For low-income urban women, a new door opens to reproductive healthcare
In urban areas, the absence of reliable information on sexual and reproductive health and rights leaves many women without basic reproductive knowledge. Informal sources often fill that gap, but the information they provide is not always accurate
For Kulsum, who lives in the narrow alley of a slum in Mohammadpur, one of her biggest fears was another pregnancy.
With two children and a limited household income, she relied on contraceptive pills from a nearby pharmacy, though no one had explained how to take them properly.
Long days as a domestic worker made her miss doses often. Then a youth-led community session introduced her to a general practitioner (GP), who finally explained the options to her.
Keep updated, follow The Business Standard's Google news channel
Similarly, when 32-year-old Mariam Begum, an RMG worker, missed several doses of her birth control pills, she became alarmed when her period stopped for two months. Later, it returned in repeated episodes of heavy bleeding. Unsure what was happening, she turned to Tasnim, a youth volunteer, who encouraged her to seek medical care.
Tasnim referred her to a local GP, where Mariam received treatment and counselling. She has since recovered and now follows her contraceptive routine correctly.
In urban areas, the absence of reliable information on sexual and reproductive health and rights (SRHR) leaves many women without basic reproductive knowledge. Informal sources often fill that gap, but the information they provide is not always accurate. Misconceptions and stigma add another layer of difficulty.
In rural Bangladesh, there is a structured system. For every 6,000–7,000 people, there is a community clinic. For around 30,000 people, there are union-level health and family welfare centres. There are also community health workers, family welfare assistants and other frontline workers responsible for facilitating access to healthcare services. In urban areas, however, no comparable government structure exists." Dr Sayed Rubayet, Country Director, Ipas Bangladesh
Since SRHR is generally not discussed properly in schools, a significant section of the population — both men and women — grows up without essential knowledge. This makes community-level education and access to trusted health services crucial.
NGOs have long tried to fill this gap in low-income urban communities. But many interventions depend on project-based community health workers, who are available only for a limited period. Their work also usually takes place during the day.
In low-income urban communities, most women work during the day. Some are employed in garment factories, while others work as domestic workers or in informal jobs. During office hours, they are often not available to attend awareness sessions or visit health workers.
For women like Kulsum and Mariam, SRHR needs to be reliable, at the right time, and within their reach.
What if public health facilities were readily available at the workplaces of urban low-income women? What if a garment worker could access an intrauterine device insertion facility at her factory clinic? What if Mariam had received accurate information from the medical centre at her workplace before her condition became frightening?
General practitioners, particularly those in low-income neighbourhoods, are often available in the evening, after working women return home. If these doctors are equipped to provide SRHR information and services, they can become a practical point of care for women who otherwise remain outside formal health systems.
Information may be available online, but for functionally literate women, another question remains: who verifies which information is authentic?
Ipas Bangladesh's project, Improving Sexual and Reproductive Health and Rights in Dhaka (ISRHRD), is working to address some of these gaps.
The project operates in Dhaka North and South city corporations, urban areas of Gazipur and Narayanganj, particularly in garment-dense areas. It aims to reach women from low socio-economic groups, adolescents, youths and female RMG workers.
Why urban areas?
"In rural Bangladesh, there is a structured system. For every 6,000–7,000 people, there is a community clinic. For around 30,000 people, there are union-level health and family welfare centres. There are also community health workers, family welfare assistants and other frontline workers responsible for facilitating access to healthcare services," says Dr Sayed Rubayet, Country Director of Ipas Bangladesh,
"In urban areas, however, no comparable government structure exists", he added.
Urban primary healthcare centres generally fall into two categories. One is the Nagar Shasthya Kendra, which traditionally provided short-acting family planning methods.
Through the project, Ipas supported the introduction of long-acting methods such as implants and IUDs, alongside existing short-acting methods. It also helped establish commodity availability, reporting and monitoring mechanisms.
In a limited capacity, gender-based violence-related services were also introduced.
Another type of facility is the comprehensive reproductive health centre, or CRHC, which provides uninterrupted services. There are around 10 CRHCs in Dhaka.
"In the CRHCs, the Ipas project provided extended services to complement the existing ones and ensure round-the-clock access to care. Alongside that, our aim was to strengthen permanent family planning service facilities," Dr Rubayet said.
Ipas has so far strengthened SRHR services at 38 urban health centres and transformed 100 GP chambers into quality SRHR service centres.
Not every case can be managed at the community or primary-care level. Women experiencing complications often require specialised services and referral support. Yet referral pathways are frequently among the weakest parts of urban healthcare systems.
To strengthen that link, the project supported secondary and tertiary-level facilities and established referral connections between community volunteers, GPs, urban clinics and higher-level facilities.
Interventions in RMGs
In partnership with the Bangladesh Knitwear Manufacturers and Exporters Association, ISRHRD also worked with around 15 factory outpatient clinics.
"We strengthened their capacity so that they could provide family planning, MR, post-abortion care and GBV-related services. We also established referral linkages between factories and healthcare facilities to ensure continuity of care," Dr Rubayet said.
The project introduced menstrual regulation services and post-abortion care alongside existing services. From 2021 to 2026, 16,865 clients received menstrual regulation services, while 32,517 clients received post-abortion care.
Strengthening referral facilities
"In Dhaka and the vicinity, almost 14 referral facilities have been strengthened. We made sure the referral facilities could serve complicated methods," Dr Rubayet said.
