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(1)Knowledge, Attitudes and Practices on Reproductive Health and Rights of Urban and Rural Women in Bangladesh Shaheen Akhter. 1．Introduction In the past few years, the issues of Reproductive Health/Rights (RH/RR) have been increasingly perceived as social problems; they have emerged as a matter of increasing concern throughout the developed and developing countries.1) Following the International Conference on Population and Development (ICPD) 1994 in Cairo, much concern has been expressed about the importance of reproductive health and rights. Here for the first time the right of women to have a safe and healthy reproductive environment was placed on the agenda.2) The conference came to involve a paradigm shift within the population discourse, from Neo-Malthusianism3) to what is called a Human Development approach.4) The Human Development approachʼs central objectives are reproductive health and the right to procreative autonomy. Its focus is on empowerment and allowing women to make individual decisions.5) According to human rights law, reproductive health is a fundamental right for every woman.6) Since 1994 reproductive choice and a womanʼs right to self-determination, sexual pleasure and premarital health have been included in the right to reproductive health.7) By referring to human rights and womenʼs reproductive rights there has been a focus on how to strengthen womenʼs voices within the issue of sexuality. Instead of focusing on lowering the birth rate through sterilization, the setting up of different kinds of empowerment projects targeting women has become more and more the norm. Empowerment was brought up on the ICPD agenda and was claimed to make women more equitable in social and in economic terms; this in turn gives women more control of their reproduction. The agenda also addressed the importance of transforming womenʼs lack of decision-making into knowledge and empowerment, especially in the sense of negotiating in sexual interaction and contraceptive use.8) This paper will discuss knowledge, attitude and practices on RH/RR of Bangladeshi women in a rural and urban context. Since independence, Bangladesh has achieved remarkable progress in important aspects of health and family welfare. However, the overall health status, and in particular the status of reproductive health, remains unsatisfactory. Bangladesh still faces alarming obstruction in the path to the goals of reproductive health and rights. In the last decade international, governmental and non-governmental organizations, human rights activists and individual researchers have been speaking about status and measures for reproductive rights. Though the common understanding of reproductive rights is that women should decide and control their own bodies and reproductive behavior, a majority of women living in the rural areas and in the poor urban settings are subject to physical, sexual, psychological and human rights violations. This activity disenfranchises women in the rural communities. (Hossain and Hassan, 2006). The insufficient health services available to women and children are evident from high infant and maternal mortality rates. Bangladesh has officially adopted the definition, concepts and recommendations of RH/RR as formulated in the ICPD program of action.9), 10) This focuses on improving the reproductive health of the population and.

(2) 132 （484）. 横浜国際社会科学研究第 12 巻第 3 号（2007年 9 月）. achieving the reproductive health goals. However, Bangladesh as a nation will not achieve these reproductive health goals unless there is a proper measure of the current situation of RH/RR and whether there should be special emphasis for any particular population group, such as rural women. 1.1．Background of the study Bangladesh is still disadvantaged in human development indicators such as per capita income, status of women, literacy, and health status, among others. According to the Human Development Report of 2005, Bangladesh was rated at the 139th (with a HDI value of 0.520 in 2003) among 177 countries. The country belongs to the category of medium human development countries. HDR 2005 indicates that from 1990 to 2003, 50 percent of the Bangladeshi people live below the national poverty line, 36 percent of the population earn less than 1.00 USD per day, and 83 percent of the population earns less then 2.00 USD per day. In 2003, the overall adult (ages 15 and above) literacy rate was only 41.1 percent. This is gender based. The overall literacy rate for men was 50.3 percent, and for women the rate was 31.4 percent. The combined primary, secondary, and higher education enrollment was 53 percent in the 2002/2003 school year. In recent years, female school enrollment has improved. Approximately 50 percent of primary and secondary school students are female. Women are often made not to be aware of their rights because of continued high illiteracy rates, unequal educational opportunities, strong social stigmas, and the lack of economic means to obtain legal assistance. The inability to obtain this legal assistance frequently keeps women from seeking redress in the courts.11) In Gender-Related Development Index, Bangladesh was rated 105th (with the value of 0.514). Women are far behind of men in many spheres of life such as in education (female adult literacy rate is 62 percent of maleʼs), income (ratio of estimated female income is 54 percent of maleʼs), ownership of property, decision making, access to information, health services and so on. Table 1 shows a comparison of indicators of Mortality and Reproductive Health Indicators among world total, more developed regions, less developed regions, and least developed countries and South Asian countries such as Bangladesh, India, Nepal and Pakistan. The following RH indicators show that Bangladesh places between Less developed regions and least developed countries. Higher number of early birth and low percentage of births with skilled attendants are evident. Women in the rural area live in more depressed condition than that compare to urban women. More than 75 percent of the Bangladeshi people live in the rural area (urban population is 24.3 percent in 2003). Educational attainment (72 percent of urban and 64 percent of rural women), empowerment (19.9 percent of urban and 13.8 percent of rural women) and access to media such as newspapers, television and radio (access to all three media: 5.5 percent of urban and 2.2 percent of rural women) are higher in urban areas than in rural areas (BDHS, 2005: 15). For the most part, rural poor women remain in a subordinate position in society, and the government has not acted effectively to protect their basic freedoms. In Bangladesh, arranged marriages are the common practice. It is customary to marry off the daughter at a young age.12) Since joint families are still the most common way of living, the girl moves into her new husbandʼs family after the wedding.13) The age difference between bride and bridegroom is usually around 5─10 years, thus girls most often get married with men who are considerably older. Due to the preference for sons, it is quite common that the husband decides to take a second wife if the first wife does not produce a son. It is illegal to marry off girls under the age of 18. The reality, according to the Bangladesh Demographic and Health Survey (2005), however, is that the average age for first marriage among women aged 20─24 is 16 years old and 80% of all women in Bangladesh were married as teenagers. 14) Bangladeshi society is a classic patriarchal society with a strict dichotomy between male and female norms. and roles. Muslim culture defines men as public actors and women as inhabitants of the private sphere. Traditionally.

