KNOWLEDGE, ATTITUDE, AND PRACTICE REGARDING

BIRTH SPACING AMONG ROHINGYA MOTHERS IN

BANGLADESH
MS Thesis

Department of Environmental Sanitation

Patuakhali Science and Technology University,
Dumki, Patuakhali-8602

December, 2022
KNOWLEDGE, ATTITUDE, AND PRACTICE REGARDING
BIRTH SPACING AMONG ROHINGYA MOTHERS IN
BANGLADESH

A Thesis
Submitted by
Name: Umma Munni
Registration No: 06903
Session: July-December 2021
In Partial fulfillment of the Requirements for the
Degree of Master of Science
in
Environmental Sanitation

Department of Environmental Sanitation

Patuakhali Science and Technology University,
Dumki, Patuakhali-8602

December, 2022

ii
 KNOWLEDGE, ATTITUDE, AND PRACTICE REGARDING
BIRTH SPACING AMONG ROHINGYA MOTHERS IN
BANGLADESH

A Thesis
Submitted to
Patuakhali Science and Technology University, Dumki, Patuakhali
In Partial fulfillment of the Requirements for the
Degree of Master of Science
in
Environmental Sanitation

…..………………………….. …………………………………
Md. Nazmul Hassan (Supervisor) Prof. Dr Golam Rabbani Akanda (Co-
Supervisor)
Professor & Chairman Associate Professor
Department of Environmental Sanitation Department of Agricultural Extension & Rural Development

…………………………………….
Md. Nazmul Hassan
Chairman, Defense Committee
PATUAKHALI SCIENCE AND TECHNOLOGY UNIVERSITY
DUMKI, PATUAKHALI-8602

December, 2022

iii
 DECLARATION

I hereby declare that this thesis represents my own work which has been done after registration
for the degree of MSc. in Environmental Sanitation Patuakhali Science and Technology
University, and has not been previously included in a thesis or dissertation submitted to this or
any other institution for a degree, or other qualifications

I have read the University’s current research ethics guidelines, and accept responsibility for the
conduct of the procedures. I have attempted to identify all the risks related to this research that
may arise in conducting this research, obtained the relevant ethical and/or safety approval (where
applicable), and acknowledged my obligations and the rights of the participants.

………………………………….
Date:…………… UMMA MUNNI

1
 ACKNOWLEDGEMENTS

I would like to express my deepest gratitude to my supervisor, Md. Nazmul Hassan, Associate
Professor, Department of Environmental Sanitation, Patuakhali Science and Technology
University, whose sincerity and encouragement I will never forget. Md. Nazmul Hassan has
been an inspiration as I hurdled through the path of this Masters degree. He is the true definition
of a leader and the ultimate role model. I am thankful for the extraordinary experiences he
arranged for me and for providing opportunities for me to grow professionally.

I also would like to profound thanks to honorable teacher Prof. Dr Golam Rabbani Akanda,
Associate Professor, Department of Agricultural Extension & Rural Development, Patuakhali
Science and Technology University for his precious advice, academic guidance, technical
support and concerned supervision of the thesis.

The officials of the institution and other concerned authorities are also thankful for their keen
interest and great support while conducting the study.
Last, but not least, my warm and heartfelt thanks go to my family for their tremendous support
and hope they had given to me. Without that hope, this thesis would not have been possible.
Thank you all for the strength you gave me.

Umma Munni

Author

2
Knowledge, Attitude, and Practice Regarding Birth Spacing among Rohingya
Mothers in Bangladesh

Abstract
Introduction: Rohingya refugees are a stateless ethnic minority from Myanmar who have fled
persecution and violence, seeking refuge primarily in Bangladesh. This KAP (Knowledge,
Attitude, and Practice) study is needed to understand their reproductive health behaviors,
specifically birth spacing, to inform targeted interventions that improve maternal and child health
outcomes in refugee camps. Objective: This study aims to assess the knowledge, attitude, and
practices (KAP) regarding birth spacing among Rohingya mothers in Cox's Bazar refugee camps
and to examine the socio-demographic determinants influencing these practices. Methodology:
A cross-sectional survey was conducted from October 2023 to February 2024, involving 504
married Rohingya women of reproductive age across five camps. Participants were selected
through a multistage sampling technique. The survey collected sociodemographic data and
assessed KAP through questionnaires, including Likert scale questions. Statistical analysis
identified socio-demographic influences on birth spacing practices. Results: The study reveals
significant gaps in birth spacing knowledge, attitudes, and practices among participants. While
46.2% practiced birth spacing (20.6% using short-term methods, 4.4% using long-term methods,
and 75.0% using natural methods), 53.8% did not. Socioeconomic factors played a crucial role:
mothers from households earning less than 10,000 BDT per month were far less likely to practice
birth spacing (OR = 26.243, p = 0.003), and unemployed husbands were less likely to engage in
birth spacing compared to employed ones (OR = 2.070, p = 0.001). Additionally, 57.3% of
participants had poor knowledge, 64.7% had negative attitudes, and only 42.5% practiced good
birth spacing methods. These findings highlight the need for targeted educational and behavioral
interventions. Conclusion: The study concludes that targeted, culturally sensitive interventions
are crucial to improving birth spacing knowledge and practices among Rohingya women.
Enhancing education, community engagement, and access to diverse contraceptive options is
essential. Collaborative efforts and longitudinal studies are recommended to sustain and evaluate
these interventions, ultimately improving maternal and child health outcomes in the refugee
camps.
Keywords: Rohingya refugees, birth spacing, maternal health, reproductive health, contraceptive
methods.

3
 TABLE OF CONTENTS
1. Declaration……………………………………………………………………… 1

2. Acknowledgement………………………………………………………………. 2

3. Abstract…………………………………………………………………………. 3

4. Introduction……………………………………………………………………… 5-6

5. Literature Review……………………………………………………………….. 7-10

6. Materials and Methods…………….…………………………………………… 11-13

Study setup and design………………………………………………………....... 11

Sampling….…………………………………………………………………….. 11

Questionnaire………………………………………………………………….. 12

Statistic evaluation……………………………………………………………….. 12

Ethical consideration…………………………………………………………….. 13

7. Results…………………………………………………………………………… 14-25

8. Discussion……………………………………………………………………….. 26-28

9. Conclusion………………………………………………………………………. 29

10. References………………………………………………………………………. 30-32

4
 Chapter 1

Introduction

Worldwide, the number of stateless individuals, typically identified as refugees, has significantly
increased over the past few decades. One prominent example is the Rohingya diaspora, who have
been fleeing their homelands Myanmar since August 25, 2017 (Inter Sector Coordination Group
[ISCG], 2017). The influx of over 700,000 Rohingya into Bangladesh has resulted in the world's
fastest-growing refugee crisis (Women’s Refugee Commission [WRC], 2019). Before this surge,
Bangladesh had about 220,000 unregistered refugees (WRC, 2019). By March 31, 2021,
approximately 884,000 Rohingya refugees, classified as Forcibly Displaced Myanmar Nationals
(FDMN), were residing in 34 camps in Ukhiya and Teknaf Upazilas of Cox’s Bazar District,
forming the largest and most densely populated refugee camps globally (UNHCR, 2021).

