Monograph Series (James P. Grant School of Public Health)

Permanent URI for this collectionhttps://hdl.handle.net/10361/123

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Sexuality and power: a follow-up workshop on sexuality and rights
(James P. Grant School of Public Health (JPGSPH), BRAC University, 10/9/2009) Hashemi, Anuradha
International gender and sexuality workshop papers
(James P. Grant School of Public Health (JPGSPH), BRAC University, 2009-10) Center for Gender, Sexuality and HIV/AIDS: a UNAIDS Collaborating Center
To act or no to act ? section 377 of the Bangladesh penal code
(James P. Grant School of Public Health (JPGSPH), BRAC University, 2009-10) Siddiqi, Dina M.
Workshop on sexuality , health and media , March 2009
(James P. Grant School of Public Health (JPGSPH), BRAC University, 2009-03) Silmi, Kazi Priyanka
HIV and AIDS interventions in Bangladesh : success , challenges and ways forward
(James P. Grant School of Public Health (JPGSPH), BRAC University, 2009-06) Center for Gender, Sexuality and HIV/AIDS: a UNAIDS Collaborating Center
Bangladesh health system in transition: selected articles
(James P. Grant School of Public Health (JPGSPH), BRAC University, 2009) Islam, Anwar
Brainstorming session on "sexuality and rights"
(James P. Grant School of Public Health (JPGSPH), BRAC University, 7/14/2008) Chowdhury, Shahanoor Akter
Reproductive health & behavior change communications : situational analysis / existing interventions in Bangladesh
(James P. Grant School of Public Health (JPGSPH), BRAC University, 2006) Kozara, Kasey Maia
Existing reproductive and sexual health interventions to young people in South Asia
(James P. Grant School of Public Health (JPGSPH), BRAC University, 2009) Hashem, Rumana
Lesson from Jim Grant's vision for public health
(James P. Grant School of Public Health (JPGSPH), BRAC University, 2005) Gautam, Kul C.
Violence against women in Bangladesh: situational analysis/existing interventions
(BRAC James P Grant School of Public Health, 2007-12) Chowdhury, Sabiha
Sexuality and rights workshop
(BRAC James P Grant School of Public Health, 2007-01) Ahmed, Nabil; Fellow, Fulbright
Reproductive tract infections and sexually transmitted infections of women in Bangladehs: a literature review
(BRAC James P Grant School of Public Health, 2007-12) Chowdhury, Sabiha
This literature review focuses on what is known about reproductive tract infections and sexually transmitted infections (RTIs/STIs) in Bangladesh from published studies. TIS/STIs can have negative consequences on the health, social life, and economic situation of women. Negative consequences on health include not just physical discomfort but also infertility, ectopic pregnancy, cervical cancer, fetal wastage, low birth weight, infant blindness, neonatal pneumonia and mental retardation. Socially, lack of awareness and cultural taboos increase a woman’s risk of contracting RTI/STI due to unsafe behavior and then inhibit them from discussing their problems and seeking appropriate treatment. Economically, STIs rank among the five most important causes of loss of productive life lost in developing countries, accounting for the wastage of several million dollars a year. Thus it is imperative that RTIs/STIs be addressed. Currently, there is no prevalence data available on RTIs/ STIS in Bangladesh. This paper compiled findings from 6 qualitative studies and 12 quantitative cross sectional studies on sex workers, rural women and health providers. It looks at five issues. First it looks at the occurrence of RTIs/STIs among different populations – pregnant women, sex workers, rural women, women visiting an urban healthcare clinic, and views of health providers with RTI/STI infected patients. Some of the prevalence studies found high STIs among sex workers in brothels and among women living near truck stands as compared to rural women and urban slum women. Second, it looks at their perceptions about RTIs/ STIs. The qualitative studies found that women did not view RTIs as purely a biomedical problem, but blamed it on the larger stresses in their lives, social economic and financial. However, many of the urban and rural women were aware of RTIs/STIs but perceived no clear difference in symptoms and consequences between RTIs and STIs. Other studies revealed that 65% of 260 homeless people were aware of STIs while 79% of 401 teagarden workers were not aware of STIs. Hygiene (washing one’s private parts after intercourse), use of condom and observing religious rules were perceived as preventive measures for RTIs/STIs among rural women in a study. Third, it discusses some of the factors that are causing RTIs/STIs among Bangladeshi women. Literature shows these factors include side effects of contraceptives, low condom use and poor negotiation skills, lack of partner communication and partner management, menstrual hygiene, and high-risk behavior. Fourth, it looks at some of the health providers Bangladeshi women seek health care from for their RTIs/STIs. The review found that treatment was sought mostly from female relatives and friends, healers, homeopaths, pharmacists and the least from allopathic doctors as it is culturally prohibited for women to be seen, let alone be physically examined, by any male other than her husband. Fifth it discusses how RTIs and STIs are managed – through programmatic forms and diagnosis. Programmatic forms include dissemination of STI knowledge through NGOled health forums, epidemiological treatment for populations with high STI prevalence, incorporation of both biomedical and cultural aspects to treatment of vaginal discharge so that the deep psychological and / or spiritual dimensions don’t go unattended. Furthermore, studies in cross-cultural psychiatry help clarify the associations between emotional distress (including depression) and unexplained gynecological symptoms. Multisectoral and interdisciplinary coalitions are needed to address lack of coordination among policy makers, weak programme management and structure as well as political unwillingness which inhibit the progress of policy into action. A study on diagnosis of STIs found that the speculum-based algorithm might be a cheap and effective diagnostic and management tool. Syndromic diagnosis and management of cervical STIs is highly compromised due to lack of diagnostic tools and by the low specificity or absence of clinical signs.
Daily health concerns in Kakabo anthropological explorations in a Bangladeshi village
(James P. Grant School of Public Health, BRAC University, 2008-08) Geest, Sjaak Van der; Selim, Nasima; Zaman, Shahaduz
Menstrual Problems of Women in Bangladesh
(BRAC James P Grant School of Public Health, 2007-12) Chowdhury, Sabiha
