Reproductive health in disasters - Bangladesh

Exploring the opportunities and challenges around reproductive health in disasters in Bangladesh.

Project Description

Start date: 15 October 2015

Duration: 32 months

End date: 31 July 2018

Total fund: US$169,782 (Research Component)

Funders

  • International Planned Parenthood Federation's (IPPF) 'Innovation Programme'
  • International Planned Parenthood Federation South Asia Region's (IPPF-SAR) SPRINT Initiative

International Planned Parenthood Federation Logo International Planned Parenthood Federation Logo, South East Asia

Research partners

  • Data Management Aid, Bangladesh.

Implementing partner

  • International Planned Parenthood Federation’s South Asia Region (IPPF-SAR), New Delhi.

Research

Research aim

The UN’s ‘Hyogo Framework for Action 2005-2015’ mainstreamed gender into all aspects of disaster management. Most recently its successor, the ‘Sendai Framework for Disaster Risk Reduction 2015-2030’, has prioritised reducing the damage to basic services and health from disasters. Although both of these international frameworks have advanced the agenda of women’s vulnerability and health system improvements for disaster risk reduction, they fall short in forwarding the agenda of women’s sexual and reproductive health (SRH). SRH issues are directly connected to a mother and child’s health and wellbeing (Cohen, 2004; UN, 2015), which is part of the UN’s Sustainable Development Goal 3 (2015-2030. Additionally, SRH problems are a leading cause of women’s illness and death worldwide (WHO, 2008).

Despite these issues, SRH remains a neglected area, even more so in the context of disasters. As such, our knowledge is limited on the ways not just women but also internally displaced men, adolescent boys and girls deal and cope with SRH in a disaster environment. When it comes to menstrual regulation (MR) or post abortion care (PAC) services, challenges are even greater, with no access to safe and timely services. Therefore, our research aims to improve the quality and availability of post abortion care services during a flood and explore the challenges around SRH of women. To do so, IPPF-SAR and the University of Leicester in collaboration with the Government of Bangladesh have developed an intervention package called RHCC. The RHCC consists of three components: a) pre-positioning of the UNFPA’s Inter-Agency Reproductive Health Kit 8 prior to flooding; b) Capacity building of the existing health workers; and c) raising Community awareness.

Overall research goal

  • To evaluate whether the integrated intervention package, RHCC has the potential to improve the quality and availability of post abortion care services in Belkuchi during a flood.

Research objectives

  • To determine whether the RHCC could increase skilled management for post abortion related complications at facility-level during a flood.
  • To assess the referral pattern for seeking menstrual regulation and post abortion care services at the facility from the union to sub-district to district levels.
  • To determine the quality of menstrual regulation and post abortion care services in the Upazila Health Complex of Belkuchi sub-district.
  • To estimate the cost involved for the RHCC in improving the quality of menstrual regulation and post abortion care services during a flood.
  • To contribute to the body of knowledge on opportunities and challenges in accessing safe post abortion services in disaster and humanitarian crises.

Outputs

  • A final report to IPPF.
  • Two policy briefs for the Government of Bangladesh.
  • Two peer-reviewed journal articles (with open access).
  • Behaviour change communication posters and leaflets.

Impact

  • Help reduce the number of women falling ill or dying as a result of unsafe MR, PAC or miscarriage during a disaster.
  • Help strengthen the existing health system by building the capacity of health workers.
  • Help support effective disaster risk management by generating new knowledge on SRH.
  • Help build partnership with the government, health workers and communities at risk for MR/PAC services during a disaster.
  • Help promote Minimum Initial Service Package (MISP) during disasters in Bangladesh.

Outcomes of the project

  • The Reproductive Health Kits 8 benefited 48 women (20% of the estimated population) directly during the flood of 2017. The use of these Kits is still ongoing and is able to benefit a further 192 women.
  • The RHCC improved skills of 10 health workers (26% of the primary health care staff) for menstrual regulation and post abortion care and they will continue to provide quality care to the 173,097 female population of Belkuchi.
  • Developed behaviour change communication posters and leaflets, context specific tools for the implementation of the Reproductive Health Kit 8 and policy briefs to improve policy and practice.
  • Enrich the body of knowledge on the opportunities and challenges in and around the nation-wide programme on ‘menstrual regulation and post abortion care’ in the context of floods.
  • Enhanced relationships between IPPF, IPPF-SAR, University of Leicester, Data Management Aid and the Belkuchi Upazila Health Complex management team for the management of the research project and for future collaborations.