Moreover, women and children constitute the majority, accounting for over 50% of the refugee
population (UNHCR, 2021). The Government of Bangladesh, in collaboration with development
partners such as the United Nations High Commissioner for Refugees (UNHCR), United Nations
Children’s Fund (UNICEF), United Nations Population Fund (UNFPA), and the World Health
Organization (WHO), is actively providing humanitarian aid to the Rohingya population (United
Nations Population Fund [UNFPA], 2017). While in Myanmar, the Rohingya were deprived of
nationality and basic rights, including access to education and healthcare, significantly impacting
their knowledge of contraception and family planning (Health Sector Cox’s Bazar et al., 2021).
Consequently, adverse maternal health outcomes are notably high among them (Chowdhury et
al., 2018). Globally, displaced women and adolescent girls face heightened sexual and
reproductive health (SRH) issues, including high maternal morbidity and mortality, unintended
pregnancies, and unmet contraceptive needs (Ainul et al., 2018).

According to a study conducted by the International Center for Diarrheal Disease Research,
Bangladesh (Icddr,b, 2019) published that the Contraceptive Prevalence Rate (CPR) amongst
Rohingya refugees increased by 2.1 percentage points, from an estimated 33.7% in 2018 to
35.8% in 2019 (Family Planning Strategy, 2021). Besides, 80% of recently delivered women
know about Injectable Depo-Provera and Oral Contraceptive Pills. Gestational age, or the
antepartum interval (ICI), is the time it takes for a woman to become pregnant or give birth again

5
after a previous pregnancy. Short interval pregnancies carry health risks, but most of the health
risks come from births spaced too closely. Furthermore, the World Health Organization
recommends a rest period of 24 months between pregnancies (Joarder et al., 2020). An interval
of at least 1 to 3 years between births is recommended. Going more than 5 years between
pregnancies involves the risk of preeclampsia. Also, birth spacing, crucial for maternal and child
health, remains a challenge among Rohingya women in Cox's Bazar refugee camps due to
limited access to family planning (FP) services and entrenched cultural beliefs (Chowdhury et
al., 2018). Adequate spacing between pregnancies reduces maternal and infant mortality rates,
enhances maternal health, and improves child development outcomes (Ainul et al., 2018).

However, cultural norms favoring large families and religious perceptions regarding
contraception often hinder the adoption of birth spacing methods among Rohingya women,
contributing to high-risk pregnancies and adverse maternal health outcomes (WRC, 2019). Data
on birth spacing prevalence in different countries highlight significant disparities, with developed
nations generally exhibiting higher rates compared to developing regions (Ainul et al., 2018).
Bangladesh, the host country for the Rohingya refugees, faces its own challenges in promoting
birth spacing, particularly in rural areas with limited access to healthcare and educational
resources (Health Sector Cox’s Bazar et al., 2021). While efforts to improve birth spacing
practices have been made at the national level, implementation remains uneven, affecting
marginalized populations such as the Rohingya refugees disproportionately (UNHCR, 2021).
Various factors and barriers influence birth spacing practices among Rohingya women in Cox's
Bazar refugee camps, including cultural norms, religious beliefs, and socioeconomic factors
(WRC, 2019). Traditional misconceptions about contraception, such as fears of infertility or
religious prohibitions, often discourage birth spacing initiatives (WRC, 2019). Moreover, the
influence of husbands and mothers-in-law in family decision-making further complicates efforts
to promote birth spacing, as do concerns about potential side effects of contraceptives (WRC,
2019).

Research on birth spacing among Rohingya women in Cox's Bazar refugee camps is essential
due to the limited existing studies and the unique challenges faced by this deprived population.
Previously, Azad et al. (2022) conducted a study in only one camp due to funding constraints.
This research aims to better understand their knowledge, attitudes, and practices regarding birth
spacing and the methods they use for birth control & to assess the socio-demographic
6
determinants of birth spacing. Further, development of coordinated and effective interventions to
improve the maternal and child health of Rohingya women in refugee camps, addressing the
existing research gap and developing targeted interventions (Chowdhury et al., 2018).
Understanding the knowledge, attitudes, and practices surrounding birth spacing among this
population can inform more effective FP programs tailored to their specific cultural and social
contexts (Health Sector Cox’s Bazar et al., 2021). By identifying and addressing the barriers to
birth spacing, such research can contribute to improving maternal and child health outcomes
among Rohingya refugees and similar displaced populations globally.

Objective:

 To assess the knowledge, attitude, and practice of birth spacing among Rohingya mothers
in Bangladesh

 To assess the socio-demographic determinants of birth spacing among Rohingya mother

in Bangladesh

7
 Chapter 2

Literature review

The Rohingya refugee crisis in Bangladesh has garnered significant attention due to its scale and
the difficulties encountered by the displaced population. Among the myriad issues affecting this
community, understanding the knowledge, attitudes, and practices related to birth spacing and its
methods is crucial for enhancing the health of mothers and children in refugee settings. This
review of literature seeks to explore existing research on this topic, shedding light on key
findings, gaps, and implications for interventions.

One of the critical factors influencing birth spacing practices among the Rohingya population is
their level of awareness and knowledge about contraception and family planning methods.
Research indicates that Rohingya refugees in Bangladesh often lack access to accurate
information regarding contraceptive options and their advantages. Rahman, Alam, and Khanam
(2020) conducted a cross-sectional study among Rohingya women living in refugee camps in
Cox's Bazar, Bangladesh, and found that a significant proportion of participants lacked
awareness of modern contraceptive methods. Similarly, Islam, Khan, and Ahmed (2019)
highlighted low levels of knowledge, attitude, and practice of contraception among women
residing in Rohingya refugee camps. These findings underscore the pressing need for targeted
educational initiatives to enhance awareness and knowledge about birth spacing methods among
the Rohingya population. Furthermore, cultural and linguistic barriers may contribute to
misinformation and misunderstandings about family planning, emphasizing the necessity for
culturally sensitive approaches that consider the linguistic and cultural context of the Rohingya
community (UNHCR, 2021).

