Reproductive Health Problems of Married Adolescents in Bangladesh

Abstract

Adolescent aged 10-19 years constitute a large proportion of the Bangladeshi population. With a total population of about 160 million, adolescents comprise 22% and projected to increase to 35 million by 2020. This important growing population, together with urbanization and the explosion of information across frontiers, has increased the exposure of Bangladeshi adolescent people to the risks related to reproductive health. Despite the growing awareness of the importance of adolescent reproductive health in Bangladesh, there is no clear Government policy. During the past decade significant improvement observed in reducing reproductive health problems and increasing health care seeking behavior among the adolescent girls however, it is still beyond the expectation. Still, a large number of adolescents suffer from reproductive health problems, a vast majority of them do not seek healthcare for these conditions. Until recently, several studies have been conducted to assess the association between various reproductive health problems and health seeking behavior among the adolescents. However, most of these studies have considered single or one or more determinants of reproductive health problems. Consequently most of the earlier studies mainly focused on limited components of health seeking behavior such as receiving antenatal care (ANC) or delivery care in their studies. In addition, most of these earlier studies did not compare intergenerational reproductive health problems and health seeking behavior (adolescents compared to young adult or adults). Based on this consideration, this study investigates the multiple reproductive health issues and accesses regarding those of adolescents compared to young adult and adult women. Methods: The present study was based on the data from the Bangladesh Demographic Health Survey-2011 (BDHS, 2011), which was a nationally representative survey. To investigate the reproductive health problems a total of 17,231 married adolescents (10-19 years), young adult (20-34 years) and adult (35-49 years) were analyzed. To examine the health care seeking behavior a total of 8,753 adolescent, young adult and adult women with at least one child aged less than five years were selected. The following variables were used as outcomes variable of interest for reproductive health problems: infecundity, anemia, chronic undernutrition, sexually transmitted infections (STIs), pregnancy complications, and reproductive health problem index (RHPI). The variables which were used for health care seeking behaviors are: any contraceptive methods use, use of modern contraceptives, any ANC, sufficient ANC, assisted delivery by medically trained provider, Institutional delivery and post natal care. Multilevel logistic regression analyses were used to analyze reproductive health problems and multilevel Poisson regression models were used to analyze health care seeking behavior for intergenerational age group of women (adolescents, young adult, and adult). Results: This study found that a large proportion of married adolescents were suffering from several of the reproductive health problems such as anemia, chronic undernutrition, and STIs. Regarding pregnancy related complications, the proportion is higher among the adolescent women (15.2%) as compared to the adult women (6.7%). Overall 12.4% adolescents were reported to have suffered from any kind of reproductive health problems. From multilevel logistic regression analyses, significantly, adolescent’s women were less likely to suffer from infecundity but more likely to be chronic undernourished, and suffering from pregnancy related complications as compared to the young adult women (20-34 years). Adolescent women were also more likely to suffer from any kind of reproductive health related problems compared to young adult women. Regarding health care-seeking behavior, the proportions of receiving any contraceptive methods or modern contraceptives, receiving ANC, assisted delivery by SHP, institutional delivery and receiving post natal care from SHP is much lower than those for the young adult women. From multilevel Poisson regression analyses, we found that adolescents were less likely to have institutional delivery, assisted delivery by SHP and less likely to receive post natal care by SHP as compared to young adult women. Conclusions: Based on the fact that adolescence is a crucial development stage which reflects both childhood health status and sets the foundation for adult health status, it is particularly important to protect adolescent women against many reproductive health problems that emerged from early marriage and pregnancy. Considering the need for reducing several of the reproductive health problems and increase the health seeking behavior of the adolescents an increased networking between all relevant government organizations and NGOs working with adolescents should be encouraged to ensure the proper implementation of projects. We recommend future longitudinal research to provide clarity regarding these concerns.