Very Young Adolescents in Bangladesh: A Review of Social and Behavior Change Programs Addressing Adolescent Childbearing

"The two most significant drivers of adolescent childbearing are child marriage and rapid childbirth soon after marriage."

This report shares the findings of research conducted in Bangladesh to synthesise and curate learning on very young adolescent (VYA) social and behaviour change (SBC) programming that contributes to reducing adolescent childbearing. The purpose of the study was to identify gaps and inform the development of a set of actionable recommendations for strengthening SBC programming. In particular, the study sought to explore the factors that drive adolescent childbearing in Bangladesh, undertand the landscape of SBC programming with VYAs that contributes to reducing adolescent childbearing, and provide an ecosystem of local organisations addressing these issues in Bangladesh. The research was conducted by Agency for All, a global health project working to generate evidence on the role of agency in effective SBC programming to improve health and well-being for individuals and communities (see Related Summaries, below).

As explained in the report, "the Government of Bangladesh (GoB) aspires to delay all childbearing to at least the age of 20, but Bangladeshi adolescents aged 10-19 continue to experience pregnancy and childbearing. According to the 2022 Bangladesh Demographic and Health Survey (BDHS) Key Indicators Report, 47.5% of 19-year old adolescents and 4.9% of 15-year-olds have ever been pregnant. VYAs are particularly vulnerable to the multiple health risks of early pregnancy and childbearing, with global evidence suggesting that VYAs face a higher risk of maternal mortality than older adolescents and young adults. Using evidence-based social and behavior change (SBC) approaches that engage VYAs, their families, communities, and systems can contribute to delaying very early childbearing among VYAs and lay the foundation to enable adolescents to delay childbearing as they age into later adolescence. However, little is known about the current state of SBC programming with and for VYAs in Bangladesh." This report seeks to address this gap.

Research activities were conducted between October 2022 and June 2023 and included: a comprehensive scan and curation of literature and documentation relevant to VYA SBC and adolescent childbearing in Bangladesh published between 2016 and 2022; key informant interviews with stakeholders in Bangladesh with expertise in VYAs, adolescent childbearing, and related topics such as child marriage; an organisational mapping of local non-governmental organisations (NGOs) implementing programmes to address adolescent pregnancy or its related drivers; community consultations in all eight divisions of Bangladesh; and a series of "Solutions Workshops" to engage diverse stakeholders in co-creating programmatic recommendations. A Core Consultative Group (CCG) composed of representatives from government, NGOs, civil society, academia, and adolescents and youth was established to contribute to the design of research activities, the interpretation of findings, and the development of recommendations.  

Related to the drivers of adolescent childbearing in Bangladesh, the report identifies the key drivers as child marriage, rapid childbirth soon after marriage, pre-marital sexual activity, and new emerging drivers such as climate change, health crises like the COVID-19 pandemic, and conflicts and humanitarian crises.

Other findings are synthesised into nine key insights, which can be summarised as follows:
 

• Very few interventions tailor strategies to reach VYAs, especially those aged 10-12.
• While some interventions directly address delaying pregnancy, more of them focus on health education or child marriage.
• Most SBC interventions fall into one of four intervention types but show limited impact on key outcomes, and data needed to consider scale-up are slim.
• SBC programmes face constraints in effectively working across levels of the socio-ecological model to address determinants.
• Strategies that address social norms and related determinants of adolescent childbearing are largely absent in current VYA SBC activities.
• SBC programmes addressing adolescent childbearing and child marriage are not consistently intervening where the need is greatest.
• SBC programmes addressing adolescent childbearing and child marriage are not evolving to meet changing conditions.
• A lack of data, learning, and evidence on VYA SBC programming in Bangladesh constrains development of programmes and policies to address adolescent childbearing.
• VYAs may fall through the cracks between different sectors and ministries, limiting the ability to scale and institutionalise programming. 
   

The insights presented point to a number of barriers that impede the ability of programmes to accelerate progress in addressing adolescent childbearing. These barriers are also highlighted in a separate section of the report and include issues related to the programming environment, social and normative barriers, programme design factors, capacity constraints, and geographic factors.

