Strategies to Reduce Exclusion among Populations Living in Urban Slum Settlements in Bangladesh

The health and rights of populations living in informal or slum settlements are key development issues of the twenty-first century. As of 2007, the majority of the world's population lives in urban areas. More than one billion of these people, or one in three city-dwellers, live in inadequate housing with no or a few basic resources. In Bangladesh, urban slum settlements tend to be located in low-lying, flood-prone, poorly-drained areas, having limited formal garbage disposal and minimal access to safe water and sanitation. These areas are severely crowded, with 4–5 people living in houses of just over 100 sq feet. These conditions of high density of population and poor sanitation exacerbate the spread of diseases. People living in these areas experience social, economic and political exclusion, which bars them from society's basic resources. This paper overviews policies and actions that impact the level of exclusion of people living in urban slum settlements in Bangladesh, with a focus on improving the health and rights of the urban poor. Despite some strategies adopted to ensure better access to water and health, overall, the country does not have a comprehensive policy for urban slum residents, and the situation remains bleak

Pornography, Pleasure, Gender and Sex Education in Bangladesh

Over the past two decades Bangladesh’s capital has grown from a small city to a large urbanised space. Such rapid urbanisation and social transformation has created unintended consequences that have implications for gender, power, sexual relationships and health. Drawing on research undertaken over several months in the backstreets of Dhaka, this publication sheds new light on the city’s changing economic and sexual landscape. Migration and the rapid mobility of a labour force of men and women who earn low wages have taken place alongside a burgeoning sex industry and influx of pornography which men particularly are taking advantage of. This study reveals how local ideas of sex and sexuality are gradually being transformed; how emerging urban spaces in the city are serving as alternative sites of communication, knowledge and information on sex; and how men’s sexual expectations and realities are shaped by larger social, political and economic structures. The authors argue that lessons learnt from these changing sexual realities must feed into strategies for sex education programmes in order to positively impact on gender relations and ultimately contribute to a vision of development which increases possibilities for wellbeing and pleasure in relationships and life, in conjunction with efforts to tackle poverty

Towards a socially just model: balancing hunger and response to the COVID-19 pandemic in Bangladesh

Summary box Responsive and timely research is needed to better understand the challenges faced by poor and vulnerable populations to inform immediate interventions and policies to address this unprecedented COVID-19 modern-day pandemic. There is a need to research changes through time to understand and address the continuous and long-term economic, mental and emotional impact of lockdown on the most marginalised. Many of the Bangladeshi population are vulnerable, yet the COVID-19 response focuses on individual behaviour with limited attention to the social, economic and contextual factors that prevent the most marginalised from following national recommendations. In the context of structural constraints, continuation of the lockdown has to be accompanied by strong political resolve to ensure that people do not go without basic meals and have basic health information and support. The experiences of people living and working in slums in Bangladesh needs to be captured and translated to context specific strategies for lockdown, as current measures risk starvation for many. In the context of COVID-19, the lockdown model is being imported from a different context (western or developed economies) with stronger economic bases and better social safety nets for those in need, but is there a better way forward for low resource contexts? Economic mortalities may overtake health mortalities for the poorest who survive on daily wage labour

WHO Takes Action to Promote the Health of Refugees and Migrants

Migration is a defining issue of our time, with 1 billion migrants globally, of whom 258 million have crossed borders. Climate change and political instability propel ever-greater displacement, with major detriments to health. Policies that fail to prevent human trafficking or guarantee essential services undermine Universal Health Coverage (UHC) and the global pledge to “leave no one behind.” The World Health Assembly should robustly implement WHO’s Global Action Plan (GAP) on the Health of Refugees and Migrants.ugees and Migrants

Day case laparoscopic cholecystectomy - what's stopping us now?

Introduction: Day surgery has many benefits for patients and the NHS, but progress in this area of healthcare has been slow. A high volume procedure, laparoscopic cholecystectomy, was chosen to explore this. The aim of this study was to explore and explain the factors that influence the uptake of day case laparoscopic cholecystectomy at three trusts and the impact of service redesign programmes on day case rates. Methods: A mixed methods collective case study was conducted across three trusts. 34 semi-structured interviews were undertaken and 5 years of hospital activity data was analysed. Results: Day case laparoscopic cholecystectomy rates did increase over a 5 year period at all trusts but to varying degrees. Factors that influenced activity according to qualitative data analysed were grouped into two themes: context and mechanisms. Conclusion: Participants did not believe that the service redesign programmes had any direct impact on their practice. New ambulatory care facilities alone did not lead to increased day case laparoscopic cholecystectomy rates because the trust that performed the most did not have any change to their infrastructure. Clinical attitudes towards performing day case laparoscopic cholecystectomy were variable and may explain the difference in day case rates

