Why early pregnancy persists among Bangladesh’s garment workers

Behind the glowing success stories of our ready-made garments industry and the tale of women empowerment lies a troubling truth in the narrow alleys of urban slums, where the limited access to healthcare, long working hours, and poor reproductive knowledge continue to push young female RMG workers into cycles of early pregnancy and unsafe abortion.  

Nearly two-thirds of Bangladesh's female garment workers were married before turning 18, 65% became mothers in their teens, and 25% carried out abortions, found a new longitudinal study by the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). With only 14% of factories offering family planning materials and most clinics operating during working hours, thousands of women are left to make life-altering decisions without information, support, or choice.

Conducted between August 2022 and December 2024 in Dhaka's Korail and Mirpur slums and Gazipur's Tongi slum, the 24-month cohort study followed 778 women aged 15–27 working in the ready-made garment (RMG) sector. These statistics tell a deeper story of financial vulnerability, gender inequality, and the failure of urban reproductive health systems to reach those who need them most. 

The illusion of empowerment 

The garment industry is often hailed as a vehicle of empowerment for Bangladeshi women. Yet, Dr Rumana Huque, Professor of Health Economics and Health Systems in the Department of Economics, University of Dhaka, and Executive Director, ARK Foundation, points out that this report challenges that assumption that financial independence reduces the risk of teen pregnancy. 

"Our laws clearly state that no one under the age of 18 may work in the garment sector," she said. "However, in reality, things are often quite different. We have long believed that when women become financially independent, they gain the ability to raise their voices and make their own decisions. As a result, issues such as early marriage, teenage pregnancy, and unsafe abortion should decline. But this report compels us to ask: why do early marriages, teenage pregnancies, and abortions still occur even after women attain financial independence?"

For many female workers, financial independence comes with a cost. To earn a living, most migrate from rural areas to urban slums, leaving their families behind. In the process, they lose the social and familial networks that once provided guidance and support. "This isolation", Dr Huque explained, "makes them more vulnerable to early marriages or intimate relationships."    

Lack of awareness 

The icddr,b study identified education and empowerment as key protective factors. The study highlighted improvements in reproductive health awareness, though gaps remain. Knowledge of emergency contraception rose from 15% to 39%, and long-term family planning awareness grew from 49% to 70%. 

Greater mobility, participation in household decisions, and the ability to express opinions were also linked to lower risks of spousal and workplace violence. "The study provides clear evidence that empowerment, education, and reproductive autonomy are deeply intertwined," said Dr Ruchira Tabassum Naved, principal investigator and emeritus scientist at icddr,b, at a seminar organised for unveiling the study results. 

"Despite being economically active, the sexual and reproductive health of female garment workers is worse than that of other women. The government, development organisations, and partners must take collective action."

The urban health gap

While rural Bangladesh benefits from an extensive community health network with family planning materials distributed free and field workers conducting door-to-door visits, the urban landscape tells a different story.

"In rural areas, community clinics and union-level centres regularly engage women about early marriage, pregnancy, and contraception," explained Dr Huque. "But in the city, such services are not integrated into formal healthcare systems. As a result, large groups — particularly female garment workers — remain outside the reach of reproductive counselling and free supplies."

The icddr,b report found that factory-level reproductive services are almost non-existent: only 22% of factories provide sanitary pads, and a mere 14% supply family planning materials or information. 

Most workers spend nine to ten hours a day at their sewing machines, leaving them with little time to visit clinics that operate between 9 am and 5 pm — the same hours they are required to work. "This timing gap," said Farzana Sharmin, Joint Secretary of the Bangladesh Knitwear Manufacturers and Exporters Association (BKMEA), at the seminar, "is a major barrier. Government clinic hours must be reconsidered if we want working women to access reproductive health services."

Patriarchy and stigma within the factory floor

Beyond accessibility, social stigma remains a major deterrent. "In our patriarchal society, women's opinions on matters like pregnancy are often disregarded," Sharmin noted during the seminar. "Negative perceptions still prevent women from buying contraceptives from shops, let alone seek reproductive counselling."

Dr Huque echoes this sentiment, adding that cultural discomfort also extends into factories themselves. "New employees receive briefings about work procedures but not about reproductive health," she said. "Health education remains excluded from workplace orientation, largely because it is considered a 'sensitive' subject. This absence of information significantly increases women's vulnerability." 

The lack of institutional support perpetuates misinformation, leaving many women reliant on informal networks or superstition for reproductive decisions. 

The study's findings also show the connection between gender-based violence and reproductive health outcomes. Psychological abuse at work rose from 48% to 55% over two years, while domestic violence among married participants also increased. Yet, only one in five women reported workplace abuse, and informal support from friends or family dropped from 35% to 21%. Experiencing domestic violence not only raises the risk of adolescent pregnancy but also traps women in cycles of dependency and fear. 

Abortion — a decision born out of necessity

One in four female garment workers reported having an abortion or menstrual regulation procedure — a figure that points to both lack of access to contraception and the economic realities of factory life.

"Many women realise that raising a child while maintaining a full-time job in a city is almost impossible," said Dr Huque. "They often live in small, shared rooms in slums, with no family support. The cost of childcare and the threat of losing income make abortion a desperate but practical choice."

Maternity leave in the RMG sector is rare, and taking time off can mean losing a job. "Even when women understand the physical toll of abortion," Dr Huque noted, "many feel they have no alternative. Their income and job security depend on staying in the workforce."

This pattern reflects a larger systemic failure in which reproductive decisions are shaped more by survival than autonomy.

The way forward 

Experts agree that factories must become part of the solution. 

Dr Huque strongly supports this approach. "Factories should provide comprehensive health and wellbeing sessions for workers," she asserted. "Separate, women-focused discussions on reproductive health must be organised, using culturally acceptable and innovative models such as small groups or one-to-one discussions where women can speak freely."

She stressed that these initiatives should be part of a broader policy commitment to bridge the urban health gap. "A large segment of our workforce remains excluded from essential family planning services," she added. "We must ensure that female workers are educated and empowered with accurate knowledge about their health, family planning, and reproductive rights."

However, Mahmud Hasan Khan, president of the Bangladesh Garment Manufacturers and Exporters Association (BGMEA), disagrees with the findings. 

"Bangladeshi RMG factories, especially those who are under the BGMEA, do not hire any worker under 18. Therefore, we do not agree with the findings of the statistics. We all strictly follow local and global regulations."