Cultural norms and beliefs play a significant role in shaping attitudes towards birth spacing
among the Rohingya population. Religious beliefs and traditional values have been shown to
influence contraceptive use and family planning decisions. Hasan, Akter, and Das (2018)
underscored the importance of understanding cultural factors, such as gender dynamics and
patriarchal norms, in influencing family planning practices among Rohingya refugees. Moreover,
stigma and taboos surrounding discussions on reproductive health may lead to negative attitudes
towards contraception within the Rohingya community. In many conservative societies,

8
including Rohingya culture, discussions about sexuality and family planning are often considered
taboo subjects. This reluctance to openly discuss reproductive health matters may hinder efforts
to promote birth spacing and contraceptive use among Rohingya refugees. However, attitudes
towards family planning are dynamic and can evolve over time in response to changing
circumstances and access to information. Ahmed, Kamal, and Rahman (2019) found that while
traditional values influenced family planning decisions among Rohingya refugees, exposure to
educational interventions and access to healthcare services positively influenced attitudes
towards contraception. This highlights the potential for targeted interventions to shift attitudes
and promote positive perceptions of birth spacing within the Rohingya community.

Access to and utilization of contraceptive methods among Rohingya refugees in Bangladesh are
impacted by numerous factors, including availability, affordability, cultural beliefs, and gender
dynamics. Ahmed et al. (2019) found that while there is a desire among Rohingya women to
delay or avoid future pregnancies, logistical barriers and service gaps impede their access to
family planning services. Limited availability of contraceptives within refugee camps and
surrounding areas further exacerbates the challenges faced by Rohingya refugees in accessing
reproductive health care. Furthermore, cultural and religious beliefs may influence the choice
and utilization of contraceptive methods among Rohingya refugees. Studies have highlighted the
impact of traditional values and religious teachings on contraceptive decision-making within
conservative societies (Hasan et al., 2018). Religious prohibitions or misconceptions about
contraception may deter Rohingya individuals from utilizing available family planning services,
despite their expressed desire to control their fertility. However, interventions aimed at
increasing access to reproductive healthcare services and providing culturally sensitive education
have shown promise in improving contraceptive utilization among Rohingya refugees. Islam et
al. (2019) found that targeted educational interventions resulted in increased knowledge and
positive attitudes towards contraception among women residing in Rohingya refugee camps.
Additionally, efforts to integrate family planning services into existing healthcare infrastructure
within refugee settings have the potential to overcome logistical barriers and improve access to
contraceptives (UNHCR, 2021).

Various interventions have been implemented to promote birth spacing and contraceptive
utilization among Rohingya refugees in Bangladesh. Community-based educational programs

9
have been developed to raise awareness about contraceptive options and address misconceptions
surrounding family planning. Islam et al. (2019) reported that targeted educational interventions
resulted in increased knowledge and positive attitudes towards contraception among women
residing in Rohingya refugee camps. These programs, delivered through community health
workers and peer educators, play a crucial role in disseminating accurate information and
empowering Rohingya individuals to make informed decisions about their reproductive health.
Furthermore, efforts to integrate family planning services into existing healthcare infrastructure
within refugee settings have shown promise in improving access to contraceptives. Ahmed et al.
(2019) highlighted the importance of providing comprehensive reproductive health services
within refugee camps, including access to contraceptives, counseling, and follow-up care. By
integrating family planning services into primary healthcare facilities within refugee camps,
healthcare providers can ensure continuous access to reproductive health care services for
Rohingya refugees. Additionally, culturally sensitive counseling and outreach services have been
implemented to address cultural and religious barriers to contraceptive utilization. Chowdhury,
Khan, and Islam (2020) emphasized the importance of culturally sensitive approaches in
promoting family planning practices among Rohingya refugees. These interventions, delivered
through trusted channels and community leaders, aim to build trust and credibility within the
Rohingya community and increase acceptance of contraceptive methods.

Furthermore, data from the Women's Refugee Commission (WRC) (2019) indicate that
comprehensive strategies that include both community engagement and direct healthcare service
provision are essential for improving contraceptive access and use. These strategies are not only
about providing contraceptives but also about ensuring that refugees have the necessary support
and information to make informed decisions. Efforts to incorporate male involvement in family
planning discussions have also been identified as crucial, as gender dynamics often influence
contraceptive use in patriarchal societies (Chowdhury et al., 2018).

Additionally, studies such as those by Casey et al. (2018) reveal that mixed-methods approaches
in humanitarian settings can provide deeper insights into the multifaceted barriers and facilitators
to reproductive health services. These studies recommend the inclusion of both qualitative and
quantitative data to tailor interventions that are context-specific and address the unique
challenges faced by the Rohingya community.

10
In the broader context, access to health care significantly impacts fertility and women's
empowerment, as seen in other humanitarian settings (Krafft, El-Khoury, & Kohler, 2019). The
lessons learned from different contexts, such as the trends in contraceptive prevalence in sub-
Saharan Africa (Ahmed et al., 2017), provide valuable insights that can be adapted to the
Rohingya context. The integration of family planning services into existing health care
infrastructure, comprehensive educational programs, and culturally sensitive approaches are
crucial for addressing the unique needs of the Rohingya refugees.

Overall, the literature underscores the importance of targeted educational interventions,

culturally sensitive approaches, and integrated healthcare services in promoting birth spacing and
contraceptive utilization among Rohingya refugees in Bangladesh. Despite the challenges, there
is significant potential for improving reproductive health outcomes through these multifaceted
strategies.

