The Taboo to Break now.

Sexual & reproductive health the silent suffering for the Women & Girls in Bangladesh
Suman Ahsanul Islam
smaislam@yahoo.com

Over the last two decades, Bangladesh has made tremendous progress on overall human development and
macroeconomic indicators attaining the MDGs; however, extreme poverty is still high 17.9% (rural) and 24.4%
(urban). A number of poverty pockets urban slums and coastal areas have not benefited as strongly as the
rest of the country due to the geographical isolation and vulnerability to natural disasters which is increasing
due to climate change. The MDG Progress Report 2012 discussed that along with income to raise the level
of food consumption, preventing hunger needs investments in other areas including basic health and
education services, sanitation and safe water, and changes in health knowledge and behaviors especially of
women and care givers (p.37). This directly correlates with the status of MDG 5.B achievement in
Bangladesh. Against a target of 72% in 2015; Bangladesh achieved 61.2% contraceptive prevalence rate.
Other indicators of this Goal are also lacking behind i.e. Antenatal care coverage (at least one visit) is currently
67.7%, against the target of 100%; Antenatal care coverage (at least four visits) is 25.5% against 50%; Unmet
need for family planning is 13.5% against 7.6%.
Bangladesh ranks 3rd in the world in terms of adolescent pregnancy, & first in Asia. Khulna, Rangpur &
Rajshahi regions are rated even higher due to social insecurity. While adolescents comprise about half of
youth population in Bangladesh, early pregnancy takes a toll on a girls health, education & rights. It also
prevents girls from realizing their potential & adversely impacts the baby. 65% of women get married before
18 years and 49% get pregnant before reaching 18 years, about 58% of adolescents begin childbearing by the
age of 19yr. Only by eliminating child marriage, approximately 0.75 million births would be reduced.
The root-cause of this low achievement is multidimensional, primarily lack of access to basic services, harmful
socio-cultural norms & taboos, massive and rapid urbanization. In the past 40 years the proportion of the
population living in urban settings in Bangladesh has increased from 5% to 28%, with roughly 45 million people
now living in urban areas, with urban slums having a density over 200,000 per square kilometer.
Women & girls are particularly among the most vulnerable and disadvantaged. They are denied sexual &
reproductive health rights because of long standing patriarchal institutions that condone child marriage and
forced marriage, segregation of the sexes, and economic exclusion that relegate women to low status. Thus
most of the health problems women and girls face are related to their reproductive system, or are caused by
The Taboo to Break now.
Sexual & reproductive health the silent suffering for the Women & Girls in Bangladesh
[Suman Ahsanul Islam, smaislam@yahoo.com]

their reproductive function. Other health problems, such as that of malnourishment or environment related
infections and chronic disease either aggravate or get aggravated due to their reproductive function. Starting
from anemia to complications of the gynecological system, women are constantly under health stress. Gender
based power inequalities hinder the men and womens attainment of sexual fulfillment and health, and
increase their vulnerability towards HIV/AIDS and STIs.
In addition, increased internal migration and socio-economic vulnerability leads to high-risk sexual behavior
among the population. There are an estimated 100,000 sex workers in Bangladesh and HIV prevalence
among sex workers in Bangladesh is estimated at less than 1%. However, a 2010 study on the attitudes of
health care workers revealed that almost 48% of health care professionals said people with HIV and AIDS
should not be allowed to mix freely with other people.
In Bangladesh, there exists a huge, neglected domain of sexual & reproductive health needs which is a source
of silent suffering, and for which there are no trained health staff providing treatment in government facilities.
The formal public health system provides few services for common sexual and reproductive health problems
such as vaginal white discharge, fistula, prolapsed, menstrual problems, reproductive and urinary tract
infections, and other sexual problems. Recent research has found that poor women and men resort to informal
providers for these problems instead. Both informal and formal markets played an important role in treating
these problems, and are inclusive of the poor, but the treatments were often unlikely to resolve the problems
due to incorrect diagnosis, over medication, lack of patient oversight and adherence to treatment regimens.
Providers ranged from village doctors without formal training to qualified private practitioners. The health
system is heavily marketised and boundaries between "public" and "private" are blurred.
In this context, the Govt. has recognized the need of sexual & reproductive health awareness & services in the
6th Five Year Plan emphasizing girls education, female reproductive health, population control service delivery
based on public-private partnership, & social mobilization. The Population Planning of the National Health
policy stresses the importance of reproductive health in reducing maternal mortality & fertility, and of the need
for continued efforts to make family planning services available, in particular to the poor & marginalized.
However, this area is not yet adequately addressed. An Urban Health Strategy has been developed by the
GoB in 2011. However, this policy has not been endorsed yet, structural & health problems continue to persist
in urban centers.
The impact of climate change, including consecutive disasters in the coastal areas is reducing livelihood
options in the coastal areas and increasing vulnerability of the communities highly impacting on their sexual &
reproductive health. However there is no sexual & reproductive health specific statistics for the region. Various
The Taboo to Break now.
Sexual & reproductive health the silent suffering for the Women & Girls in Bangladesh
[Suman Ahsanul Islam, smaislam@yahoo.com]

studies show that social taboos around menstruation and norms about appropriate behaviour for women and
girls are reported to contribute to health problems in young women. Adolescent girls report perinea rashes and
urinary tract infections, which have not yet been addressed adequately.
In disaster situations, pregnant women cannot stroll in marooned condition, they are forced to stay back inside
the house and ultimately fall victim to unhygienic reproductive health conditions. In many cases, it has been
observed that people are not keen to establish a marital relationship with women from water logging/flood
affected areas because those women generally suffer from skin diseases.
Poverty driven by climate change impact creates influx of huge population to cities. Slum-dwellers struggle
constantly to access basic amenities. One-third of girls in Dhakas slums were married before the age of 15
years. Many women die in slums during pregnancy and childbirth. Mortality of children younger than 5 years in
slums is almost double that in rural areas. Antenatal care, skilled birth attendance, and full childhood vaccine
coverage are quite low in urban slums. Primary health-care clinics regularly held in slums are not open at
convenient times for working women. Community mobilisation to improve health services hardly exists. Major
increases in organised urban commercial sex indicate one avenue of survival for these women, increasing the
risk of HIV/AIDS infection.
Slum-dwellers who work in readymade garments (RMG) industries have added risks of sexual & reproductive
health vulnerabilities. In general, nearly 3 million women and girls work in garment factories in Bangladesh,
and represent 85% of the workforce in the countrys largest export industry. Most have little education, having
dropped out of school early to support their families. Young women often start work at the age of 18 and
usually continue till they are 30-35, working long hours for very poor pay. Among many exploitation and
vulnerabilities such as unsafe infrastructure, inadequate & discriminating wage, poor living condition in slums,
long working hours, less payment for overtime etc.; sexual & reproductive health rights and sexual harassment
are the most unspoken sufferings that women & girl workers of RMG experience every day.
Female RMG workers reports 8 different health & nutrition problems faced by the women during pregnancy.
General weakness/loss of weight/anaemia is a primary problem for the pregnant mothers. Excessive bleeding
during menstrual cycle, irregular & extended menstruation & abdominal pain are also common among the
workers. Several studies show the rate of miscarriage among garments workers is very high & most of them
experience abortions more than once. According to the District Magistrate of Narayangonj (neighboring town of
the Capital city Dhaka), around 345,000 female RMG workers live in the town where on an average 3 to 5
infants have been abundant in dustbin and clinics in every month; indicate the extreme level of inhuman
exploitation caused by sexual & reproductive health Rights violation.
The Taboo to Break now.
Sexual & reproductive health the silent suffering for the Women & Girls in Bangladesh
[Suman Ahsanul Islam, smaislam@yahoo.com]

While about 90% of the countrys girls, between 10 to 18 years have been victims of sexual harassment,
women & girl in RMG are specifically affected by various forms of violence & sexual harassment at home,
community and work places, including harmful traditional practices; one-third of girls in Dhakas slums were
married before age of 15yr. About 61% of marriages were arranged, with 31% involving dowry; 30% of girls not
asked for consent, 28% did not want to marry.
According to a health study conducted by Nari Uddog Kendra (Centre for Womens Initiatives), 66 percent of
women working in garment factories complained that their health had deteriorated since they began work in
the factories. One quarter reported respiratory problems after working in the factories for five years or more,
and one fifth reporting symptoms of repetitive strain injuries had been working for six years or more. Long
hours of work in one particular position, lack of access to clean toilet facilities and inadequate ventilation in
factories were major factors in health problems. A fear of job loss, sexual harassment and inadequate
communication between management and worker also remain unaddressed.
In the aftermath of Rana Plaza, in 2013, it is clear that despite nation and international efforts there is still a
huge lack of initiative when addressing worker conditions, which remain abysmal especially for women.
Garment factories are cramped, dark, poorly lit rooms with hazardous conditions compounded by a lack of
ventilation and there is an appalling failure to hold factory owners responsible for the health and safety of their
workers.

The Taboo to Break now.

Sexual & reproductive health the silent suffering for the Women & Girls in Bangladesh
[Suman Ahsanul Islam, smaislam@yahoo.com]