| Summary: | BACKGROUND: Since gaining independence in 1971, the total fertility rate in Bangladesh has decreased from 6.9 births per woman to 2.3. However, Bangladesh ranks second in the world for greatest number of pregnancies by age 18. Modern contraceptive use among married adolescent girls is low at 47%, whereas the rate of unintended pregnancy is high at 21%. The United Nations and the Government of Bangladesh have indicated that provision of adolescent-friendly reproductive health services is a critical next step in family planning programming.
METHODS: Guided by the Social-Ecological Model, I applied mixed methods to determine factors that influence modern contraceptive use among married adolescent girls in Bangladesh. For the quantitative component, I used a logistic regression approach and the 2014 Bangladesh Demographic and Health Survey (BDHS) data to develop models for modern contraceptive use among nulliparous married adolescent girls (n=641). For the qualitative component, I conducted nine key informant interviews with family planning experts at the Ministry of Health and non-governmental organizations, and facilitated focus group discussions with 60 health workers. Data were collected in Khulna division where total fertility is low and in Sylhet division where total fertility is high.
FINDINGS: Contrary to expectations, contraceptive use was not associated with access to family planning services or with female autonomy. Continuing education after marriage, however, was associated with contraceptive use. These associations were robust to the inclusion of common correlates of contraceptive use, including: girl’s awareness of emergency contraception, older age at first sex, younger age, girl’s preference for more children, termination of pregnancy, husband’s desire for fewer children than the girl, marriage to a husband 30 years of age or greater, and wealth. Health workers’ personal biases against adolescents’ contraceptive use, and the belief that hormonal contraceptives cause infertility are barriers to service provision and contraceptive use among adolescents.
RECOMMENDATIONS: To reduce early childbearing in Bangladesh, health workers require training to provide family planning services to adolescents. Increasing community knowledge of modern contraception is equally important. Efforts are required to enroll and retain married adolescent girls in secondary education.
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