Investigation of factors impacting sexual and reproductive health literacy and access to services among young Rohingya refugee women in Bangladesh

Abstract

Background: The Rohingya refugee crisis in Cox’s Bazar, Bangladesh, remains a severe humanitarian emergency. Young Rohingya women aged 15-24 years are especially at risk of adverse SRH outcomes due to early marriage, high fertility, short inter‐pregnancy intervals, and gendered power imbalances that limit their autonomy. This doctoral research investigated their SRH literacy and the sociocultural and structural barriers and facilitators of their access to and use of SRH services within the camps.

Methods: This research employed a mixed-methods design. A systematic review was followed by a cross-sectional survey of 686 young women across eight camps in Cox’s Bazar. Simultaneously, a qualitative phenomenological study involving 40 participants (including young women, men, leaders, and providers) explored lived experiences. Data were integrated through an intersectional socio-ecological framework to interpret findings.

Results: Quantitative findings revealed that while 84.7% of married participants were aware of FP, only 27% possessed functional literacy regarding specific methods, and contraceptive prevalence was 44.9%. Husband-controlled decision-making halved the likelihood of contraceptive use. HIV/STI awareness was low (12.4%), with testing uptake under 3%. Literacy, employment, and fieldworker visits were significant predictors of service engagement. Qualitatively, barriers included myths and shame (intrapersonal), patriarchal surveillance (interpersonal), and religious stigma (community). Structural barriers centred on "place-based" paradoxes, restrictive policies, and the lack of youth-friendly, private infrastructure.

Conclusion: This study highlights that SRH outcomes are dictated by a complex interplay of systemic exclusion and gendered power. It proposes a multi-tiered framework emphasising peer-led education, male engagement, and structural policy reforms to transition from emergency aid toward rights-based, sustainable SRH care.