Family planning knowledge, attitude and practice among Rohingya women living in refugee camps in Bangladesh: a cross-sectional study

Abstract

Background Considering the high risk of maternal morbidity and mortality, increased risks of unintended pregnancy, and the unmet need for contraceptives prevalent among the Rohingya refugees, this study aims to explore the knowledge, attitude, and practice (KAP) of family planning (FP) and associated factors among Rohingya women living in refugee camps in Bangladesh. Methods Four hundred Rohingya women were interviewed. Data were collected using a structured and pretested questionnaire, which included study participants’ socio-demographic characteristics, access to FP services, knowledge, attitude, and practice of FP. Linear regression analysis was performed to identify the influencing factors of FP-KAP. Results Of the 400 Rohingya refugee women, 60% were unaware that there was no physical harm brought by using a permanent method of birth control. Half of the women lack proper knowledge regarding whether a girl was eligible for marriage before the age of 18. More than two-thirds of the women thought family planning methods should not be used without the husband’s permission. Moreover, 40% were ashamed and afraid to discuss family planning matters with their husbands. Of the study participants, 58% had the opinion that a couple should continue bearing children until a son is born. Linear regression analyses found that study participants’ who have a profession, have less children, whose primary source of FP knowledge was through a physician/nurse, have had FP interventions in the camp, and talk with a health care provider on FP were found to have better FP-KAP. Conclusion The study showed that Rohingya refugee women are a marginalized population in terms of family planning and their comprehensive FP-KAP capability was low. Contraceptives among the Rohingyas were unpopular, mainly due to a lack of educational qualifications and family planning awareness. In addition, family planning initiatives among Rohingya refugees were limited by a conservative culture and religious beliefs. Therefore, strengthening FP interventions and increasing the accessibility to essential health services and education are indispensable to improving improve maternal health among Rohingya refugees.

"I don't want my marriage to end" - A qualitative investigation of the sociocultural factors influencing contraceptive use among married Rohingya women residing in refugee camps in Bangladesh

“…This nding corroborates with other study nding conducted in the same setting (15). The reasons for wanting more children can be attributed to various factors, including a preference for male offspring(20), the expectation of nancial protection and care in old age (21,22), the belief that children are blessings from God associated with prosperity (20,23) the aim to contribute to the growth of the Islamic population, the expectation of better chances of survival in refugee camps (24,25) and the hope of getting additional food cards with bene ts such as food, medicine, and clothes (15). In addition, another signi cant reason for desiring children is rooted in traditional gender roles, which expect women to become mother shortly after marriage and consider motherhood as the primary responsibility in a woman's life (26,27).…”

“…The main reasons for the disapproval were identi ed as the husband's desire for more children (31,32), religious belief (33), social stigma associated with contraceptive use (28,34) and misperception regarding the side effect of contraceptives (28, 31). Religiously and culturally, Rohingya women believe that engaging in any activity without their husband's permission is considered a sin (15). This belief provides justi cation for husbands' actions, regardless of their appropriateness.…”

Women's participation in childbearing decision-making and its effects on short-interval births in Rohingya refugee camps of Bangladesh

“…Covariates considered in this study were selected based on a review of relevant literature in refugee settings. 1 , 3 , 4 , 5 , 9 , 11 , 12 , 13 These included women's age (≤19 or ≥20), education (no education or at least some education), and work engagement outside the household (yes or no). Women's intentions regarding their most recent pregnancy, which occurred within two years of the survey and resulted in a live birth, were also included as an explanatory factor.…”

“…Access to family planning and contraception remains challenging in refugee settings worldwide, including Bangladesh, with limited awareness of these options. 1 Consequently, unintended pregnancies (52%) and short interval births (<33 months interval between the two most recent births, 37%) are more prevalent in these contexts. 2 , 3 Such higher rates of short interval births are linked to adverse maternal and child health outcomes, including stillbirth, neonatal mortality, and maternal mortality.…”

“…Existing research in the context of refugees primarily focuses on family planning, contraception, and maternal healthcare services, and their associated factors, as well as the gender-based violence. 1 , 3 , 4 , 5 , 9 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 This limited focus restricts policymakers' ability to develop evidence-based policies and programs aimed at enhancing women's participation in reproductive decision-making and reducing the incidence of short interval births. Therefore, this study aims to explore the extent of women's participation in decision-making with their partner regarding when to have a child, short interval births, and their associations.…”