USAID: Advancing Adolescent Health, Changes in Action CHANGES IN ACTION Stories of improving adolescent health and well-being in Bangladesh USAID: Advancing Adolescent Health, Changes in Action Message from the Country Director Preface Plan International Bangladesh The A2H project was a three-year project (January 2016-January 2019) with the goal to improve ASRH and FP knowledge by increasing access and Plan International (Plan) is an international non-governmental organization use of related services for married and unmarried adolescents. The cohorts (NGO) committed to a just world that advances children’s rights and targeted in this project include unmarried and married girls and boys ages equality for girls. Founded in 1937, Plan now works in more than 50 10-14 and 15-19. developing countries, including Bangladesh. Plan started its work in Bangladesh in 1994 and currently has programs in the districts of Rangpur, The project objectives were three-pronged, with a foundational belief that Dinajpur, Lalmonirhat, Nilphamari, Gazipur, Burguna, Khagrachori, improving ASRH knowledge and access at the supply and demand sides Kishoreganj, Jessore, Bogura, Chattogram, Sylhet, and Dhaka. Key focus of service within a broader enabling environment would lead to increased areas include health education; child protection; disaster risk management; demand for ASRH, FP, and associated health issues, as well as positive and water, sanitation, and health. The main objective of Plan’s health changes related to delaying age at marriage, healthy birth spacing, and programming in Bangladesh is to “ensure that all pregnant and lactating strengthened AFHS at formal and informal health centers/providers. mothers, children under 2 years of age, and young people—including the most vulnerable—benefit from access to appropriate quality health services Specific objectives of the project included: through strengthening government health systems, comprehensive child upbringing, and sexuality education.” • delivery of ASRH, delaying age at marriage, FP, nutrition, and foundational life skills training via a peer-to-peer model to married and The United States Agency for International Development (USAID)-funded unmarried adolescents in the following cohorts: unmarried girls/boys Advancing Adolescent Health (A2H) project is one of Plan International ages 10-14, and unmarried or married girls/boys ages 15-19 (including Bangladesh’s most prestigious programs and was implemented in the pre-marital couples, newly-married couples, married couples with no Rangpur district. The goal of A2H was to improve adolescents’ sexual children, and married couples with one or more children); and reproductive health (ASRH) and family planning (FP) knowledge, and • strengthening AFHS and FP services and information, as well as increase the access and use of related services for married and unmarried comprehensive confidential counseling in both government and adolescents, ages 10–19. Specific results around strengthened ASRH community health centers and with formal and non-formal providers; included delaying age at marriage, delaying age at first birth, and improving and birth spacing. • engaging key community gatekeepers in the intervention areas to The project gained attention throughout different communities in Rangpur, become resources, advocates, and accountable for their communities’ engaging and impacting adolescents, their parents, religious leaders, adolescent population to assist in delaying age at marriage, delaying teachers, community elites, government officials, and health service age at first birth, and safe birth spacing—along with an increased providers. The project successfully equipped 185 government-run health demand for access to and utilization of strengthened sexual and service centers with adolescent-friendly health services (AFHS) and reproductive health and FP services. adolescent corners. A2H’s intervention area was in the Rangpur district, with a specific focus in eight Upazilas and 76 Unions with a rural-urban mix of Union Parishads I would like to thank my A2H team members for their tremendous work, (UP), three Municipalities, and one City Corporation. More than 300,000 along with my Plan colleagues who provided support. adolescents and 52,000 community gatekeepers—including parents, Orla Murphy community leaders, and service providers—benefited from the project. i ii USAID: Advancing Adolescent Health, Changes in Action Project achievements included: A collection of success stories from USAID-A2H • more than 300,000 adolescents received life skills training on sexual and Story Collection and Writing reproductive health Sadaka Tamanna, Nusrat Amin, Almass Ali • 185 AFHS Corners were established in government facilities Coordination and Compilation • 60,000 adolescents received services from the upgraded facilities Sadaka Tamanna • 209 facility-based health service providers received training on AFHS • 872 outreach workers were oriented on the delivery of AFHS Editing Rehan Uddin Ahmed Raju, Kate