Worried lives : poverty, gender and reproductive health of married adolescent women living in an urban slum in Bangladesh

The thesis is concerned with the lives of married adolescent women in an urban slum in Bangladesh, and how the injustices of a harsh political economy impact on their bodily health and shape their reproductive experiences. My contribution in the thesis is to clearly demonstrate how political economic inequalities and social conditions - 'structural violence' contribute to adverse reproductive health experiences for poor married adolescent women. These disparities compel married adolescent women to make pragmatic choices, which puts their bodies and reproductive health lives at risk. The parameters that determine married adolescent women's well-being and reproductive health are rooted in power relations and lack of access to political and economic resources. I argue that the term 'reproductive health' cannot be addressed without first addressing the context of extreme poverty, hunger and violence threatening men and women's survival. Social and economic justice needs to be integral to solutions to improve the health of poor women and men. The study is located in an urban slum in Dhaka, the capital of Bangladesh. The city has undergone immense transformation with industrialization and the migration of rural families into the city looking for food, shelter and jobs. Ethnographic fieldwork was carried out for fourteen months, and case studies, in-depth narratives and long-term participant observations provide rich empirical data. In addition, a survey was carried out to gather general background information, including young women's reproductive histories. Urban slum dwellers constitute thirty per cent of total fourteen million population of the city. Extremely poor urban migrants are unable to find affordable housing. They set up or rent shack settlements built on vacant or disused government/ private land, on the margins of the city - usually in flood prone areas, never knowing when they might be forcibly removed. Most of the slum dwellers live on less than US $63 a month, holding onto insocure jobs, with many permanently unemployed. Young married women in the slums are extremely vulnerable in this unpredictable and insecure urban landscape because of their age, gender and poverty. Chronic deprivation, harsh political and economic conditions and suffering are part of an everyday existence for poor married adolescent women and their families living in slums. This raises many important questions: what do we mean by reproductive health experiences when we look at their lives? Can we separate reproductive health experiences from other aspects of their lives, the material, social and politicaleconomic? How do the broader global, local and socio-cultural, political and economic factors affect health and reproductive health experiences and behaviour? How do young women make sense of and act in this dynamic and difficult urban environment with what reproductive health outcomes? What multiple effects might structural and social inequalities have on married adolescent women lives and their reproductive health experiences? The thesis illustrates how conditions of poverty, unequal class, and gender and power relations structure risk for young women and leave them with few options. This is evident in the context of reproductive and sexual health negotiations and fertility behaviour. Poor married adolescent women construct a 'political economy of the body' and pragmatically acquiesce with decisions made by others, such as, unsafe sex, too many pregnancies, and forced abortions, even though they may violate their sense of bodily integrity and well-being. Health care services are dismal and fragmented. Abortions may be through legal or illegal means and are understood to further jeopardize young women's health. Such pragmatism puts their bodies at risk, but gains them advantages and limited power within their social situation. I demonstrate how disparities of power operate in the lives of poor married adolescent women and critically shape health meanings, reproductive health experiences and practices. It is imperative we acknowledge and address the inequalities within Bangladesh, as well as examine the global inequalities between the rich countries and poor countries all of which create an underclass, who are unable to realize their health potential. I maintain that unless issues of social and economic justice are tackled, in the long term, 'reproductive health,' and health in general, will not improve for the poor

Creating a public space and dialogue on sexuality and rights: a case study from Bangladesh

This article describes and analyses a research based engagement by a university school of public health in Bangladesh aimed at raising public debate on sexuality and rights and making issues such as discrimination more visible to policy makers and other key stakeholders in a challenging context. The impetus for this work came from participation in an international research programme with a particular interest in bridging international and local understandings of sexual and reproductive rights. The research team worked to create a platform to broaden discussions on sexuality and rights by building on a number of research activities on rural and urban men’s and women’s sexual health concerns, and on changing concepts of sexuality and understandings of sexual rights among specific population groups in Dhaka city, including sexual minorities. Linked to this on-going process of improving the evidence base, there has been a series of learning and capacity building activities over the last four years consisting of training workshops, meetings, conferences and dialogues. These brought together different configurations of stakeholders – members of sexual minorities, academics, service providers, advocacy organisations, media and policy makers. This process contributed to developing more effective advocacy strategies through challenging representations of sexuality and rights in the public domain. Gradually, these efforts brought visibility to hidden or stigmatised sexuality and rights issues through interim outcomes that have created important steps towards changing attitudes and policies. These included creating safe spaces for sexual minorities to meet and strategise, development of learning materials for university students and engagement with legal rights groups on sexual rights. Through this process, it was found to be possible to create a public space and dialogue on sexuality and rights in a conservative and challenging environment like Bangladesh by bringing together a diverse group of stakeholders to successfully challenge representations of sexuality in the public arena. A further challenge for BRAC University has been to assess its role as a teaching and research organisation, and find a balance between the two roles of research and activism in doing work on sexuality issues in a very sensitive political context

