Sexual Health

Sexual and reproductive health challenges among street adolescents in Sylhet city, Bangladesh: A cross-sectional study.

TL;DR

Street adolescents in Sylhet City face severe sexual and reproductive health challenges, including high rates of sexual abuse, low contraceptive use, and limited STD knowledge, with significant gender disparities, which should be addressed through appropriate and urgent interventions.

Key Findings

Nearly one-third of street adolescents reported having had sexual intercourse, with a dramatic gender disparity between females and males.

  • 32.56% of all 311 participants reported ever having sexual intercourse.
  • 76.79% of female participants reported sexual intercourse compared to only 6.35% of male participants.
  • The gender difference was statistically significant (p < 0.001).
  • Participants were aged 16-19 years with a mean age of approximately 17.3 years for both sexes.
  • Data were collected via face-to-face interviews from August to December 2023 in Sylhet City Corporation, Bangladesh.

Contraceptive use among sexually active street adolescents was very low, with condoms being the primary method used.

  • Only 14.14% of participants reported using contraceptives.
  • Condoms were cited as the primary contraceptive method.
  • The low contraceptive use occurred in the context of a population with reported sexual activity and high pregnancy rates.

Among female participants who had ever had sex, the majority reported a pregnancy, and approximately half reported having had an abortion.

  • 81.13% of female participants who had ever had sex reported a pregnancy.
  • 50.67% of those female participants reported having had an abortion.
  • These findings reflect a pattern of unplanned pregnancies in the context of low contraceptive use.

Knowledge of sexually transmitted diseases (STDs) among street adolescents was alarmingly low.

  • Only 2.33% of participants were aware of STD transmission methods.
  • This near-total lack of STD knowledge was observed across a sample of 311 adolescents.
  • Low STD knowledge co-occurred with reported sexual activity and low contraceptive use, indicating compounded risk.

Sexual abuse was reported by a majority of street adolescent participants.

  • 61.79% of all participants reported experiencing sexual abuse.
  • Logistic regression identified younger age (AOR: 0.62, 95% CI: 0.48–0.79) as associated with higher odds of sexual abuse.
  • Being female (AOR: 9.10, 95% CI: 3.58–25.3) was strongly associated with higher odds of experiencing sexual abuse.
  • Longer duration of stay on the streets (AOR: 1.14, 95% CI: 1.02–1.27) was also associated with higher odds of sexual abuse.

Less than half of street adolescent participants utilized sexual and reproductive health (SRH) services.

  • Only 45.97% of participants reported utilizing SRH services.
  • This low service utilization occurred despite high rates of sexual activity, sexual abuse, and pregnancy among the sample.
  • SRH-seeking behavior was assessed via the semi-structured questionnaire alongside sociodemographic and SRH status data.

The study sample was predominantly male, with a roughly 3:2 male-to-female ratio among street adolescents surveyed.

  • 62.8% of the 311 participants were male and 37.2% were female.
  • Participants ranged in age from 16 to 19 years.
  • Mean age was approximately 17.3 years for both sexes.
  • The cross-sectional study was conducted in Sylhet City Corporation, Bangladesh, from August to December 2023.

What This Means

This research surveyed 311 street-dwelling adolescents aged 16–19 in Sylhet, Bangladesh, to understand their sexual and reproductive health (SRH) situations. The study found that a substantial portion had engaged in sexual activity, but with very little protection or knowledge about STDs — only about 2 in 100 participants knew how sexually transmitted diseases are spread, and only about 1 in 7 used any contraception. Among girls who had been sexually active, more than 8 in 10 had become pregnant, and about half had undergone an abortion, reflecting the serious consequences of unprotected sex and limited access to health services. The study also found that sexual abuse was extremely common, affecting nearly 62% of participants. Girls were about nine times more likely than boys to report sexual abuse, and adolescents who had lived on the streets longer faced greater risk. Despite these serious health needs, fewer than half of the adolescents had ever used any SRH services, indicating a major gap between need and access to care. This research suggests that street adolescents in urban Bangladesh, especially girls, face profound and interconnected vulnerabilities related to sexual and reproductive health — including abuse, unintended pregnancy, and lack of information or services. The findings point to an urgent need for targeted outreach programs, accessible health services, and educational efforts specifically designed for this highly marginalized group.

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Citation

Ahmed Y, Khan M, Afroz L, Nurunnabi M, Abbas M. (2026). Sexual and reproductive health challenges among street adolescents in Sylhet city, Bangladesh: A cross-sectional study.. PloS one. https://doi.org/10.1371/journal.pone.0340865