Reimagining gendered community interventions: the case of family planning programs in rural Bangladesh

Abstract

Family planning programs in Bangladesh have been successfully operating for over half a century, achieving phenomenal reductions in fertility rates. Acknowledging restrictions on women’s freedoms, much of the initial program design was concentrated on giving household supplies for women priority. However, one unfortunate impact of these outreach services is that, by bypassing the opportunity to challenge patriarchal attitudes directly, they inadvertently reinforce the power relationships of the status quo. Hence, we problematise the decision-making structures within Bangladesh’s family planning programs. We argue that the fundamental flaw with Bangladesh’s family planning program is the lack of conscious effort to understand women’s health choices and decision-making as a complex contextual process of relational, structural, and institutional forces. Additionally, avoiding men in these programs often creates new dependencies for women, as this approach does not directly seek to build relational bridges based on equality between genders. As a result, many women still depend on permission from their husbands and family for reproductive health services and face constrained family planning choices and access to care. We recommend that family planning programs adopt a broader vision to create new and more sustainable possibilities in an ever-evolving social relations landscape where gender is constantly negotiated. Such strategies are even more pressing in the post-Covid world, as national systems are exposed to uncertainty and ambiguity.

Patriarchal Influence on Contraceptive Use and Reproductive Decision Making: A Study on Selected Areas in Sirajganj District

“…The divisions of Rangpur and Rajshahi have the highest rates of contraceptive prevalence (69.8% and 69.4%, respectively), and Sylhet and Chittagong have the lowest rates (47.8% and 55.0%, respectively) (Hossain et al, 2018). According to certain research findings, gender norms-which are influenced by patriarchy in Bangladesh-played a significant role in the interpersonal dynamics around the use of contraceptives (Newmann et al, 2021;Bhatia et al, 2024). Women's use of contraceptives is inversely correlated with men's normative attitudes (Mejía-Guevara et al, 2021).…”

“…Despite efforts to promote reproductive health awareness and services, challenges persist due to cultural stigmas and inadequate access in rural and marginalized communities (Khan, 2023). These barriers underscore the need for comprehensive strategies that address socio-cultural norms, promote gender equality, and empower women in decision-making processes (Bhatia et al, 2024). According to Amraeni et al (2021), extended families have a custom wherein parents consistently favor their husband's authority above that of the wife, reinforcing the patriarchal idea that the wife's status is lower than that of her husband.…”

“…Women's capacity to choose contraception wisely is adversely affected by this lack of availability (Khan, 2023). The current family planning policies in Bangladesh frequently fail to consider the intricate dynamics between relational, structural, and institutional elements that impact the health decisions and choices of women (Bhatia et al, 2024). Gender inequality may increase, and women could develop new dependency if men keep themselves out of family planning programs (Bhatia et al, 2024).…”

“…The current family planning policies in Bangladesh frequently fail to consider the intricate dynamics between relational, structural, and institutional elements that impact the health decisions and choices of women (Bhatia et al, 2024). Gender inequality may increase, and women could develop new dependency if men keep themselves out of family planning programs (Bhatia et al, 2024). In Bangladesh, traditional gender norms and patriarchal influence still affect how people use contraceptives and make decisions in Bangladesh, where open discourse on sexual health is frowned upon, ensuring sexual and reproductive health and rights is an arduous undertaking (Islam, 2022).…”

“…When it comes to access to contraception, the impoverished and rural communities are disproportionately disadvantaged (Khan, 2023). We contend that the primary shortcoming of Bangladesh's family planning policy is the deliberate failure to recognize women's health choices and decision-making as intricate contextual processes influenced by institutional, structural, and relational factors (Bhatia et al, 2024). Furthermore, as this strategy does not specifically aim to forge relational bridges based on gender equality, excluding men from these programs frequently leads to women developing new dependencies (Bhatia et al, 2024).…”