Married Adolescent Women's Reproductive Health In Bangladesh.

Adolescent Reproductive Health (ARH) is relatively a new area of health intervention in Bangladesh and it is becoming an important issue. Among the women, married adolescents are particularly vulnerable regarding reproductive health problem in Bangladesh. Considering the social significance of adolescent and married adolescent women's vulnerability regarding reproductive health in Bangladesh, this study analyzed some specific components of reproductive health with regard to married adolescent women. Using data from Bangladesh Demographic and Health Survey-2004, this study consecutively unfolded the physical fitness for childbearing of married adolescent women, their fertility regulation behavior (unmet need for contraceptive and causes of non-use of contraceptives), pattern of giving first childbirth and maternal health services utilization behavior.Married adolescent women in Bangladesh, who were non-pregnant, are in unfavorable position for childbearing.The estimates show that 16.03% of currently married adolescent women (CMAW) had unmet need for contraceptive and there was, about 5%, differential between rural and urban areas regarding CMAW's unmet need for contraceptive. The extent of CMAW's unmet need for contraceptive was the highest in Sylhet division among the six divisions in Bangladesh. Husband's objection to use contraceptives is one of the principal causes of non-use of contraceptives of CMAW who had unmet need for contraceptive and it was more leading in urban areas.To examine the disparities of unmet need for contraceptive of CMAW by the effects of different covariates, this study applied the binary logistic regression technique. CMAW with marital duration 0-4 years were more likely to have an unmet need for contraceptive compared to CMAW with marital duration 5-9 years. CMAW with one living child or 2 or more living children are more likely to have an unmet need for contraceptive than CMAW with no living child. CMAW who are from Barisal or Chittagong or Sylhet division are more likely to have an unmet need for contraceptive than CMAW from other divisions.Considering the negative consequences of early first childbirth in Bangladesh, in this study attempts have been made to estimate the extent of early first birth (at adolescence) and pattern of giving first childbirth (first birth intervals since marriage) by ever married adolescent women (EMAW) and then to examine the impacts of covariates on timing of the first birth. Cox proportional hazard model has been used in this study for examining some covariates' impacts on timing of EMAW's first birth. Analysis shows that EMAW resided in urban areas have shorter first birth intervals than those EMAW who resided in rural areas and age at marriage has statistically significant impact on timing of first birth. This study has estimated the extent of maternal health services utilization and also has analyzed individual's characteristics (based on Andersen's health seeking behavior model) for identifying significant characteristics for raising maternal health services utilization. Antenatal care (ANC) utilization by EMAW during their last pregnancy is only about 54 percent. Other health services utilization by EMAW during their last birth are also very low. EMAW from rural areas are less likely to use maternal health services than EMAW from urban areas. Education level, household wealth index and place of residence were shown to have significant impact on ANC utilization. Education level and family structure have shown statistically significant effects for raising delivery by EMAW at health facility or institutional level (other than home). Education level and type of family, where they (EMAW) lived, has shown statistically significant effects on receiving assistance at delivery. Age at childbirth of married adolescent mothers (whose deliveries were at home) shows statistical significant effect on postnatal care utilization. EMAW of ages 17-19 years are more likely to receive postnatal care at their last childbirth compared to EMAW of ages <17 years.For making future pregnancy outcomes safer, it is necessary to encourage married adolescent women, through community health education, to delay childbearing and that to use family planning services. Nearly half of married non-pregnant adolescent women are undernourished and it has increasing pattern with age increases. It should be necessary to pay special emphasizes in the country's Health, Nutrition and Population Sector Program, and in the National Nutrition Program (NNP) for improving adolescent women's nutritional status.For meeting the need for contraceptive of CMAW, interventions should be made, paying special emphasize for 10-14 years age-group and rural areas. More efforts should be implemented in country's family planning programs, emphasizing special attention to newly married adolescent women to meet their need for contraceptive. Also it should be needed, by making appropriate communication programs, to encourage CMAW's husbands to use (by any one of the couple) contraceptives. It should be needed further research on causes of non-use of contraceptives (who has unmet need) because a large proportion of EMAW (who has unmet need) did not cite specific cause of non-use.It should be needed to let inform CMAW very well about the perils of early first birth by making appropriate communication programs. Chittagong division and urban areas should be paid more consideration for lengthening duration between marriage and first birth. Early childbearing can be postponed by delaying marriage. Due to prevailing cultural and social norms favoring early marriage, only legislation for age at marriage is not the effective way in delaying marriage. There are some other ways, such as policies and programs - to increase opportunities for education and more education, to increase parents' (of adolescents) awareness about negative consequences of early marriage and early childbearing.More important is the need to longer the interval between marriage and first birth, it should be needed to encourage newly married adolescent women (also their husbands) to use contraceptive which are relevant to spacing births. Since education level as above primary and even primary level education can increase the chances of an EMAW's use of maternal health services (ANC, place of delivery and assistance at delivery), so for raising maternal health services utilization by EMAW, some long term interventions, such as providing education to girls, should be emphasized. Short term intervention as community education (reproductive health education for community) for adult members of extended families and also that for EMAW should be introduced. For raising ANC utilization, programs for maternal health services should target EMAW from low household wealth index at both in urban and rural areas of Bangladesh.