11
 Chapter 3

Methods and Materials

Study setup and design

This study used a quantitative research approach designed with a camp-based cross-sectional
survey. It was conducted at Rohingya Refugee Camps 12, 16, 22, 25, and 27 in Cox's Bazar
(Ukhia, Teknaf Region), part of the Chittagong District, which is geographically the largest of
the eight administrative divisions of Bangladesh. These camps were selected as the study area
due to recent influxes of Forcibly Displaced Myanmar Nationals (FDMN) and the absence of
prior studies. Additionally, they are densely populated and situated remotely from Cox's Bazar,
representing one of the largest Rohingya regions in Bangladesh. (These camps were selected as
the study area due to recent influxes of Forcibly Displaced Myanmar Nationals (FDMN) and the
absence of prior studies. Located approximately 35 kilometers from Cox's Bazar, these camps
are situated at a latitude of 21.4509° N and a longitude of 91.9487° E. The area is characterized
by its remote and challenging terrain, which complicates access to basic services and healthcare.
Additionally, these camps are among the most densely populated regions hosting Rohingya
refugees in Bangladesh, further emphasizing the need for focused research and targeted health
interventions. The survey was conducted from October 2023 to February 2024.
Sampling
Firstly, a multistage sampling technique was utilized, primarily employing simple random
sampling. From the 34 camps in Cox's Bazar, five camps were selected. Secondly, different
communities within these camps were then chosen. The selection of households will be carried
out using simple random sampling, at least 3-5 block from each camp will be randomly chosen
based on homogeneity and transportation accessibility, geographical location. Data collection
clusters will be identified utilizing the GoB UNHCR Population Map - April 2023. Thirdly,
households will be selected through convenience sampling due to the clear demarcation, easy
access, transport facility and naming of lanes in densely populated slums. Finally, the population
for the study consisted of married Rohingya refugee women of reproductive age (18–49 years
old) living with their families (husbands and children) in the camps, with at least one or two
children before the survey. A total of 95523 Rohingya people were living in those Camps. While
more than half of the population is women and 8534 of them were women of reproductive age, to

12
achieve the required sample size, approximately 2-3 blocks per camp will be chosen. Then we
will randomly select the women from different blocks of camps. We try to excluded the mother
who had specially some clinical problem with habitual abortions and who had ill during this
research study. The sample size was determined using the single population proportion formula,
with assumptions of a 50% frequency of best Family Planning and Knowledge Attitude Practice,
a significance level of 5%, and a margin of error of 5%. Additionally, a non-responder rate of
10% was considered. The final sample size was determined to be 425.
𝑛=𝑍2×𝑝×(1−𝑝) 𝑑2n=d2Z2×p×(1−p)
where 𝑍Z is the Z-value (1.96 for a 95% confidence level), 𝑝p is the assumed population
proportion (0.5), and 𝑑d is the margin of error (0.05)
Questionnaire:
The survey encompassed four key sections: sociodemographic data, knowledge assessment,
attitude, and practice evaluation, supplemented by Likert scale questions to gauge the intensity of
respondents' attitudes and perceptions regarding birth spacing. Sociodemographic information
collected included marital status, age, income, religion, education, and occupation of both
respondents and their husbands. Knowledge questions focused on awareness of short birth
intervals, contraceptive methods, and understanding of birth interval health implications.
Attitude inquiries explored perceptions regarding birth spacing importance, gender roles, and the
impact of family size on health and happiness, with respondents indicating their level of
agreement or disagreement on a 5 point Likert scale. Additionally, practice-related queries
delved into current birth spacing practices, preferences for short or long-term methods, and
satisfaction levels with chosen techniques, alongside reasons for non-adoption and barriers to
accessing birth spacing services. The inclusion of Likert scale questions allowed for a more
nuanced exploration of respondents' attitudes, providing quantitative data to complement the
qualitative insights gathered through the structured questionnaire. This comprehensive approach
aimed to provide a holistic understanding of the factors influencing birth spacing behaviors
among Rohingya women in Cox's Bazar refugee camps.
Statistic evaluation
Both descriptive and statistical analyses were employed in this study. Descriptive analysis
involved the creation of frequency tables, including percentages, means, and numbers, which
were then tabulated and graphed to visually represent the data. To measure the mean difference

13
between continuous variables. Additionally, a Chi-square test was carried out to identify
associations among categorical variables. Furthermore, regression analysis was employed to
assess the relationship between outcome variables and various factors, including knowledge,
attitudes, practices, and other relevant variables. For data analysis, the Statistical Package for
Social Sciences (SPSS) version 23 was utilized. A significance level of 5% was considered for
all statistical tests.

Ethical Consideration
The study design was approved by the Office of the Refugee Relief and Repatriation
Commissioner (RRRC), Bangladesh, and Patuakhali Science and Technology University.
Participation in the research survey was entirely voluntary, with participants informed about
risks and benefits beforehand. Written consent was obtained from all study participants before
data collection. Strict privacy and anonymity measures were adhered to during the study.
Cultural and religious beliefs of the Rohingya community were respected, and efforts were made
to be aware of any practices, norms, or taboos related to reproductive health and family planning
that may have influenced participants' responses or willingness to participate. Data collection,
storage, and analysis procedures ensured participants' identities were protected, with assurances
that their information would not be shared with any unauthorized individuals or agencies. The
research was conducted for educational purposes and was entirely self-funded, with no financial
support from any other agency or organization.

14
 Chapter 4
Results

The descriptive data from Table 1 indicates that the majority of the respondents were young
adults between the ages of 18-25 years (41.3%), followed by respondents under the age of 18
years (46.6%) and those over 25 years of age (12.1%). In terms of religion, almost all
respondents identified as Muslim (99.6%). The vast majority of respondents had no formal
education, with 76.4% unable to read and write, 17.1% able to read and write, and 6.0% with
primary education. Most of the respondents were housewives (83.7%), while a minority were
employed (16.3%). The majority of respondents' husbands also had low levels of education, with
56.0% unable to read and write, 20.6% able to read and write, 19.8% with primary education,
and only 3.6% with secondary education or higher. In terms of household income, the majority of
households earned less than 10 thousand BDT monthly (65.1%), followed by households earning
between 11 to 25 thousand BDT (32.3%) and those earning more than 25 thousand BDT (2.6%).

Table 1. Socio-demographic characteristics of the study population (n=504)

Characteristics Frequency (n) Percentage (%)

Respondent’s Age

<18 years 235 46.6

18 - 25 years 208 41.3

> 25 years 61 12.1

Respondent’s Religion

Muslim 502 99.6

Respondent’s Education

Unable to read and write 385 76.4

Able to read and write 86 17.1

Primary education 30 6.0

Respondent’s Occupation

15
 Housewife 422 83.7

Employed 82 16.3

Respondent’s Husband Education

Unable to read and write 282 56.0

Able to read and write 104 20.6

Primary education 100 19.8

Respondent’s Husband Occupation

Unemployed 279 55.4

Farmer 31 6.2

Employed 190 37.7

Household Monthly Income (BDT)

Less than 10 thousand 328 65.1

Between 11 to 25 thousand 163 32.3

Table 2. Distribution of knowledge-related attributes among the Rohingya mothers (N=504)

Variables Categories Frequency Percentage (%)

(n)

Ever heard about the short birth

interval?
Yes 241 47.8

No 263 52.2

How many months’ short birth interval?

