This 8-page document discusses adolescent reproductive health in Bangladesh and Nepal. It provides comparative information on adolescent pregnancy, childbirth, and menstrual regulation practices in both countries. Some key findings are that Bangladesh has higher rates of adolescent motherhood (64.3%) compared to Nepal (17%), and Nepalese adolescents have better knowledge and practices around menstrual hygiene. The document concludes that sexual education and expanded access to contraceptive methods could help improve adolescent reproductive health outcomes in Bangladesh.

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Submitted by Submitted to
Manuel Hasda
ID No: 1431257681
Masters of Public Health
Semester: Summer-2015
Manuel_hasda@yahoo.com
Subject: Adolescent Health (PBH 771)
Date: 28 August-2015
Dr. Mridula Bandyopadhyay
Faculty Member of Public Health Department North
South University
Contents:
SL Topics Page No
01 Contents 01
02 Abbreviation 02
03 Importance of AdolescentReproductive Health 02
04 Comparative information on Adolescent pregnancy, childbirth and Menstrual
Regulation in Bangladeshand Nepal
03
05 The Leveland trends in ARH in Bangladesh 05
06 The Way to improve the Adolescent Reproductive Health include sex education
and contraceptiveMethods using
05
07 Conclusion 06
08 References 07
Abbreviation:
ARH AdolescentReproductiveHealth ICW InternationalConference on Women
ASFR Age-specific fertility rate IMR InfantMortality Rate
BMI Body Mass Index MR MenstrualRegulation
BRAC Bangladesh Rural Advancement
Committee
MMR MaternalMortality Rate
DHS Demographic andHealth Survey UN United Nation
FPAB Family Planning Association of
Bangladesh
WHO World Health Organization
ICDP International Conference on Population
and Development
PRESENT ADOLESCENT PREGNANCY, CHILDBIRTH AND
MENSTRUTION SITUATION IN BANGLADESH

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Introduction:
There is widespread international agreement that young men and women have a right to sexual and
reproductive health. The global community, first at the International Conference on Population and
Development (ICPD) held in Cairo in 1994 and then at the Fourth International Conference on Women
(ICW) in Beijing in 1995, resolved to protect and promote the rights of adolescents and youth to sexual
and reproductivehealth information andservices (UN, 1994;UN, 1995)
Adolescent reproductive health includes pregnancy; child birth and menstruation has been a global
concern due to possible change of life course, health and socio-economic consequences for both
individual as well as societal level. Despite this, little is known on the motherhood at adolescence in
Bangladesh. The findings of BDHS survey-2014 suggest that 64.3% of the ever married adolescents
begun childbearing. Among them 53.6% were already mother and other 10.7% were pregnant for the
first time. Amongst the adolescents, 22.8% childbirths were mistimed. More than two-thirds of the
adult married women started childbearing in their teen ages. The results of the multivariate logistic
regression analyses reveal that women’s education, husband’s education, childhood place of residence,
sex of household head, religion, wealth and place of region are important determinants of adolescent
motherhood in Bangladesh. 1
What is Adolescent Reproductive Health and why it is important?
According to WHO definitions, Adolescents are aged 10 to 19 years. ARH is a state of complete
physical, mentaland social well being and not merely the absence of disease or infirmity, in all matters
relating to the reproductive system of people between the ages of 10 and 19. The Adolescent are the
good citizen and future for any country but they are being underprivileged specially in reproductive
Health and happening bad effects such as; early marriage, early pregnancy, high MMR, IMR (30-50%
higher), 50% adolescent mothers malnourished (BMI <18.5), Mean age at first pregnancy 18 years, no
involvement in decision regarding marriage, Discontinued education immediately after marriage,
Married female adolescents lack awareness on RH issues (Source: In-depth Interviews and BDHS
2004,2007). So it is important to recognize that while the world in many cultures expands for boys,
giving them greater autonomy, mobility, opportunity and power, many girls are systematically being
deprived of this advantages.2 and if they are nurtured and provide reproductive health care, they will be
developed in future.