Bangladeshi women suffer from menstrual problems such as dysmenorrhoea, menorrhagia, light and heavy bleeding during menstruation, and irregular period and are constantly worried if they menstrual flow is not a “normal” amount. They believe that a good menstrual flow is needed to stay healthy. If the flow decreases, they think that they’re must be “bad blood” trapped within their bodies, and if it stops altogether, they are concerned that they may have become infertile. Inability to conceive is viewed negatively in Bangladeshi society and women are subjected to psychological distress by society if they are perceived as infertile. Also, there are many social, cultural and religious taboos surrounding menstruation such as staying away from food such as fish, eggs, meat, sour fruits, etc during menstruation. Moreover, they are often advised to stay indoors as menstrual blood may attract evil spirits. Furthermore, these women also experience menstrual problems as side effects of contraceptives such as Norplant, IUD, and the pill, and sometimes discontinue its use as a result which may lead to unplanned pregnancies. Gynecological problems such as those related to menstruation are a major concern among Bangladeshi women, but social stigma and shame stand as a barrier against seeking proper healthcare. Often, they seek health advice from female relatives and unqualified health providers which in turn often leads to incorrect treatment and chronic menstrual related illnesses. Only a few studies have been carried out on menstrual problems in Bangladesh and most of them are either part of larger studies on side effects of contraceptives or a few small-scale exploratory studies. The aim of this literature review is to learn about local terminologies used to describe menstrual problems, to understand the practices and restrictions surrounding menstruation during adolescence, to learn about concerns surrounding infertility and its causes, to look at menstrual problems which result from use of contraceptives, and to examine patterns of health seeking behaviour of Bangladeshi women to treat their menstrual illnesses. This literature review was carried out by obtaining information from published reports, books and articles collected from local NGOs. Some information was also gathered from interviews with staff from local NGOs and gynaecologists from Bangladesh Railway Hospital. The review found that notions surrounding menstrual blood include perceptions that it is polluted and women should not serve food during this condition or touch anyone with an eye or skin infection as it may worsen their illness. Religious teaching also states that women are polluted during menstruation and cannot offer prayers in this state. Women tend to use local terminology to refer to menstrual problems such as kaler chut for dysmenorrhoea, humka batas for menorrhagia, and khum jhore if they get their periods twice or more a month. Perceived causes of menstrual related illnesses include evil spirits, lack of enough food, birth control pills, etc. During adolescence, girls are taught about the various restrictions during menstruation such as not going outside and staying away from certain foods such as fish, eggs, meat, sour fruits. When they encounter menstrual problems, family members either take them to traditional and religious healers such as per, fakir and huzurs or their mothers send someone to buy medicine from the pharmacy. Bangladeshi women from lower socio economic backgrounds mostly use menstrual rags to absorb menstrual blood. These rags are often not washed well with soap. Also they are dried in dark places as it is considered embarrassing if others see these rags and it is believed that ghosts, fakirs, crows and flies can cause menstrual problems if they come in contact with these rags. These improper cleaning practices cause women to get illnesses such as RTIs from these rags. When menstrual flow is low or absent, women often perceive themselves to be infertile. Fertility is highly valued in Bangladeshi society and infertile women face many forms of social rejection and marginalization from their communities. In several studies, it was found that women blame evil spirits for their infertility. As Bangladeshi women equate a regular amount of menstrual flow with good health, contraceptive methods which alter this flow are causes for concern among these women. A study showed that use of Norplant implants cause dysmenorrhoea, intermenstrual bleeding or amenorrhea which the women dislike, yet they continue to use this method because of its effectiveness as a contraceptive. DMPA injectables were shown to cause spotting or amenorrhea among its users, but also had benefits of improving dysmenorrhoea with time. Oral contraceptives were shown to cause mainly intermenstrual bleeding but lowered menstrual pain, amount of menstrual flow and duration of menstruation. The intra uterine device (IUD) was said to cause excessive menstrual bleeding (22-24%), irregular menstruation (11-12%) and lower abdominal pain (11-13%) among 801 women in a study. About a quarter of the women reported pain during the last menstrual period and virtually all said they had no intermenstrual bleeding. Among the 198 who had discontinued use, 34.3 % had reported excessive bleeding, 17.2% reported complete expulsion, and 16.1% stated lower abdominal pain/white discharge as the causes for discontinuation. Other studies showed women to be concerned whether Norplant causes amenorrhoea because they feel impure blood is trapped within their bodies or when Norplant or IUD causes continuous bleeding because they cannot go near their husbands, pray or prepare food, as they are perceived to be in a polluted state. Despite the side effects some women may choose to continue use of Norplant as it protects them for 5 years from getting pregnant. Women in some studies also agonized when the pill or injectables brought about amenorrhoea because they believed the methods had dried out the uterus and had made them infertile. Women tend to ask other women for advice for their gynecological problems, especially women from their natal homes but rarely those who are their in laws according to a study. They also asked a traditional healer (kabiraj) from problems such as menorrhagia as they feel that these illnesses are caused by evil spirits which only traditional healers can cure. Herbal pills that cause severe bleeding are prescribed when menstrual blood is thought to be trapped within the womb by herbalists. Another method employed to remove this trapped blood is D&C (Dilation and Curettage) which “washes” out the perceived build up of fat.

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