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An Assessment of Advancing Adolescent Health

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An Assessment of Advancing Adolescent Health An Assessment of the Advancing Adolescent Health Program in Bangladesh Quamrun Nahar Anadil Alam Sadia Afrin Sharad Barkataki Shusmita Khan Ali Ahmed Iffat Sharmin Musarrat Rubina Mannan Mizanur Rahman February 2020 ACKNOWLEDGMENTS We would like to thank several people who made important contributions to this research project and report. We thank Rehan Uddin Ahmed Raju, project director, Advancing Adolescent Health (A2H) program, and Hossain Ahmad, monitoring and evaluation specialist, A2H program, from Plan International, Bangladesh, who provided support throughout the process of the assessment. We also extend our thanks to Maruf Ahmed, regional project manager, A2H, from the Eco-Social Development Organization and Mizanur Rahman, project manager, A2H, from the World Mission Prayer League Hospital, for their support and cooperation during the study implementation. We also thank Glynnis McIntyre, monitoring, evaluation, research, and learning advisor, Plan International, United States of America, and Ikhtiar Uddin Khandaker, head of health program, Plan International, Bangladesh, for reviewing the draft report. We thank S. N. Mitra and Shahidul Islam, of Mitra and Associates, who aided in survey data collection for the assessment. We thank Atik Ahsan and Nitai Chakraborty for their support during study protocol development and sample selection for the research project. And we thank Ali Imam, Shehreen Zakir, Zakia Siddiqui, Sharmin Islam, Mahmudur Rahman Khan, and Tanjida Ahmed for their input and contribution to the report. We are grateful to the United States Agency for International Development (USAID)/Bangladesh team members who reviewed this report and provided important insights. In particular, we thank Kanta Jamil for her valuable time reviewing the research protocol, providing technical input during data analysis, and reviewing the report. We acknowledge the support and inspiration provided by Samina Chowdhury. We thank the knowledge management team of the USAID-funded MEASURE Evaluation project, based at the University of North Carolina at Chapel Hill, for editorial, design, and production services. Without the combined assistance and support of all these people, this report would not have been possible. Cover Adolescent girls attend an A2H life-skills session in Bangladesh. Photo: Anadil Alam Key words Adolescent health, sexual and reproductive health, early marriage, family planning, life skills Suggested citation Nahar, Q., Alam, A., Afrin, S., Barkataki, S., Khan, S., Ahmed, A., Sharmin, I., Mannan, M. R., & Rahman, M. (2020). An Assessment of the Advancing Adolescent Health Program in Bangladesh. Chapel Hill, NC, USA: MEASURE Evaluation, University of North Carolina CONTENTS Figures ................................................................................................................................................................................... 7 Tables .................................................................................................................................................................................... 8 Abbreviations ....................................................................................................................................................................... 9 Executive Summary .......................................................................................................................................................... 10 Introduction ....................................................................................................................................................................... 14 Advancing Adolescent Health Project Description................................................................................................ 14 Scale of the Program and Project Coverage ....................................................................................................... 17 Objectives of the Assessment .................................................................................................................................... 17 Methods .............................................................................................................................................................................. 19 Study Sites ..................................................................................................................................................................... 19 Sampling and Data Collection.................................................................................................................................... 20 Household Survey ................................................................................................................................................... 20 Qualitative Study and Facility Assessment .......................................................................................................... 21 Respondent Characteristics ........................................................................................................................................ 22 Household Survey ................................................................................................................................................... 22 Characteristics of Participants for the Qualitative Study .................................................................................. 23 Data Analysis ................................................................................................................................................................ 23 Results ................................................................................................................................................................................. 24 Program Participation .................................................................................................................................................. 24 Socioeconomic Characteristics of Program Participants, Nonparticipants, and Comparison Area Adolescents .............................................................................................................................................................. 24 Level of Program Participation ............................................................................................................................. 25 Session Attendance ................................................................................................................................................. 26 Circumstances in Favor of Program Participation ............................................................................................ 27 Reasons for Dropout and Nonparticipation in Life-Skills Sessions ............................................................... 29 Short-Term Effects of Participation in the Program ............................................................................................. 31 Age at Marriage and Negotiation Skills ............................................................................................................... 31 Family Planning ....................................................................................................................................................... 37 Menstrual Hygiene .................................................................................................................................................. 41 Gender Norms and Sexual Harassment .............................................................................................................. 47 Health Service Use .................................................................................................................................................. 49 Association between Intensity of Program Participation and Knowledge, Attitudes, and Practices ........ 50 Adolescent-Friendly Health Facility Assessment .................................................................................................... 51 Discussion and Recommendations ................................................................................................................................ 53 Discussion ..................................................................................................................................................................... 53 Advancing Adolescent Health Assessment 5 Recommendations ....................................................................................................................................................... 54 References .......................................................................................................................................................................... 56 Appendix A. Unmarried Adolescent Girls Questionnaire ......................................................................................... 57 Appendix B. Married Adolescent Girls Questionnaire ............................................................................................... 88 Appendix C. Performance Monitoring Plan Indicator Matrix ................................................................................. 128 6 Advancing Adolescent Health Assessment FIGURES Figure 1. Advancing Adolescent Health life-skills approach ..................................................................................... 15 Figure 2. Project sites and assessment areas ................................................................................................................
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