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Comparative information on Adolescent pregnancy, childbirth, and
menstrual regulation (MR) in Bangladesh and Nepal
Adolescent Pregnancy and child birth in Bangladesh and Nepal
Bangladesh: Like early marriage, early pregnancy is common among female adolescents in
Bangladesh. Pregnancy and motherhood often occur before adolescents are fully developed physically,
which exposes them to particularly acute health risks during pregnancy and childbirth. Overall, 53.6%
of the adolescents were already mothers and another 10.7% were found to be pregnant for the first
time. This implies that 64.3% of the Bangladeshi married adolescents experience motherhood in their
teen ages. According to BDHS report, almost one-third (32.7%) of the adolescents begins childbearing
in their teen ages irrespective of maritalstatus.1
In Bangladesh, about 1
/3 adolescents are already mothers and another 5% are pregnant with their first
child. The teenage child bearing has begun to increases rapidly with age, from 14% at age 15 to 58% at
age 19. Adolescent women residing in rural areas are more likely than those in urban areas to have
begun childbearing (37% versus 25%). Those with no education are far more likely to have begun
childbearing compared with those with some secondary education. Adolescent mothers are more likely
than women in their 20s to suffer pregnancy-related complications andto die from childbirth.4
Nepal: In a report, it is showed that Unmet need for family planning has been estimated to be highest
(42%) for married girls age 15-19 (MoHP et al., 2012). 5% females age 15-19 at the time of survey had
married by age 15, and 10 % females age 20-24 had married by age 15.In Nepal DHS 2011 only 1% of
never-married female adolescents and youth age 15-24 had ever had sexual intercourse. In contrast, the
proportion of never-married male adolescents and youth age 15-24 thathad ever had sexual intercourse
was 22% in 2011. Current use of modern contraceptives among currently married 15-19 age adolescent
and young women, by age group 24%. Unmet need family planning 15-19 ages is 41.5%. The Age-
specific fertility rate (ASFR) among women 15-19 in Nepal is 81%. Proportion of adolescents and
youth age 15-19 that have started childbearing 17%. According Nepal DHS 2011 live birth is 84%, still
birth/miscarriage 13%, abortion 3%. Adolescent childbearing is still common in Nepal, although it is
decreasing. In 2011 one of every six female adolescents age 15-19 was already pregnant or had given
birth.3

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Adolescent Menstrual Regulation
In Bangladesh: Using manual vacuum aspiration menstrual regulation (MR) is ‘one of the safest
medical procedures when performed by trained health care providers with proper equipment, correct
technique and applying universal precautions for infection control’. MR is a recognized interim method
of establishing non-pregnancy for a woman who is at risk of becoming pregnant. Whether or not she is
in fact pregnant is no longer an issue6.
Menstrual problems are perceived by Bangladeshi women as the
second mostcommonhealth problems they experience (Ziauddin, 1993).5
Although almost70% of the adolescentgirls in the FPAB study were aware of the need for maintaining
some cleanliness during the menstrual period, these girls noted that they came to understand only after
two to three years of the onset of menstruation that a clean pad or cloth is important. Most girls (80%)
in the BRAC study used pieces of old rags as pads during menstruation. 60% adolescent girls used rags
that were wet or had not been dried in a hygienic fashion. 90% girls in the urban slum study associated
menstruation with being unclean or impure. The consequences of not maintaining hygiene during
menstruation (e.g., becoming sick, itching, or ulceration of genitals) were least known among the
female adolescents, especially those who were unmarried. Mothers, sister-in-laws, and friends are the
sources of information aboutmenstruationfor mostof them.4
In Nepal: In a study of Nepal, it is showed that only 6.0% of girls knew that menstruation is a
physiologic process, 36.7% knew that it is caused by hormones. 94% of them use the pads during the
period butonly 11.3%disposeit. Overallknowledge andpracticewere 40.6%and 12.9%respectively7.
Around 52.0% of girls mentioned that menstruation begins at the age of 12 years. 100% girls told that
they don't cook food during the menstrual period and around 70.7% girls do not go to schools during
period. Around 92.7% women do not sleep in their house in first period. On asking to the cause of
menstruation only 36.7% replied that it is due to hormones. Their knowledge seems to be inefficient
because only 25.3% know that bleeding is from uterus. Results show that these Nepalese girls
(100.0%) do not eat their food on the same place during period. Around 100.0% of women use pads
during period but only 29.3% changes their pad daily. But still the kind of pad they use were piece of
clothes by 98.0%. Though 24.0% of girls were taught about menstruation by their guardian's friends
and teachers still 98.0% of girls have a view that these things are not taught them properly. There are
only 18.0% of girls who clean their genitalia for menstrual purpose while only 11.3% use soap while
cleaning7.

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Few trends and level of Bangladesh and Nepal in Adolescent Reproductive health
Particulars
Nepal Bangladesh
1996 2001 2006 93-94 96-97 99-00 2004
Percentage of Women of Reproductive Ages 539 42 10
Trends in Age-specific Fertility Rates 130 9 110 9 100 9 150 10 140 10 140 10 140 10
Percentage of Women 15-19 Who Are
Mothers or Pregnant with First Child
24 9 21 9 19 9 5 10
Adolescent Fertility 199 3310
BAN Nepal
Unmet need family planning 15-19 age 18% 4 42.0% 3
Modern contraceptive method uses 15-19 47% 6 24.0% 3
Adolescents birth Rate 1000 in 2013 79% 11 72% 11
Adolescent pregnancy rate 100 in 2011 93% 11 78% 11
Adolescent girls used rags that were wet or
had not been dried in a hygienic fashion
60% 4 98% 7
The table presents trends in the percentage of 15-19 adolescent women age, fertility rate, unmet family
planning, modern contraceptive method use rate, birth rate and menstruation using in hygienic rate. It
shows that Nepal is better than Bangladesh in Adolescent reproductive health management especially
in the Nepal adolescent fertility rate, family planning and contraceptive methods using and menstrual
hygienic practicing.
The way to improve the adolescent pregnancy, childbirth, and menstrual
regulation (MR) rates in Bangladesh
Many government agencies, including the Ministry of Health, have initiated service interventions
(mainly counseling and education) for adolescents. Commendable efforts are also being made by
nongovernmentalorganizations to promote adolescenthealth andprovide specific services. Suchas;
1. Raising public awareness aboutthe importanceof adolescentandreproductive health
2. Strengtheningsexualand reproductive health educationfor allages, especially the young;
3. Strengtheningservice provisionfor adolescentincludingusing the contraceptivemethods
4. Clarifying policies and reconcilingthem to meetrealneeds;
5. Enforcing existing laws and promulgating new ones if needed;
6. Strengtheninginteragencypartnerships;and

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7. Conducting more research onadolescents’ sexualand reproductive health.
To improve the issues the mentioned initiatives have to implement mandatorily especially the Sex
Education and the contraceptive methods using facilities. If Adolescent educated on reproductive
health, they will be empowered to manage themselves as well as state burden will be reduced. To
educated the adolescent we can follow adolescent-friendly services, peer education and counseling,
provide information and education campaign; form youth clubs, conduct street theater on social norms
and teacher & community leaders education on it. The overall intervention period ranged from 12 to
24 months8.
Conclusion:
In conclusion, there has been a marked change in the overall scenario of adolescents both in Nepal and
Bangladesh that affects their sexual and reproductive health. With the available data, policy and
strategies related to adolescent and youth sexual and reproductive health should be updated. It will be
worthwhile for policy-makers and program managers to assess critically which interventions work best
in the health sector and beyond, especially in sex education and contraceptive method using. For this, it
is essential that based on evidence, we understand what risk and protective factors play roles in
adolescent sexual and reproductive health behaviors and outcomes Bangladesh and how they operate.
This information can help focus effective services and communication on those youth who are at
greatestrisk for adverse sexualand reproductivehealth outcomes.

