Development and Testing of Balika Bodhu: a Social Norm Intervention to Address Denial of Sexual and Reproductive Health and Rights to Married Adolescent Girls in Rural Bangladesh

Background Sexual and reproductive health and rights (SRHR) are vital to one's health and development. Over the last few decades Bangladesh, known as a patriarchal society, has made remarkable progress in improving contraceptive use, and maternal health. However, the progress has not been consistent in different SRHR domains and is not uniform across different groups of reproductive aged females. The progress was particularly slow in realising SRH rights of the women. Evidence suggests that choice and consent of females are ignored in all spheres of SRHR and that patriarchal gender and social norms, and discriminatory laws and practices in Bangladesh perpetuate denial of SRHR to females. Due to high prevalence of child marriage in Bangladesh (59%) (NIPORT & ICF, 2019) a huge proportion of adolescent girls are married before reaching 18. In a patriarchal setting such as Bangladesh with very strong gender and age hierarchies these child brides typically command the lowest power in the marital home. They typically have lower education than those who get married in adulthood. They also lack voice and bargaining skills. In such a context, the husband or mother-in-law may figure prominently in decisions about using contraception and the timing of childbearing. In this context, denial of SRHR usually becomes part of their lived experiences.

Although social norms are recognised as one of the main drivers of denial of SRHR to married adolescent girls (MAG), social norms theories and approaches to programming are relatively new and there has been little attempt to develop and rigorously test interventions to address such social norms worldwide and in Bangladesh. Also, a handful of programmes have been implemented worldwide and in Bangladesh to empower partnered female adolescents for promoting SRHR. But, we argue that conceptualization of empowerment in these initiatives were often not grounded in solid theory and evidence. Thus, empowerment programmes for women and girls often fail to include a critical component, namely, movement building and collective agency and critical consciousness, without which empowerment cannot take place in its true sense.

The current study proposes to develop and test Balika Bodhu, a social norm intervention to address the gaps in programming and in the literature combining a comprehensive empowerment programme for MAGs with engagement of other stakeholders to increase demand, access and practice of positive behaviours in relation to SRHR among these MAGs. Balika Bodhu covers married adolescent girls aged 15-19 years.

The Balika Bodhu intervention The Balika Bodhu intervention will be developed heavily drawing on CARE's IMAGINE model, and on SAFE, a project spearheaded by icddr,b and aimed at promoting SRHR and addressing violence against women in slums of Dhaka.

Balika Bodhu intervention will be implemented by Nari Maitree, an NGO working on women's issues. The research team will conduct both quantitative and qualitative monitoring for documenting implementation fidelity. Effectiveness of the intervention will be assessed in changing social norms endorsing denial of SRHR to MAGS and in empowering them to demand, access and practice SRHR. The intervention will involve a 12-month gender transformative participatory programming for: (1) empowering MAGs and (2) creating an enabling environment in the family and the community for the MAGs to demand, access and practice SRHR.