RESUMO
BACKGROUND: Previous research suggests that child marriage may be accelerated during times of crisis and insecurity as resources are scarce and child marriage may be a survival strategy for girls and their families. In 2017, the Rohingya experienced a mass displacement to Bangladesh in response to escalating violence in Myanmar. This displacement has resulted in an estimated population of nearly 1 million Rohingya living in Cox's Bazar. METHODS: We conducted in-depth interviews (n = 48) and focus group discussions (n = 12) with Rohingya male and female adolescents and young adults (14-24 years), and program managers and service providers (n = 24) working in Cox's Bazar to understand their experience of living or working in the camps, preferences for timing of marriage, and marriage practices in Myanmar and in the camps. We also interviewed Bangladeshis in the host community to complement our understanding of marriage in the camps and its influence in the broader community. Our primary objective was to describe how displacement influenced marriage timing and practices. RESULTS: We found that child marriage is a strong cultural phenomenon among the Rohingya, primarily rooted in socio-cultural and religious beliefs around readiness for marriage. Although child marriage was practiced by the Rohingya in Myanmar, specific state law and oppression by military forces prevented many from marrying before age 18. Now this preference is more easily practiced in the camps in Bangladesh where the displaced Rohingya experience less marriage regulation. Host community participants perceive the presence of the Rohingya as encouraging both polygamy and child marriage in their communities, leading to tension among the host community. CONCLUSIONS: Our findings support evidence that conflict and displacement increase child marriage in populations already vulnerable to child marriage by exacerbating gender inequities. However, our findings also suggest group norms around religious and cultural preferences for age at marriage play a significant role in post-displacement behaviors surrounding marriage.
RESUMO
PURPOSE: In a country like Bangladesh that has made great progress in contraceptive use with one of the lowest levels of fertility and highest levels of contraceptive use, understanding what factors influence women's decisions to discontinue a contraceptive method and not switch to a new method is critical in designing interventions and programs that will help enable Bangladesh to reach its FP2020 goals. Research on side effects has focused on physical manifestations like headaches, moodiness, abdominal pain, and menstrual irregularities. While physical effects alone may stop women from continuing a contraceptive method, less is known about how side effects influence women's daily activities and lives. The purpose of this study is to understand the ways that side effects affect Bangladeshi women's participation in different social settings. METHODS: Thirty-five in-depth interviews with married women who recently discontinued or switched to a different contraceptive method were conducted in Sylhet and Khulna Divisions. Interviews explored reasons for discontinuation including experience of side effects and impact of side effects on women's lives. RESULTS: Key themes emerged including that side effects are not only experienced physically but are barriers to women's participation in many aspects of their lives. The spheres of life that most commonly appeared to be influenced by side effects include religion, household, and sexual intimacy irrespective of method used or residence. CONCLUSION: Family planning providers need to be aware of these additional consequences associated with contraceptive side effects to provide tailored counseling that recognizes these issues and helps women to mitigate them. For Bangladesh to achieve its FP2020 goals, understanding the broader context in which family planning decisions are made vis-à-vis side effects is critical to design programs and interventions that meet all the needs of women beyond just their fertility intentions.
