| publichealthnotes

































SEXUAL and reproductive health and rights lie at the foundation of bodily freedom, gender justice and fair development. They are not limited to medical access but stretch into the right to decide — freely and safely — about one’s body, one’s relationships and one’s future. For Bangladesh, which has made remarkable socio-economic progress in recent decades, ensuring access to these rights remains a journey of both achievement and glaring omission.

As the country aims to fulfil its commitments under the Sustainable Development Goals, particularly those on health and gender equality, the urgency of strengthening sexual and reproductive rights cannot be overstated. This is not just about ticking off indicators. It is about ensuring that women, girls and communities pushed to the margins can exercise real choices. And that will take more than policy documents, it will require reform, cultural change and deliberate investment.


Bangladesh has seen real gains in maternal and reproductive health. Maternal deaths have dropped sharply, from over 570 per 100,000 live births in 1990 to just above 120 by 2020, according to estimates by the World Health Organisation. Family planning services, largely led by community-based health workers, have reached rural areas where clinics were once a rarity. The increase in contraceptive use is a direct result of those efforts.

Government programmes like the Health, Population and Nutrition Sector Programme, with backing from civil society groups and donors, have brought real change, improving antenatal care, expanding vaccine coverage and building on family planning legacies from the 1970s and 1980s. Those earlier efforts have long been held up as global models of how low-cost, community-based interventions can deliver results.

But even these gains conceal serious gaps. Too many people are still denied full access to reproductive rights, not because laws are missing, but because rights are not reaching those who need them most.

Bangladesh still ranks among the highest in adolescent pregnancy rates in South Asia. Data from UNICEF shows that over a quarter of girls aged between 15 and 19 are already married or in a relationship, and many are already mothers. For them, the risks are immediate, complications during childbirth, poor nutrition and abrupt ends to education. These outcomes are not accidental. They are consequences of the way we have built, or failed to build, systems around them.

Child marriage continues despite being illegal. In practice, poverty, dowry expectations and social pressure win out. The 2017 Child Marriage Restraint Act left room for exceptions under ‘special circumstances’ and that clause has been misused again and again, eroding the law’s power.

Then there is education, or the absence of it. Sexuality education in schools is barely present. What little exists tends to be vague, clinical, or awkwardly handled. It skips over vital discussions — consent, gender roles, healthy relationships, identity. Without this, adolescents are left vulnerable. They do not have the tools to understand themselves or protect themselves. And many teachers are not trained, or even willing, to have these conversations.

Contraceptives may be more available than before, but not everywhere and not for everyone. In remote regions, women still face shortages, poor counselling and dismissive attitudes from providers. A lack of male involvement only adds to the problem. And when contraception fails or is denied, unintended pregnancies rise. That is where the danger of unsafe abortion comes in, still a major cause of maternal death. Menstrual regulation is legal and has been widely practised, but social stigma and fear push many to hide. And those outside the traditional family structure — adolescents, unmarried women — face even more danger and judgement.

Reproductive health is not just a question of supply and services. It is about power. In many families, decisions on pregnancy, contraception, or even hospital visits are not made by the woman herself. Husbands, in-laws, or elders often take charge.

That control extends beyond the household. Women face reproductive coercion, domestic abuse and legal systems that are either inaccessible or indifferent. And for LGBTQ individuals, people with disabilities, or sex workers, discrimination piles on top of invisibility.

Gender inequality is structured into the delivery of healthcare, education and justice. A genuine rights-based approach would centre women’s experiences, challenge authority where needed and bring accountability into how services are designed and delivered.

There is another layer, one that is growing. Bangladesh is one of the most climate-vulnerable countries in the world. Natural disasters are more frequent, more intense. Floods, cyclones and saltwater intrusion — they all displace communities and break apart systems.

And in these emergencies, sexual and reproductive health services are often among the first to go. Women and girls find themselves without menstrual products, without contraception, and without access to maternal care. Gender-based violence often spikes, and with few safe spaces or legal recourse, it goes unreported and unaddressed. Early marriage, trafficking and abuse increase. Yet despite this, climate adaptation plans rarely mention sexual or reproductive health.

It is not enough to build cyclone shelters if they do not stock menstrual supplies or allow privacy. If we are to take climate resilience seriously, then reproductive health must be part of the plan.

Non-governmental organisations have played an essential role in closing gaps left by public systems. They train providers, reach isolated communities, produce education materials and push for change at national level. Organisations like BRAC, Naripokkho and Marie Stopes Bangladesh have shown how innovation, when rooted in community, can lead to real rights-based progress. But these efforts are under strain. New regulations, funding cuts and bureaucratic blocks are making it harder for civil society to operate.

Bangladesh already has several key policies in place, the National Population Policy, the Adolescent Health Strategy and others. But there is a yawning gap between what is written and what is implemented. Funding is thin, coordination poor and data often missing or not broken down by region, age, or gender.

Comprehensive sexuality education needs to be part of the national curriculum — not as an add-on, but as a core subject. It should be honest, age-appropriate and inclusive. Teachers need to be trained, not just with materials, but with support to speak confidently and without fear of backlash.

Health services for adolescents must be overhauled. Confidentiality, respectful care, flexible hours — these are not luxuries but essentials. Clinics should provide information on contraception, support menstrual health and treat infections. Adolescents should be part of designing these services so they feel safe and understood.

Access to menstrual regulation and post-abortion care must be widened. Many women do not even know these services exist. Training providers, particularly in rural and climate-affected areas, to offer judgment-free care is an urgent need.

Gender-based violence services must be embedded in health facilities. That means creating safe environments, offering trauma support and ensuring survivors can access legal help when needed.

Emergency planning must include reproductive care. Mobile clinics, contraceptives and menstrual kits — these should be part of every disaster plan. Frontline responders need to know how to address violence, provide care and protect dignity in the worst of times.

Finally, community health workers and peer educators are vital. They are often the first, and sometimes only, point of contact. Recognising and investing in them improves trust and uptake in the places that need it most.

Bangladesh has already shown it can lead in family planning and maternal health. But the full promise of reproductive rights remains unrealised. This is not just about healthcare. It is about power, equity and justice.

If we want a future where no girl is forced into marriage, where no woman risks her life on unsafe procedures, where no person is denied care because of identity or stigma, then we need to act.

Let us not settle for progress that only reaches some. Let us build systems that hear the silenced, serve the excluded and protect the vulnerable. The tools are within reach.

Musharraf Tansen is a development analyst and former country representative of the Malala Fund.



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