Understanding individual, family and community perspectives on delaying early birth among adolescent girls: findings from a formative evaluation in rural Bangladesh

Ghazaleh Samandari,Sara Gullo,Aloka Talukder,Lily Brent,Bidhan Krishna Sarker,Syeda Nabin Ara Nitu,Humaira Aziz,Sadia Nishat Mahfuz,Carolyn Grant,Nafisa Lira Huq

doi:10.1186/s12905-020-01044-z

Abstract

BackgroundPregnancy among adolescent girls in Bangladesh is high, with 66% of women under the age of 18 reporting a first birth; this issue is particularly acute in the northern region of Bangladesh, an area that is especially impoverished and where girls are at heightened risk. Using formative research, CARE USA examined the underlying social, individual and structural factors influencing married girls’ early first birth and participation in alternative opportunities (such as education or economic pursuits) in Bangladesh.MethodsIn July of 2017, researchers conducted in-depth interviews of community members in two sub-districts of northern Bangladesh (Kurigram Sadar and Rajarhat). Participants (n = 127) included adolescent girls (both married and unmarredi), husbands of adolescent girls, influential adults in the girls’ lives, community leaders, and health providers. All interviews were transcribed, coded and organized using Dedoose software.ResultsParticipants recognize the health benefits of delaying first birth, but stigma around infertility and contraceptive use, pressure from mothers-in-law and health provider bias interfere with a girl’s ability to delay childbearing. Girls’ social isolation, lack of mobility or autonomy, and inability to envision alternatives to early motherhood compound the issue; provider bias may also prevent access to methods. While participants agree that pursuit of education and economic opportunities are important, better futures for girls do not necessarily supersede their marital obligations of childrearing and domestic chores.ConclusionsFindings indicate the need for a multi-level approach to delaying early birth and stimulating girls’ participation in economic and educational pursuits. Interventions must mitigate barriers to reproductive health care; train adolescent girls on viable economic activities; and provide educational opportunities for girls. Effective programs should also address contextual issues by including immediate members of the girls’ families, particularly the husband and mother-in-law.

Highlights

Pregnancy among adolescent girls in Bangladesh is high, with 66% of women under the age of 18 reporting a first birth; this issue is acute in the northern region of Bangladesh, an area that is especially impoverished and where girls are at heightened risk
Child marriage is closely associated with early birth among adolescent girls; 90% of adolescent pregnancies in the developing world are to girls who are already married and married adolescents are more likely to experience frequent and early pregnancies than their unmarried peers [1, 2]
Study subjects and selection Based on an extensive desk review on fertility decisionmaking among adolescents in Bangladesh, researchers wanted to include diverse groups of participants that represented the spheres of influence in the reproductive decision-making of adolescent girls

Summary

Introduction

Pregnancy among adolescent girls in Bangladesh is high, with 66% of women under the age of 18 reporting a first birth; this issue is acute in the northern region of Bangladesh, an area that is especially impoverished and where girls are at heightened risk. Adolescent girls who undergo early marriage (often defined as prior to age 18) and subsequent rapid birth are more likely to experience a host of negative physical, mental and economic outcomes including complications during pregnancy and delivery, higher rates of maternal mortality, and poor educational and economic outcomes for both themselves and their children [1,2,3,4]. A number of factors influence married adolescent girls’ ability to delay early childbearing. Married adolescent girls are less likely to engage in family planning, due to a lack of knowledge of contraceptives and maledominated partner dynamics which limit their individual ability to control the timing and frequency of pregnancy [4, 8, 9]. Adolescents experience an inordinate number of obstacles to accessing reproductive services within the formal health system, including bias of providers, stigma around contraceptive use, and lack of physical or financial access to health facilities [10,11,12,13]

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