Understanding individual, family and community perspectives on delaying early birth among adolescent girls

Background: Pregnancy among adolescent girls in Bangladesh is high, with 66% of women under the age of 18 reporting a first birth; this issue is particularly acute in the northern region of Bangladesh, an area that is especially impoverished and where girls are at heightened risk. Using formative research, CARE USA examined the underlying social, individual and structural factors influencing married girls’ early first birth and participation in alternative opportunities (such as education or economic pursuits) in Bangladesh. Methods: In July of 2017, researchers conducted in-depth interviews of community members in two sub-districts of northern Bangladesh (Kurigram Sadar and Rajarhat). Participants (n = 127) included adolescent girls (both married and unmarredi), husbands of adolescent girls, influential adults in the girls’ lives, community leaders, and health providers. All interviews were transcribed, coded and organized using Dedoose software. Results: Participants recognize the health benefits of delaying first birth, but stigma around infertility and contraceptive use, pressure from mothers-in-law and health provider bias interfere with a girl’s ability to delay childbearing. Girls’ social isolation, lack of mobility or autonomy, and inability to envision alternatives to early motherhood compound the issue; provider bias may also prevent access to methods. While participants agree that pursuit of education and economic opportunities are important, better futures for girls do not necessarily supersede their marital obligations of childrearing and domestic chores. Conclusions: Findings indicate the need for a multi-level approach to delaying early birth and stimulating girls’ participation in economic and educational pursuits. Interventions must mitigate barriers to reproductive health care; train adolescent girls on viable economic activities; and provide educational opportunities for girls. Effective programs should also address contextual issues by including immediate members of the girls’ families, particularly the husband and mother-in-law

A cluster randomized controlled trial for measuring the impact of a social norm intervention addressing child marriage in Pirgacha in Rangpur district of Bangladesh: study protocol for evaluation of the Tipping Point Initiative

Child Marriage (CM) is one of the major developmental concerns in Bangladesh, reporting one of the highest rates of CM (59%) globally. To date, interventions to address CM in Bangladesh have failed to seriously engage with social norms that are important contributors to CM. This paper describes the evaluation design of the Tipping Point Initiative that aims to reduce CM through social norm change and increasing adolescent girls’ agency to voice their rights. The Tipping Point Initiative evaluation trial employs a mixed method design. The quantitative component includes a three-arm Cluster Randomized Controlled Trial design, where Arm 1 receives Tipping Point Program (TPP); Arm 2 receives Tipping Point Program Plus (TPP+), a social norms-enhanced version of TPP; and Arm 3 is the Control. The trial covers 51 clusters (villages) in Pirgacha, in Rangpur district, randomized into three study arms (17 per arms). From each cluster, a cohort of 25 adolescent girls aged 12–<16 years were selected randomly for participation in the survey and intervention. Further, a cross-section of adults (six males and six females) were randomly selected from each cluster for survey. Qualitative baseline data were collected from two purposively selected intervention villages in each intervention arm. Thirty In-Depth Interviews, eight Key Informant Interviews and 16 Focus Group Discussion were conducted with adolescent girls, boys, adult women and men. Same strategies have been followed at endline. The intervention was implemented from April 2019 to December 2020. The endline was conducted 10 months after the end of intervention. Intention-to-treat analysis approach will be used for impact assessment. Both narrative analysis and Grounded Theory approach will be employed in analysing qualitative data. The learnings are expected to inform programs and policies regarding what works and does not work to address CM in such social norms intervention in Bangladesh