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Rahman A, Strong J, Mondal PP, Maynard A, Haque T, Moore AM, Afsana K. Perceptions and attitudes of Rohingya community stakeholders to pregnancy termination services: a qualitative study in camps of Cox's Bazar, Bangladesh. Confl Health 2024; 18:19. [PMID: 38433199 PMCID: PMC10910813 DOI: 10.1186/s13031-024-00574-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 01/28/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Rohingya women suffer from inaccessibility to sexual and reproductive health services in Myanmar. After the forcible displacement of the Rohingya from Myanmar to Bangladesh in 2017, pregnancy termination services have been increasingly important and desired, while knowledge gaps and obstacles to access services still exist. The role of community stakeholders is critical as gatekeepers and decision-makers to improve and strengthen pregnancy termination services for women in camps. However, there is paucity of evidence on their perspectives about pregnancy termination. This qualitative study aims to understand the perception and attitudes of Rohingya community stakeholders to pregnancy termination in the camps of Cox's Bazar. METHODS We used purposive sampling to select 48 participants from the community stakeholders, 12 from each group: majhis (Rohingya leaders), imams (religious leaders), school teachers, and married men. We conducted in-depth interviews of all the participants between May-June 2022 and October-November 2022. Data were coded on Atlas.ti and analysed using a thematic content analysis approach. RESULTS Multiple socio-cultural and religious factors, gendered norms and stigma associated with pregnancy termination acted as barriers to women seeking services for it. From a religious stance, there was greater acceptance of pregnancy termination in the earlier period than in the later period of pregnancy. We observed that pregnancy termination among community stakeholders in earlier stages of pregnancy than later. However, circumstances, such as a woman's marital status, whether she sought her husband's permission or her ability of childcare capacity, were often framed by community stakeholders as 'acceptable' for pregnancy termination. Health concerns and social and contextual factors can influence community stakeholders supporting pregnancy termination. CONCLUSIONS The community stakeholders perspectives on barriers and enablers of pregnancy termination were variable with the context. These perspectives may support or impede women's ability to choice to seek pregnancy termination services. To improve women's choice to pregnancy termination, it is critical to consider roles of community stakeholders in creating their supporting attitudes to women's choice and access, and to designing targeted culturally appropriate interventions with communities support and engagement.
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Affiliation(s)
- Atiya Rahman
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh.
| | - Joe Strong
- London School of Economics and Political Science, London, UK
| | | | | | - Tasnima Haque
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | | | - Kaosar Afsana
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
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Khan MN, Khanam SJ. Women's participation in childbearing decision-making and its effects on short-interval births in Rohingya refugee camps of Bangladesh. Lancet Reg Health Southeast Asia 2023; 15:100250. [PMID: 37521319 PMCID: PMC10372892 DOI: 10.1016/j.lansea.2023.100250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/01/2023] [Accepted: 07/06/2023] [Indexed: 08/01/2023]
Abstract
Background Women's involvement in family planning decision-making is significantly low among refugee women, potentially leading to an increased unintended and short interval pregnancies. This study aims to investigate the relationship between women's decision-making in childbearing and short-interval births among Rohingya refugee women in Bangladesh. Methods Data from 719 women residing in three Rohingya refugee camps in Ukhiya, Cox's Bazar, Bangladesh, were analyzed. The outcome variable was birth spacing, categorized as short (<33 months between the two most recent births) or normal (≥33 months between the two most recent births). The primary explanatory variable was women's involvement in fertility decision-making with their partner, classified as never, sometimes, and always. Multivariate logistic regression analysis was conducted to assess the association between the outcome and explanatory variable while adjusting for potential covariates. Findings 58% of births occurred within a short interval, while almost 48% of women reported no participation in fertility decision-making with their partner. Short interval birth was found to be increasing with decreasing women's participation in fertility decision-making with their partner. Women who sometimes or never made fertility decisions with their partner had 1.20 times (95% CI, 1.01-1.88) and 1.69 times (95% CI, 1.06-2.29) higher likelihood of short interval births, respectively, compared to women who always decided with their partner. Interpretation Low women's participation in fertility decision-making with their partner among Rohingya refugees increases short interval births and adverse maternal and child health outcomes, including mortality. This highlights the need for counselling programs to educate and empower women, promoting joint fertility decision-making by couples. Funding This research did not receive any specific funds.