(3) Knowledge, Attitudes and Practices on Reproductive Health and Rights of Urban and Rural Women in Bangladesh（Shaheen Akhter）（485） 133. Table 1 Reproductive Health Indicators of Word total and some regions and countries.. World total More developed regions Less developed regions Least developed countries Bangladesh India Nepal Pakistan. Indicators of Mortality Infant Maternal mortality mortality per 1000 ratio live births 55. Reproductive Health indicators Contraceptive Prevalence Births per 1000 women Any Modern aged 15─19 method methods. Total fertility rate (2005). % births with skilled attendants. 56. 61. 54. 2.60. 62. 8. 26. 69. 55. 1.57. ─. 60. 61. 59. 54. 2.82. ─. 94. 119. 4.86. 32. 3.10 2.92 3.50 4.00. 14 43 11 23. 54 64 60 75. 380 540 740 500. 120 72 113 69. 58 48 39 28. 47 43 35 20. Source: UNFPA, State of world population 2005. women were defined by their relation to their father, husband, and son(s) (Earth and Fahmida, 2003: 1─25). Despite early marriage and early child bearing, powerful cultural taboos prevent adolescents from knowing anything about sex and reproduction (Ahmed, 1991). Bangladeshi girls are not supposed to know about menstruation or sex before they experience them (Earth and Fahmida, 2003: 1─25). Their knowledge of symptoms, transmission and prevention of sexually transmitted infections and HIV/AIDS is inadequate. In addition, a pervasive sense of shame and embarrassment prevents girls from seeking health care for their reproductive health problems especially if the provider is male (Bhuiya et al., 2000). These above mentioned behaviors and practices on RH of Bangladeshi women trigger social research interest in the context of rural and urban settings. The common health problems faced by both rural and urban women are lower abdominal pain accompanied by heavy bleeding and white discharge and irregularity of the menstrual cycle (Khan, 1997; Haq and Khan,1990). The major concern, though, is that they do not discuss these since they do not consider these normal illnesses. Although urban educated women sometimes visit doctors, women in rural areas are taken to kabiraj/hekim (herbal medicine specialist especially in the rural areas) to be prescribed with Tabij and herbal medicines. Other women are taken to pir (saints), fakir (religious persons) or huzurs (mullah) for panipora (sanctified water) (Haq and Khan, 1990). Their limitations of knowledge, attitudes and unscientific practices have a negative impact on womenʼs reproductive health. Recently, the Government of Bangladesh adopted the National Population Policy with the objective to improve the status of family planning, reproductive health services, and maternal and child health care in the context of the Millennium Development Goals (MDG). More recently, with the adoption of the Millennium Development Goals (2000), governments have agreed that addressing womenʼs reproductive health is key to promoting gender equality and the right to development (CRR p. 10). Without proper study and research it is impossible to address the problem associated with reproductive health issues. This is especially true considering the difference in knowledge, attitude and practices between rural and urban Bangladeshi women. It is very important to study the overall situation and to know the differences rural and urban Bangladeshi women face on reproductive health/rights issues. Therefore, the objectives of this study are to - assess womenʼs knowledge about their reproductive health/ rights,.

(4) 横浜国際社会科学研究第 12 巻第 3 号（2007年 9 月）. 134 （486）. Age at marriage, education, income, ...... Urban women. Reproductive health/rights: menstruation, safe abortion, choice of contraception, safe motherhood, child health care, HIV/AIDs, ..... Rural women. Culture, society and religion, male control in patriarchal society, gender differentiation, women’s sense of “shame”, taboos, ..... Figure 1 Analytical framework.. - assess womenʼs knowledge, attitudes and practices about menstruation, contraception and abortion, safe motherhood practices, and reproductive health care includes RTI/STDs, HIV/AIDS, and to - examine the decision making power of women with regards to number, timing and birth spacing of children. The results so far obtained could be used as an important guide to assist policymakers and administrators in evaluating and designing the programs and strategies for improving reproductive health services with a special consideration for rural women. This research examines the hypothesis that age at marriage, education and income/empowerment are conventionally related to womenʼs knowledge, behavior and practices of reproductive health/rights. Figure 1 shows the causation which effects a womanʼs reproductive knowledge, attitudes/behavior and practices in both rural and urban areas. In addition, cultural, social, and religious factors, patriarchy, gender inequality, and womenʼs social position have influences on womenʼs reproductive lives. The above causations also have different effects on rural and urban women and hence on their different reproductive behavior and practices. 2．Methodology 2.1．Study design, study site, and the participants The study is mainly based on primary data and supported by secondary sources of information, such as books, reports, journals and research papers. It consists of both data gathering by questionnaires and in-depth interviews with Bangladeshi married women. The fieldwork was conducted from February to March, 2006 in 8 wards/villages of the two districts: Dhaka and Tangail. Out of the 8 wards/villages, 4 wards were selected from urban areas in Dhaka City Corporation. 15). having almost all types of urban facilities and 4 villages from rural areas in Tangail district16) which is. about 100 kilometers away from Dhaka. The socio-economical scenario in rural areas of Bangladesh are almost the same all over the country with lack of roads and transportation, electricity supply, sanitation and people of rural areas do not have access to mass media, news papers, health service facilities and so forth.17) The wards/villages were selected.

(5) Knowledge, Attitudes and Practices on Reproductive Health and Rights of Urban and Rural Women in Bangladesh（Shaheen Akhter）（487） 135. purposively. The households in a village/ward were selected randomly. The questionnaires were created by the author and used to collect information from married respondents at their reproductive ages, between 15 and 49 years old. A total of 504 respondents, half of them from the rural areas and half of them from urban areas, were interviewed. In the rural areas a total of 251 respondents were interviewed from 4 villages in the Basail Thana of the Tangail district. Among these respondents, 80 were from the Fulki, 57 from Habla, 51 from Kanchanpur, and 63 from Jaugani. In the urban areas, a total of 253 respondents were interviewed from 4 wards in the Dhaka City Corporation areas. Among these respondents, 64 were from the Rupnagar in Mirpur Thana, 46 from Mohakhali in Gulshan Thana, 46 from Sanirakhra in Demra Thana, and 97 from Sheiker Bazer in Sabujbag Thana. Gulsan, Mirpur and Sabujbag, and Demra are the representative areas where high, middle and low (slums or daily workers) economic class people usually live, respectively. 2.2．Tools and techniques Interviews, comprised of structured and semi-structured questions, were conducted based on the results of the questionnaires. All together, 66 questions were given to each respondent in the structured part. These were comprised of several topics, including socio-demographic information (age, educational and income level and occupation). Also included were knowledge, attitude and practices on RH issues such as family planning and contraception, menstruation regulation and abortion, number, timing and birth spacing of children. Other topics were safe motherhood practices, sexual health and rights, gender consciousness, and decision-making processes on reproductive health. The pilot testing was conducted in the Dhaka City Corporation area to construct a consistent questionnaire. A total of 5 female assistant interviewers were trained for four days by the author. The training consisted of lectures on how to complete the questionnaires and mock interviews between participants. Thereafter, the participants spent three days in practice interviewing in study areas of Dhaka city. Based on my personal observations in the field and suggestions made by the pretest field teams, the revisions of the wording of the questionnaires were made. Limitations of studies are very common in social work. One of the major difficulties was the time constraint. The concern of the research topic often shaped various forms of psychosomatic defense among the interviewees. In general, the respondents hesitated to discuss their sexual and reproductive health behaviors. Some respondents were incapable of understanding the importance for conducting a study particularly for women. Hence, they sometimes showed deprecating attitudes toward the interviews or skipped some questions. In some cases there was non-cooperation from the respondentsʼ husbands who considered the interviews a waste of time. Although the study was carried out in two districts in Bangladesh and the number of respondents appears small, the study attempts to give a relevant picture of rural and urban areas. 3．Result and Findings 3.1．Socio–economic and demographic characteristics of the respondents Selected socioeconomic and demographic characteristics of the respondents are presented in Tables 2─3 and Figure 2, which show the respondentsʼ age, occupation and educational level. All the respondents of the study were married women with at least one child. The reason for selecting women in the reproductive ages and with at least one child was to enable them to answer all the question sets in the questionnaire. The age distribution of the respondents is presented in Table 2 below. Table 2 shows that the largest age group of the urban respondents is between 20 to 24 (33.6 percent) years old. The second largest age group of the urban respondents is between 25 to 29 (23.7 percent) years old. In contrast, the ages of the rural respondents are more evenly distributed. The 20 to 24 and 25 to 29 year group each has 21.9 percent of the.

