Designing a Culturally Responsive Intervention to Improve Sexual and Reproductive Health Service Access among Climate-Displaced Adolescent Girls in Urban Slums of Dhaka, Bangladesh
1
Department of Public Health and Informatics, Bangladesh Medical University, Dhaka, Bangladesh
2
Department of Gynecological Oncology, Bangladesh Medical University, Dhaka, Bangladesh
Popul. Med. 2026;8(Supplement Supplement 1):A465
ABSTRACT
BACKGROUND:
Child marriage remains a major public health challenge in Bangladesh, particularly among climate-displaced families living in urban slums. Poverty, displacement, school discontinuation, and limited access to health services reinforce early marriage. Evidence on context-specific intervention models for climate-affected urban adolescents remains limited.
METHODS:
A mixed-methods study was conducted in Duaripara, a climate-displaced slum in Mirpur, Dhaka. Data Collection included a cross-sectional survey (n=144) and phenomenological qualitative interviews (IDIs=24, KIIs=8) with adolescents, parents, and stakeholders. Delphi-style workshops (n=3) facilitated intervention co-design and validation.
RESULTS:
Quantitative data revealed 47.2% of adolescent girls were married/engaged, with 82.3% of these marriages occurring before age 18. Drivers included family decisions (63.2%) and economic hardship. Although 64.6% knew where to access SRH services, awareness was significantly higher among married (39.6%) versus unmarried girls (15.3%). School attendance was a strong protective factor, reducing marriage odds by 97.9% (OR=0.021, p<0.001). However, 69.4% were out of school, primarily due to poverty (49%) or marriage (37%). Qualitative findings identified fragmented, pregnancy-centric SRH services, economic barriers to menstrual hygiene, and stigma limiting unmarried girls' access. Misinformation was pervasive, with 34.7% having no knowledge of menstruation. Gender norms restricted autonomy, with parents/in-laws controlling 72.9% of SRH decisions. Safety concerns (65.3% felt unsafe) and judgmental healthcare providers further deterred care-seeking. Workshop-derived recommendations emphasized integrated SRH education, adolescent-friendly health corners, economic support to keep girls in school, community dialogue platforms, and engagement with religious leaders to address norms.
CONCLUSIONS:
Child marriage among climate-displaced adolescents in urban slums is shaped by intersecting economic, educational, gender, and health system barriers. The study demonstrates the feasibility of a participatory, multi-sectoral intervention model integrating adolescent-friendly health services, community norm change, economic support, and school retention strategies to improve sexual and reproductive health outcomes and reduce early marriage risk.
Child marriage remains a major public health challenge in Bangladesh, particularly among climate-displaced families living in urban slums. Poverty, displacement, school discontinuation, and limited access to health services reinforce early marriage. Evidence on context-specific intervention models for climate-affected urban adolescents remains limited.
METHODS:
A mixed-methods study was conducted in Duaripara, a climate-displaced slum in Mirpur, Dhaka. Data Collection included a cross-sectional survey (n=144) and phenomenological qualitative interviews (IDIs=24, KIIs=8) with adolescents, parents, and stakeholders. Delphi-style workshops (n=3) facilitated intervention co-design and validation.
RESULTS:
Quantitative data revealed 47.2% of adolescent girls were married/engaged, with 82.3% of these marriages occurring before age 18. Drivers included family decisions (63.2%) and economic hardship. Although 64.6% knew where to access SRH services, awareness was significantly higher among married (39.6%) versus unmarried girls (15.3%). School attendance was a strong protective factor, reducing marriage odds by 97.9% (OR=0.021, p<0.001). However, 69.4% were out of school, primarily due to poverty (49%) or marriage (37%). Qualitative findings identified fragmented, pregnancy-centric SRH services, economic barriers to menstrual hygiene, and stigma limiting unmarried girls' access. Misinformation was pervasive, with 34.7% having no knowledge of menstruation. Gender norms restricted autonomy, with parents/in-laws controlling 72.9% of SRH decisions. Safety concerns (65.3% felt unsafe) and judgmental healthcare providers further deterred care-seeking. Workshop-derived recommendations emphasized integrated SRH education, adolescent-friendly health corners, economic support to keep girls in school, community dialogue platforms, and engagement with religious leaders to address norms.
CONCLUSIONS:
Child marriage among climate-displaced adolescents in urban slums is shaped by intersecting economic, educational, gender, and health system barriers. The study demonstrates the feasibility of a participatory, multi-sectoral intervention model integrating adolescent-friendly health services, community norm change, economic support, and school retention strategies to improve sexual and reproductive health outcomes and reduce early marriage risk.
| eISSN: | 2654-1459 |
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