Child bearing and sexual and reproductive health and

Child bearing and sexual and reproductive health and rights in Dhaka slums SAFE baseline survey findings Sajeda Amin, Laila Rahman and Md. Irfan Hossain Population Council 12 July 2012, icddr, b Sasakawa Auditorium, Dhaka

Sexual and reproductive health (SRH) rights- basic human rights • Responsible, satisfying, safe sex life • Freedom to decide if, when, how often to bear children • Information and access to safe, effective, affordable and acceptable methods of fertility regulation of choice • Health care services enabling women to go safely through pregnancy and childbirth • Provide couples best chance of having a healthy infant

Objective Explore factors associated with SRH rights related practices, attitudes, and knowledge of ever married 15 -29 years females of Dhaka slums Sample Ever married Currently married and non-pregnant 2, 989 2, 542

Conceptual framework Personal characteristics Age, education, marital and work status, orphan hood, home division, migration status, wealth quintiles Spousal characteristics Education, extra-marital relationship, child with other women, alcohol consumption, violent behavior Marriage characteristics Timing, number, registration, love marriage, girls’ consent, dowry demand • 3 or more births • Menstruation regulation (MR), ANC, Delivery, PNC • Current FP use; STIs • SRHR awareness • Attitude towards condom use by unmarried males • Never heard of MR • Do not know of STIs • Adverse effect of teenage pregnancy

FINDINGS

High risk childbearing & SRH practices Did not receive medical attention for postnatal care 87% Did not receive medical attention during delivery 78% Did not receive medical attention for antenatal care 76% Current non-use of modern FP methods Current reproductive and sexully tract infections Had 3 and above live births Ever had menstruation regulation 42% 21% 16% 13%

Childbearing by age group 96% 85% 47% 15 -19 (n=506) 9% 20 -24 (n=1227) First time currently pregnant 3% 25 -29 (n=1255) Mother

Challenging attitude towards SRH rights 33% 85% 87% Inadequate reproductive health rights awareness Inadequate sexual health rights awareness 33% Don't support use of condoms by unmarried males unmarried females All should be able to enjoy sex lives that are safe and satisfying with dignity, equality, responsibility and mutual respect

Inadequate awareness on SRH issues Don't know about sexually transmitted diseases 54% Don't know about adverse effect of teenage pregnancy- newborn's health problem 57% Don't know about emergency contraceptives 54% Never heard of menstruation regulation Don't know about danger period of becoming pregnant 49% 27%

Current non-use of any modern contraceptive (odds ratios) 0. 75000000 * 0000001 Highest 0. 74 * Fourth Middle Second 0. 88 0. 71 * Wealth- Lowest (r) 1. 00 Had active choice in marriage 0. 81 Did not choose the groom (r) Married once * 1. 00 0. 57 ** Married more than once (r) *Significant at p≤. 05; **p≤. 01; ***p≤. 001. (r)- Reference category. 1. 00

Risk and protective factors for having an MR (odds ratios) 1. 69 ** 1. 35 * 1. 00 *** 0. 3800001 Not working (r) Working Migrated to Dhaka (r) Non-migrated, born in Dhaka Husband has Husband don't extra-marital have extrarelation (r) marital relation *Significant at p≤. 05; **p≤. 01; ***p≤. 001. (r)- Reference category.

Inequality in wealth and age matter in accessing non-medical or no care for delivery (odds ratios) Highest Fourth Middle 0. 69 * 0. 59 *** 0. 73 * Second 1. 1 Wealth qunitile- Lowest (r) 25 -29 20 -24 Age: 15 -19 (r) 1. 00 0. 53 *** 0. 59 *** 1. 00 All couples should have best chance of having a healthy infant *Significant at p≤. 05; **p≤. 01; ***p≤. 001. (r)- Reference category.

Factors associated with receiving nonmedical or no assistance for post natal care by 42 days of delivery (odds ratios) e an d ab pl m co Se co nd ar y in y ar nd co *Significant at p≤. 05; **p≤. 01; ***p≤. 001. (r)- Reference category. ** 0. 39 ov et e pl m co y ar Se y ar im Pr Pr im tio ca ed u m n pl (r et e ) t he s ig H ur th Fo dl id M . . t es til qu ni lth * *** 0. 61 0. 56 W ea e 0. 45 . 9 e- Lo w 20 25 -2 4 -2 ) (r 9 -1 15 e: Ag ** o *** 0. 42 0. 89 0. 57 *** 0. 50 *** nd 0. 58 N *** 1. 00 0. 88 in co 1. 00 Se co 1. 00

Correlates of inadequate STI knowledge (odds ratios) 1. 00 *** ** *** 0. 69 *** 1. 00 0. 75 *** 0. 57 0. 53 *** 0. 51 *** 0. 41 ed ra t ig ka m ha M ig ra t N ot D to ed ot N ng : W or ki (r ) ki ng W or ng (r ) e w or ki ov an d ab pl ry nd a Se co ar y nd co Se om in c y ar Pr im et e pl co m co in y ar Pr im m pl (r n tio ca ed u o et e ) 9 -2 25 4 -2 20 N Ag e: 15 -1 9 (r ) *** 0. 13 *Significant at p≤. 05; **p≤. 01; ***p≤. 001. (r)- Reference category.

Early marriage and husband’s violence behavior tend to contribute to three or more live births (odds ratios) Husband did not get involved in violence with other men 0. 650000000 * 000001 Husband got involved in violence with other men (r) Marriage at or above 15 years 1. 00 0. 330000000 *** 000001 Marriage before 15 years (r) *Significant at p≤. 05; **p≤. 01; ***p≤. 001. (r)- Reference category. 1. 00

Conclusions § Young, poor & less educated females are more likely to be vulnerable to SRHR violation § Women’s current work status contribute to their positive attitudes and behaviors, but the inverse relationship with MR and work may indicate challenges faced by pregnant working women § Association of SRHR with early marriage and spousal characteristics indicate importance of involving males and early marriage prevention interventions § Educated girls in slums may be used as role models and peer promoters to improve SRHR

Thank You