In rural northern Bangladesh, CARE partnered with icddr,b to find out. We planned to use those findings to inform the design of the IMAGINE programme, which aims to address harmful social norms driving adolescent childbearing.
Bangladesh has one of the highest rates of child marriage in the world, and two-thirds of Bangladeshi girls have already given birth at least once by their 18th birthday. We sought to understand the underlying social, individual, and structural factors that make early motherhood a common reality. Through in-depth interviews with adolescent girls (both married and unmarried), husbands of adolescent girls, influential adults in the girls’ lives, community leaders, and health providers in two sub-districts of northern Bangladesh (Kurigram Sadar and Rajarhat), we discovered some answers. (Findings of this research were recently published in the BMC Women’s Health journal).
Reasons to “hurry up” and have a child as soon as possible
As it turns out, a married couple’s decision on when to have their first child is influenced by a complex constellation of external factors. We learned from our interviews that childbirth improves a married girl’s position in her husband’s family and increases her role as a participant in family decisions. Motherhood also endears her to her in-laws, particularly the mother-in-law. The husband’s status is also elevated once the couple has children, and he is accorded greater respect from his family members as a responsible earner and family man. It is easy to see how this would incentivise a couple to pursue pregnancy right away after marriage.
Perception of others
As childbirth is often viewed as evidence of a couple’s commitment to each other in the communities we studied, not having a child may be looked at with suspicion. One unmarried adolescent girl told us it may be perceived as evidence of infidelity. She said:
“If any married girl wants to delay her first childbirth, then her husband, mother-in-law, and father-in-law suspect that she had a relationship with someone before she got married and that she is continuing that relationship.”
Others may see a lack of offspring as a sign of infertility. “My husband [would be] called as impotent and this family will be identified as a ‘bad’ family within the community,” said one 17-year-old girl. This assumption often leads to rejection and sanctioning of the girl herself and can also jeopardise the standing of her marital family in the eyes of her friends and neighbours.
Reasons to “slow down” and wait to have a child
Naturally, not every newly married couple has children right away. In addition to trying to understand what factors contribute to the norm of early motherhood, we also sought to understand why those who waited to have a child made that decision.
Although newlyweds experience all the social pressures we highlighted, they also understand that early childbearing comes with a host of health risks. Many participants, including the girls themselves, told us that pregnancy at a young age increases girls’ risk of a difficult pregnancy or delivery, thereby increasing the likelihood of death or injury for both the girl and her child. As one married adolescent explained:
“There are lots of benefits to delaying first pregnancy. The mother and the baby will remain healthy.”
Participants also mentioned the economic advantages that are possible if a couple waits to have a child. One husband told us:
“Due to my wife delaying first childbirth, I was able to save money for a few years and establish a grocery shop in my village. Through this shop, I can generate regular income. After establishing my grocery shop, I could better manage all the costs related to the pregnancy of my wife, such as medicine and ultrasound tests.”
Others mentioned that postponing pregnancy allowed the girl to work and generate some income for the household.
Another influencing factor: access to care
Of course, making the decision to put off having a child is just one step a couple would have to take. To make this desire a reality, they also need access to adolescent-friendly family planning and reproductive health services. Issues of mobility and health care worker attitudes and beliefs might still stand in their way. Norms dictate that married girls typically must seek permission from their husbands and/or mothers-in-law to venture outside their homes, including to seek out health services or contraception. This permission may not be granted, as married adolescent girls who are seen “moving around” on their own may be judged harshly by others in the community. The husbands also usually have sole decision-making power over whether or not the couple will use contraception, at least at first. One 14-year-old married girl said:
“I am the new daughter-in-law; I will not be allowed to go outside alone. The girls who are married for a while can go alone to the health centre; their husbands will not stop them.”
Even if girls are able to visit the health centre, either accompanied by their family members or given permission to visit alone, they may not get the quality, patient-centred care they need to realise their family planning goals. Health care providers themselves often don’t have experience of counselling or providing family planning services to adolescents and they may subscribe to the same restrictive norms, attitudes, and beliefs as others in the community and may have misconceptions about the safety of various contraceptive methods for adolescents.
We learned in this research that married adolescent girls in rural northern Bangladesh often have children soon after marriage to prove their fertility, please their in-laws, and establish their position in the family and community. Fear of stigma around infidelity, severe limitations in mobility and decision-making power, and health services that fail to meet their distinct needs further decrease girls’ ability to prevent childbirth soon after marriage. This constellation of factors illustrates that a holistic intervention package that moves beyond a focus on education or awareness-raising around family planning methods is needed to address the complex social norms, individual attitudes and beliefs, and structural barriers that keep early childbearing in place.
CARE’s IMAGINE programme is working to respond to these issues with a comprehensive approach in Bangladesh as well as Niger, west Africa. Programme activities have been designed to inform and equip girls to build their agency, skills, and capabilities and foster imaginative aspirations for alternatives to early childbirth, while simultaneously engaging families and communities and influencing systems to create a better environment for girls to exercise their rights and make decisions about their health and lives. We are keeping a close eye on what is working effectively and what is not, and we should have some lessons to share in the near future about how to address root causes of early childbirth after marriage.
For more details on the IMAGINE programme, visit us on care.org or contact: