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Accessing sexual and reproductive health (SRH) services in underserved urban areas of Dhaka is often challenging as the location of clinics, their hours of operation, and the SRH services offered do not always meet the needs of community members. Adolescents and unmarried women face additional barriers to accessing SRH services, including concerns about privacy given the associated social stigma.
Throughout underserved neighbourhoods in Dhaka, there are private general practitioner (GP) chambers that conveniently operate in the back of pharmacies and beyond normal clinic hours. However, GPs are not integrated into the broader health system and lack access to the training and commodities required to provide quality gender responsive SRH services.
The Improving sexual and reproductive health and rights (SRHR) in Dhaka project, aims to improve the SRHR of women and adolescents in Dhaka by enhancing the availability, accessibility, and use of high quality SRH services. This includes the ongoing training and mentorship of GPs to provide judgement-free, client-centered, and gender-sensitive SRH services. GPs are also equipped with essential medical equipment and reproductive commodities to provide essential SRH services such as menstrual regulation (MR) (the local term for abortion), post-abortion care (PAC), and family planning (FP) services including short- and long-acting reversible contraceptives.
The impact of working with community-based GPs to improve SRH is reflected in experiences described by providers such as Dr. Anowara. A lack of formal SRH training and knowledge related to MR prevented Dr. Anowara from providing needed SRH services to women and adolescents, as she did not know how to perform procedures, nor where to refer clients for these services. Through the project, Dr. Anowara received six weeks of clinical training on MR, PAC and family planning methods. She developed confidence in her ability to help clients, and women and adolescents in the community came to know she could be trusted to provide quality SRH services. This impact was described by Dr. Anowara:
…after the community people came to know about the availability of MR, PAC and FP services in the chamber, I am getting more clients from the slum areas for MR and PAC services. The training helped me significantly to learn the standard protocol for MR services. I am very happy to serve such underprivileged women with safe MR and PAC services.
Strengthening the capacity of GPs to provide SRH services that are responsive to the needs of underserved women and adolescents in Dhaka contributes towards an improvement in the urban health landscape. The provision of gender-sensitive SRH care by GPs serves to expand access to community-based services in times and locations that are convenient for women and adolescents in underserved areas. As well as improving health outcomes, improving quality and access to SRH services allows more women and adolescents, especially those that are most vulnerable, to exercise their reproductive rights.
