observation and assessment, qualitative interviews, and a stakeholder consultation workshop. Results: In collaboration with relevant stakeholders from the Government of Bangladesh and local and international NGOs, Ipas performed structural renovation and logistical arrangements to ensure facility readiness within the camps. Until December 2022, it provided comprehensive training on menstrual regulation, post-abortion care, and family planning services to around 700 service providers from partner organisations and expanded its activities from 8 to 51 service delivery points in 23 camps. Overall, 42 213 FDMN women received menstrual regulation and post-abortion care, while 339 334 received family planning services from these facilities, with a growing trend over time. Conclusions: Despite the challenges and barriers inherent to a humanitarian setting, Ipas's programme activities have achieved significant progress in providing menstrual regulation, post-abortion care, family planning services, and trauma/survival-centred care to the FDMN women and girls. A flexible approach, stakeholder coordination and commitment, cohesive methods for health systems strengthening, and community engagement were instrumental to the success of Ipas's humanitarian response programme.

Decision-making process in seeking antenatal care: A cohort study in a poor urban and a typical rural area in Bangladesh.

Background: Decision-making in choosing and using maternal health care among different care-seeking options is a complex process influenced by multilevel factors. Existing evidence on maternal health care-seeking behaviour stems primarily from cross-sectional studies with limited information. Therefore, we designed a cohort study to better understand the decision-making process in antenatal care (ANC) seeking. Methods: We conducted this mixed-methods study among pregnant women at <27 weeks of gestation in a poor urban area (n = 1320) and a typical rural area of Bangladesh (n = 1239) whom we followed up till eight weeks after delivery. In view of quantitative methods, we interviewed all enrolled women 5-6 times four weeks apart. For the qualitative approach, we conducted 70 case studies in the urban area and 46 in the rural area by interviewing the participants and their close family members. Results: In the urban area, about one-third of the pregnant women (38.4%) sought ANC at non-governmental organisations, and nearly an equal proportion went to public facilities (36.6%). In both the situations, women preferred facilities with one-stop services at a reasonable cost. In contrast, the lack of readiness in public facilities of the rural area pushed women (77.8%) toward private facilities for ANC. The reputation of the facilities, availability of skilled care providers, diagnostic tests, and ultrasonography services therein were the key influencing factors in the participants' decisions to seek ANC services from specific facilities. Conclusions: The availability of one-stop services was a key factor for participants' choosing of a facility for ANC. For the urban setting, there is a need to establish large public facilities with one-stop service provision in different zones, along with supporting non-governmental organisations in poor areas. For the rural setting, there is an urgent need to strengthen ANC service provision in public facilities at the community- and the sub-district level to redirect women from the private to the public sector to ensure low cost, quality services.