Promoting adolescent health in Bangladesh: How peer support helped one girl delay pregnancy

Shilpi was married off by her parents against her will. She was only 15. Thankfully, her husband Rashid agreed to delay childbirth despite pressures from his family.

Shilpi was only 15 years old when she married Rashid in 2008. Marrying off daughters at an early age was standard practice for parents living in northern Bangladesh and remains so today for many families across the country.

After her wedding, Shilpi joined Bakul Kishori, an empowerment group that provides adolescent girls with the tools needed to gradually change cultural practices, particularly those pertaining to early marriage and pregnancy. Activities include discussions on how to most effectively change behaviour related to reproductive health, as well as one-on-one counselling, peer-to-peer support, and life skills training that help adolescents say no to early marriage. Bakul is the name of a flower, and kishori means adolescent girl. Bakul Kishori is one of more than 10,000 groups supported by Plan Bangladesh and seven other local development organizations through CIDA's Adolescent Reproductive Health project which also aims to increase access to quality health services for adolescents. During one of the group sessions, Shilpi came to understand the potentially harmful effects of early marriage and pregnancy.

While maternal mortality in Bangladesh has declined by nearly 40 percent since 2001, the rate remains high, with 194 maternal deaths per 100,000 live births in 2010―dropping from 322 in 2001. Girls who get pregnant are at risk of serious health complications, including dangerous hemorrhaging and fistula, a painful internal injury caused by obstructed childbirth that commonly leads to serious maternal morbidities and social exclusion.

When Shilpi heard about those risks, she invited her husband, Rashid, to discuss pregnancy with a counsellor. After hearing about the risks, Rashid agreed to delay having children for another five years despite pressures from his parents and neighbours to produce offspring. Together, the couple met with a female health care provider, who informed them about the various family planning options available.

Shilpi's mother-in-law and neighbours continued to pressure the newlyweds. Deeply rooted cultural practices and traditions caused a rift between Shilpi and Rashid and their extended family, who insulted and criticized the couple. Unable to convince their close relatives of the risks, Shilpi and Rashid returned to the counsellor. With the help of a parent peer―a parent who has been trained to speak to other parents about adolescent issues―the mother-in-law and neighbours eventually came to understand the harmful effects of early pregnancy on mother and child.

Today, the village no longer pressures the couple; their parents and neighbours now support them and advocate against early marriage and pregnancy.

This project is part of CIDA's priority theme of securing the future for children and youth and improving maternal, newborn and child health. As of November 2011, more than 9,000 female adolescents between 10 and 19 years of age have benefited from the project.