He explained that complications may arise when, for instance, a woman requires MR or post-abortion care after having undergone multiple caesarean sections.
"From complicated services to all simplified methods, all are readily available in the facility centre. In every situation, counselling is a priority," he said.
According to Dr Rubayet, even in the private sector, access is largely confined to short-term contraceptive methods such as condoms and oral pills, while long-acting and permanent options — including IUDs, implants, tubectomy and ligation — remain far less available.
From the general practitioner level
At the GP level, the project tried to change how services were delivered by selecting general practitioners from low-income communities and training them to provide SRHR services they had not previously offered.
"In this project, provision of service is overhauled as general practitioners are selected from low socio-economic areas," Dr Rubayet said.
Many MBBS doctors, he said, were not previously providing family planning services, menstrual regulation services or other SRHR-related care. Cases related to gender-based violence were often treated only as police matters and referred to local police stations. As a result, many providers were not properly oriented on the broader SRHR service pathway.
Under the project, the capacity of 766 service providers and 296 community health workers were trained on menstrual regulation, post-abortion care, family planning and sexual and gender-based violence services to ensure quality, rights-based and stigma-free SRHR service delivery.
When youth make the social change
In the ISRHRD project, youths are helping challenge deeply rooted social norms that keep reproductive health issues shrouded in silence.
They organise courtyard meetings, door-to-door discussions, folk performances, street dramas and other engagement activities to spark conversations around family planning, menstrual health, child marriage and gender-based violence in their communities.
More than 1,500 youth volunteers, alongside nearly 300 outreach workers, have been mobilised across urban low-income communities.
Tasnim, one of the volunteers, said the work changed the way she understood these issues.
"Before joining, I never really thought about issues like menstruation, pregnancy or gender-based violence. I didn't understand their significance," she said.
"Take gender-based violence. Before joining the programme, I might have thought, 'If a husband hits his wife, that's their personal matter.' I didn't realise how serious it was or that it constituted a form of violence that could have serious social and legal consequences."
Tasnim said she also enjoyed participating in awareness campaigns.
"We visited schools, talked to adolescents about puberty and reproductive health, distributed educational materials and organised different activities. Those experiences were very meaningful to me," she said.
For Yeasin Rahman, another volunteer, the silence around reproductive health in schools was one reason he became interested in the work.
"Issues related to reproductive health were often ignored or skipped over in schools, even though they are completely normal topics. When one of my friends offered me the opportunity to work here, I didn't want to miss it," he said.
Yeasin said volunteers explain the difference between short-term and long-term family planning methods.
"We tell people that some methods can provide protection for several years, while others require more regular use. We provide the information that we are trained to share, and when someone needs more detailed guidance, we refer them to GPs or healthcare providers," he said.
Sometimes, GPs also join the volunteers in field activities and community sessions so that people can receive accurate information directly from healthcare professionals.
When asked how he feels working as a male volunteer in this field, Yeasin said many people still feel embarrassed to talk about menstruation, family planning or reproductive health.
"Some even make jokes about these topics. But I don't think that is appropriate. These are normal health issues, and people should be able to discuss them without shame," he said.
So far, outreach workers and youth volunteers under the project have mobilised 1,067,118 community members.
Advocacy for a change
For Ipas, advocacy is another major part of the work. The first area concerns family planning commodities.
"The government has a responsibility to ensure that all citizens have access to family planning services. That means family planning commodities must be procured on time and supplied consistently to government facilities, NGO facilities and DGFP facilities," Dr Rubayet said.
"Beyond commodities, we also advocate for adequate budgeting within government programmes. SRHR must receive appropriate priority within government planning processes. Funding is needed not only for commodities but also for training, service delivery tools and other programme requirements," he added.
Removing policy barriers
The existing restrictions prevent some midwives from providing certain services, even when they have the technical competence to do so. Other regulatory barriers also limit access.
"We also advocate for the updating of national technical documents, training materials, guidelines and scale-up plans. We want evidence-based interventions and standard technologies to be incorporated into government policies and programmes," Dr Rubayet said.
"Over the past several years, we have continuously advocated for strengthening MR and post-abortion care services because Bangladesh has a substantial unmet need for these services. We have also worked with government agencies to update national policies and technical strategies. More broadly, we advocate for strengthening urban health systems," he added.
Challenges facing the health system
According to Dr Rubayet, two major concerns demand urgent attention.
The first is the shortage of family planning commodities.
"Government supply levels have declined significantly. Compared to estimated national needs, current availability is far below what is required. In some areas, supplies have fallen to around 40% of need within just the last three years. This requires urgent procurement action," he said.
The second concern is the health workforce.
"For the past three to four years, there has been very limited recruitment. At the same time, many experienced personnel have retired or left the system," Dr Rubayet said..
The problem is compounded by the lack of training. Many newly recruited staff have not received proper SRHR training in recent years. Government monitoring mechanisms have also weakened since sector programmes ended.
Effective monitoring requires field visits and operational budgets for travel and supervision. These resources are often unavailable. When monitoring declines, service quality also deteriorates.
"Even services that do not heavily depend on commodities — such as tubectomy and vasectomy — have experienced declines in coverage. The problem is therefore not only about commodities; it is also about management, oversight and accountability," Dr Rubayet said.