The report offers the following main recommendations, with further suggestions for how each can be realised in practice: 

1. Increase investment in programmes and strategies to intentionally reach VYA boys and girls to lay the foundation for delayed marriage and childbearing: This goal can be achieved by, for example, improving stakeholder understanding of the rationale for working with VYAs and how investing in SBC programming with VYAs can facilitate reductions in child marriage and adolescent childbearing.

2. Increase programmatic emphasis on delaying adolescent childbearing, including with married VYAs: This goal can be achieved by exploring and evaluating different strategies to increase the emphasis on delaying the first pregnancy in SBC programmes. 

3. Design and implement VYA SBC programmes that work across all levels of the socio-ecological model, in alignment with global and national evidence and promising practices: The report lists a number of ways this goal can be achieved. They include, for example: reaching VYA boys and girls using evidence-based curricula in school and through out-of-school small group approaches; engaging parents and families to improve their knowledge, skills, attitudes, behaviours, and norms; and engaging men and boys, alongside girls and women, in gender-synchronised strategies.

4. Prioritise VYA SBC programming in areas with the greatest burden, and ensure programmes reach adolescents most vulnerable to child marriage and adolescent childbearing: This goal can be achieved by investing in supporting NGOs to expand their coverage and/or thematic areas to better serve districts with the highest prevalence of adolescent childbearing and by targeting SBC programmes to the most vulnerable adolescents and ensure those who are most affected by inequality are reached with appropriate support.

5. Innovate and learn about new strategies to engage VYAs within the changing context and conditions of Bangladesh: Suggestions here include increasing SBC activities and investment for VYAs in urban settings, especially in slum areas, and identifying new approaches for engaging communities in urban contexts. SBC programmes could also conduct research on VYA media and technology habits to inform future programming and develop the capacity of organisations working on climate change to integrate SBC programmes for VYAs and their communities into existing interventions.

6. Increase routine and systematic data collection with VYAs to better understand their lives, practices, and evolving needs: This goal can be achieved by including VYAs in the national health information system and by incorporating VYAs in relevant surveys with lines of inquiry to assess the sexual and reproductive health (SRH) of VYAs and other important aspects of VYA development.

7. Conduct analysis of existing data to share what is known about the lives of VYAs in Bangladesh: Suggestions here include, for example, encouraging the use of existing data collection tools tailored to VYAs and conducting implementation learning, research, and evaluations, with a focus on scale and institutionalisation of VYA SBC programmes in Bangladesh.

8. (Re)invigorate and formalise cross-sectoral collaboration and coordination among government, NGOs, and private sector organisations to operationalise national policies and plans that contribute to reducing adolescent childbearing at all levels of government: This goal can be achieved by, for example, reinvigorating national coordination groups, technical working groups, and networks that have a mandate to improve VYA health and well-being, including the prevention of child marriage and adolescent childbearing, and by providing technical assistance to lower tiers of government to strengthen their capacity to implement national policies.

9. Invest in adolescent and youth leadership and support their agency to advocate for stronger responses to child marriage and adolescent childbearing: This goal can be achieved, for example, by allocating funding to youth-led organisations to lead implementation and learning activities related to VYA SBC programming and by providing funding to establish and/or strengthen platforms for youth and youth-led organisations to advocate for the needs and rights of VYAs and hold their government accountable for action on child marriage and adolescent childbearing at all levels.

10. Strengthen the capacity of a range of stakeholders in VYA SBC programming to lay the foundation to reduce adolescent childbearing: This goal can be achieved by using proven capacity development methodologies to improve the organisational, technical, and network capacity of the GoB, NGOs, and research entities.

The report also includes the following two case studies of global programmes that have been adapted to Bangladesh, outlining evaluation results as well as key learnings:  
 

• Choices, Voices, Promises - a gender-transformative SBC approach that aims to improve gender-equitable attitudes, behaviours, and norms related to child marriage, education, and SRH among VYA girls and boys aged 10-14, their families, and their communities.
• The Gender Equity Movement in Schools (GEMS) programme - a school-based intervention aimed at fostering gender-equitable attitudes, examining social norms that define the roles of men and women, and countering gender-based violence among young adolescents.

Click here for the 13-page executive summary in PDF format.