"I don't want my marriage to end": a qualitative investigation of the sociocultural factors influencing contraceptive use among married Rohingya women residing in refugee camps in Bangladesh.

BACKGROUND: The timely provision of comprehensive contraceptive services to Rohingya women is impeded due to a lack of clarity and understanding of their traditional beliefs and cultural frameworks. Recognizing this challenge, our paper aims to explore the socio-cultural factors influencing the utilization of contraceptives among married Rohingya women living in the refugee camps of Cox's Bazar, Bangladesh. METHOD: A qualitative study was conducted in two unregistered Rohingya camps (Camp 7&14) located in Ukhiya Upazila, Cox's Bazar from January 10th to 20th, 2022. A total of 14 In-Depth Interviews (IDIs) were conducted among married Rohingya women of reproductive age (15-49 years), along with 16 Key Informant Interviews (KIIs) involving stakeholders engaged in reproductive healthcare provision. Participants were selected using purposive sampling. All interviews were conducted in the local language, recorded, transcribed verbatim, and subsequently translated into English. The data were analyzed using NVivo (Version 11), and the analysis process followed Neuman's three-phase coding system. RESULTS: Five broad themes were identified: Sociocultural expectations and values attached to births, power imbalances within marital relationships, the role of religious beliefs, fear of side effects, and misperceptions about contraception. Having a larger number of children is viewed positively as it is believed that children play a crucial role in preserving the lineage and contributing to the growth of the Islamic population. Despite expressing an inclination towards contraception, the disapproval of husbands becomes a significant barrier for women. Defying their husbands' wishes can result in instances of Intimate Partner Violence (IPV) and even marriage dissolution within the camps. Moreover, the fear of side effects, such as a particular method would cause infertility, discourages women from using contraception. Many of these fears stem from myths, misconceptions, and mistrust in the existing medical system. CONCLUSION: Addressing the socio-cultural barriers that prevent women from using modern contraception will have important public health implications. These findings can support in crafting culturally sensitive programs and educational interventions. These initiatives can assist Rohingya refugee women in planning their pregnancies and reducing high-risk pregnancies, ultimately leading to a decrease in maternal mortality rates within the community.

The timely provision of comprehensive contraceptive services to Rohingya women is impeded due to a lack of clarity and understanding of their traditional beliefs and cultural frameworks. Taking this into account, our objective is to investigate the socio-cultural factors that influence the utilization of contraceptives among married Rohingya women living in the refugee camps of Cox's Bazar, Bangladesh. A total of 14 IDIs and 16 KIIs were conducted in two unregistered Rohingya camps. We found that contraceptive use among Rohingya refugees was constrained by various socio-cultural and religious beliefs. The desire for a larger number of children to ensure the continuity of the lineage and to be able to contribute to the growth of the Islamic population serves as a major barrier. Lack of decision-making power regarding reproductive life not only stops participation but also makes women vulnerable to IPV and marriage dissolution within the camps. Moreover, the fear of side effects, such as a particular method would cause infertility, discourages women from using contraception. Many of these fears stem from myths, misconceptions, and mistrust in the existing medical system. Young women often acquire information about both true side effects and myths from their social networks. Therefore, developing culturally sensitive programs and educational interventions targeting the women, their peers, and other related communities is indispensable to assist Rohingya refugee women in overcoming the identified barriers to contraception.

Prevalence, inequality and associated factors of overweight/obesity among Bangladeshi adolescents aged 15-19 years.

