World Population Day: Sylhet wakes up to family planning
At 26, Bina Roy, a tea garden worker at Khejuri Tea Garden of Sreemangal upazila in Moulvibazar, is already a mother of four after getting married at 16.
She has had three miscarriages and could go on to have more children as she has no idea what family planning is.
"Do we have any time to make any plans for the family?" asked Bina, who gets Tk 120 a day by picking tea leaves and constantly frets over how she will manage food for her big family.
Bina is not alone.
A 2019 awareness guide on Sexual and Reproductive Health Rights and Family Planning in 12 tea gardens in the Sreemangal and Kamalganj upazilas of Moulvibazar district paints a picture of a vicious cycle of poverty, high fertility rates and pregnancy-related health risks, reproductive health complications and illiteracy.
The study -- conducted by the Society for Environment and Human Development, the Centre for Injury Prevention and Research, Bangladesh (CIPRB) and the United Nations Population Fund -- found that almost half of the women surveyed in 12 tea gardens in Sreemangal and Kamalganj upazilas of Moulvibazar district were married off before they turned 18 years of age.
And 55 percent of them have never used birth control. Although 45 percent of the women were found taking birth control pills, intrauterine contraceptive devices and implants, none of their husbands has ever used any contraceptive.
The situation is just the same in the haor areas of Sunamganj, where religious orthodoxy, inaccessible transportation system, illiteracy and social propaganda by rural midwives against family planning reign supreme.
One such example is Mafia Begum of Dariapara village in Madhyanagar of Dharmapasha upazila of Sunamganj.
Last year, at the age of 18, she had a stillbirth at home even though it is widely known that being pregnant as a teenager puts girls at higher risk of complications during childbirth.
She is pregnant again and has not made any antenatal visits to the local community clinic or family welfare assistant due to the reluctance of her husband and mother-in-law.
Similarly, Nazia Sultana of Haripur area of Jaintapur upazila of Sylhet, is a mother of three after she was wedded off at the age of 16 and will most likely have more children given the lack of family planning for reasons pertaining to restrictions from family and religion.
A report last month of the Bangladesh Bureau of Statistics also revealed that the Contraceptive Prevalence Rate (CPR) was the lowest (32.7 percent) among the women of the Sylhet division.
The family planning situation is comparatively worse among tea workers, so is the total fertility rate, unmet needs, maternal deaths and stillbirth, said Binoy Sing Rowtia, a health assistant at Sreemangal Upazila Health Complex.
The situation used to be worse in the past, said Rowtia, who has been working on this issue in Sreemangal for the past 10 years.
The tea workers are not interested in hospital delivery, as they consider the arrangements needed for transport, blood, and medicine to be a hassle.
They largely depend on the local midwives, although most of them are not trained.
"When complications arise, they bring them to the hospitals, often with nothing left in our hands," he said, adding that superstition and phobia prevent them from going to health facilities from the onset.
Besides, most of the men have a lack of interest in using condoms, Rowtia added.
"Religious orthodoxy is so prevalent in this area that we cannot go to any house and talk about family planning directly," said Fauzia Begum, family welfare assistant in Haripur area of Jaintapur upazila in Sylhet.
They try to segue the matter after educating on children's health, vaccinations and so on but are stopped in their tracks.
"They use the excuse of religion," she said.
In terms of haor areas of Sunamganj, Halima Akhter, family welfare assistant at Sreepur South Union Family Planning and Health Centre, said they face huge difficulties in reaching remote villages in Tanguar Haor areas by boat during the monsoon as there is a constant fear of accidents due to the storm surge.
And in the dry season, they need to spend a good amount on transportation from their salaries.
The government should take timely and need-based intervention for people of tea workers, who are ostracised from the mainstream society, and haor areas, said Pulak Raha, team leader at Advance Family Planning initiative.
Even if a family planning expert makes a weekly visit to the tea workers and provide them with the required information and equipment, it can go a long way in protecting their reproductive health rights and well-being, he said.
For massive awareness campaigns, public-private partnership is needed involving the tea workers and the garden owners, Raha added.
Geographical diversity is one of the major challenges for the Sylhet division in providing uninterrupted family planning services to couples, said Md Kutub Uddin, divisional director of Family Planning.
"Still, we have recently started to bring pregnant mothers to local hospitals through naval ambulance, repair our health centres and seek help from the local administration for assisting us in providing services."
Uddin acknowledged there is a gap in the services because of inadequate infrastructure and human resources.
"Almost one-third of the positions are vacant," he said.
Additional reporting by Mintu Deshwara
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