R EPRODUCTIVE HEALTH SEEKING BEHAVIOR OF YOUNG MARRIED WOMEN Dr. Aftab Uddin Gano Unnayan Sangstha (GUS)

O UTLINES OF PRESENTATION Objectives Methodology Key Findings Lessons Learned Recommendations

To assess the socio – economic characteristics of the married adolescents; To assess the attitudes of the parents and the community about health seeking behavior of the married adolescents; To investigate the barriers or constraints in health seeking behavior of the adolescents; To investigate the factors affecting the married adolescents health seeking behavior. GENERAL OBJECTIVE : TO ASCERTAIN THE HEALTH SEEKING BEHAVIOR OF YOUNG MARRIED WOMEN IN B ANGLADESH S PECIFIC OBJECTIVE ( S ):

M ETHODOLOGY A cross sectional study designed to obtain information from the primary and secondary sources; No. and Categories of sample Respondents: Married Adolescents & Newlywed Couple from upazila, union and village levels: 1680 Program managers and service providers: 14 UFPO, 14 MO (MCH-FP), 14 Sr. FWVs, 28 Family Planning Inspectors (FPIs), 28 Family Welfare Visitors (FWV), 28 SACMOs, and 84 Family Welfare Assistant (FWAs) Focus Group Discussion: 10

M ETHODOLOGY Data collection: data were collected during May 2012 employing 8 sets of pretested instruments; Data Analysis and results preparation: Collected data were analysed by using EPI INFO and SPSS in IBM/IBM compatible PC. Uni-variate and bi-variate analysis were done to prepare tables in line of the objectives of the study and for preparing the report.

K EY FINDINGS Adolescent married women: 50% were under 17 and 37% were exactly 18 years, 36% had primary education while 53% had secondary level; Nearly 90% were aware of the services such as: FP methods (68%), ANC service, delivery care, postnatal care, conduct delivery, general health service, vaccination and childcare. More than 16% respondents were currently pregnant and…9 in 10 adolescents received ANC; Main sources were: Public sector (79%), private practitioners (26.3%), and NGO clinics (24.8%) 20% of women received ANC at community clinic

K EY FINDINGS 45% adolescents wanted to have baby after the age of 20 and only 14% wanted baby earlier. Current use of contraception: CPR (any method)- 52% with variations in high performing (62%) and low performing (43%) areas; The pill was the most popular method in all regions; Injectables were the second most popular method in low performing area, and Condoms were the second most popular method in medium performing area; Public sector provides more than 83% of all users; FWAs were the most important source supplying 43%, 70% and 60.5% to users in high, medium and low areas respectively.

K EY FINDINGS Complication for using FP method- 25% users in the low performing area as against 10.3% in high performing area had complications while using FP method; Obstacles and assistance for receiving services- Very few young women had faced obstacles from both families and community; 77.8% of the respondents in high performing area as against 90% in medium performing areas got assistance from health clinics.

K EY FINDINGS Factors associate with attitude of health care service: Two-third respondents suggested that mass campaign and courtyard meeting could raise awareness and increase the utilization of health care service; Suggested following steps:  improve quality of services  increase the adequate number of doctors  provide aids and medicines  provide adequate contraceptive materials and  give quality training to the service providers

K EY FINDINGS Program managers and service providers: 62.5% managers described the status of health seeking behavior of women as average; Women sought: delivery and childcare (50%) and RH care (38%) mostly (94%) from FWA/FWV/SACMO 87% providers perceived that clients received appropriate services according to their needs FP methods and RH services, care for pregnant women, mother and child care. All program managers opined that the attitude of the parents, community and relatives appear to be good towards women’s health seeking behavior

K EY FINDINGS Main obstacles for receiving services by a women Superstition lack of awareness of health in the family lack of skilled worker and their frequent absence Service providers opined that further steps needed: courtyard meeting group meeting with young and new couple campaign including religious leaders to enhance existing service reception by the clients.

K EY FINDINGS One in five managers stated: providers faced difficulties/obstacles while providing services to their clients The most mentioned reasons: Religiosity and non-cooperation of husband of the newlywed couples for receiving FP method; To overcome providers recommended, to: build awareness in the society and among adolescents (99%) promote general education (60%), and develop awareness from religious perspective (68%)

L ESSONS L EARNED Maternal, child and family planning services were available in the health center and 90% adolescent married women during their pregnancy received antenatal care mainly from the public sector. Overall, 50% of the adolescent women used contraception, and pill was the most popular method in all regions-high, middle and low performing areas. Negligible amount of respondents were using permanent method.

L ESSONS L EARNED Public sectors have been the important source of supplies for family planning users in Bangladesh Private sector as the second largest provider In general, very few young women had faced obstacles from families and community. However, the main obstacles for the adolescent married women while receiving health service: Religiosity and the lack of cooperation of husband of the newlywed couples lack of health awareness in family lack of skilled workers, and lack of transport

R ECOMMENDATIONS Launch effective BCC campaigns to increase coverage of RH-FP (ANC, Delivery, PNC and FP) services among adolescents; Arrange adequate and efficient training programs including refreshers training to increase service providers’ knowledge and skills; Increase community awareness by medically trained personnel about importance of RH-FP services so that young women can seek institutional and skilled services;

R ECOMMENDATIONS Provide effective counseling with appropriate information, and treat complications of contraceptive use to prevent dropout; Ensure timely supply of appropriate FP methods based clients’ demand; Equip service centers with adequate field workers to deliver adolescent care services; Increase quality of services for FP method: adequate time for counseling and motivation clinical examination, and explaining to the clients about the problems and appropriateness of the FP methods.

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