This is the abstract presentation of Sigma Ainul, which was presented as part of the 9th session of #APCRSHR10 Virtual, on the theme of "Humanitarian response and sexual and reproductive health and rights (SRHR) in Asia and the Pacific". C H A I R Chonghee Hwang Senior Manager, Family Planning 2020 (FP2020) P L E N A R Y S P E A K E R Tomoko Kurokawa Humanitarian Advisor, UNFPA Asia Pacific "Building Resilience across the Humanitarian Development Peacebuilding Nexus" A B S T R A C T P R E S E N T E R S * Sahlil Ahmed | Challenges Health Workers Face While Providing Sexual and Reproductive Health Services to Rohingya Refugees in Refugee Camps in Cox’s Bazar, Bangladesh: A Qualitative Study * Sayantan Chowdhury | Genesis of maternal mortality surveillance and response in the Rohingya refugee crisis * Sigma Ainul | Contraceptive non-use among the Rohingya and changing dynamics in post-displacement to Bangladesh * Manju Karmacharya | Transitioning from Minimum Initial Service Package to Comprehensive SRHR services responding Rohingya crisis in protracted Emergency in Cox’s Bazar, Bangladesh For more information on this session go to www.bit.ly/apcrshr10virtual9 #SRHR #sexualhealth #reproductiverights #familyplanning #womenshealth #genderequality #SDGs #BodilyAutonomy #humanitariancrisis #humanitariandisaster #pandemic

1. CONTRACEPTIVE NON-USE
AMONG THE ROHINGYA
AND CHANGING DYNAMICS IN
POST-DISPLACEMENT TO
BANGLADESH
October 12th, 2020
APCRSHR10Virtual: "Humanitarian response and sexual and
reproductive health and rights (SRHR) inAsia and the Pacific"
Presenter: SIGMA AINUL, Population Council
Co-authors: Iqbal Ehsan, Eashita Farzana Haque, AJ Melnikas, Sajeda
Amin, Ubaidur Rob

2. 2
Rohingya Camps in Bangladesh
• one million displaced
Rohingya reside in
camps
• two Upazilas of Cox’s
Bazar (Ukhia and
• 60% are below age 18
• Historically, the Rohingya
population has been
understudied
• Lack of data on
demographic profile,
marriage, Sexual and
reproductive health,
family planning, and
service seeking behaviorAge at marriage: 16.8 ± 2.2 years
Age at first pregnancy: 18.0± 2.4 years
Contraceptive prevalence rate (CPR) : 34%
Facility delivery: 10% reported wish to avail Source: Chowdhuri et al. 2018 (Icddr,b- UNFPA study)

3. 3
Objectives and Methodology
• Objectives: to explore the ways in which religion and social approbation are
invoked to discourage contraceptive use among the Rohingya
• Qualitative study: July- August 2018
• Collected in two-time frames: pre and post arrival to Bangladesh
Table 1: Sample size by data collection method
In-Depth Interviews Focus Group Discussions
Rohingya Program
managers
and service
providers
Majhi &
Imam
Rohingya
women
Host
community
Sample (n) 48 24 4 2 6
Population Males and
females,
unmarried and
married
NGOs,
INGOs, UN,
DGHS,
doctors,
paramedics
and
frontline
workers
Majhis and
Imams
Adult
females
Adolescent
males and
females

4. CONTRACEPTIVE
NON-USE

5. 5
• Dominant religious belief
Preference for large families
“ “
..the Huzurs (Muslim
religious leaders) tell us not
to use a contraceptive
method. It is a sin. Allah
made women fertile so that
they can bear children.
– IDI, Married woman, age 21
“
“• Desire to increase Muslim clan
In Myanmar, Mogh used to abduct and kill boys and men, so we
used to want more male and that is why we take more children. we
did not use contraceptives
– Adult woman , FGD

6. 6
• Fear of side effects about contraception is
widespread
• Association of contraception with immorality
Misinformation, Stigma
The contraceptive user will lose her fertility.
..contraceptive methods will cause irregular
menstruation and prolonged bleeding
“
“
– IDI, Married woman, age 20
bad people use condom for going to bad place. Why would
anyone use condom among family (between husband and
wife)!
“
“
– FGD , Majhee

7. 7
Oppositions from Gatekeepers
 Husband and Mother-in-laws play
major role in decision making
“
I wanted to have pill, but my mother-in-law restricted
me; she says, I will die. My husband also did not let me.
I tried several times in secret but couldn’t. … women
want relief in their body. But husbands and their
family want children. They say its Allah’s order.
- IDI, married, age 20
“

8. CHANGING
DYNAMICS IN
POST-DISPLACEMNT
TO BANGLADESH

9. 9
Being in a ‘Transient state” has decreased
resistance towards contraception
we are now in a miserable time. Neither Bangladesh nor
Myanmar- we are now of nowhere. If they drove us now,
where will we go with so many children. For this, women
are now using contraceptives.”
– ( FGD with Majhees)
in our society, people think more children as a good thing.
This is Allah’s will, but the case is different in camp. Here
living space is small, shortage of food, no money, living
condition is constrained and hard here. Women here should
use contraceptives”
- (IDI , married girl, age 19)
“
“
“
“

10. 10
Increased availability of contraceptives in the
camp
more people are having pills here in the camp; use of depo
is also more than before (Myanmar) because it is easily
available here… birth spacing is good for both mother and
children. I think everyone should use it because now
nothing is like before”
- (IDI, married, age 20)
““
• Increased availability and accessibility of
contraceptive in the camp
• Influence of group behavior is indicated and
attributed for increased use of
in the camp

11. 11
• Birth ‘spacing’ is acceptable over birth ‘control’-
for the health of woman and children
• Certain contraceptive are more acceptable than
others
Right “messaging” is key
“ “we have heard of implant … it is taken for 4 to 5 years, but we
are afraid to receive this (implant). If we insert and then if we
need to go back to Myanmar, how can we remove it there! Who
will help us?—this fear works in mind. If anyone dies with it
inside body that will be of great sin will”
- (Adult women, FGD)

12. RECOMMENDED
ACTIONS

13. 13
• As traditional cultural beliefs and practices
impedes contraceptive use and access,
community Health Education need to be
prioritized and different groups of actors need
to be engaged
– Engage community members and religious leaders in
designing programs
– Mobilize Majhees to working with husbands
– Raise awareness among the elder Rohingya women
about SRH and engage them as agents for positive
change
1. Community Health Education need to be
prioritized

14. 14
• Reach out to adolescents
and youth rather than
waiting for them to reach out
– Use of outreach
– Engagement of
Rohingya volunteers
along with service
providers (to build trust)
• Health education tools
responsive to low literacy
level (use of visual materials)
materials)
2. Expand Efforts to Improve SRH

15. The Population Council conducts research
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evidence: It’s our model for global change.
For further information about this research please reach out to
Sigma Ainul <sainul@popcouncil.org>