(6) 136 （488）. 横浜国際社会科学研究第 12 巻第 3 号（2007年 9 月）. Table 2 Age group of respondents Urban Age group N %. Rural N. %. N. %. 15─19 18. 7.1. 15. 6.0. 33. 6.5. 20─24 85. 33.6 55. 21.9 140. 27.8. 25─29 60. 23.7 55. 21.9 115. 22.8. 30─34 50. 19.8 49. 19.5 99. 19.6. 35─39 26. 10.3 48. 19.1 74. 14.7. 40─44 12. 4.7. 21. 8.4. 33. 6.5. 45─49 2. 0.8. 8. 3.2. 10. 2.0. Total. 100. 251. 100. 504. 100. 253. Total. Source: Field survey: 2006. respondents. Overall 27.8 percent of the respondents belong to the group of 20 to 24 years old and 22.8 percent belong to the group of 25 to 29 years old. Education levels of respondents are shown in Figure 2. The educational status of the respondents has a significant impact on their empowerment, income, mobilization and access to information. Therefore, education affects the knowledge, attitudes and behavior women have toward the reproductive system. Disadvantaged by the rural urban difference, Figure 2 clearly shows that rural women lag behind their urban counterparts in educational attainment. Among all respondents, 20 percent of women are categorized to be illiterate, 12 percent are literate (they are considered to be ʻliterateʼ if they can manage to write their names regardless of their ability to read or write any other signs), 32 percent completed primary education, 31 percent completed secondary education, only 2.4 percent had higher secondary education and only 2 percent attained a university degree. In general, urban women have higher educational level than rural women due to the urban facilities. Thirty percent of urban women and 35 percent of rural women never went to school. There are no rural respondents who finished their degree level education and only very few rural respondents (0.8 percent) attained secondary education. In the urban areas, 4 percent of the respondents completed a university degree and another 4% fall in the secondary education category. The rural-urban differences in educational attainment resulted from rural womenʼs early marriage, lack of urban facilities, communication problem, gender discrimination, and lack of awareness, social and religious barriers. The lower educational attainment of rural women reflects on their occupation and lower income level and ultimately it reflects to their lower level of reproductive knowledge. Respondentʼs distribution by occupation is presented in Table 3. It shows that 87 percent of respondents are housewives. In the urban areas, 77.1 percent of women are housewives, and 2.8 percent respondents are government or NGO officials, teachers (2 percent), garment-worker (5.1 percent), small business (1.6 percent), paid day labors (0.8 percent), crafts-woman/weaver (4 percent) and domestic helper/maidservants (6.7 percent). In the rural areas, most of the women are unemployed and 97.6 percent are housewives, 1.2 percent is public/NGO officials and 1.2 percent runs small business. In the urban areas, the higher percentage of educational accomplishment and relatively higher educational level of the respondents as well as better job availability enables a higher rate of empowerment for women than that of the rural respondents. The majority of rural respondents (96.8 percent) and a significant proportion of urban respondents (75.5 percent) do not have their own income. They depend on their husbandsʼ income. The monthly income of urban women is higher.

(7) Knowledge, Attitudes and Practices on Reproductive Health and Rights of Urban and Rural Women in Bangladesh（Shaheen Akhter）（489） 137. 35. Urban. Percentage (%). 30. Rural. 25. Total. 20 15 10 5 0 Illiterate. Literate. Class I-V Class VI-X Class XII. Degree. Educational level Source: Field survey: 2006. Figure 2 Percentage of respondents and their educational level Table 3 Occupation of respondents Respondentʼs Occupation. Urban N. Rural. Total. %. N. %. N. %. Govt. or Non Govt. services 7. 2.8. 3. 1.2. 10. 2.0. Teacher. 5. 2.0. 0. 0.0. 5. 1.0. Housewife. 195. 77.1. 244. 97.2. 439. 87.1. Garment worker. 13. 5.1. 0. 0.0. 13. 2.6. Business. 4. 1.6. 3. 1.2. 7. 1.4. Paid day labor. 2. 0.8. 0. 0.0. 2. 0.4. Crafts-woman/Weaver. 10. 4.0. 1. 0.4. 11. 2.2. Domestic help. 17. 6.7. 0. 0.0. 17. 3.4. Total. 253. 100.0. 251. 100.0. 504. 100.0. than rural women. Income levels are disproportionate in favor of urban women because they can work in the formal and informal sectors of the economy. On the other hand, rural women have no such opportunities and a limited working environment. The level of income raises a womanʼs social status, as well as social mobility and it assists in helping them exercise their rights. The total family income of the urban respondents is also higher than that of the rural respondents. 3.2．Women s knowledge, attitudes and practices on Reproductive Health and Rights issues Womenʼs awareness about reproductive health and rights related issues such as menstruation, contraception, pregnancy, childbirth and abortion were constructed by asking a series of questions such as whether they have heard.