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2018

  • From 2 to 5 January 2018, four key informant interviews were conducted.
  • On 1 March, a top-level dissemination meeting was organised in Dhaka by the University of Leicester and Data Management Aid. This meeting was attended by 28 representatives from UNFPA, UN Women, BAPSA, Ipas, World Vision, icddr,b-Chakaria, Karmaneer, World Vision, the British High Commission, University of Dhaka, Chittagong University and the Government of Bangladesh. For more information, please see the press release.
  • The summary of the research findings was shared with Belkuchi’s Upazila Health and Family Planning Officer on 3 March 2018 in order to seek feedback.
  • On 23 June, an orientation event was organised in collaboration with the Upazila Health and Family Planning Officer to orient health workers in Belkuchi on the Reproductive Health Kit 8 and on MR and PAC services, prior to the monsoon season. This event was attended by 203 health workers from Belkuchi, in-house health staff of the Upazila Health Complex, the Civil Surgeon of Sirajganj District, Mrs Denise Corsel (Research Assistant, University of Leicester), Md Maqbul Bhuiya (Executive Director, Data Management Aid) – amongst others. For more information, please see the press release.
  • Behaviour change communication posters and leaflets (designed based on the findings of the project) were handed over to Belkuchi Upazila Health Complex on 23 June. The BCC posters were distributed to the 60 health care facilities and leaflets were distributed to 203 health workers in Belkuchi.
  • On 3 July, the project’s final research findings were presented at the Asian Ministerial Conference in Disaster Risk Reduction in Ulaanbaatar, Mongolia.
  • On 31 July, the Final Project Report was submitted to the funder, IPPF.
  • On 12-15 November, the project’s findings will be shared through a poster presentation at the International Family Planning Conference in Kigali, Rwanda.
  • In November, the launch of the Final Project Report and dissemination of the project’s overall findings will be held in Bangkok, Thailand. Key stakeholders will be invited to attend.

2017

  • On 18 January 2017, we had our first Advisory Board Meeting. Our board members consisted of Prof Peter Jackson from the University of Leicester; Prof Andrew Collins from Northumbria University; and Dr Vinette Cross from the University of Wolverhampton. We also had the honour of Mrs Alison Mckinley’s attendance, as well as Dr John Atibila’s to advise us on the Theory of Change (ToC). This meeting went very well and we received good feedback, which we will take forward. The next Advisory Board Meeting is planned to be held in November.
  • University of Leicester received ethical clearance on 23 January 2017 to start the data collection.
  • From 7 January to 4 February, IPPF-SAR in collaboration with icddr,b, Ipas and BAPSA provided two two-week basic and refresher medical courses on MR and PAC services to one medical officer, six family welfare visitors and three nurses.
  • From  13-14 February 2017, IPPF-SAR and icddr,b organised four half-day orientation programmes for a total of 100 different health workers. These orientation programmes included a combination of capacity building and raising awareness on the Reproductive Health Kit 8.
  • On 23 February 2017, the 370 structured interviews and 5 in-depth interviews to understand the reproductive health issues amongst our sampled population were completed.
  • On 6 April 2017, four Reproductive Health Kits 8 were transferred and pre-positioned in Belkuchi Upazila Health Complex. These Kits had been procured from Copenhagen.
  • On 12 July 2017, flooding began in our research location and continued until September.
  • The administration of the Reproductive Health Kits 8 began from the 14 August and thus, the Intervention Phase began.
  • Three community awareness programmes were held by iccdr,b at: Belkuchi Upazila Health Complex on  22 August 2017; Bhangabari Union Health and Family Welfare Center on 21 August 2017; and at Daulatpur Union Health and Family Welfare Center on 5 October 2017.
  • On 20 September, Dr Nibedita Ray-Bennett presented our project’s baseline findings at the IHRR/DWD Conference at Durham University. The presentation was well received by the audience and the chair.
  • On 10 October, our project was featured on UNISDR’s PreventionWeb in light of the International Day for Disaster Reduction.
  • From 13-26 November, focus group discussions with family welfare visitors, nurses and family welfare assistants were conducted.
  • On 28 November, the Intervention Phase was completed.
  • From 9-14 December, a field visit was conducted. For more information, please see our blog.
  • On 20 December, semi-structured interviews with the women who received care from the Reproductive Health Kit were completed.

2016

  • Severe flooding in our research location occurred from July to August 2016.
  • The ‘Co-ordinating: IPPF-SARO Innovation Project Meeting’ took place in New Delhi, from 22-23 August 2016. The Meeting discussed and finalised the next phase of the fieldwork and research plan for this research project.
  • A field visit of our research location in Belkuchi, Sirajganj took place on 8 September. For more information on our research location, please click here.
  • Dr Nibedita Ray-Bennett presented the project and her research at the Asian Ministerial Conference on Disaster Risk Reduction, an international event in New Delhi on 5 November 2017. The contribution of the conference went into the regional document and led to sexual and reproductive health language being present in the final conference outcome document
  • Press release issued by University of Leicester Press Office: Women's sexual and reproductive health during humanitarian crisis tackled at international conference.

2015

  • The project has started and a two-Day Inception Meeting took place in Dhaka on 2-3 November 2015.
  • Press release in Dhaka IPPF project inception meeting begins in city’, Daily Sun, Dhaka, 3 November.
  • Press release issued by University of Leicester Press Office: New project to help reduce unsafe abortion death rates in disaster zones.

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One of our students in Salta, Argentina

One of our students in Salta, Argentina