International Public Health Commons^™

Balika Fact Sheet: Highlight On Married Adolescents, Population Council

Poverty, Gender, and Youth

In Bangladesh, marriage marks the beginning of sanctioned sexual activity as well as increased social isolation. When girls are not in school, they miss the opportunity to interact with same-age peers and form social networks. They may be less likely to gain skills and knowledge and have less earning power. Married adolescents have poorer sexual and reproductive health knowledge and more unequal gender attitudes. Young girls who are married to much-older men are in a disadvantaged position to negotiate in their marital home. This can have implications for realizing sexual and reproductive choice and health rights. This Bangladeshi Association for …

Balika Fact Sheet: Highlight On Schooling, Population Council

Poverty, Gender, and Youth

School attendance is universal in the Bangladeshi Association for Life Skills, Income, and Knowledge for Adolescents (BALIKA) study area, but the persistence of early and child marriage leads to high dropout rates among girls. Compulsory primary education is free in Bangladesh, and policies to improve access to schooling are generally credited with universal schooling at young ages. Only 1 percent of 12–15-year-olds have never attended school compared to 9 percent among 15–18-year-olds in the study area. The recent expansion of educational opportunity presents new challenges. Bangladesh is unusual by global comparison in the high proportion of girls who are married …

Balika Fact Sheet: Highlight On Marriage, Population Council

Poverty, Gender, and Youth

Early marriage deprives girls of the opportunity for personal development and their rights to full reproductive health and well-being, education, and participation in civil life. Bangladesh stands out in international comparisons as having an extraordinarily early age at marriage for girls and a considerable average age difference in marriage between girls and their husbands. This Bangladeshi Association for Life Skills, Income, and Knowledge for Adolescents (BALIKA) fact sheet, “Highlight on Marriage,” concludes: In Bangladesh, marriage remains early by most standards and the majority of girls still get married before reaching the legal age of 18 years. By age 19, more …

From Evidence To Action: Results From The 2013 Baseline Survey For The Balika Project, Sajeda Amin, Sigma Ainul, Farhana Akter, Mohammad Masudul Alam, Md. Irfan Hossain, Johana Ahmed, Ubaidur Rob

Poverty, Gender, and Youth

The Population Council and partners are working on a program to generate evidence on what works to prevent child marriage in Bangladesh. This report is an integral part of the program and presents evidence from a baseline study conducted in three districts in southern Bangladesh. The study documents data from a survey conducted in 96 villages on education, livelihoods, sexual and reproductive health, and social life. The program, which offers skills development for girls who are at highest risk and live in impoverished areas of the country with the highest child marriage prevalence, explores the potential benefits of investing in …

Balika Fact Sheet: Highlight On Girls' Social Lives, Population Council

Poverty, Gender, and Youth

In Bangladesh, in addition to schooling, work opportunities, and family-building patterns, social networks, mobility, and civic participation are important dimensions of young people’s lives. Previous studies have suggested ways in which the seclusion of Bangladeshi women by purdah exerts a strong influence on girls’ lives. This Bangladeshi Association for Life Skills, Income, and Knowledge for Adolescents (BALIKA) fact sheet, “Highlight on Girls’ Social Lives,” concludes that school enrollment plays a positive role by affording girls greater mobility and access to clubs and institutions, and by promoting social interactions. Adolescent girls in rural Bangladesh are usually socially isolated, and have restricted …

Evaluation Of The Impact Of The Voucher Program For Improving Maternal Health Behavior And Status In Bangladesh, Md. Noorunnabi Talukder, Ubaidur Rob, Syed Abu Jafar Md. Musa, Ashish Bajracharya, Kaji Tamanna Keya, Forhana Rahman Noor, Eshita Jahan, Md. Irfan Hossain, Jyotirmoy Saha, Benjamin Bellows

Reproductive Health

Vouchers, a demand-side financing (DSF) instrument for health-care services, were introduced in Bangladesh in 2006. The DSF program grants vouchers to pregnant women to receive free antenatal, delivery, and postpartum care services as well as free medicine, and financial assistance is provided for transportation. Deliveries with skilled service providers are financially incentivized and providers are reimbursed for their services from a special fund. After piloting DSF initially in 21 subdistricts (upazilas), the government expanded it to another 12 upazilas in 2007 (the second phase), and in its third phase in 2010 the program was expanded to another 11 upazilas. To …