From knowing our needs to enacting change: findings from community consultations with indigenous communities in Bangladesh

Introduction: Indigenous peoples are among the most marginalized peoples in the world due to issues relating to well-being, political representation, and economic production. The research consortium Goals and Governance for Global Health (Go4Health) conducted a community consultation process among marginalized groups across the global South aimed at including their voices in the global discourse around health in the post-2015 development agenda. This paper presents findings from the consultations carried out among indigenous communities in Bangladesh. Methods: For this qualitative study, our research team consulted the Tripura and Mro communities in Bandarban district living in the isolated Chittagong Hill Tracts region. Community members, leaders, and key informants working in health service delivery were interviewed. Data was analyzed using thematic analysis. Findings: Our findings show that remoteness shapes the daily lives of the communities, and their lack of access to natural resources and basic services prevents them from following health promotion messages. The communities feel that their needs are impossible to secure in a politically indifferent and sometimes hostile environment. Conclusion: Communities are keen to participate and work with duty bearers in creating the conditions that will lead to their improved quality of life. Clear policies that recognize the status of indigenous peoples are necessary in the Bangladeshi context to allow for the development of services and infrastructure.publishedVersio

Internalized HIV/AIDS-related Stigma in a Sample of HIV-positive People in Bangladesh

Internalized stigma among people living with HIV/AIDS (PLHA) is prevalent in Bangladesh. A better understanding of the effects of stigma on PLHA is required to reduce this and to minimize its harmful effects. This study employed a quantitative approach by conducting a survey with an aim to know the prevalence of internalized stigma and to identify the factors associated with internalized stigma among a sample of 238 PLHA (male=152 and female=86) in Bangladesh. The findings suggest that there is a significant difference between groups with the low and the high-internalized HIV/AIDS stigma in terms of both age and gender. The prevalence of internalized stigma varied according to the poverty status of PLHA. An exploratory factor analysis (EFA) found 10 of 15 items loaded highly on the three factors labelled self-acceptance, self-exclusion, and social withdrawal. About 68% of the PLHA felt ashamed, and 54% felt guilty because of their HIV status. More than half (87.5% male and 19.8% female) of the PLHA blamed themselves for their HIV status while many of them (38.2% male and 8.1% female) felt that they should be punished. The male PLHA more frequently chose to withdraw themselves from family and social gatherings compared to the female PLHA. They also experienced a higher level of internalized stigma compared to the female PLHA. The results suggest that the prevalence of internalized stigma is high in Bangladesh, and much needs to be done by different organizations working for and with the PLHA to reduce internalized stigma among this vulnerable group

Intersecting Disadvantages for Married Adolescents: Life After Marriage Pre- and Post-COVID-19 in Contexts of Displacement.

PURPOSE: Although there is a growing evidence base on the drivers of child marriage, comparatively little is known about the experiences of married girls in refugee settings and how their development trajectories diverge from those of their nonmarried peers, particularly in the context of the COVID-19 pandemic. Drawing on cross-national panel data from Bangladesh and Jordan, this article explores diversity in child marriage experiences in contexts affected by forced displacement, highlighting how married girls\u27 well-being differs from that of their unmarried peers, and how COVID-19 has reinforced these differences. METHODS: We analyzed longitudinal survey data-collected pre- and post-COVID-19-from the Gender and Adolescence: Global Evidence study with 293 ever-married and 1,102 never-married adolescent girls. Multivariate regression analysis assessed the well-being of married and unmarried girls across contexts and refugee status, both prior to and during the COVID-19 pandemic. These quantitative data are complemented by in-depth qualitative data from adolescents (n = 112), and key informant interviews with service providers and community leaders (n = 62). RESULTS: Our findings highlight that married girls in contexts affected by displacement are disadvantaged in multiple ways, but that the patterning of disadvantage varies across contexts, and that marriage can also have protective effects in certain contexts. The COVID-19 pandemic has, however, served to exacerbate existing inequalities in all contexts. DISCUSSION: Although child marriage prevention efforts remain critical, there is also an urgent need for programming that targets married girls in refugee and host communities to mitigate negative outcomes among this vulnerable group