SRHR situation in Bangladesh According to WHO definitions, young people are aged 10 to 24 years. Adolescents are a large and growing segment of the global population. In Bangladesh 10-24 year olds constitute about 32 % of the population, with 12 % belonging to the 10-14 years age group, another 11 % belonging to the 15-19 years age group and more than 9% are in 20-24 years age group (BDHS 2007). It shows, demographically, that Bangladesh is a young country as more than one-third of the population is under the age of 25. However in assessing commitments made since the International Conference on Population and Development (ICPD) in 1994, adolescent’s sexual and reproductive health rights remain inadequately addressed. While adolescence generally is a healthy period of life, many adolescents are less informed, less experienced, and less comfortable accessing family planning and reproductive health services than adults.
Bangladesh, with an estimated population of over 160 million, has the highest density of population in the world. In 2007 Bangladesh Demographic and Health Survey (BDHS) is the most recent and reliable source of information on demographic and maternal and child health in Bangladesh. The main findings are as follows: According to current fertility rate, on average, women will have 23% of their births before reaching 20, more than half of births (55%) during their twenties and one fifth during their thirties. Khulna and Rajshahi has reached replacement level fertility. Sylhet has the highest fertility (3.7) followed by Chittagong (3.2).The contraceptive prevalence rate for married women in Bangladesh has increased from 8% in 1975 to 56 % in 2007, 55.8% of currently married women in Bangladesh are currently using a contraceptive method. 8% stated that they are relying on traditional methods. The pill is by far the most widely used method (29%), followed by inject able (7%), female sterilization, periodic abstinence and condoms (5% each), and withdrawal (3%). Less than 1% of women mentioned the use of male sterilization, IUD and Norplant. 38% of married adolescents (15 -19) are currently using modern family planning methods. Early marriage is a problem in Bangladesh. It mainly happens due to poverty, lack of education, and lack of knowledge about their rights. Only 18 % of births in Bangladesh are attended by medically trained personnel. Nearly 2 in three births in Bangladesh are assisted by untrained traditional attendants, and 6% of deliveries are assisted by relatives and friends. The poor reproductive situation of mothers also reflects on child health. The number of infant deaths per 100.000 live births is 52i . Still more than 500,000 women die unnecessarily during pregnancy, childbirth or after delivery. Poor women are more likely to be affected by harmful traditional practices, with higher risks of maternal death, illness and injury. The Government's Health and Family Welfare Centers (HFWCs) provide RH services to the rural people.
However, traditionally, these facilities have primarily given priority to women and children and as such, health facilities do not cater to the health needs of adolescents and youths. Of every 10,000 ever-married women, about 17 suffer from fistulaii; an abnormal connection between the lower portion of the large intestine and the vaginaiii. This often results from an injury during childbirth, and can cause serious infections. It is an indication of poor sexual and reproductive health 10 care. A significant number of women living with fistula in Bangladesh are not aware of treatment possibilities that could change their lives. Many live alone, ostracized by husbands, family, and community. Some women are accused by community members of being afflicted with a curseiv. Although both male and female adolescents have RH needs, female adolescents in Bangladesh particularly face serious challenges. This is manifest in various ways, including restrictions on the mobility of women and the social norm that adolescents would need the assent of male household head to seek medical services. Female adolescents also lack access to health information and services, which is exacerbated by their disadvantaged positions in economic, social and political terms. Gender discrimination in the form of discrimination against women has been identified as one of the prime ARH issues in Bangladesh. at least one out of three women has been beaten, coerced into sex, or otherwise abused in her lifetime, with the abuser usually someone known to her. Sexual diversity is still a highly controversial issue and hardly any government policy worldwide defends the rights of sexual minorities. Considering the situation,
In Bangladesh, there is considerable progress towards the MDG on Child health (MDG-4), but little progress on maternal mortality (MDG-5) and hardly any progress on SRHR (MDG-6). In no other sector does civil society play a more permanent and indispensable role than in the promotion of good sexual and reproductive health and Rights (SRHR). The huge social, cultural and political sensitivity around the issue means that other stakeholders are often unable or unwilling to effectively address SRHR issues.In many countries –Governments have the primary responsibilities to address the necessary conditions for the realization of good SRHR but lack of knowledge, skill, resources or willingness to do so. Strategic investments in SRHR, with civil society as key driver for change, is not only a prerequisite for poverty alleviation-exemplified by the fact that Millennium Development Goals (MDGs) 3 (Gender Equality), 5 (Maternal Health) and 6 (HIV/AIDS) have a direct relationship with SRHR. So the program of UBR will affect the total improvement of the SRHR situation of Bangladesh and also helps to achieve the MDG. The coming five/six years will be crucial for making real progress in achieving ICPD and the MDGs related to SRHR. Also timely planning is needed beyond 2015 to retain momentum on the realization of SRHR policies and programs. Bangladesh has made impressive achievements over the last decades in the area of Reproductive Health, such as maternal mortality ratio is declined by 40%. In between 2001 and 2010 maternal mortality ratio dropped from 322 deaths per 100.000 live births to194 deaths per 100.000 live births (Maternal Mortality Survey 2010) and dramatic increase in the use of modern contraceptives by married couples, CPR 55.8% (BDHS 2007). The Bangladesh Demographic and Health Survey (DHS 2007) show good progress towards achievement of the Millennium Development Goal MDG-4 on child health and also progress towards MDG-5 maternal mortality reduction.