Maternal Health Commodity Landscaping Exercise: A Snapshot Of The Bangladesh Program, Sharif M.I. Hossain, Saumya Ramarao, Ismat Ara Hena, Ubaidur Rob

Reproductive Health

Despite consistent efforts of the government and national stakeholders, every year in Bangladesh over 5,000 mothers and thousands of children die. Most of these deaths would be preventable with increased access to quality services including existing medicines and other health commodities. The United Nation’s Commission on Life-Saving Commodities for Women and Children suggests that an important cause of these deaths is lack of access and appropriate use of 13 life-saving commodities. This document describes an effort by the Population Council to assess the country’s policies, guidelines, and availability for these 13 life-saving commodities as well as engaging with key stakeholders …

Operationalizing A Proposed National Protocol For The Prevention And Management Of Severe Pre-Eclampsia And Eclampsia Using A Loading Dose Of Magnesium Sulphate At Community Health Facilities In Bangladesh, Population Council

Reproductive Health

About 20 percent of maternal deaths in Bangladesh are caused by pre-eclampsia and eclampsia. Most of these deaths, which occur during care within local communities due to lack of maternal health information, poor antenatal care attendance, and delays in seeking care, can be easily prevented with low-cost maternal health commodities. A quasi-experimental pre- and post-test study, with no control group, was implemented to assess the abilities of community facility service providers to screen and detect eclampsia patients, administer a loading dose of magnesium sulphate to diagnosed patients, and refer them to an appropriate facility for condition management. These interventions were …

Reducing Unsafe Menstrual Regulation Through Medication In Bangladesh, Ubaidur Rob, Ismat Ara Hena, Nargis Sultana, Md. Irfan Hossain, Reena Yasmin, Tapash Ranjan Das, Farid Uddin Ahmed

Reproductive Health

The Population Council and Marie Stopes Bangladesh, in collaboration with the Directorate General of Family Planning and with funding from the World Health Organization, tested the feasibility of introducing menstrual regulation with medication (MRM) in Bangladesh and assessed the acceptability of providing MRM using the combination drug regimen mifepristone and misoprostol in urban and rural public health facilities. As reported in this policy brief, the study demonstrates that it is feasible and safe to introduce MRM in rural and urban public health facilities. Given the choice, almost two-thirds of women preferred MRM to manual vacuum aspiration and women receiving MRM …

Prevalence Of Unintended Pregnancy And Needs For Family Planning Among Married Adolescent Girls Living In Urban Slums Of Dhaka, Bangladesh, Fauzia Akhter Huda, Sabiha Chowdhuri, Bidhan Krishna Sarker, Noushin Islam, Anisuddin Ahmed

Reproductive Health

This STEP UP research report examined the prevalence and basic underlying factors of unintended pregnancy among married adolescent girls in five urban slums in Dhaka, Bangladesh. The specific objectives of the study were to: 1) document the prevalence of unintended pregnancy among married adolescent girls aged 15–19 years living in urban slums of Dhaka; 2) identify the factors associated with or which contribute to unintended pregnancy among urban married adolescent girls; 3) estimate the proportion of married adolescent girls who have an unmet need for family planning (FP) services; and 4) explore the barriers to access and effective use of …

Financial Inclusion Of Female Garment Workers, Sigma Ainul, Md. Irfan Hossain, Sajeda Amin, Ubaidur Rob

Poverty, Gender, and Youth

Since the 1980s rapid growth in the manufacturing of ready-made garments for export has created new opportunities for women industrial workers in Bangladesh. This study explores ways of improving the financial capabilities of these young, inexperienced wage earners through a targeted program of financial education. It also aims to identify scalable financing models that can be replicated to increase the opportunities of garment workers. The project culminated in a workshop to share results from the research study and to elicit discussions and recommendations based on the findings of the study. Recommendations include a preference for in-factory training in peri-urban areas, …

Introducing Medical Mr In Bangladesh: Mrm Final Report, Ismat Ara Hena, Ubaidur Rob, Nargis Sultana, Md. Irfan Hossain, Reena Yasmin, Tapash Ranjan Das, Farid Uddin Ahmed

Reproductive Health

The Population Council Bangladesh, in collaboration with the Directorate General of Family Planning and Marie Stopes Bangladesh, with funding from the World Health Organization and the DFID-supported STEP UP project, conducted an 18-month operations research study from January 2012 to June 2013. This operations research tested the feasibility of introducing menstrual regulation with medication (MRM) in Bangladesh and assessed accessibility of the combination regimen of mifepristone and misoprostol in urban and rural health facilities. Based on this study’s results, the feasibility of introducing MRM services in Bangladesh is clear, and women receiving MRM were satisfied with their overall quality of …

Understanding Unintended Pregnancy In Bangladesh: Country Profile Report, Fauzia Akhter Huda, Sabiha Chowdhuri, Yolande Robertson, Noushin Islam, Bidhan Krishna Sarker, Ashrafi Jahan Azmi, Laura Reichenbach

Reproductive Health

The objective of this report is to identify the determinants of unintended pregnancy and unmet need for family planning in Bangladesh and therefore provide a strong body of evidence that will contribute to issue identification, evidence generation, and communication for use of evidence in policy and programming. The evidence generated can be used to find ways to reduce the rate of unintended pregnancy and hence reduce the risk of abortion-related morbidity and mortality; ultimately this will aid Bangladeshi couples in reaching their fertility goals. Results demonstrate that Bangladesh has shown progress and promise in several areas of family planning and …

Slides: Draft Power In Developing Country Agriculture--South Asia, Arjun Makhijani

2012 Energy Justice Conference and Technology Exposition (September 17-18)

Presenter: Dr. Arjun Makhijani, President, Institute for Energy and Environmental Research (IEER)

13 slides

Incentivizing Providers To Improve Maternal, Newborn And Child Health Services In Bangladesh: Pay-For-Performance Model Refinement And Advocacy (P4p Mra) Final Report, Md. Noorunnabi Talukder, Ubaidur Rob, Laila Rahman, A.K.M. Zafar Ullah Khan, Riad Mahmud, Azizul Alim, Ismat Ara Hena, Farhana Akter, Anup Kumar Dey

Reproductive Health

An operations research project by the Directorate General of Health Services (DGHS) of the Ministry of Health and Family Welfare, Government of Bangladesh tested the feasibility of a pay-for-performance (P4P) approach, which offered financial incentives to reward service providers for meeting and exceeding specified performance targets for maternal, newborn, and child health services. In response to the encouraging findings, the DGHS implemented a follow-up project, with technical assistance from Population Council and UNICEF, to utilize the experiences and findings of the P4P OR project. Despite it short duration, implementation of the revised P4P scheme induced improvements in service volume and …

Defining Effective Voucher Management Information Systems: A Blueprint For Information Systems To Support Scalable Reproductive Health Voucher Programs, Based On System Evaluations With Programs In Bangladesh, Cambodia, Kenya, Uganda, And Tanzania, Mahad Ibrahim, Benjamin Bellows, Jaspal S. Sandhu

Reproductive Health

This document defines the key elements of information systems to support the development of effective, scalable voucher information systems. It is based on an engagement between the Gobee Group and the Population Council to strengthen information systems of reproductive health voucher programs in five countries in 2011–12. At the time of publication of this document, the Population Council was in the midst of a multiyear evaluation of five of the biggest reproductive health programs worldwide, an effort supported by the Bill & Melinda Gates Foundation. While the work supporting this report has been focused on reproductive health voucher programs—which provide …

Costos Del Matrimonio—Negociaciones Maritales En Países En Vías De Desarrollo, Sajeda Amin, Ashish Bajracharya

Poverty, Gender, and Youth

Durante las dos últimas décadas, el Population Council ha acumulado una cantidad de información sobre las causas y correlaciones del matrimonio infantil y documentó sus efectos adversos sobre el bienestar de las mujeres y niñas. En muchas partes de los países en vías de desarrollo, el hecho de comprender el matrimonio infantil es central a la hora de diseñar programas que promuevan transiciones saludables para la edad adulta. La investigación del Council subraya la importancia de los rituales y las prácticas de intercambio matrimonial en todo el mundo y documenta la variación considerable en estas prácticas. Promoción de transiciones a …

Les Coûts Du Mariage—Les Transactions Matrimoniales Dans Le Monde En Développement, Sajeda Amin, Ashish Bajracharya

Poverty, Gender, and Youth

Au cours des deux dernières décennies, le Population Council a receuilli une multitude d'informations sur les causes et les corrélats du mariage des enfants et documenté ses effets néfastes sur le bien-être des femmes et des filles. Dans de nombreuses régions du monde en développement, la compréhension du mariage des enfants est au coeur de la conception de programmes qui favorisent des transitions saines vers l'âge adulte. Les travaux de recherche du Population Council soulignent également l'importance des rituels et des pratiques d'échange matrimoniales dans le monde et éclairent les différences considérables entre ces pratiques. Promouvoir des transitions vers l'âge …