(8) 138 （490）. 横浜国際社会科学研究第 12 巻第 3 号（2007年 9 月）. these terms, how old were they when they gained knowledge about these issues, what is their level of knowledge, and what is their sources of information. This study discusses only the valid percentage of women who have either little, partial or complete knowledge about the RH related issues. Considering womenʼs perception on RH, only 25 percent of the urban respondents and 6.4 percent of the rural respondents have heard the term “reproductive health”. Only after brief discussions, they understood the concept. In urban areas about 55.7 percent respondents and in rural 61.8 percent respondents have no idea about reproductive rights recognition. Twenty eight percent urban and 21.5 percent rural women agreed with the statement that ʻreproductive health is basic human rightsʼ. From this study it is clear that women are not very aware of their basic human rights. It is also notable that a higher percentage of urban women is aware of ʻreproductive healthʼ and ʻreproductive rightsʼ than their rural counterparts. 3.2.1．Knowledge, attitudes, and practices on menstruation management Menstruation is typically the entrance for a woman into the reproductive cycle. In Bangladesh, since there is no formal school education about sex, sexuality and reproductive health, most young girls have little ideas about menstruation before they enter into this cycle. Figure 3a shows the percentage of respondents by age at which they became aware of the term ʻmenstruationʼ. Most of the respondents came to know about menstruation at the age of 12 to 13 irrespective of rural or urban areas. Bangladeshi women acquire knowledge about menstruation around the age at which they would enter into the reproductive cycle. Figure 3b shows the percentage of women by source from which they gained knowledge. Overall women gain knowledge about menstruation mostly from friends (11%), mother (38%), and sisters (13%) and from relatives (35.5%). Regarding the sources of the knowledge, it seems that there is no significant difference between rural and urban respondents. School health education and the mass media have not provided much knowledge about this matter. The respondents were asked that “whether they knew how to take care of themselves during menstruation” and how do they manage the menstruation? Although 97 percent of respondents said ʻyesʼ, most of the young respondents have incomplete and misleading information on the process of menstruation and the hygienic management of menstruation. Bangladeshi women, especially rural women do not always have access to contemporary treatment materials such as sanitary napkins, tissue or clean cloth. A large portion─more than 87.3 percent of urban women and more than 90 percent of rural women use old cloths during menstruation and they reuse them without washing them properly and drying thoroughly. Menstrual cloths are dried in dark hidden places to avoid others seeing them, as it is considered a taboo to display these cloths to others. These results reveal that majority of the women still live with poor health consciousness. It was observed that most of the women who used rejected waste cloths are suffering from severe menstrual pain, abnormal vaginal bleeding, genital itching, and lower backache. About 15 percent of urban women and only 2.4 percent of rural women use disposable sanitary napkins. Women in Bangladesh do not feel free to use sanitary napkins and most of them do not have the financial ability to buy disposable sanitary napkins. There are many problems such as religious and cultural barriers. They cannot easily go to market because of ʻPurdaʼ18). Even those who go to the market feel shy and hesitate to buy such material from the drug store because of hidden traditional and social practices. It is evident from the interviews that many women feel shy about asking family members to buy sanitary napkins. The mobility of menstruating women is limited. They do not leave the home, especially in the evening. There are many ʻdonʼ tsʼ applied to them during their menstruation period: ʻdo not touch anything which is holly and secret, ʻdo not go outsideʼ and so on. For instances, after stopping menstrual bleeding, one should take a special bath, wash her hair and cut her nails to be purified before she touches the Holy Quran and start prayers. There are some food-taboos also applied to menstruating rural women. Fish, meat, eggs, milk, hilsa fish and prawns are not taken during menstruation. Some other foods, such as vegetables, sour fruits and food cooked with turmeric are also restricted. These food taboos could.

(9) Knowledge, Attitudes and Practices on Reproductive Health and Rights of Urban and Rural Women in Bangladesh（Shaheen Akhter）（491） 139. 50 Urban Rural. 40. Total. 30 20. 40. Urban. 30. Total. Rural. 20 10 0. 10 0 7. 8. 9 10 11 12 13 14 15 16 17. Fr ie nd s M ot he r Si st e Re r la tiv Sc e M as ho o l s m ed ia ot he r. Percentage (%). 50. Percentage (%). 60. Age (years). Source. Figure 3 (a) Percentage of respondents by age at which they acquired knowledge about menstruation and (b) different sources. certainly contribute to poor nutritional status of women and may cause anemia (Earth and Fahmida, 2003). Pollution is ascribed to the menstrual bleeding by society and extends the taboo to social behavior. The unwritten rule is that any problem related to menstruation is not to be disclosed by the suffering woman. 3.2.2．Family planning and contraception One of the important aspects of reproductive rights is the womanʼs accessibility to contraceptives and the right to choice of it. Although the women of Bangladesh are already inundated with all kinds of contraceptives, there is a basic question of whether or not they have the right to choose those contraceptives. The answer seems to be that there is no choice for the women living in poverty combined with illiteracy. Although they are made to use them in their own bodies, they are treated as though they are nothing but “targets”. Akhter, for example, stated “Contraceptive methods are still devised in ways, which ensure greater control over the womenʼs bodies. The family planning organizations are simply pushing these methods on the poor women as targets” (Akhter 1996: 191─209). In my observations through interviews, it should be pointed out that women, especially when they are poor, do not have the required information about the contraceptives to make the right choice for themselves. The information of side effects is not shared with the users. In many cases, the information is not even shared by the motivators such as family planning and health field workers or supervisors, NGO activists, medical representatives of medicine companies and other service providers. Akhter also cited examples from her experiences of the women in the rural and urban areas how womenʼs bodies over a period of last 30 years have been systematically violated. She mentioned, “Contraceptives, ranging from pills, IUDs, injection, implants, surgical and non-surgical sterilizations, from experimental to the rejected ones, have been dumped on the bodies of women”. Personal interviews also reveal how women are affected by so many other factors. These include being over-medicated or prescribed the wrong medication, lack of health care facilities, least concern for the side-effects of contraceptives, poisoned foods and atmosphere, unhealthy working conditions. This makes the lives of all women more and more unbearable. The poorer women suffer the worst. The respondents were asked “whether they know different contraceptive methods”, “which method she is currently using”, and “which is the most effective contraceptive method”. Figure 4 shows the percentages of respondents using.

(10) 横浜国際社会科学研究第 12 巻第 3 号（2007年 9 月）. 50. Urban. 40. Rural Total. 30 20 10. er s Ot h. IU D W it h Fe dr m aw al al es ter i li za M tio ale n ste r il iza tio n Sa fe pe rio d In jec No tio m n et ho du se d*. Pi ll. 0 Co nd om. Percentage (%) of respondents. 140 （492）. Contraceptive methods Figure 4 Percentages of respondents by contraceptive method. ( No method used means the respondents currently do not use any contraceptive method).. different contraceptive methods. Ninety-one percent (rural and urban) of women have used contraceptive methods and 9 percent have never used any. In both urban and rural areas, the largest percentage of respondents used the oral pill. 42 percent of rural women and 29.5 percent urban women used this method. Nearly 40 percent of urban respondents and 50 percent of their rural counterparts answered that the pill is the most useful contraceptive method and effective for birth control. The oral pill is the most popular method probably because it is the most advertised, cheapest and easiest to use. The government and NGO service providers distribute the pill among poor women free of cost. The second most popular method is the injection. It is used in the urban areas by 11.2 percent and by 19 percent respondents in the rural areas. In Bangladesh, menʼs involvement in practicing contraception is very rare. Recently menʼs participation is decreasing 0.2 percent (Prothom Alo, Daily news papers in Bangladesh Date: 24th April). Only 7 percent of urban men and 4% of rural men (in average 5.6 percent of all male population) use condoms. It seems that women are very reluctant to use this contraceptive method, although Bangladeshi women are ignorant about the side effects of oral pill and other methods. Few educated women know the terrible side effects of using some of the contraceptive methods; this is due to the lack of access to the information in government policy. The dominant notion of patriarchy, gender discrimination in every sphere of their lives, and gender inequity play an important role disenfranchise women when it comes to reproductive rights. Women do not typically have power over their husbands to freely decide the contraceptive methods. The government policy tends to be gender biased as it seemingly considers women as a targeted group for population control. It is not necessarily the major option of women in poverty to use any particular method of contraceptive. Rather, it seems to be the governmentʼs policy, planning and development program, which is directly related to Foreign Aid policy, to encourage enough women to use contraceptives and, as above, the governmentʼs policy can well be related.

