Family planning is a critical issue around the world in terms of accessing the services, supplies and enabling the environment to express an individual’s autonomous choice. In Bangladesh, the biggest controversy around family planning is giving family planning information to unmarried young adolescents. The Government of Bangladesh is still uncertain about how to address unmarried adolescents and youth in regard to the use of contraceptives.
However, married adolescents and youth also need family planning. According to the 2007 Bangladesh Demographic and Health Survey, 17% of all married women have an unmet need for family planning. Israth Jahan (not a real name), who is 25 years old and a mother of a 1-year-old child, told me, “I had no idea about any contraception when I got married at the age of 18. I am still unclear about many methods.” Before giving birth, Israth had an abortion because her husband’s economic situation was not good enough to have a child when they were first married. The couple had the misperception that using a long-acting method before their first child would create difficulties for future pregnancies. So, they used condoms and oral contraceptive pills, and because of irregular use, Israth got pregnant.
Family planning is not only about access, but also about youth-friendly health services. If a service provider’s attitude is not friendly and comforting, there is a high possibility that a client will not return to that facility. Israth shared an experience: when she received a contraceptive implant, she experienced irritation (a common side effect) after two days and went to the nearest government facility. She went there and asked to remove the implant. The service provider, without a second question, removed it and did not even bother to tell her why it was irritating.
After the experience, Israth did not receive any other long-acting method; rather, her husband is using condoms. But sometimes he does not want to use them because he says it interrupts his pleasure. As a result, Israth needs to take emergency contraceptive pills (ECP) frequently. She is concerned that frequent use of ECP may have an impact on her reproductive life (ECP has no effect on fertility, but this is a common misconception). She wants to use a long-acting method, but she is afraid that she will not receive safe and proper instruction. Israth strongly recommends capacity strengthening for service providers, so they have a better understanding of youth family planning needs and an unbiased attitude toward young users.
Ensuring youth-friendly services is very important for young people, so they can become familiar with family planning processes and methods. Young people like Israth should be able to access equitable, accessible, acceptable, appropriate and effective health services. Family planning can help us have control over not only our bodies but also our lives. Without autonomy over our bodies, we cannot achieve autonomy over our lives.
The writer is the Country Coordinator of IYAFP-Bangladesh.