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Affiliation(s)
- Md Nuruzzaman Khan
- Corresponding author. Department of Population Sciences, Jatiya Kabi Kazi Nazrul Islam University, Mymensingh, Bangladesh.
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Jayaweera R, Powell B, Gerdts C, Kakesa J, Ouedraogo R, Ramazani U, Wado YD, Wheeler E, Fetters T. The Potential of Self-Managed Abortion to Expand Abortion Access in Humanitarian Contexts. Front Glob Womens Health 2021; 2:681039. [PMID: 34816230 PMCID: PMC8593970 DOI: 10.3389/fgwh.2021.681039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 07/26/2021] [Indexed: 11/13/2022] Open
Abstract
Refugees and displaced people face uniquely challenging barriers to abortion access, including the collapse of health systems, statelessness, and a lack of prioritization of sexual and reproductive health services by humanitarian agencies. This article summarizes the evidence around abortion access in humanitarian contexts, and highlights the opportunities for interventions that could increase knowledge and support around self-managed abortion. We explore how lessons learned from other contexts can be applied to the development of effective interventions to reduce abortion-related morbidity and mortality, and may improve access to information about safe methods of abortion, including self-management, in humanitarian settings. We conclude by laying out a forward-thinking research agenda that addresses gaps in our knowledge around abortion access and experiences in humanitarian contexts.
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Affiliation(s)
| | | | | | - Jessica Kakesa
- International Rescue Committee, Kinshasa, Democratic Republic of the Congo
| | | | | | | | - Erin Wheeler
- International Rescue Committee, New York, NY, United States
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Jeffries R, Abdi H, Ali M, Bhuiyan ATMRH, El Shazly M, Harlass S, Ishtiak A, Mazhar MKA, Prajapati M, Pang QY, Singh B, Tabu F, Baidjoe A. The health response to the Rohingya refugee crisis post August 2017: Reflections from two years of health sector coordination in Cox's Bazar, Bangladesh. PLoS One 2021; 16:e0253013. [PMID: 34115800 PMCID: PMC8195412 DOI: 10.1371/journal.pone.0253013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
On August 25 2017, an unprecedented influx of Rohingya refugees began from Rakhine State in Myanmar into Bangladesh's district of Cox's Bazar. The scale and acuteness of this humanitarian crisis was unprecedented and unique globally, requiring strong coordination of a multitude of actors. This paper reflects on the health sector coordination from August 2017 to October 2019, focusing on selected achievements and persisting challenges of the health sector strategic advisory group (HSSAG), and the health sector working groups including epidemiology and case management, sexual and reproductive health, community health, mental health and psychosocial support, and emergency preparedness. In the early days of the response, minimum service standards for primary health care were established, a fundamental initial step which enabled the standardization of services based on critical needs. Similarly, establishing standards for community health outreach was the backbone for capitalizing on this important health workforce. Novel approaches were adopted for infectious disease responses for acute watery diarrhoea and varicella, drawing on inter-sectoral collaborations. Sexual and reproductive health services were prioritized from the initial onset of the crisis and improvements in skilled delivery attendance, gender-based violence services, abortion care and family planning were recorded. Mental health service provision was strengthened through community-based approaches although integration of mental health programmes into primary health care has been limited by availability of specialist psychiatrists. Strong, collaborative and legitimate leadership by the health sector strategic advisory group, drawing on inter-sectoral collaborations and the technical expertise of the different technical working groups, were critical in the response and proved effective, despite the remaining challenges to be addressed. Anticipated reductions in funding as the crisis moves into protracted status threatens the achievements of the health sector in provision of health services to the Rohingya refugees.