Costs Of Marriage—Marriage Transactions In The Developing World, Sajeda Amin, Ashish Bajracharya

Poverty, Gender, and Youth

Over the past two decades the Population Council has amassed a wealth of information on the causes and correlates of child marriage and documented its adverse effects on the well-being of women and girls. In many parts of the developing world, understanding child marriage is central to designing programs that promote healthy transitions to adulthood. Council research also underscores the importance of rituals and practices of marriage exchange around the globe and documents the considerable variation in these practices. Promoting Healthy, Safe, and Productive Transitions to Adulthood Brief No. 35 synthesizes some broad themes that have emerged from research on …

Empowering Adolescent Girls In Rural Bangladesh: Kishori Abhijan, Sajeda Amin

Poverty, Gender, and Youth

In 2001, UNICEF initiated a pilot intervention to test whether livelihoods opportunities could ameliorate early marriage and other adverse outcomes for girls in rural Bangladesh. Kishori Abhijan (“Adolescent Girls’ Adventure”) aimed to lower school dropout rates, increase girls’ independent economic activity, and raise the age at which girls marry. Life-skills training consisted of enhancing self-esteem and leadership skills and providing education related to gender roles and discrimination, health and nutrition, and legislation and legal rights, particularly early marriage and girls’ and women’s rights. Livelihoods training included vocational skills. As noted in Promoting Healthy, Safe, and Productive Transitions to Adulthood Brief …

A P4p Model For Increased Utilization Of Maternal, Newborn And Child Health Services In Bangladesh, Md. Noorunnabi Talukder, Ubaidur Rob, Laila Rahman, Ismat Ara Hena, A.K.M. Zafar Ullah Khan

Reproductive Health

In Bangladesh, maternal health programs are not yet reaching the desired level of facility-based obstetric care service. Most deliveries are conducted by untrained persons at home, demonstrating inequity in access to recommended maternal health care services and underutilization of existing obstetric and newborn care services. Suboptimal performance by providers is a key barrier to improving availability and quality of maternal, newborn, and child health (MNCH) services. To increase use of facility-based services, an operations research study of “pay-for-performance” (P4P) incentives for providers and subsidization of consumer costs was initiated in 2010. The study, part of the Government of Bangladesh–United Nations …

Innovative Financing Through Pay-For-Performance For Providers To Improve Quality Of Care In Bangladesh: Transforming Research Into Action, Md. Noorunnabi Talukder, Laila Rahman, Ismat Ara Hena

Reproductive Health

To improve access to, and use of, facility-based obstetric and newborn care services in rural areas, the Government of Bangladesh is implementing two innovative performance-based financing programs: demand-side financing (DSF) and pay-for-performance (P4P). Both programs have contributed to the increase in institutional deliveries, yet not enough women receive the recommended care during pregnancy and delivery. DSF and P4P are implemented in parallel and have their own merits and limitations. As described in this brief, a two-day workshop was organized in 2011 in Dhaka to identify the lessons learned and limitations of P4P and DSF models and scopes for cross-learning. Both …

Strengthening Union Level Facility For Providing Normal Delivery And Newborn Care Services: Facility Assessment Report, Md. Noorunnabi Talukder, Ubaidur Rob, A.K.M. Zafar Ullah Khan, Amar Krishna Baidya, M. Mostafizur Rahman Khan, Nargis Sultana

Reproductive Health

In Bangladesh, first-level fixed-facility services—provided at the union level through Health and Family Welfare Centers (HFWCs)—are designed to improve maternal and child health by making services available in rural areas. However, most HFWCs do not have the capacity to provide normal delivery services. HFWCs could help women receive free normal delivery services within a convenient distance from their home, if they were strengthened with necessary human resources, infrastructure, and equipment. The Population Council, with financial assistance from the UK Department for International Development (DFID), carried out a policy and research systems study to strengthen union HFWC’s provision of normal delivery …

Strengthening Union Level Facility For Providing Normal Delivery And Newborn Care Services: Workshop Report, Ubaidur Rob, Md. Noorunnabi Talukder, A.K.M. Zafar Ullah Khan

Reproductive Health

In Bangladesh, a network of government health facilities providing maternal and child health services has been established. In rural areas, first-level fixed-facility service is provided at the union level through Health and Family Welfare Centers (HFWCs). These facilities are designed to improve maternal and child health by making services available to the people in rural areas, however a full range of reproductive health services for women is not available in those facilities. At present, no evidence exists to support whether or not HFWCs can safely and cost-effectively provide normal deliveries. There is a need for a policy research initiative that …