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References:
1. S. M. Mostafa Kamal ADOLESCENT MOTHERHOOD IN BANGLADESH: Adolescent and
intergenerationalfertility patterns 2009 September;29(10):P-1
Available from: http://iussp2009.princeton.edu/papers/91121
2. Md. Mofejul Islam Adolescent Reproductive Health IN Bangladesh: status, strategy and issues
2013 April;22(4): P:4 Availablefrom:
https://www.academia.edu/4928811/Adolescent_reproductive_health_in_Bangladesh
3. Naresh Khatiwada, Pushkar Raj Silwal, Dr. Rajendra Bhadra, Tirtha Man TamangSexualand
Reproductive Health of Adolescents and Youth in Nepal: Trends and Determinants Further
Analysis of the 2011 Nepal Demographic and Health Survey, Katmandu Nepal March 2013. P:
20-51
4. Abul Barkat, Murtaza Majid ADOLESCENT AND YOUTH REPRODUCTIVE HEALTH IN
BANGLADESH: Public Health Research, Human Development Research Center Dhaka,
Bangladesh January 2003. P:15-24 http://pdf.usaid.gov/pdf_docs/PNACT786.pdf
5. Sabiha Chowdhuri Menstrual Problems of Women in Bangladesh James P. Grant School of
Public Health BRACUniversity Monographseries: 5. P:1
http://dspace.bracu.ac.bd/bitstream/handle/10361/356/MenstrualReview_3rd%20Dec%2007%2
0Monograph%20series%205%20PDF.pdf?sequence=1
6. ZA Tahmina Sarker, Nazme Sabina Sida Swedish Support to the Menstrual Regulation
Program of Bangladesh: Evaluation 07/39 Asia Department Art. no. Sida40257en ISBN 978-
91-586-8168-2ISSN 1401—0402. P:12
http://www.sida.se/contentassets/8b4958889a6c44b2a6acde9e50fe9bba/0739-swedish-support-
to-the-menstrual-regulation-program-in-bangladesh_1970.pdf
7. Adhikari P1, Kadel B2, Dhungel Sl3, Mandal A3 Knowledge and practice regarding menstrual
hygiene in rural adolescent girls of Nepal Journal (2007), Vol. 5, No. 3, Issue 19, 382-386.
P:1-5 Available from:
http://www.researchgate.net/publication/5249256_Knowledge_and_practice_regarding_menstr
ual_hygiene_in_rural_adolescent_girls_of_Nepal
8. Sanyukta Mathur, Manisha Mehta, Anju Malhotra Youth Reproductive Health in Nepal: IS
PARTICIPATION THEANSWER? January 2004. P:7
http://www.icrw.org/files/publications/Youth-Reproductive-Health-in-Nepal-Is-Participation-
the-Answer.pdf

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9. Anjushree Pradhan, Prakash Dev Pant, Pav Govindasamy NEPAL TREND REPORT: Trends
in Demographic and Reproductive Health Indicators in Nepal Further analysis of the 1996,
2001, and 2006Demographic andHealth Surveys Data, -December 2007
Available from: http://dhsprogram.com/publications/publication-TR5-Trend-Reports.cfm
10. Quamrun Nahar , Hosik Min Demographic and Health Surveys (DHS): Trends and
Determinants of Adolescent Childbearing in Bangladesh 2008 NO 48 Available from:
http://www.researchgate.net/publication/239574942_Trends_and_Determinants_of_Adolescent
_Childbearing_in_Bangladesh
11. Available from:http://data.worldbank.org/indicator/SP.ADO.TFRT