Displaced Rohingya communities in Cox’s Bazar are experiencing vital advancements in sexual and reproductive health services, driven by a significant rise in facility-based deliveries and broader family planning adoption, a new study has found.
Preliminary findings disseminated at a research workshop on Thursday show that targeted community interventions have successfully boosted institutional delivery rates, expanded contraceptive use, and progressively transformed local health-seeking behaviours.
The findings were shared at a research dissemination workshop titled “From Research to Practice: Evidence-Based Approaches to Facilitate Behaviour Change” held at Hotel Amari Dhaka.
The study was conducted by the BRAC James P Grant School of Public Health at BRAC University, in collaboration with the Bangladesh Red Crescent Society and with support from the Swiss Red Cross. It employed a quasi-experimental before-and-after design with embedded implementation research across Camp 2-East and Camp 13.
Guided by the COM-B (Capability, Opportunity, Motivation–Behaviour) framework, the study assessed shifting knowledge, attitudes, intentions, and practices regarding institutional delivery and family planning.
Intervention areas demonstrated a clear surge in awareness regarding skilled birth attendants, alongside a sharp decline in the traditional perception that home is the safest place for childbirth. Consequently, the intention to deliver in health facilities remained high, yielding visible improvements in actual institutional delivery rates over the study period. Women also reported a greater voice in deciding their place of delivery.
The study also revealed positive shifts in family planning, where contraceptive use steadily increased in intervention areas despite a parallel decline in comparison areas. This upward trend was supported by improved male awareness and approval of family planning methods.
Both men and women identified community health volunteers as their primary and most trusted source of family planning information, validating the deep impact of localised peer-led outreach.
Despite these encouraging advancements, the research highlighted several ongoing socio-cultural and structural barriers. Religious concerns remain an important factor influencing the non-use of family planning, while qualitative data pointed to deep-seated socio-cultural norms such as purdah practices, community perceptions, and apprehensions regarding exposure to male medical providers during childbirth.
These are further compounded by infrastructure-related challenges, including inadequate lighting, transportation constraints, overcrowded facilities, medicine shortages, language barriers, and provider attitudes.
The study identified community health volunteers and religious leaders as vital catalysts for positive behavioural change. Tailored community engagement initiatives involving husbands, imams, and local leaders – complemented by regular household visits, maternal support packages, community transport arrangements for pregnant women, and the sharing of positive facility-based birth experiences – served as crucial facilitators.
BDRCS Secretary General Kabir M Ashraf Alam emphasised that health-seeking behaviour in humanitarian environments is shaped by a complex combination of social norms, cultural beliefs, religious perspectives, family dynamics, trust, and access-related challenges.
He stated that BDRCS remains committed to promoting evidence-based programming, asserting that research must actively inform decisions and optimise programmes for better real-world outcomes.
Country Representative of the Swiss Red Cross in Bangladesh Paul Drossou noted that applying the COM-B model in Rohingya camps shows that when capability, opportunity, and motivation are strengthened together, barriers can be transformed into pathways of empowerment and resilience.
The research and dissemination event were funded by the Stanley Johnson Foundation. The workshop brought together representatives from government agencies, development partners, humanitarian organisations, the Red Cross Red Crescent Movement, and various academic and technical institutions.