Costing And Economic Analysis Of Strengthening Union Level Facility For Providing Normal Delivery And Newborn Care Services In Bangladesh, Sushil Ranjan Howlader

Reproductive Health

For a long time, the reduction of the maternal mortality ratio has constituted a major challenge for the health, nutrition, and population sector of Bangladesh. The objectives of this Population Council study is to estimate the costs of the additional inputs required for strengthening Health and Family Welfare Centers (HFWC) for providing normal delivery and newborn care services, the cost-effectiveness, and the financial implications of the addition of capacity. Results clearly show that the benefit-cost ratio for the intervention will be quite high. Some additional measures on the demand side should thus adopted. Intensive behavior change communication activities including interpersonal …

Innovative Financing Through Pay-For-Performance For Providers To Improve Quality Of Care In Bangladesh: Transforming Research Into Action, Md. Noorunnabi Talukder, Ubaidur Rob, Laila Rahman, Ismat Ara Hena

Reproductive Health

To improve access to and use of facility-based obstetric and newborn care, the Government of Bangladesh is implementing two innovative performance-based financing programs, namely demand-side financing (DSF) and pay-for-performance (P4P). With the purpose of identifying the lessons learned, limitations of the P4P and DSF models, and scopes for cross learning, a two-day workshop was organized in Dhaka. This workshop report, prepared by the Population Council, resulted in several recommendations to modify DSF and P4P schemes. In Bangladesh, the need for continuing performance-based financing programs to meet MDGs and other health indicators is beyond argument, but it is urgently required to …

Expanding Access To Safe Abortion And Post-Abortion Care: Recommendations Of A South Asia Regional Consultation, Population Council

Reproductive Health

A South Asia Regional Consultation, organized by the Population Council with representation from governments and key stakeholders of Bangladesh, India, Nepal, and Pakistan, was held in New Delhi, to discuss ways of expanding women’s access to safe abortion services. The Consultation deliberated on ways of expanding the provider base for safe induced abortion so as to overcome inadequate and inequitable access to safe abortion. They also looked to expand access to services for the management of incomplete abortion and complications of unsafe abortion that persist in the region and, thereby, to reduce morbidity and mortality resulting from unsafe abortion. In …

A Pay-For-Performance Innovation Integrating The Quantity And Quality Of Care In Maternal, Newborn And Child Health Services In Bangladesh, Laila Rahman, Ubaidur Rob, Riad Mahmud, Azizul Alim, Ismat Ara Hena, Md. Noorunnabi Talukder, Md. Hafizur Rahman

Reproductive Health

The Population Council explored the possibilities of introducing a Pay-for-Performance (P4P) scheme in Bangladesh to improve maternal, newborn and child healthcare (MNCH) services. Based on the consultation and with guidance from the Government of Bangladesh, the Population Council and UNICEF provided technical assistance to the Directorate General of Health Services (DGHS) to test two P4P strategies for MNCH service providers to improve service volume and quality of care, and for poor clients to receive services subsidized through vouchers or coupons. The first strategy is a combination of pay-for-performance for providers and subsidized coupons for poor pregnant women, newborns, and under-five …

Identifying Opportunities And Challenges To Strengthen Union Level Facility For Providing Normal Delivery And Newborn Care Services: Findings From Policy Advocacy Activities, Md. Noorunnabi Talukder, Ubaidur Rob, A.K.M. Zafar Ullah Khan

Reproductive Health

The Population Council/Bangladesh, with assistance from the UK Department for International Development (DFID), organized a series of advocacy meetings and workshops that were carried out as part of a policy and systems research study titled “Strengthening Union Level Facility for Providing Normal Delivery and Newborn Care Services.” The Council held one consultative meeting, one stakeholders’ meeting, two experience-sharing workshops in Jamalpur and Thakurgaon, two local-level advocacy workshops in Kurigram and Habiganj, and two roundtable dialogues with journalists from Bengali and English newspapers. This document includes five reports: Strengthening HFWCs (Health and Family Welfare Centers) for Normal Delivery and Newborn Care …

Kishor-Kishorider Jonno Ortho Sikkha [Financial Education For Adolescents], Sigma Ainul, Marzina Khatun, Najneen Mahbooba

Poverty, Gender, and Youth

No abstract provided.