Adolescent Sexual and Reproductive Health and Rights in Urban Slums, Bangladesh: A Structural Analysis of Demographic and Health Surveys Between 2014 and 2022

<p><span>Adolescent sexual and reproductive health and rights (ASRHR) constitute global health priorities, yet adolescents living in structurally vulnerable contexts—like urban slums—experience a disproportionate burden of adverse outcomes. In Dhaka (Bangladesh), 40% of the 23 million population live in 5,000 slums. While the country is experiencing high rates of child marriages and teen pregnancies and low contraception use, ASRHR challenges remain insufficiently documented in urban slums. To better inform interventions, it is essential to explore societal structures (cultural, social, economic, political) shaping complex ASRHR outcomes. To identify societal structures associated with child marriage, teen pregnancy and contraception use, Bangladesh Demographic and Health surveys (2014-2018-2022) were analyzed using Poisson regression, reporting adjusted prevalence ratios with 95% confidence intervals (APRs (95%CI)). Over the three surveys, there were 15,502 girl participants aged 15-24, with a fair distribution across wealth index quintiles and Bangladesh regions. Child marriage varied from 70.4% (2014) to 62.3% (2022) at the national level but remained stable in slums (73.4%-74.3%). For child marriage, girls’ higher education was protective at the national level (2014: 0.80 (0.76-0.84), 2018: 0.83 (0.80-0.97), 2022: 0.79 (0.75-0.83)) and in slums (2014: 0.65 (0.54-0.80), 2018: 0.78 (0.70-0.87)). As a societal structure, child marriage was associated with increased risks of teen pregnancy for all years at the national level and in slums, with the highest APRs in 2022 (1.45 (1.42-1.48) and 1.57 (1.44-1.71) respectively). Lower contraception use was associated with having a woman as the head of the household at the national level (0.84 (0.81-0.88) in 2014, 0.93 (0.83-1.04) in 2018, 0.86 (0.83-0.89) in 2022) and in slums (0.86 (0.78-0.96) in 2014, 0.92 (0.89-0.95) in 2018, 0.89 (0.79-1.00) in 2022). Our findings suggest complex interconnection between ASRHR outcomes and a large influence of social and cultural structures, like family dynamics, gender norms, and community norms.</span></p>