Sexual Health

Barriers to access and utilization of sexual and reproductive health services among young Rohingya refugees in Bangladesh.

TL;DR

Substantial barriers limit SRH service access for young Rohingya refugees, especially unmarried individuals, requiring services tailored to marital status, gender, age, and prevailing community norms.

Key Findings

Young Rohingya refugees primarily relied on informal social networks rather than formal health systems for SRH information.

  • The most common sources of SRH information were friends, cousins, and elder siblings, in addition to health educators.
  • Community health educators were also cited as information sources, suggesting some formal channels exist but informal ones predominate.
  • Data collected through in-depth interviews with 12 young Rohingya refugees and informal conversations with 7 service providers between May and July 2021.

Marital status was a key determinant of access to SRH services, with married individuals having easier access than unmarried individuals.

  • Young people reported it was easier for married people to obtain SRH services than for sexually active unmarried people.
  • Unmarried people had limited or no access to contraceptive methods, even though services were nominally available.
  • While unmarried young males could visit drug stores or informal health providers, for unmarried young females it was described as 'impossible to do so in privacy.'

Gender norms shaped SRH service utilization differently for males and females, with males showing reduced inclination to seek services.

  • Self-identified male participants exhibited reduced inclination for SRH services and information.
  • Males commonly held the belief that sexually transmitted infections could be managed easily without consulting service providers.
  • Service providers corroborated these findings, emphasizing the low utilization of facility-based services by men and the prevalence of STI misconceptions.
  • Married males utilized fewer services and were more reluctant to visit healthcare facilities than married females.

Health system infrastructure constraints, including crowded facilities and limited operating hours, created practical barriers to SRH service access.

  • Half of the participants raised concerns about limited operating hours of health posts and distant field hospitals, especially at night or in the afternoon.
  • Crowded facilities and trust issues affected service quality.
  • Limited healthcare infrastructure was identified as a systemic barrier suggesting the need for resource improvements.

Conservative social structures and stigma around sexual activity significantly limited young people's efforts to seek SRH services.

  • Stigma around sexual activity and SRH limited young people's help-seeking behavior.
  • Conservative social structures were identified as a major sociocultural barrier alongside health system constraints.
  • Access and utilization were described as 'heavily influenced by social, cultural, and gender norms, as well as the various identities individuals hold within society (e.g., a young, unmarried female with limited literacy).'

What This Means

This research suggests that young Rohingya refugees living in Cox's Bazar, Bangladesh face multiple overlapping barriers when trying to access sexual and reproductive health (SRH) services. The study, based on in-depth interviews with 12 young refugees and conversations with 7 health service providers, found that who a person is — whether they are married or single, male or female, and how literate they are — strongly shapes whether and how they can access care. Unmarried young people, particularly females, were largely cut off from contraceptive services and could not seek help privately, while young males tended to underestimate the seriousness of sexually transmitted infections and avoided formal health facilities altogether. Practical problems with the health system also played a role. Facilities were overcrowded, operating hours were limited (especially at night or in the afternoon when many people needed them), and field hospitals were often too far away. Young people largely turned to friends, siblings, and cousins for reproductive health information rather than trained providers, suggesting that informal networks fill gaps left by the formal health system. Service providers themselves confirmed that men rarely used formal services and that misconceptions about STIs were widespread. This research suggests that simply making SRH services available is not enough — the services must be designed with an understanding of the social, cultural, and gender dynamics of the community they serve. Tailoring services to account for marital status, gender, age, and community norms could help reduce these gaps, particularly for the most marginalized groups such as unmarried young women with low literacy.

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Citation

Alam Siddiquee N. (2025). Barriers to access and utilization of sexual and reproductive health services among young Rohingya refugees in Bangladesh.. Reproductive health. https://doi.org/10.1186/s12978-025-02178-9