>12-18 months 167 33.1

>18-24 months 194 38.5

>24 months 58 11.5

16
 Don't know 85 16.9

Which birth interval has a health

advantage?
Below 2 years 171 33.9

2–4 years 155 30.8

4 years 38 7.5

I don’t know 140 27.8

If you said 2–4 years’ interval, for

whom?
Mother’s health 162 32.1

Newborns and 65 12.9

child health
Next child 42 8.3
health
I don’t know 134 26.6

Which birth interval has a health

disadvantage?
Below 2 years 147 29.2

2–4 years 105 20.8

Above 4 years 59 11.7

I don’t know 193 38.3

Is practicing birth spacing is good?

Yes 184 36.5

No 320 63.5

Know contraceptives used for birth

interval?
Yes 472 93.7

No 32 6.3

17
Table 2 provides insight into the knowledge-related attributes among Rohingya mothers, with a
total sample size of 504 respondents.

The distribution of knowledge-related attributes among Rohingya mothers showed that the
majority of them had heard about short birth intervals (47.8%), with a significant percentage
unaware of it (52.2%). Among those who were aware, a larger proportion knew about birth
intervals greater than 18-24 months (38.5%) compared to shorter intervals. When asked about the
health advantages of birth intervals, most mothers believed that intervals between 2-4 years were
beneficial (30.8%) for various reasons, including the health of the mother (32.1%) and newborns
and child health (12.9%). However, a significant portion admitted they did not know (27.8%).
Regarding health disadvantages, a higher percentage believed that intervals below 2 years were
harmful (29.2%), though a significant number were unsure (38.3%). Additionally, the majority of
mothers did not think practicing birth spacing was good (63.5%). Despite this, a substantial
number were knowledgeable about contraceptives used or birth intervals (93.7%) (table 2)

Oral Contraceptive Pill (OCP) 98

Knowledge about contraceptive

Condom 77
methods

Intrauterine Device (IUD) 3

Injection Depo-Provera 353

Female Sterilization 2

0 50 100 150 200 250 300 350 400

Frequency (n)

Figure 1. Knowledge about contraceptive methods among Rohingya mothers (n=504)

Figure 1 illustrates Rohingya mothers' knowledge about contraceptive methods among a sample
of 504 respondents. Among the methods depicted, injection Depo-Provera appears to be the most
widely recognized, with 353 respondents indicating awareness of it. Condoms follow with 77

18
respondents, while oral contraceptive pills (OCP) and intrauterine devices (IUD) are known to 98
and 3 respondents, respectively. Female sterilization is recognized by only 2 respondents. These
findings provide insights into the contraceptive awareness levels among Rohingya mothers,
highlighting the prevalence of certain methods over others within this community.

Table 3. Distribution of attitude-related attributes among the Rohingya mothers (N=504)

Attitude Questions Strongly Disagree, No opinion, Agree, Strongly

disagree, n (%) n (%) n (%) n (%) agree, n (%)

Applied optimal birth 29 (5.8) 246 27 (5.4) 109 93 (18.5)

interval is important (48.8) (21.6)

Having 2 years birth 40 (7.9) 239 (7.4) 31 (6.2) 108 86 (17.1)

interval is enough (21.4)

Husband willingness is a 51 (10.1) 69 (3.7) 19 (3.8) 271 94 (18.7)

must to birth interval (53.8)

Many children have health 72 (14.3) 202 (0.1) 33 (6.5) 108 89 (17.7)
problem (21.4)

Many children have 54 (10.7) 218 19 (3.8) 148 65 (12.9)

physical and psychological (43.3) (29.4)
problems for the women

Many children have 50 (9.9) 232 19 (3.8) 121 82 (16.3)

physical and psychological (46.0) (24.0)
problems for the father

Deliver until male child 9 (1.8) 284 56 (11.1) 131 24 (4.8)

gained is recommended (56.3) (26.0)

Having many children 10 (2.0) 210 125 (24.8) 123 36 (7.1)

proves women fertility (41.7) (24.4)

No need of limit child since 8 (1.6) 42 (8.3) 383 (76.0) 57 14 (2.8)

19
 it is out of god (11.3)

Having few children has 30 (6.0) 138 13 (2.6) 293 30 (6.0)

economic advantage (27.4) (58.1)

Females has equal power to 213 (42.3) 210 24 (4.8) 54 3 (.6)

limit children as male (41.7) (10.7)

Having few children makes 20 (4.0) 157 21 (4.2) 270 36 (7.1)

family unstable economy (31.2) (53.6)

Many children make family 34 (6.7) 141 19 (3.8) 280 30 (6.0)

psychologically unstable (28.0) (55.6)

Short birth interval has 36 (7.1) 194 42 (8.3) 207 25 (5.0)

health problems (38.5) (41.1)

Having many children 59 (11.7) 205 30 (6.0) 174 36 (7.1)

makes less happy than (40.7) (34.5)
having fewer one

Having many children 43 (8.5) 96 (19.0) 30 (6.0) 307 28 (5.6)

reduces the quality of care (60.9)
given for them

Women who have female 21 (4.2) 98 (19.4) 90 (17.9) 262 33 (6.5)

children, should deliver (52.0)
until they got male children

The majority of Rohingya mothers (48.8%) agreed that the optimal birth interval is important,
while only 5.8% strongly disagreed. A significant portion, 48.8%, of mothers disagree that
applying an optimal birth interval is important, while 21.6% agree with this statement. Regarding
the necessity of the husband's willingness for birth interval decisions, 53.8% agree, and 18.7%
strongly agree. When it comes to the belief that delivering until a male child is gained is
recommended, 26.0% agree, and 4.8% strongly agree. Similarly, 21.4% agree that a 2-year birth
interval is sufficient, with 17.1% strongly agreeing. Health problems associated with having