BACKGROUND: The objective of the current study was to estimate the prevalence and associated factors of overweight/obesity among Bangladeshi adolescents aged 15-19 y and to identify whether wealth-related inequality exists for overweight/obesity among Bangladeshi older adolescents. METHODS: We analyzed publicly available national representative secondary data from the 2019-2020 Bangladesh Adolescent Health and Wellbeing Survey. This cross-sectional survey was carried out among 18 249 adolescents aged 15-19 y regardless of their marital status using a two-stage stratified sampling technique (the data of 9128 eligible adolescents were included in this analysis). The WHO reference population for body mass index-for-age (1+Z score) was considered as overweight/obesity. RESULTS: We found that girls had significantly (p<0.05) higher prevalence of overweight/obesity (11.63%) than boys (8.25%); however, their biological sex as well their age were not significantly associated with higher odds of overweight/obesity. Those who were in their higher grade (grade 11 and higher) in the school and had been exposed to media were more likely (1.67 and 1.39 times, respectively) to be overweight/obesity compared with primary grade (0-5) and those who experienced no media exposure, respectively. Inequality analysis revealed that adolescents belonging to wealthy households had significantly higher rates of overweight/obesity than those in poorer households (concentration index=0.093). CONCLUSIONS: The study exhibited the multifaceted nature of overweight/obesity among Bangladeshi older teenagers, revealing that their school grade, exposure to media content and wealth-related inequality emerged as significant contributing factors. The findings underscore the urgent need for targeted interventions and public health strategies to address the escalating burden of overweight and obesity in this age group.

Multilevel analysis to identify the factors associated with caesarean section in Bangladesh: evidence from a nationally representative survey.

BACKGROUND: Caesarean delivery has a significant role in reducing maternal and child death. However, unnecessary utilization has adverse health effects. This study aimed to assess the prevalence and associated factors of caesarean delivery in Bangladesh. METHODS: Data from the latest Bangladesh Multiple Indicator Cluster Survey (MICS, 2019) was used in this study. Since MICS data are hierarchical in nature, multilevel modelling was used. RESULTS: The prevalence of caesarean section (CS) was 67.4% among Bangladeshi women. Multilevel analysis suggests the age of the women, household wealth status, utilization of antenatal care (ANC) , delivery at a health facility and division were significantly associated with CS. Women who delivered in a private health facility had the highest odds for CS (odds ratio [OR] 10.35 [95% confidence interval {CI} 8.55 to 12.54]). Women 30-34 y of age had a 36% higher likelihood of CS compared with women 15-19 y of age (OR 1.36 [95% CI 1.03 to 1.79]). The odds of CS positively increased with household wealth status. Women who had at least one ANC visit had a 1.7 times higher possibility of CS (OR 1.70 [95% CI 1.26 to 2.30]). CONCLUSIONS: Policy guidelines on caesarean deliveries are urgently needed in Bangladesh to avoid unnecessary caesarean deliveries and protect mothers from the consequences.

Factors associated with women's approval on intimate partner violence in Bangladesh: A cross-sectional analysis of latest demographic and health survey 2017-18.

BACKGROUND: In Bangladesh, intimate partner violence (IPV) is high among women faced by their husband. Regrettably, IPV is often justified by the women themselves, resulting in poor social and health outcomes among them. In this paper, we explored the factors that influence the approval of IPV among the women by their husband in Bangladesh. METHOD: The present used the data from the most recent Bangladesh Demographic and Health Survey (BDHS) 2017-18. The BDHS 2017-18 followed a two-stage stratified random sampling techniques and the present analysis was carried out among a weighted sample of 20,127 women. Multivariate logistic regression was used to identify the demographic and socio-economic factors associated with the approval of IPV among the women. RESULTS: Overall, one in five women (20.5%) approved at least one form of violence by their husband. In adjusted analysis, women who completed secondary education were 57% less likely [AOR = 0.43, 95% CI: 0.34-0.54] to approve IPV compared to those who had no formal education. Similarly, women who belonged to Hinduism and other religious group were 42% less likely [AOR = 0.58, 95% CI: 0.45-0.74] to approve IPV compared to those who practiced Islam. Moreover, women who were exposed to television, participated in the decision on household purchase and moving outside home had 14%, 19%, and 21% less chance for approving IPV by the husband for at least one reason (p < 0.05). CONCLUSION: This study highlighted that many women in Bangladesh approve violence by their husband which could be a major obstacle to the reduction of violence from society. Behavior change intervention should be implemented, particularly targeting the less-educated Muslim women to increase the awareness on IPV in Bangladesh.