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Small Box, Big Difference

How an intervention for newlyweds in Bangladesh is empowering young couples to take control of their reproductive lives

Married as a child, Chandana Bala did not have agency over when she got pregnant. But today, as the mother of four children, Chandana has taken ownership over her reproductive future, using a contraceptive method she learned about from Pathfinder’s Shukhi Jibon project.

But what if we had reached Chandana earlier? That’s what Pathfinder’s latest intervention aims to do—reach newlyweds on the day of their wedding, aiming to help young brides like Chandana plan for families when they are ready.

Despite improvements in reproductive health over the last three decades, Bangladesh still suffers from high rates of unintended and early pregnancies, and more than half of Bangladeshi girls are married before their 18th birthday. Seeing this ongoing challenge, four years ago, in 2017, the Directorate General of Family Planning in Bangladesh (DGFP) piloted a small program in the Brahmanbaria district, where information boxes on family planning methods were given to newlywed couples. The pilot was a real success—73% of the young couples who received the information chose to delay their first pregnancy as a result.

The Family Planning Information Box comes with a suite of information on family planning, including how to access it, how to use it, and more detailed information on how to connect with local providers.

Today, Pathfinder is ramping up the intervention, in collaboration with the Government of Bangladesh, to reach newlywed couples in 10 different upazilas (regions) with diverse demographics. And the intervention has made a huge buzz in those communities.

On the day of their wedding, newlywed couples receive a surprise box from a local representative, in the presence of a community health worker known to the couple, or at other times, a local religious leader or government official. The box is filled with information for the newlyweds. It comes with a congratulatory letter from the DGFP, a booklet on reproductive wellbeing, leaflets on oral contraception and condoms, samples for the couple to use, a wall clock with the national family planning call center number, and reminder stickers to promote the call center number so couples can seek information and guidance from local health workers.

But the box doesn’t work on its own. It’s part of a much larger effort from USAID’s Shukhi Jibon Project to meet young people where they are, collaborating with local leaders, trusted community members, family members, and religious leaders, all who are involved to ensure the message is taken seriously.

The work takes time and effort to create buy-in. But Pathfinder has a 360 degree approach to getting it. “When we looked at the data from the pilot program,” says Tania Jahan, Shukhi Jibon’s Community Engagement & Social and Behavior Change Manager, “we found that there was some resistance from local imams and marriage registrars. We saw this, so immediately started our coordination efforts with local Islamic foundations with permission from the National Level Authority of the Islamic Foundation, under the Ministry of Religious Affairs in Bangladesh. Pathfinder worked with the local imams, community decision makers, and health workers, creating communications channels between the service providers and the local community leaders, to create more knowledge around sexual and reproductive health. The more these two groups coordinate, the easier our work is. Our work is to develop an environment that enables this discussion, so community members are more likely to participate actively in the intervention.”

FIRST SIX MONTHS:

A couple from Jalalabad, Sylhet received counseling on family planning from a Family Welfare Assistant (FWA) trained by USAID's Shukhi Jibon project, who work closely with the families to provide services and to foster a supportive environment for delaying pregnancy.

And, for imams like Mohammad Abul Bashar, it seems to be working. “It is a tremendous initiative to provide an information box to our newlywed couples,” says Abul, an imam at the Lunapara Jame Mosque, in Gouripur, Mymensing. “I advised the new couple to read the information booklet, as well as to communicate with the local Family Welfare Assistant (FWA) to develop a better understanding of family planning methods. I am committed to discussing sexual and reproductive health at my mosque, and the importance of family planning for adolescents to prevent early pregnancy, maternal death… and, to enrich happy families.”

Today, Abul actively promotes family planning in his community— and he’s one of more than 600 community leaders that have already been reached and are participating in the intervention.

Pathfinder also works to cultivate acceptance from family members. “Sometimes family members aren’t supportive, and the social pressure can be strong,” says Jahan. “So, we incorporate this component, when we actually hand over the box. It’s not just the couple that are present—it’s the full family. Through the conversation we have, with local leaders and FWAs, we provide an opportunity for engagement and discussion.”

Pathfinder also works to support FWAs directly, by providing them specific training on adolescent and youth sexual and reproductive health. These trainings include the importance of reaching this key population, topics that are specific to adolescents and youth, as well as interpersonal communication and discrimination issues many adolescents face.

“This is the 10th year of my professional life,” said a local Family Planning Inspector from Bharadhoba Union, who recently attended a Pathfinder training. “But it’s the first time I’ve had an adolescent and youth focused orientation, and I believe this is true for most of the participants. Now, I will regularly follow up with the local FWAs I work with to ensure the discussion of sexual and reproductive health issues and information specific to adolescents.”

This connection is critical, as adolescents in Bangladesh, regardless of marital status, do not regularly visit health facilities. So frontline health workers have the potential to play the “core contact” role to reach youth where they are.

Jahan adds, “The family welfare assistants are recruited by the community. They know the community, the local leaders, the imams. And, in many cases, these FWAs provide social, financial and reproductive information. So the program meets community members—particularly newlyweds— where they are at.”

For the newlyweds we are reaching, it often means the difference between having little agency, and having real choice.

Jayanti Roy, Family Welfare Assistant, provides family planning counseling to a family in Jalalabad, Sylhet, Bangladesh.

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