(11) Knowledge, Attitudes and Practices on Reproductive Health and Rights of Urban and Rural Women in Bangladesh（Shaheen Akhter）（493） 141. to the interest of other institutions. Therefore, the “rights” of women appear to remain far from reach of those who are the most in need. The suitability and safety of the contraceptives according to health conditions and socio-economic situation of women have received negligible attention by family planning service providers of both the government and NGOs. In Bangladesh, though there are more than half a dozen contraceptives available for women, there are hardly any methods available except for the condom and vasectomy for use by men. Making contraceptives available only for women does not ensure the womenʼs own decision. Through interviews it is evident that women have to get permission from their husbands to use contraceptives. About 17 percent women, 25 percent husbands and 57 percent both partners are involved in the decision to start using contraception. Whoever is making the decision, it does not ensure that women can freely decide whether she or her husband will take part in contraception. This means that the patriarchal attitudes have not changed. Rather, the patriarchal social control has been strengthened through the training by the religious and community leaders for the successful implementation of family planning methods (Hossain and Akhter, 2006). These leaders only talk to men about the measures of contraceptives. But the men who are motivated otherwise to control their children, pursued their wives for the acceptance of contraceptives. Therefore, women lose control over her reproductive rights and fertility practice through the patriarchal institutions (Akhter, 1996: 89─98). The Contraceptive Prevalence Survey conducted by NIPORT in Bangladesh (2004) only focused on finding out the rate of women using various methods of contraceptives (BDHS, 2005). It did not investigate whether women have the necessary information regarding the choice of contraceptives. Even the massive amount of publicity and propaganda in favor of contraceptives always target the women, especially women in poverty in both rural and urban Bangladesh. The media is also biased in controlling child birth. They believe that family planning means stopping child birth of a fertile woman rather than a man. As a consequence, the women users do not seem to have any unbiased source of information regarding the pros and cons of contraceptives. 3.2.3．Pregnancy and childbirth (a) Safe motherhood and child health care Estimates of the maternal mortality rate in Bangladesh range from 320 to 400 maternal deaths per 100,000 live births. Many mothers do not receive prenatal care. The percentage of women who do receive such care is more than twice as high in urban areas (59%) than in rural areas (28%). Over 90% of deliveries take place in the home. 64% are attended by traditional birth attendants, “Daima” (the local name of traditional birth assistant, usually they are elderly women). Only 12% are assisted by trained personnel/nurse. Figure 5 shows respondentsʼ age group at (a) first marriage and (b) first delivery. The average age of marriage for girls is 13─16 years. In urban areas 64% and rural areas 54% girls get married in this age group and a natural outcome of this early marriage is early pregnancy. The majority of first pregnancies occur at 16─17 years for rural women (~31%) and 18─19 years for urban women (~28%). 78% of rural women and 70% urban women get pregnant before or at the age of 19 years. In recent years, Bangladeshi women have had nearly 3.8 pregnancies in their life time (total fertility rate 3.8). Maternal deaths account for nearly 25% of all deaths to women aged between 15 to 44 years. Much of the deaths are due to obstetric complications such as hemorrhage and infection, eclampsia, septic abortion, lack of antenatal care, and high risk pregnancies. Child birth remains a risky affair despite major strides in child survival. The women in Bangladesh suffer from short term and long term morbidities related to childbirth and reproductive health. It is evident from Figure 5(a) that early marriage is still a major social problem in Bangladeshi societies. The teen age motherʼs body may not ready to produce a healthy child. They do not have sufficient knowledge about the process of pregnancy and childbirth. Early marriage and early child bearing before biological and social maturation persists in many communities. In general, early marriage and early child bearing are more common in rural areas than that in.

(12) 142 （494）. 横浜国際社会科学研究第 12 巻第 3 号（2007年 9 月）. (a). (b). 35. 70 Rural Total. 50 40 30 20 10. Percentage of respondents (%). Percentage of respondents (%). Urban 60. Urban. 30. Rural Total. 25 20 15 10 5 0. 0. 9─12 9-12 13─16 13-16 17─20 17-20 21─24 21-24 25─28 25-28 29─32 29-32 Age group of first marriage. 14─15 14-15 16─17 16-17 18─19 18-19 20─21 20-21. 21+ 21+. Age group of first delivery. Figure 5 Respondents age group at (a) first marriage and (b) first delivery.. urban. One research study shows that before conception they were pressured by their in-laws for a grandson. All most half of the mothers reported a physical problem during the first pregnancy (Rabbo and Akhter, 2005: 32─52). The under-five mortality rate for the most recent five years (1999─2003) is 88 per 1000 live births, and infant mortality is 65 per 1000 live births. About half of all under five-deaths occurs during neonatal period, about a quarter occur during the postnatal period and another quarter occurs between the ages 1 and 4 years. This indicates the vulnerable condition of mothers, especially the pregnant mothers, during child bearing and delivery services. This includes malnourished and mothers in ill health. There is a far difference between poor and rich people in safe motherhood and child health care practices. In HDR 2005 it states that a birth attended by skilled personnel among 20% of the richest people is 42.1% and among 20% poorest people is only 3.5%. Infant mortality rate and under five mortality rates are 93 and 140 per 1000 live births among the poorest 20%. For the richest 20%, these rates are 58 and 72.4 per 1000 life births. Begum (2004: 1─35) stated that there was a co-relation between antenatal and postnatal care and higher education of husband and wife. She found that an educated mother took both ANC and PNC better than a lower educated mother. This result shows that the educational attainment of both parents is very important element to reduce the maternal mortality. (b) Decision making power of women with regarding number, timing and birth spacing of children International human rights documents and other UN consensus documents (such as The Charter of the United Nations Universal Declaration of Human Rights, Convention on the Elimination of all forms of Discrimination Against Women (CEDAW), International Conference on Population and Development (ICPD) Programme of Action (also known as the Cairo Consensus) and ICPD +5 and ICPD +10 goals, Beijing Platform for Action, Millennium Declaration)* recognized the basic rights of all couples and individuals to decide freely and responsibly the number, spacing, and timing of their children. However, due to widespread gender discrimination, Bangladeshi women cannot freely decide the number, timing, and spacing of their children. This study reveals that only 7% of the urban and 2%.