20
many children are acknowledged by 21.4%, while 17.7% strongly agree with this issue. The
impact of having many children on women's physical and psychological well-being is seen as a
concern by 29.4% of mothers, with 12.9% strongly agreeing. The corresponding impact on
fathers is agreed upon by 24.0% of mothers, with 16.3% strongly agreeing. There is a notable
disagreement, 56.3%, against the recommendation of delivering until a male child is gained, and
1.8% strongly disagree with this notion. The belief that having many children proves women's
fertility is disagreed upon by 41.7%, with 2.0% strongly disagreeing. When considering divine
influence on family planning, 11.3% agree that there is no need to limit children since it is out of
God's control, while 2.8% strongly agree. The economic advantage of having fewer children is
recognized by 58.1%, with 6.0% strongly agreeing. Conversely, 42.3% strongly disagree that
females have equal power to limit children as males, and 41.7% disagree with this statement. The
belief that having fewer children makes the family economically unstable is held by 53.6%, with
7.1% strongly agreeing. Additionally, 55.6% agree that many children can make the family
psychologically unstable, with 6.0% strongly agreeing. The health problems associated with a
short birth interval are agreed upon by 41.1%, with 5.0% strongly agreeing. The notion that
having many children makes a family less happy than having fewer children is agreed upon by
34.5%, with 7.1% strongly agreeing. Furthermore, 60.9% agree that having many children
reduces the quality of care given to them, while 5.6% strongly agree. Lastly, 52.0% of mothers
agree that women who have female children should continue delivering until they have male
children, with 6.5% strongly agreeing.
These findings underscore the complex interplay of cultural, gender, and socioeconomic factors
shaping reproductive attitudes among Rohingya mothers. They highlight the need for culturally
sensitive and gender-responsive approaches in reproductive health interventions to address the
diverse needs and perspectives within the community.

Table 4. Distribution of practice-related attributes among the Rohingya mothers (N=504)

Variables Categories Frequency (n) Percentage (%)

Already practice birth spacing?

Yes 233 46.2

No 271 53.8

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 Which type of birth spacing do you have
chosen?
Short term 104 20.6

Long term 22 4.4

Natural 378 75.0

Are you satisfied with the birth spacing

technique?
Yes 255 50.6

No 249 49.4

Is proper service available in camp for

practice birth spacing?
Yes 344 68.3

No 160 31.7

The distribution of practice-related attributes among the Rohingya mothers (N=504) revealed
that 46.2% already practiced birth spacing, while 53.8% did not. Among those who practiced
birth spacing, 20.6% chose short term methods, 4.4% chose long term methods, and 75.0% chose
natural methods. Additionally, 50.6% of mothers were satisfied with their chosen birth spacing
technique, while 49.4% were not. Furthermore, a majority of mothers (68.3%) reported that
proper services for practicing birth spacing were available in the camp, while 31.7% reported
that they were not available.

Knowledge aTTITUDE
Poor Good Negative Positive

35%
43%
57%
65%

Practice
22
Good Bad
 42%

58%

Figure 2. Distribution of the study participant's level of Birth spacing Knowledge(left), Attitude
(right) and Practice(below) Score among Rohingya mothers (n=504)

The study's findings on the participants' levels of knowledge, attitude, and practice regarding
birth spacing reveal significant gaps. Specifically, 57.3% of participants have poor knowledge
about birth spacing, while 42.7% possess good knowledge. Attitudinally, a majority of 64.7%
exhibit negative attitudes towards birth spacing, in contrast to the 35.3% who have positive
attitudes. In terms of practice, 42.5% of participants employ good birth spacing methods,
whereas 57.5% engage in poor practices. These results underscore the critical need for targeted
educational and behavioral interventions to enhance birth spacing knowledge, attitudes, and
practices among the study population.

Table 5. Factors that affect not practicing birth spacing based on multinomial logistic regression

Factors Odd 95% CI (Lower Bound-Upper Bound) P-value

Ratio

Age

<18 years 0.497 0.016-15.275 0.689

18 - 25 years 0.235 0.008-6.959 0.402

> 25 years Reference category

Household Income

23
 Less than 10 thousand 26.243 2.979-231.211 0.003*

Between 11 to 25 5.473 0.641-46.707 0.120

thousand

More than 25 thousand Reference category

Respondent’s Education

Unable to read and 0.294 0.022-3.96 0.356

write

Able to read and write 0.370 0.027-5.013 0.455

Primary education 0.578 0.040-8.444 0.689

Secondary and above Reference category

Respondent’s Occupation

Housewives 0.741 0.416-1.320 0.309

Employed Reference category

Respondent’s Husband Education

Unable to read and 0.554 0.161-1.904 0.348

write

Able to read and write 0.585 0.176-1.944 0.382

Primary education 1.010 0.315-3.235 0.987

Secondary and above Reference category

Respondent’s Husband Occupation

Others 2.103 0.117-37.865 0.614

Unemployed 2.070 1.345-3.185 0.001*

Farmer 0.107 0.024-0.487 0.004*

Employed Reference category

Here, the asterisk (*) indicates a significant association at a 95% confidence interval level (P<0.05).

24
The multinomial logistic regression analysis revealed several significant factors influencing the
likelihood of not practicing birth spacing among Rohingya mothers (N=504). Household income
emerged as a significant predictor, with mothers earning less than 10 thousand exhibiting
substantially higher odds of not practicing birth spacing compared to those earning more than 25
thousand (OR=26.243, p=0.003). Furthermore, husbands' occupation had a notable impact, as
unemployed husbands were less likely to practice birth spacing than employed ones (OR=2.070,
p=0.001). Conversely, farmers demonstrated significantly lower odds of not practicing birth
spacing compared to employed individuals (OR=0.107, p=0.004). However, variables such as
age, education level, and occupation of the respondents did not yield significant effects on birth
spacing practices. These findings underscore the socioeconomic dynamics influencing
reproductive behaviors among Rohingya mothers, emphasizing the need for targeted
interventions to address disparities and promote informed family planning decisions within the
community.

Chapter 5

Discussion

Our investigation into knowledge, attitude, practice regarding birth spacing practices among
Rohingya refugee women in Cox’s Bazar. Besides results on birth spacing practices among
Rohingya refugee women in Cox’s Bazar camps revealed a nuanced landscape of reproductive
health within displaced populations. The findings elucidate critical factors influencing
contraceptive use and highlight the multifaceted nature of reproductive decision-making in
challenging contexts.

The study identified that 46.2% of respondents engage in birth spacing, predominantly through
natural methods (75.0%), with household income significantly influencing practices. This
underscores the resilience of Rohingya women in navigating their reproductive health despite
adversities. However, the prevalence of natural methods also indicates limited access to modern
contraceptives, aligning with Hasan's assertion that refugee settings often face constraints in
accessing comprehensive reproductive health services (Hasan, 2019).

25
In contrast to our findings, Ahmadi et al. reported a higher prevalence of birth spacing in Iran
(75.2%), suggesting contextual variations in contraceptive practices (Ahmadi et al., 2018). While
satisfaction levels with chosen methods were comparable, our study highlighted lower
availability of proper services for birth spacing, emphasizing disparities in service accessibility
across contexts.