Ezzes, Kamal Arrm, Glynnis McIntyre • more than 53,000 community members were oriented on adolescent health issues Translation • 273 Community Sales Agents (CSAs) were trained to distribute health Kamal Armm, Shamima Nawshin and FP commodities in their rural communities Assistance • 250 vulnerable girls received skills-based training via economic empowerment activities Hossain Ahmed, Mohammad Abu Syed Design and Layout I am thankful to my team and others who contributed to this project and Sadaka Tamanna, Rehan Uddin Ahmed Raju, Jennifer Teichman who created this publication as a visual representation of the life-changing work of A2H. Photography Rehan Uddin Ahmed Raju Sadaka Tamanna, Nusrat Amin, Shamima Nawshin, Bari Sarker, Rehan Project Director, USAID-A2H Uddin Ahmed Raju, Almas Ali Changes In Action All stories were collected and are shared with permission from the subject. This publication is brought to you by the United States Agency for International Development-Advancing Adolescent Health Activity and is made possible by the generous support of the American people through USAID. The contents are the responsibility of Plan International and do not necessarily reflect the views of USAID or the U.S. Government. iii iv USAID: Advancing Adolescent Health, Changes in Action Table of Contents A Story of Mother-Daughter Survival Against the Odds 1 Referral Service Helping Girls Access Health Care Facilities 3 A Mother’s Promise to Fight Against Child Marriage 5 Creating Lasting Change 7 I Hope to Stand on My Own Two Feet 9 Prevention is Protection 11 Dedicated to Adolescent Health Welfare 13 One Last Phone Call 15 Weaving Dreams 17 Making a Difference Through Coordinated Effort 21 Change Starts With Me 22 Enduring Impact 23 Switch to Good Habits 24 Now I Have an Identity 25 Passing the Baton of Leadership 27 A Plea to Ensure an Adolescent-Friendly Environment 29 All it Takes is Confidence 26 You May Have to Fight Your Own Struggle 31 Guarding Against Child Marriage 33 Dignity Through Work 35 Asha’s Dreams Become Reality 37 Encouraging Youth Leadership 39 v vi USAID: Advancing Adolescent Health, Changes in Action A Story of Mother-Daughter Survival Against the Odds “I saw that my mother had to start her life from scratch in the blink of an eye. My mother was a child bride and never worked a day in her life outside the home before my father left her with three mouths to feed. We children added extra pressure on the already poverty-stricken family of my mother. With help of a relative, my mother landed a job in a garment factory. From an early age, I knew I had to be independent and stand on my own feet so that my world doesn’t crumble upon if anyone leaves me,” said Babli Akhter, age 17, from Rangpur Sadar Upazila. Her father abandoned his wife and children when he got married for the second time. Babli, her mother, and her two brothers had to leave her father’s home and move to her maternal grandparents’ house. Babli’s mother, Monira Begum, wanted to marry her at an early age and arranged for a proposal when Babli was in class eight. Their neighbors intervened, pressuring Monira Begum not to go forward with the marriage, based on Babli’s academic merit. In 2017, Babli became a registered adolescent beneficiary of the A2H project. Through life skills sessions she learned about the physical, mental, and social consequences of early marriage. She was well aware of her mother’s atypical decision to postpone marriage for her daughter. Because she felt her mother would be an advocate for others, Babli asked her to attend A2H project meetings and be a Gatekeeper of the A2H project. Monira Begum said, “At first, I reluctantly agreed and started to attend. In the meetings, project staff shared factual information on adolescent health. I learned about the mental and social consequences of early marriage and Babli with her mother, Monira Begum early pregnancy. My life came flashing back before my eyes. My education was stopped when I was in class three due to poverty. My father married me off when I was around 13. I was a child bride, had a miscarriage, and In the middle of her Secondary School Certificate examination, Babli fought against death. I was left with three little children by my husband started losing eyesight in her left eye. After the exam, she had an operation. without any warning. My father married me off to break the poverty chain But it did not stop her from pursuing her goal. “The project taught both of and exposed me to health risks and I almost repeated my father’s mistake. us the importance of taking care of one’s health at the adolescent stage Both of us were wrong. Rather than breaking the chain, we were creating a and how to access proper information. My daughter is now a source of vicious poverty cycle and exposing our daughters’ health to risk.” proper information for her peers,” Monira Begum said with pride. 1 2 USAID: Advancing Adolescent Health, Changes in Action to come here where I can be Referral Service Helping Girls Access with my friends.