(13) Knowledge, Attitudes and Practices on Reproductive Health and Rights of Urban and Rural Women in Bangladesh（Shaheen Akhter）（495） 143. of the rural women could decide in themselves whether or not to have a child as well as the number and spacing of children. Most of the cases both partners (62─68%) and in a considerable number of cases the husbands, make these decisions. (Field survey: 2006) Although 88% women said the ideal number of children is two, 31.5% women have one child, 32.5% have two, 20.4% have three, 10% have four and about 5% women have more than four children. Women those have one or two children at the time of this survey might have more children in future. 61.5% women think women can bear their first baby at the age of 20 but in Figure 5 it shows that 78% rural women and 70% urban women get pregnant before or at the age of 19 years. 1% women think that the gap between two children should be one year, 3% think it should be 2 years, 13% think that the gap should be three years, 21% four years and 62% think the gap should be more than four years between two children. But in practice, most of the women have only one or two years gap between two children. Although women knows it is necessary to have sufficient gap between two children for womenʼs health concerns and safe child birth, they cannot decide on their own when they should get pregnant, how many children they will have and what will be the gap between two children due to womenʼs status in society, lots of cultural, traditional view of son preferences, and religious barrier. 3.2.4．Safe abortion Abortion in Bangladesh is practiced in the form of menstruation regulation (MR). Access to abortion facilities is an important determinant of reproductive health care. Abortion is considered illegal in Bangladesh. Hence, for legal constraints and to escape from social criticism most abortions are done under the name of “menstrual regulation” which is within 10 weeks since the last menstrual period, but in practice, it is sometimes provided into the 12th week (Akhter, 1988:37─48). Present studies show that 92.0% of urban and 76.7% of rural respondents have partial knowledge about abortion or miscarriage. Women were asked “whether they would accept abortion if they have an unwanted pregnancy”. Womenʼs positive attitudes about induced abortion in urban areas are 53.8% and 36.7% in rural areas. From this result it is evident that many women still have negative views (46.2% urban and 63.3% rural respondents) about induced abortion. Induced abortion is considered killing according to social and religious norms (Islam, 1981:1─17). From these studies 23 percent of urban and 16 percent of rural respondents had an abortion sometime in their life. These abortions were not due an unwanted pregnancy. Instead, there were some complicacies in pregnancy such as miscarriage or ectopic pregnancies. In those cases the pregnancy was ended by natural or induced abortion. 35 percent urban and 71 percent rural respondents answer that they do not have abortion or menstrual regulation facilities in their areas. 33 percent urban and 56 percent rural respondents have complications such as heavy bleeding, headache, cannot move, abdominal pain and so forth during or after an abortion. If they have such complications, 63 percent of the urban respondents visit a female doctor, 5.2 percent visit male doctors and 31 percent visit an unqualified “doctors”. And 30 percent rural respondents visit female doctors, 30 percent visit male doctors and 39 percent visit unqualified “doctors”. There are social and psychological backgrounds that also influence reproductive behavior. A Lower percentage of rural women visit female doctors because female doctors are not available in rural areas. Access to abortion/MR services is poorer in rural areas compared to urban areas. In general, there have not been any voluntary service providers for abortion or menstrual regulation in Bangladesh. As a result, in both urban and rural areas, substantial proportions of women are obtaining abortion services from traditional midwifes. These are not always successful (Sing et al, 1997: 59). In Bangladesh, the overall incidences of abortions are increasing, in part because desired family size is declining and in part due to contraceptive method failures (Kabir and Chowdhury, 2004). 3.2.5．RTI/STD, HIV/AIDS Reproductive tract infection includes a variety of bacterial, viral, and protozoan infections of the lower and upper reproductive tracts of both sexes. Most of these are sexually transmitted diseases (STDs). Women can be infected not.

(14) 横浜国際社会科学研究第 12 巻第 3 号（2007年 9 月）. 144 （496）. Knowled e about STD/RTI. 100 90. Percentage (%). 80 70. Overall knowledge. 60. Partial knowledge. 50. Little knowledge Total. 40. No knowledge. 30 20 10 0 Urban. Rural. Total. Urban. Rural. Total. Figure 6 Respondents knowledge regarding STD/RTI and HIV/AIDS. only through sexual intercourse, but also the use of unclean menstrual cloths; insufficient knowledge of menstrual hygiene, and the use of unclean water. Most STDs are RTIs although some such as syphilis, hepatitis B, vaginal discharge, severe abdominal pain and AIDS are also systemic diseases. Some RTIs result in life threatening cervical cancer and transmission of the human immune deficiency virus (HIV), the organism that causes AIDS. Chapter 3 of ICPD Programmed of Action recommended actions “to prevent, reduce the incidence of, and provide treatment for STDs including HIV/AIDS and the complications of such as infertility”. Figure 6 shows the respondentsʼ acquaintances about RTI and AIDS, causes and how to prevent these diseases. 82% of urban and 88% of rural women have no clear idea about STD/RTIs. 2.8% of urban and 1.2% of rural women have overall knowledge, 8% of urban and 4% of rural respondents have partial knowledge, and 7.5% of urban and 7.2% of rural respondents have little knowledge about STD/RTIs. Regarding HIV/AIDS, a higher percentage of respondents have heard the terms HIV/AIDS (92.1% urban and 72.4% rural). That compares to the respondentsʼ knowledge about STD/RTI (18.2 urban and 12.4% rural). This awareness is due to the awareness programs in the mass media about HIV/AIDS. It means that the mass media, Governments proper policy could be played important role to increase womenʼs awareness about RH/RR related issues. 19.8% of urban and 7.2% of rural women have overall knowledge, 42.3% of urban and 33.1% of rural respondents have partial knowledge and 30.0% of urban, 34.3% of rural respondents have little knowledge and 8% of urban and 25% of rural women have no knowledge at all about HIV/AIDS. Regarding both STD/RTIs and HIV/AIDS, a higher percentage of urban women have knowledge about these diseases than their rural counterparts. These results are evidence that womenʼs knowledge about RTI/STD and HIV/AIDS is very insufficient. There is no special information, education, group counseling, or in-home discussion about STD/RTI and HIV/AIDS. Since sex education is not governed by Bangladeshi governments, people have the perception that sex is a sin or secret matter, or simply a process of reproduction. Religious barriers make this situation worse. About 60% of rural women, in contrast to about 47.8% of urban women do not know how to have safe sex or the necessity of having safe sex. Although a.

