Adolescent Health Education and Human Rights Abuse Reporting through mobile devices in the Rohingya camps of Bangladesh

The Rohingya refugee crisis gained prominence in the world news in August 2017. More than 1 million Rohingya were forcibly displaced from Myanmar to Bangladesh and as in other contexts experience appalling living conditions as migrants with little hope of returning to Myanmar. According to a WHO (2018) report there are more than 150 development agencies and partners engaged in the camps providing health information; from sanitation to nutrition to Sexual and reproductive health rights. SPIDER partnered with mPower Social Enterprises to consolidate and contribute to information access to adolescents in the refugee camps in collaboration with the NGOs working in the health space in the camps. 

Focusing on adolescent females the baseline study interviewed 722 adolescent girls in a sample of 4 camps and found that their vulnerability persists mainly because religious and socio-cultural beliefs continue to shield them. The age bracket for the girls interviewed is 10-19 and about 70% across the 4 camps had already given birth by their 18th birthday. About the same number admitted to not fully understanding the changes that were taking place in their bodies during puberty, not to mention what early child birth meant to their health. 

Generally more than 55% of those who reside in the camps are in the bracket of children, and of these 14% are ages 12-17 and almost 60% of the population is under the age of 18. They have limited access to education and according to the baseline an alarming number of girls are married before the age of 18. An almost equal number of young women experience physical, psychological and financial abuse on a regular basis. Sociocultural dictates ensure that young girls rarely leave home. In addition religious beliefs contribute to the isolation of young girls, as does fear of them being exposed to forms of abuse and violence outside their homes. The reality is that as a migrant adolescent female, she faces limited freedom, limited access to services and other resources, limited networks and support groups outside of the family structure. Culture dictates that young women must be protected and this comes in the form of being confined to the home. This increases their vulnerability to early marriages/pregnancy or forced prostitution and violence. While they are imbued with fear of the public sphere they still record an astounding number of violent abuse experienced.

This presents a measure of difficulty for various organisations wanting to reach these young ladies and empower them with knowledge on their Sexual Reproductive Health Rights (SRHR). Yet it is the same young women who informed the baseline survey the various forms of abuse they have been subjected to, confirming that violence against women is predominantly from intimate partners or family members. 

mPower Social enterprises set out the mammoth task of facilitating the process of knowledge sharing on SRHR for adolescent girls in the migration camps. The baseline unearthed a number of alarming social challenges including the fact that access to and use of mobile phones (the go to device in this initiative) is extremely limited. In addition, the use of mobile phones for disseminating health information requires government approval. But over and above these restrictions is the limited education recorded among the sampled 722 girls. They cannot read, or write, which means that packaging information that will empower adolescent females requires not just culturally sensitive textual language. Information has to be visually presented in person to facilitate the interactive process required in this exchange. Visual communication will go further in reaching the adolescents and their family, but the images must be culturally sensitive and relatable to the community. 

The baseline questionnaire was administered and required that the field researchers had to go knocking from home to home to be able to reach the intended beneficiaries to understand what their information gaps and needs were. Realising the scarcity of mobile phones, the project set out to equip the Community Health Workers (CHWs) and the Majhis (the camp leaders of each block) with mobile devices with a host of information services made available on these devices. The CHWs and the Majhis were the established structures in the camps as information points for the migrant community. The NGOs in the camps already relied on the CHWs and Majhis in providing information to adolescents because of the limited exposure that the young women had to education as well as to the outside world. The CHWs moving from home to home would share videos, images and disseminate visual information to the beneficiaries. Visual presentation of the information worked extremely well in a community that registers large numbers of girls who cannot read. The lure of moving images on what was perceived as sophisticated technology saw a significant growth in knowledge about SRHR when the research team returned to carry out an endline survey evaluating the impact of the intervention. 

The benefits for those providing the information using mobile devices are manifold:

• The digitalised information package, reduces the heavy load of carrying hard copy material to use when knocking from door to door.
• The digital system’s ability to store large amounts of data also eases the process of retrieving, rearranging, analysing and searching for information through the data base.
• Will contribute to minimising service duplication
• Share and spread resources to reach more people
• There is the undisputed lure of electronic devices that also enhances the social capital of the CHW as they move within the community.

For the adolescents and their families there is a certain pull of moving images across an interactive screen. Sharing even sensitive health information captivated parents and their children to watch videos, listen to audio, play games and engage with information related to health.

The endline survey recorded a decline in the number of adolescents who were shy or afraid of the changes happening to their bodies during puberty. There was also a rise in knowledge about the various family planning methods available as well as the acceptance that one can experience safe child delivery in an NGO clinic in the camp. Despite the recorded improvement in terms of knowledge and access to various services, the choices for the adolescents remain limited and are still controlled by the young women’s husbands, mothers-in-law, or families even as the CHW’s record more efficient approach to service provision, and information sharing within the camps.