Moreover, the study revealed significant gaps in knowledge regarding the legal age for marriage
among respondents, echoing Tanabe et al.'s findings on reluctance towards modern birth control
methods among refugees due to cultural and religious factors (Tanabe et al., 2017). This
underscores the importance of addressing cultural beliefs and norms in family planning
interventions, as emphasized by Chowdhury et al. (2018).

Furthermore, the influence of male partners on birth interval decisions underscores the need for
promoting male involvement in family planning programs, aligning with Khan et al.'s assertion
on the significant impact of male approval on contraceptive use (Khan et al., 2021). Culturally
sensitive interventions engaging both genders are crucial for challenging traditional gender
norms and fostering equitable decision-making processes.

The findings of this study highlight significant gaps in the knowledge, attitudes, and practices
regarding birth spacing among Rohingya refugee women in Cox's Bazar. With 57.3% of
participants exhibiting poor knowledge, 64.7% demonstrating negative attitudes, and 57.5%
engaging in poor birth spacing practices, it is evident that there is a critical need for targeted
educational and behavioral interventions. These gaps are further compounded by socioeconomic
factors, with lower household income and unemployment among husbands negatively impacting
birth spacing practices. Comparatively, other studies have found similar trends in displaced and
marginalized populations. For instance, research conducted among refugee populations in Jordan
found that inadequate knowledge and negative attitudes towards contraceptive use were
prevalent, significantly affecting birth spacing practices (Krause et al., 2015). Similarly, a study
in Uganda among internally displaced women revealed that socio-cultural beliefs and
misconceptions about contraceptives were major barriers to effective birth spacing (Sileo et al.,
2019). In contrast, studies in more stable environments show better outcomes. For example, in a
study conducted in urban areas of Ethiopia, a higher level of awareness and positive attitudes
towards family planning correlated with improved birth spacing practices (Assefa et al., 2017).

26
This comparison underscores the importance of stability and access to comprehensive
reproductive health education and services in improving birth spacing practices.

Our study offers a comprehensive examination of birth spacing practices among Rohingya
refugee women in Cox’s Bazar camps, providing valuable insights into previously underexplored
aspects of reproductive health. By employing robust cross-sectional study methodology, we
ensured the reliability and validity of our findings, enhancing the credibility of the research
outcomes. The inclusion of socio-cultural, economic, and structural factors enriched our
understanding of birth spacing practices within the Rohingya community. Moreover, comparative
analysis with existing literature augmented the depth of our research, revealing variations in
contraceptive practices and service accessibility across different populations.

Nevertheless, our study faces limitations that warrant consideration. Reliance on self-reported
data may introduce bias, potentially affecting the accuracy of our findings. The cross-sectional
design limits our ability to establish causal relationships between variables, indicating the need
for longitudinal research to track changes over time. Additionally, the sample size and potential
selection bias may restrict the generalizability of our findings to the broader Rohingya
population.

Moving forward, our study suggests several recommendations for future research and
interventions. Longitudinal studies can provide insights into changes in birth spacing practices
and reproductive health outcomes over time. Culturally sensitive interventions tailored to the
socio-cultural context of the Rohingya community are essential for promoting contraceptive use
and birth spacing practices. Community engagement, involving local stakeholders and leaders, is
crucial for designing and implementing effective reproductive health programs. Efforts should
focus on improving access to comprehensive reproductive health services, empowering
Rohingya women to make informed decisions about their reproductive health.

27
 Chapter 6

Conclusion

The study identifies significant gaps in knowledge and attitudes regarding birth spacing among
Rohingya refugee women in Cox’s Bazar camps. While traditional contraceptive methods are
known, understanding and adoption of modern contraceptives are limited, influenced by socio-
cultural and religious factors. Attitudinal barriers further impede effective family planning.

Addressing these challenges necessitates multifaceted approaches prioritizing education,

community engagement, and diverse contraceptive options. Culturally sensitive interventions
involving both genders are crucial for informed decision-making. Improved access to
reproductive health services within camps is vital for empowering women and enhancing
maternal and child health outcomes.

Efforts must be ongoing and collaborative. Longitudinal studies can evaluate intervention
effectiveness, while partnerships with local organizations enhance cultural relevance. By
prioritizing education, access, and community engagement, we can bridge the knowledge gap in

28
birth spacing among Rohingya refugee women, contributing to their overall well-being and
empowerment.

Chapter 7
References
Ainul, S., Ehsan, I., Haque, E., Amin, S., Rob, U., Melnikas, A. J., & Falcone, J. (2018).
Marriage and sexual and reproductive health of Rohingya adolescents and youth in
Bangladesh: A qualitative study. Population Council.
https://knowledgecommons.popcouncil.org/cgi/viewcontent.cgi?
article=1467&context=departments_sbsr-pgy
Ahmadi, M., Moosazadeh, M., & Roudbari, M. (2018). Utilization of modern contraceptive
methods and its predictors among women who had under-five children in the last five
years in Iran. Journal of Research in Medical Sciences, 23(1), 60.
Ahmed, S., Choi, Y., Rimon, J., Alzouma, S., & Gichangi, P. (2017). Trends in contraceptive
prevalence rates in sub-Saharan Africa since the 2012 London Summit on Family
Planning: Results from repeated cross-sectional surveys. Lancet Global Health, 5(5),
e402-e413.
Ahmed, S., Kamal, M. M., & Rahman, M. A. (2019). Contraceptive use among Rohingya
refugees in Bangladesh. BMC Women's Health, 19(1), 1-6.
Assefa, H., Fikru, C., & Melesse, Y. (2017). Knowledge, Attitude and Practice of Birth Spacing
among Women in Urban Areas of Ethiopia. Ethiopian Journal of Health Development,
31(2), 77-85.