(15) Knowledge, Attitudes and Practices on Reproductive Health and Rights of Urban and Rural Women in Bangladesh（Shaheen Akhter）（497） 145. considerable percentage of rural and urban respondents think that the condom is the best way to have safe sex, in practice most of them utilize the pill instead (Only 7% of urban men and 4% of rural men use condoms). Women lag behind in terms of access to reproductive rights and health information. Government and NGOs policies toward the education of people about these matters are still scarce. Mass media like radio, television, news paper could play an important role in raising the awareness of these diseases and providing knowledge through an information based approach, including group discussion. Since most of the instances rural women are more disadvantageous condition in respect of their knowledge on safe sex, safe abortion, STD/RTI and HIV/AIDS and other RR and RH issues and reproductive health services, a special measure should be taken by the Government, NGOs, International Organizations, policy makers and services provider to increase the awareness of rural women on these issues and improve the health services and facilities in rural Bangladesh. 4．Conclusions The study has depicted a number of findings that womenʼs reproductive health and rights are directly related to womenʼs education, age at marriage, income, empowerment, and self consciousness. The study tried to determine the rural-urban differences on reproductive health behaviors and practices. The study specifically examined the knowledge of rural and urban women on menstruation, contraception and abortion, safe motherhood and child health care, RTI/ HIV, and womenʼs decision making processes. The highest percentage of Bangladeshi women has no idea that ʻreproductive healthʼ is basic human rights. Women are not conscious about their basic rights. Rural and urban poor women are in further disadvantaged regarding knowledge of RH issues compared to the urban middle class. Urban womenʼs level of knowledge is higher due to urban facilities, higher level of educational attainment, income, employment. Rural women are disadvantaged by the lack of these facilities, education, and income. In Bangladesh a majority of women live in poor health conditions. They are still practicing the traditional ways of behavior in exercising their reproductive lives. Most of them do not have proper knowledge about hygienic menstrual management and the result is that many of these are suffering from a number of ailments such as RTIs, severe abdominal pain, abnormal bleeding, irregular menstruation means irregular ovulation, genital itching, and lower backache and so forth. Most of the women do not have their own income and do not have the ability to buy disposable sanitary napkins (only 15% of urban and 2.4% of rural women use disposable sanitary napkins). There are some religious and social reasons for this behavior such as women cannot easily go to market because of practices of ʻPurdhaʼ, they feel hesitant and shy about asking family members including their husbands to buy sanitary napkins. Additionally, there are some food-taboos also applied to menstruating rural women. Fish, meat, eggs, milk, hilsa fish, prawns, vegetables, sour fruits and food cooked with turmeric are not taken during menstruation. Since most of the respondents are housewives, economically not empowered, and subordinate to their husbands, they do not have decision making power to choose contraceptive methods. 50.2 percent of rural and 39.5 percent of urban women use the pill. The second highest percentage is injection. In urban areas 11.2 percent of women use injections, compared to 19 percent in the rural areas. In Bangladesh, menʼs involvement in the practice of contraceptive methods is very few. Only 7 percent of urban and 4 percent of rural males are using condoms. Illiterate women and housewives are more vulnerable to bad choices for contraceptive measures. Patriarchal and a male dominated society play an important role on the contraception practices. Education is needed to raise menʼs awareness for womenʼs reproductive health care. Early marriage and early child bearing are still prevalent in Bangladeshi societies. 64 percent of urban and 54 percent of rural girls get married between the ages of 13 and16 years old. The highest frequency of respondentsʼ first.

(16) 146 （498）. 横浜国際社会科学研究第 12 巻第 3 号（2007年 9 月）. pregnancies occurs at the age of 16 to17 years old (rural women~31 percent and urban women~22 percent). The teenage mothers neither have sufficient knowledge about the process of pregnancy nor are they ready psychologically and physically for childbirth. Over 90 percent of deliveries take place in home. 64 percent of deliveries are accomplished using traditional birth attendants and only 12 percent are assisted by doctors and trained personnel/nurse. The Government should improve reproductive health care services in the rural areas for the sakes of secured delivery for both mother and child. Many women have a negative view (46.2% of urban and 63.3% of rural respondents) about induced abortion because of some social and religious beliefs. In Bangladesh there are no sufficient laws and policies for the legality of abortion. Proper abortion law may prevent induced abortion which causes a large number of maternal deaths. Womenʼs knowledge about RTI/STD and HIV/AIDS are also insufficient. There are only few steps to prevent AIDS only mass media but not in details. Hence, it is recommended to introduce group discussion addresses to adolescents, and especially NGOs based initiatives should be taken raising consciousness, including all classesʼ of peoples on RH/RR including RTI/STDs and HIV/AIDS. Decision making processes regarding the number, timing and birth spacing of children typically involve both partners (husband and wife). However, other reproductive decisions such as use of contraception, utilization of health care services, and initiation of sexual relationships are solely taken by husbands. The inability to make decisions results from gender discrimination, lack of womenʼs empowerment and subordination, and male domination. Womenʼs reproductive rights are often abused by social norms and harmful unequal practices. Open discussion of sexual health is still a proscribed issue in Bangladesh. Thus individuals, including adolescents and couples, do not have adequate information regarding these issues. With regard to reproductive health care, most of them have no idea how reproductive health works. Through this study by both the questionnaire based and in-depth interviews the major findings could be summarized as follows: (i) The information on sexual health is too scanty to warrant any meaningful interpretation of the status in Bangladesh, both in rural and urban areas. (ii) The traditional attitude of the society towards women limits their role as well as their basic human rights. (iii) Women have no right to choose safe family planning methods. There is no proper guidance for married couples and a lack of counseling systems even from doctors. There are no specific reproductive laws and policies for women. (iv) Early marriage is still a major social problem in Bangladeshi society because due to lack of social security, proper laws, poverty, and lack of womenʼs social mobility. (v) Sexually transmitted diseases have long presented a serious threat to the health and well being in rural and urban areas in Bangladesh due to poor level of knowledge regarding these diseases. Based on these above findings I have the recommendation for the authority to develop appropriate reproductive laws and health care policies. Sexual and physical education should be incorporated at the high school level to provide proper knowledge of the reproductive function. The effective implementation of reproductive health education and creating congenial social environments in an effort to enable people so that they can exercise their reproductive rights as recognized by international community. Finally I would like to conclude that a wide gap was found between urban and rural respondents in Bangladesh regarding their reproductive behaviors and exercising their reproductive rights. Urban women were found to have higher social mobility, higher educational accomplishment, late marriage, income and health care facilities. Rural women are in disadvantageous positions in respect of their knowledge, behavior and practices of most of the reproductive heath and rights issues discussed above. Hence, appropriate comprehensive special measures as well as balanced development policies and programs should be taken by the Government, NGOs, International Organizations, policy makers and services provider to increase their awareness on these issues and improve the health care services and facilities and.

