For Asma, the sound of the school bells ringing always took down her a lane of nostalgia and pleasant memories. The smell of new books mesmerised her, she loved writing with her special pink pen that she holds close to her heart, and she loved letting her imagination run wild while writing poetry and stories. Growing up, she aspired to become a writer. Little did she know that the hands she would have used to write stories would have been used to hold a small infant in her arms.
The firstborn of a young mother, 13-year-old Asma was always shouldered with the responsibility of not only taking care of her four younger siblings and her chronically ill mother, but also managing household chores. Because of these responsibilities, she could not attend classes regularly. However, whenever she did go to class, she treasured each class to its fullest. Unable to handle the workload that came with raising five children, her mother eventually suffered from dementia. Her father was barely making ends meet to provide for his family, despite pulling rickshaws all day. Whatever little time Asma had to complete her homework was spent in the dark because of the lack of electricity.
Poverty derailed Asma and her family to the point where her parents made the decision to marry her off to their neighbours' 25-year-old son. It goes without saying that Asma had to bid farewell to her books and throw in the towel in her ring of dreams of becoming a writer. Instead of waking up and putting on her school uniform, she woke up to the retorts of her mother-in-law ordering her to cut the vegetables and do the family's laundry in the nearby pond. While she labouriously toiled around the house to make her in-laws happy during the day, she eagerly awaited her husband's return from work in the evening. However, sometimes these efforts would go in vain because he would not come back some nights. On some nights, he would even yell at her, and in many cases, demean her for no apparent reason. And she woke up with the physical and emotional scars of a domestic violence, even after she found out she was carrying their child.
Unbeknownst to Asma and her family, she was suffering from a complicated pregnancy which required constant bedrest. The nearest hospital was five kilometres away from their home and they had no means of getting to the hospital unless they took the local bus. For Asma, hopping on the bus would mean taking out the 15 taka from her pocket that she did not have and enduring unwanted staring and attention from men on the bus, unless she was with her husband. Moreover, she was too weak to even walk to the bus stop and her mother-in-law much preferred her to invest her time in managing the household responsibilities. With each passing month, Asma became increasingly weak but her husband and in-laws brushed it off as her not being "mentally strong enough". Asma is also severely underweight for her age and did not get adequate nutrition, considering the fact that she was eating for two. Merely seven months into the pregnancy with the help of just her female relatives and a blanket, she gave birth to a severely underweight baby boy, unsure of whether she will be able to celebrate his first birthday.
Asma is one of many cases exemplifying why it is important to prioritise gender in bringing forth change for a more prosperous nation. According to the United Nations (UN) estimates, as of 2018, 750 million girls were married before the age of 18. Moreover, one in five women and girls have experienced physical violence by an intimate partner within the past year. In light of these issues and other gender-related complexities, Sustainable Development Goal 5 was developed in order to "Achieve gender equality and empower all women and girls".
The Sustainable Development Goals (SDGs) are critical blueprints into a more resilient and prosperous world, consisting of seventeen different components, attempting to achieve sustainable development by 2030. Specifically, the fifth SDG, emphasises that gender equality is a multifaceted phenomenon that highlights the importance of equal access to education, healthcare, a sustainable career and financial security, and representation in economic and political decision-making process. Although the world has faced upward trends in terms of achieving progress towards gender equality and female empowerment, women and girls still experience discrimination and violence, particularly in developing countries, not excepting Bangladesh.
Specifically, one of the Goal 5 targets, which are outlined in the box, is centred on eliminating all harmful practices, such as "child, early and forced marriage", which still remains a common practice in rural Bangladesh. As a result, it compromises adolescent girls' ability to get an education, and increases their chances of becoming pregnant before reaching adulthood, both of which can be detrimental to their health.
Another Goal 5 target is to "ensure universal access to sexual and reproductive health and reproductive rights". Asma's story depicts how the extra layer of vulnerability associated with gender inequality can influence women's uptake of healthcare services. Because of limited access to education, women are severely uninformed about important health issues, particularly in the case of sexual and reproductive health issues since these topics remain highly stigmatised in our society, and are not normally discussed in everyday conversation. Moreover, the importance of availing these healthcare services is not emphasised, thus leading to limited awareness about available healthcare services for sexual and reproductive health issues. In particular, young women in their adolescent years report the highest rates of late or no prenatal care. According to recent UNICEF estimates, only 46 per cent of the women in South Asia received at least four antenatal visits throughout the course of their pregnancy. However, in rural Bangladesh, even fewer women and girls have limited access to healthcare facilities and skilled birth attendants, such as physicians, midwives or other adequately trained community-based birth attendants. This is due to various reasons such as but not limited to: far distances from healthcare facilities, lack of transportation options, lack of awareness about the importance of seeking healthcare, limited awareness about sexual and reproductive health issues and the lack of perceived urgency in case of complications. When trying to solve public health issues, it is important to understand and explore the underlying reasons prior to designing public health interventions.
Asma's story is by no means uncommon. In fact, she is one of the many young women and girls who face these socio-cultural issues, for which their health is compromised. Since these health issues are prevalent enough to affect a whole community, they eventually become public health concerns. Therefore, in order to tackle these public health concerns, it is essential to facilitate multidisciplinary public health interventions in order to address these issues. One of the most effective ways to design public health interventions is by using the bottom-up approach. In other words, we could identify the problems faced by the local people based on the socio-cultural context in which they reside and then design our interventions accordingly, using feasible solutions. It would be beneficial to keep the SDGs in mind when designing these interventions because they can provide more specific goals for the betterment of the health of our communities. Therefore, in an ideal situation, the women and girls of our community can know about their health issues and know what they can do about, while not having to worry about whether they will make it safe at the end of the day.
Samira Dishti Irfan is currently working as a Research Officer in the Infectious Diseases Division of International Centre for Diarrhoeal Diseases, Research, Bangladesh (icddr,b). She attained her Bachelor's degree in Integrative Biology from University of California, Berkeley and her Master’s in Public Health (MPH) from North South University.
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