29
Azad, A. K., Reza, M. M., Das, S., & Kamruzzaman, M. (2022). Reproductive health knowledge
and practice among Rohingya refugee women in Bangladesh. Reproductive Health,
19(105). https://doi.org/10.1186/s12978-022-01410-0
Azad, S. (2019). The child was born in a Rohingya camp in search of relief. Daily Jugantor.
Retrieved from https://www.jugantor.com/todays-paper/city/180508
Casey, S. E., Chynoweth, S. K., Cornier, N., Gallagher, M. C., & Wheeler, E. E. (2018).
Progress and gaps in reproductive health services in three humanitarian settings: Mixed-
methods case studies. Conflict and Health, 12(1), 20.
Choudhury, R. K., Pal, M., Datta, N., & Misra, R. (2019). Factors influencing the spacing of
children in a rural district of West Bengal: A multivariate analysis. Journal of Family
Medicine and Primary Care, 8(7), 2283–2288.
Chowdhury, A. I., Khan, M. N., & Islam, M. M. (2020). Factors influencing family planning
practices among married Rohingya refugees in Bangladesh: A qualitative study.
Reproductive Health, 17(1), 1-11.
Chowdhury, M. A. K., Billah, S., Karim, F., Khan, A. N. S., Islam, S., & Arifeen, S. E. (2018).
Report on demographic profiling and needs assessment of maternal and child health
(MCH) care for the Rohingya refugee population in Cox’s Bazar, Bangladesh. Dhaka:
Maternal and Child Health Division, ICDDR,B.
DBC News. (2019). Excessive birth rate in Rohingya camps. Retrieved from
https://dbcnews.tv/news/15d0efeaa736e0
Hasan, K. (2019). Rohingya crisis: population exploding as 91,000 babies are born in two years.
Dhaka Tribune. Retrieved from https://www.dhakatribune.com/bangladesh/rohingya-
crisis/2019/08/29
Hasan, M., Akter, T., & Das, R. (2018). Family planning awareness and practices among the
women in a selected slum area in Dhaka city. Journal of Medicine, 19(1), 39-43.
Health Sector Cox’s Bazar, Government of Bangladesh, SRH Working Group Cox’s Bazar.
(2021). SRH Working Group’s strategy on family planning for the Rohingya
humanitarian crisis 2021–2023. UNFPA.
https://bangladesh.unfpa.org/sites/default/files/pub-pdf/clean_final_srh_wg_s_family_pla
nning_strategy_2021.pdf
Inter Sector Coordination Group (ISCG). (2017). Situation report: Cox’s Bazar influx. ISCG.
https://www.humanitarianresponse.info/sites/www.humanitarianresponse.info/files/
documents/files/170920_iscg-sitrep_influx-august-2017-1_0.pdf
Inter Sector Coordination Group (ISCG). (2018). Situation report Rohingya refugee crisis: 1
November 2018. Retrieved from
https://reliefweb.int/sites/reliefweb.int/files/resources/iscg_situation_report_1_nov_2018.
pdf
Islam, M. M., Khan, M. N., & Ahmed, S. (2019). Knowledge, attitude and practice of
contraception among the women living in Rohingya refugee camps in Bangladesh: A
cross-sectional study. BMC Women's Health, 19(1), 1-9.
30
Joarder, T., Sutradhar, I., Hasan, M. I., & Bulbul, M. M. I. (2020). A record review on the health
status of Rohingya refugees in Bangladesh. Cureus, 12(8).
Kamal, S. M. M. (2012). Socioeconomic factors associated with contraceptive use and method
choice in urban slums of Bangladesh. Asia-Pacific Journal of Public Health, 24(3), 506-
525.
Karin, S. (2020). Status of Rohingya in refugee camps of Bangladesh: a review study. Open
Access Library Journal, 7(09), 1. https://doi.org/10.4236/oalib.1106575
Khan, M. N., Islam, M. M., Rahman, M. M., & Rahman, M. M. (2021). Access to female
contraceptives by Rohingya refugees, Bangladesh. Bulletin of the World Health
Organization, 99(3), 201.
Krafft, C., El-Khoury, M., & Kohler, P. (2019). How does access to health care affect fertility
and women's empowerment? Evidence from Syria. The World Bank Economic Review,
33(2), 276-301.
Krause, S. K., Jones, R. K., & Purdin, S. J. (2015). Programmatic Responses to Refugees’
Reproductive Health Needs. International Family Planning Perspectives, 31(4), 181-186.
Malteser International. (2019). Inside the Kutupalong refugee camp, Cox’s Bazar. Retrieved
from https://www.malteser-international.org/en/our-work/asia/bangladesh/life-in-a-
refugee-camp.html
Melnikas, A. J., Ainul, S., Ehsan, I., Haque, E., & Amin, S. (2020). Child marriage practices
among the Rohingya in Bangladesh. Conflict and Health, 14(1), 1–12.
https://doi.org/10.1186/s13031-020-00274-0
Rahman, M. M., Alam, A., & Khanam, R. (2020). Contraceptive use among the Rohingya
women living in the refugee camps in Cox's Bazar, Bangladesh: A cross-sectional study.
PloS One, 15(6), e0234537.
Rahman, M., Haider, M. M., Hasan, M. M., Sohag, A. A. M., & Moniruzzaman, M. (2018).
Factors affecting knowledge and attitude of married women regarding family planning
methods in rural Bangladesh. International Journal of Perceptions in Public Health, 2(4),
303-312.
Sileo, K. M., Wanyenze, R. K., Lule, H., & Kiene, S. M. (2019). Determinants of Family
Planning Service Uptake and Use of Contraceptives Among Postpartum Women in Rural
Uganda. International Journal of Public Health, 64(5), 673-683.
Tanabe, M., Myers, A., Bhandari, P., Cornier, N., Doraiswamy, S., & Krause, S. (2017). Family
planning in refugee settings: findings and actions from a multi-country study. Conflict
and Health, 11(1), 9. https://doi.org/10.1186/s13031-017-0112-2
UNHCR. (2018). Reproductive Health in Refugee Situations: An Inter-agency Field Manual.
United Nations High Commissioner for Refugees.
United Nations High Commissioner for Refugees (UNHCR). (2021). 2021 joint response plan
for Rohingya humanitarian crisis. UNHCR.
https://reporting.unhcr.org/sites/default/files/2021-12/2021%2520JRP.pdf

31
United Nations Population Fund (UNFPA). (2017). UNFPA Rohingya humanitarian response
monthly situation report. UNFPA. https://bangladesh.unfpa.org/sites/default/files/pub-
pdf/UNFPA_SitRep_External__16-March%202018%20Final.pdf
United Nations Population Fund (UNFPA). (2021). Family planning strategy 2021. UNFPA.
https://bangladesh.unfpa.org/sites/default/files/pubpdf/clean_final_srh_wg_s_family_plan
ning_strategy_2021.pdf
Women’s Refugee Commission (WRC). (2019). A clear case for need and demand: accessing
contraceptive services for Rohingya women and girls in Cox’s Bazar. Women’s Refugee
Commission.
https://www.womensrefugeecommission.org/wp-content/uploads/2020/04/Contraceptive-
Service-Delivery-in-the-Refugee-Camps-of-Cox-s-Bazar-Bangladesh-05-2019.pdf

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