(17) Knowledge, Attitudes and Practices on Reproductive Health and Rights of Urban and Rural Women in Bangladesh（Shaheen Akhter）（499） 147. ensure reproductive rights of women in rural Bangladesh. List of Acronyms: AIDS: Acquired Immune Deficiency Syndrome ANC: Antenatal Care HDI: Human Development Index HDR: Human Development Report HIV: human immunodeficiency virus ICPD: International Conference on Population and Development MDGs: Millennium Development Goals MR: Menstruation Regulation NGOs: Non Government Organizations RH: Reproductive Health RR: Reproductive Rights RTI: Reproductive Tract Infection STD: Sexual Transmitted Diseases PNC: Postnatal Care UNDP: United Nation Development Program WHO: World Health Organization CRR: Center for Reproductive Right. Notes 1) The term developed country is used to categorize countries with developed economies in which the tertiary and quaternary sectors of industry dominate. This level of economic development usually translates into a high income per capita and a high Human Development Index (HDI). Countries with high gross domestic product (GDP) per capita often fit the above description of a developed economy. A developing country has a relatively low standard of living, an undeveloped industrial base, and a moderate to low Human Development Index (HDI) score. Developing countries, there is low per capita income, widespread poverty, and low capital formation. 2) Hussain, 2003, Gender and Reproductive Behaviour: The Role of Men, p. 48. 3) Rao, Mohan, An Imagined Reality: Malthusianism, Neo-Malthusianism and Population Myth, Harvard University. http://www.hsph.harvard.edu/Organizations/healthnet/reprorights/poppapers.html 4) Presser and Sen, 2000, Women’s Empowerment and Demographic Process: Laying the Groundwork., p. 3. 5) Steinbock, 1998, Rethinking the right to reproduce. 6) UNIFEM, www.unifem.org . 7 Sen and Batliwala, 2000, Empowering Women for Reproductive Right, p. 15. 8) From object to Subject: Bangladeshi women’s perception of Empowerment, Ulrika Sundh, Master Thesis, 2004, Linköpings University, p. 1. 9) Global Policy Committee of the World Health Organization, 2 May 1994; and the WHO Position paper on health, Population and Development, Cairo 5─13 September 1994 http://www.who.int/topics/reproductive_health/en/ “The World Health Organization defines ʻ Reproductive Healthʼ as a condition in which reproduction is accomplished in a state of complete physical, mental, and social well-being, and not merely the absence of diseases or disorders of the reproductive process. Reproductive health therefore implies that people have the capability to reproduce and the freedom to decide when and how often to do so that is the rights of men and women to be informed and to have access to safe, effective,.

(18) 148 （500）. 横浜国際社会科学研究第 12 巻第 3 号（2007年 9 月）. affordable and acceptable methods of the family planning of their choice. In addition, they have the right to choose legal methods for the regulation of fertility. The right to access appropriate health care services will enable women to proceed safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant.” 10) Center for Reproductive Rights: Women of the world, South Asia., P. 10. “A reproductive rights framework offers a powerful tool for advancing womenʼs reproductive health and empowering women to address the social conditions that jeopardize their health and lives. They encompass a broad range of nationally and internationally recognized political, economic, social and cultural rights that include two key principles: that all persons have the right the reproductive health care, and the right to make their own decisions about their reproductive lives. Reproductive rights includes liberty, security, health, and reproductive health. It also includes family planning, consisting of the right to decide the number, spacing, and timing of child bearing. The rights to consent to marriage, not to be subjected to torture or other cruel, inhuman or degrading treatment or punishment, the right to be free from sexual violence and so forth.” 11) Bangladesh Country Report on Human Rights Practices (2000) http://www.state.gov/g/drl/rls/hrrpt/2000/sa/692.htm 12) Joint family is when several generations live together in one family. 13) Simmons & Koening, 1994 Constrains on Supply and Demand for Family Planning: Evidence from rural Bangladesh pp. 133─146. 14) Kabeer, N. (1988) “Subordination and Struggle: Women in Bangladesh”, New Left Review I/168. “Bangladesh belongs to what has been described as a belt of ʻ Classic Patriarchy ʼ which stretches from northern Africa across the Middle East to the northern plains of the Indian sub-continent. The social structures in this belt are characterized by their institutionalization of extremely restrictive codes of behaviour for women. They stand in marked contrast to the societies of south India and much of Southeast Asia whose institutions and practices permit a more egalitarian system of gender relations. In as much as both Muslim and non-Muslim societies are encompassed within this belt, Islam is only partially implicated in their extreme forms of female subordination. What the societies have in common are the practice of rigid gender segregation, specific forms of family and kinship and a powerful ideology linking family honour to female virtue. Men are entrusted with safeguarding family honour through their control over female members; they are backed by complex social arrangements which ensure the protection—and dependence—of women.” 15) There are six metropolitan cities in Bangladesh. Dhaka is one of them and the capital city of Bangladesh. There are sixty four administrative districts and 460 ʻUpazilas ʼ (Thana/ Police stations) in Bangladesh. The district and Upzila head quarters also have the urban facilities. From every part of Bangladesh people migrated to Dhaka city for jobs, business and other financial activities. In Dhaka City Corporation there are 93 wards. There are some wards where rich people usually reside and other wards middle class and slums or daily lavers reside. I have selected four dwards from different region of the Dhaka city corporation area as these areas can cover all economic classes people and urban facilities. Hence, study areas represent over Dhaka City corporation as well as other part of urban areas in Bangladesh. 16) Tangail is one of the 64 administritative District. There are nine Upazilas (Thana/ Police stations) in Tangail Districts. The Tangail District and nine Thana head quarters are considered as urban areas. Each Thana consists of several Unions and each Union consists of several villages. The rural study (four villages) areas were selected from Basail Thana of Tangail District. There are more than seventy thousands villages in Bangladesh. Although there are differences in societies in villages of the different part of Bangladesh, the poor conditions of infrastructures, transportation, power suply, sanitation, health serviceas are the common scenario in all villages (rural areas) of Bangladesh. Hence, the study (four villages) area in Tangail district aparently represents the rural area of Banglathesh. 17) Bangladesh Cultural Overview, http://asiarecipe.com/banculture.html 18) Purdah is the practice that includes the seclusion of women from public observation by wearing concealing clothing from head to toe and by the use of high walls, curtains, and screens erected within the home. Purdah is practiced by Muslims and by various Hindus, especially in India. The system of Purdah affects women severely in terms of their mobility, schooling, opportunities, access to communication channel, and their exposure to health care facilities. http://departments.kings.edu/ womens_history/purdah.html.

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