Studies

Over 45 million people live in urban regions in Bangladesh, where the share of the population in urban settings has climbed from 5% to 28% in the last 40 years. This study—conducted in Shattola, a slum in Dhaka, because of its high-density population and increased rate of teen mothers—aims to explore the maternal health information-seeking behaviour of adolescent girls of reproductive age in the area, through the lens of social norms. Apart from high rates of adolescent pregnancy, the slum has limited facilities for adolescent maternal healthcare. The primary goals of the study are to identify adolescent girls’ maternal health information needs during their reproductive years and to learn how social norms act as obstacles when seeking information related to maternal health.

Researchers: Md. Ashraful Haque; Rabeena Sultana Ananna; Nayeem Hasan; Mst. Farhana Akter; A.F.M. Zakaria

Timeline: October 22 to January 2023

Status: Completed

Contact: Rabeena Sultana Ananna; rabeena.sultana@bracu.ac.bd

Context

Bangladesh has one of the highest adolescent fertility rates in the Asia Pacific, with 128 births per 1000 girls aged 15 to 19 [UNICEF. Adolescent fertility rate in Bangladesh, 2019]. Adolescent girls are married off three to four years earlier than the legal marriage age of 18. Married adolescent girls go through unavoidable social and family pressure to get pregnant soon after marriage as proof of their fertility [National Institute of Population Research and Training (NIPORT), Bangladesh Demographic and Health Survey 2014]. Their incapacity to obtain family planning (FP) and reproductive health (RH) services encourages early childbirth and marriage. Evidence illustrates that 20% of teenage mothers gave birth unintendedly [NIPORT, Bangladesh Demographic and Health Survey 2014], and unwanted pregnancies are more than twice as common among married adolescent girls in Bangladesh’s slums as in non-slum areas. Adolescent girls of reproductive age who actively seek information on maternal health often tend to have better health-seeking behaviours and maternal health outcomes. With little to no research on maternal health information seeking behaviour of reproductive-aged adolescent girls in slums, especially in connection with social norms, this study collected data from purposively selected married and unmarried adolescent girls aged 15–19 of different occupations.

Access to timely and relevant maternal health information is crucial for informed decision-making and reducing maternal morbidity and mortality. Accurate maternal health information promotes positive health behaviors and better maternal health outcomes [Rosenfield A, Maine D, Maternal Mortality – A Neglected Tragedy, The Lancet]. Delays in seeking appropriate care during pregnancy significantly increase maternal risks. While some studies have addressed maternal and neonatal mortality in slums, there is a notable gap in research on the health information-seeking behavior of adolescent girls in Bangladesh’s urban slums. This is critical, given that slums host over 5.7 million people, approximately 3.8% of the national population, most of whom are migrants seeking better economic opportunities [Centre for Urban Studies (CUS), National Institute of Population Research and Training (NIPORT), Measure Evaluation. Slums of Urban Bangladesh: Mapping and Census, 2005]. Addressing the maternal health information needs of this marginalized group is essential for improving maternal health outcomes in Bangladesh.

Publications

Journal: Social Norms and Maternal Health Information-seeking Behavior Among Adolescent Girls: A Qualitative Study in a Slum of Bangladesh

Objectives

This study aims to explore the maternal health information-seeking behavior of adolescent girls of reproductive age in a slum through the lens of social norms. The primary goals of this study were to identify adolescent girls’ maternal health information needs during their reproductive years and to learn about how social norms working as the obstacles they face when seeking information related to maternal health.

This study is relevant to SDG 3 (ensuring healthy lives and promoting well-being for all at all ages) and SDG 5 (achieving gender equality and empowering all women and girls).

Methodology

The study undertook an exploratory qualitative method to understand maternal health information-seeking behaviour among adolescent girls of reproductive age in a slum of Dhaka, Bangladesh. We used the term ‘adolescent girls of reproductive age’ by considering the most known definition of adolescents, who are from 10-19 years, and the reproductive age of a woman, which is 15-49 years, according to the World Health Organization. In this context, adolescent girls of reproductive age refer to girls who are between 15 and 19 years old. This approach was selected for this study due to its nature of investigating research objectives by exploratory questions.

The lack of in depth research on maternal healthcare access among this age group living in slums led us to a need for an in-depth exploratory study. For this, we conducted 12 in-depth interviews (IDIs), two focus group discussions (FGDs) and two key informant interviews (KIIs) to provide a data source for triangulation. A total of 26 participants were recruited, whereas 34 were approached. IDI participants provided subjective viewpoints and FGD participants helped us to understand the community perspective. Participants of KII facilitated to get objective viewpoints of the data collected by other methods. We developed separate guidelines for IDI, KII and FGD participants. The Consolidated criteria for Reporting Qualitative research (COREQ) guided the reporting of the study.

Findings and Recommendations

As evident by the research data, the necessities for reliable maternal health information are not being met in the studied slum. The pursuit of reliable health information is further constrained by existing social norms and stigma, lack of education and awareness, the timing of service provision, etc. Time poverty and limitations of mobilisation and agency in decision-making also contribute to the lack of information and access to service. This gap demonstrates the need of context-appropriate interventions to remove barriers to access to information regarding maternal health.

Findings suggest three core recommendations. First, to organize and arrange the health service for adolescents by considering their occupational engagement. More specifically, before providing health services, it is essential to ensure the proper information is disseminated properly. If not, the overall goal will continue to face challenges. Second, only targeting adolescents for awareness sessions is not enough. As the husbands and in-laws are the key decision-makers in most households, they should also be engaged and made well-aware about the risks associated with the lack of maternal health care information. Third, programs targeting the reduction of maternal mortality rate and ensuring adolescent sexual and reproductive health and rights (SRHR) should focus more on social norms and stigma as these are embedded into our society and culture. In Bangladesh, there is a dearth of research on social norms regarding behavior seeking maternal health information and other SRHR issues taking the specific social norm’s framework into consideration. More studies could be done on context-specific social norms for further research purposes and to ensure interest in this field continues.