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Affiliation(s)
| | - Hassan Abdi
- United Nations Population Fund, Cox’s Bazar, Bangladesh
| | - Mohammad Ali
- Ministry of Health and Family Welfare Coordination Center, Cox’s Bazar, Bangladesh
| | | | - Mohamed El Shazly
- United Nations High Commissioner for Refugees, Cox’s Bazar, Bangladesh
| | - Sandra Harlass
- United Nations High Commissioner for Refugees, Cox’s Bazar, Bangladesh
| | - Asm Ishtiak
- Ministry of Health and Family Welfare Coordination Center, Cox’s Bazar, Bangladesh
| | | | | | | | | | - Francis Tabu
- International Organisation for Migration Cox’s Bazar, Bangladesh
| | - Amrish Baidjoe
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- World Health Organisation, Regional Office of South East Asia, Delhi, India
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Ahmed R, Aktar B, Farnaz N, Ray P, Awal A, Hassan R, Shafique SB, Hasan MT, Quayyum Z, Jafarovna MB, Kobeissi LH, El Tahir K, Chawla BS, Rashid SF. Challenges and strategies in conducting sexual and reproductive health research among Rohingya refugees in Cox's Bazar, Bangladesh. Confl Health 2020; 14:83. [PMID: 33292373 PMCID: PMC7708138 DOI: 10.1186/s13031-020-00329-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 11/24/2020] [Indexed: 12/01/2022] Open
Abstract
Background Rohingya diaspora or Forcibly Displaced Myanmar Nationals (FDMNs), took shelter in the refugee camps of Cox’s Bazar, Bangladesh due to armed conflict in the Rakhine state of Myanmar. In such humanitarian crises, delivering sexual and reproductive health (SRH) services is critical for better health outcomes of this most-at-risk population where more than half are adolescent girls and women. This is a reflective paper on challenges and related mitigation strategies to conduct SRH research among FDMNs. The research on which this paper is based employed a concurrent mixed-method design combining a cross-sectional survey and qualitative interviews and group discussions with FDMNs to understand their SRH needs and demand-side barriers. Assessment of health facilities and qualitative interviews with healthcare providers and key stakeholders were carried out to assess facility readiness and supply-side barriers. Challenges and strategies The researchers faced different challenges while conducting this study due to the unique characteristics of the FDMN population and the location of the refugee camps. The three key challenges researchers encountered include: sensitivity regarding SRH in the FDMNs, identifying appropriate sampling strategies, and community trust issues. The key approaches to overcome these challenges involved: actively engaging community members and gatekeepers in the data collection process to access respondents, identifying sensitive SRH issues through survey and exploring in-depth during qualitative interviews; and contextually modifying the sampling strategy. Conclusion Contextual adaptation of research methods and involving community and local key stakeholders in data collection are the key lessons learnt from this study. Another important lesson was researchers’ identity and positionality as a member of the host country may create distrust and suspicion among the refugees. The multi-level complexities of humanitarian settings may introduce unforeseen challenges and interrupt research plans at different stages of research which require timely and contextual adaptations.
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Affiliation(s)
- Rushdia Ahmed
- BRAC James P Grant School of Public Health, BRAC University, 5th Floor, (Level-6), icddrb Building, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
| | - Bachera Aktar
- BRAC James P Grant School of Public Health, BRAC University, 5th Floor, (Level-6), icddrb Building, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Nadia Farnaz
- BRAC James P Grant School of Public Health, BRAC University, 5th Floor, (Level-6), icddrb Building, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Pushpita Ray
- BRAC James P Grant School of Public Health, BRAC University, 5th Floor, (Level-6), icddrb Building, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Abdul Awal
- BRAC James P Grant School of Public Health, BRAC University, 5th Floor, (Level-6), icddrb Building, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Raafat Hassan
- BRAC James P Grant School of Public Health, BRAC University, 5th Floor, (Level-6), icddrb Building, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Sharid Bin Shafique
- BRAC James P Grant School of Public Health, BRAC University, 5th Floor, (Level-6), icddrb Building, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Md Tanvir Hasan
- BRAC James P Grant School of Public Health, BRAC University, 5th Floor, (Level-6), icddrb Building, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Zahidul Quayyum
- BRAC James P Grant School of Public Health, BRAC University, 5th Floor, (Level-6), icddrb Building, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | | | - Loulou Hassan Kobeissi
- Department of Reproductive Health Research, World Health Organization, Geneva, Switzerland
| | - Khalid El Tahir
- Health Sector Coordination Office, World Health Organization, Cox's Bazar, Bangladesh
| | | | - Sabina Faiz Rashid
- BRAC James P Grant School of Public Health, BRAC University, 5th Floor, (Level-6), icddrb Building, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
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