National Strategy For Adolescent Health 2017 2030 1

National Strategy for
Adolescent Health 2017-2030
ˆK‡kvi evÜe ¯^v¯’¨‡mev
Ministry of Health and Family Welfare

The People's Republic of Bangladesh
National Strategy for Adolescent Health 2017-2030
December, 2016
Published by:
MCH Services Unit
Directorate General of Family Planning
6, Kawran Bazar, Dhaka-1215
Funded by:
UNFPA, Bangladesh
Cover Design:
Amal Das
Printed by:
Color Line, 01715 812345
National Strategy for
Adolescent Health 2017-2030
MCH Services Unit

Executive Summary
Bangladesh has an adolescent population of approximately 36 million: more than one-fifth of the
total population of Bangladesh is those between the ages of 10 and 19 years (BBS, 2015a). This large
cohort presents significant potential for the social and economic development of the country if we
make the necessary investments to make them healthy and productive. It has been evidenced that
investments in adolescent health can bring a triple dividend of immediate benefits, benefits into
future adult life and benefits for the next generation of children (Pattonet al., 2016). A strong
strategy, which identifies key areas for investment, is essential if the overall health and wellbeing of
adolescents is to be realized. This National Adolescent Health Strategy was developed to address
the overall health needs of adolescents by taking a broad and holistic understanding of the concept
of health. It also fills a gap where adolescent health issues were not addressed comprehensively in
other policy documents.
The National Adolescent Health Strategy has been developed using a participatory process, with
active participation and contributions from key stakeholder groups. Under the leadership of the
Ministry of Health and Family Welfare and immediate guidance of the Directorate General of Family
Planning, a core committee and several technical committees were established to provide expert
input and ensure a comprehensive strategy document. The strategy development process included
reviewing of existing national and international literature to assess current trends in adolescent
health, conducting five divisional consultations with local level stakeholders, conducting four focus
group discussions with adolescents, conducting meetings of the core committee and technical
committees and organizing a two-day national workshop. The final draft of the strategy document
was presented to the Inter-Ministerial Committee and finalized subsequent to incorporating their
comments.
The National Adolescent Health Strategy has identified four priority thematic areas of intervention:
adolescent sexual and reproductive health, violence against adolescents, adolescent nutrition and
mental health of adolescents. In addition social and behavioural change communication and health
systems strengthening are included as cross cutting issues, which need to be addressed for the
effective implementation of the strategy. The management of the National Adolescent Health
Strategy will require an effective management and coordination structure, which has been detailed
in the final section of this strategy document. This document highlights the importance of all
relevant actors in the development sector – both Government and Non-Government – working in
collaboration with each other if the goal and vision of this strategy is to be realized during the given
time period.
The National Adolescent Health Strategy has been developed for a period of 15 years – from 2016 to
2030 – to be in line with the Sustainable Development Goals. The Strategy envisions that by 2030, all
adolescents in Bangladesh will be able to enjoy a healthy life and has the goal of all adolescents
attaining a healthy and productive life in a socially secure and supportive environment. This strategy
is guided by human rights principles and clearly states that all adolescents, irrespective of their
gender, age, class, caste, ethnicity, religion, disability, civil status, sexual orientation, geographic
divide or HIV status, have the right to attain the highest standard of health. The Ministry of Health
and Family Welfare is committed to ensuring the effective implementation of this strategy, which will
contribute to the overall wellbeing and health of all adolescent boys and girls of Bangladesh.
CONTENTS
Executive Summary
Messages i-vi
Acknowledgement vii
Abbreviations and Acronyms viii-ix
CHAPTER 1: Background
1.1 Defining Adolescence 1
1.2 Adolescents in Bangladesh 1
1.3 The Social Context of Adolescent Health 2
CHAPTER 2: Commitment and Response to Adolescent Health

2.1 Bangladesh's International Commitments to Adolescent Health 3
2.2 Legal and Policy Responses 3
2.3 The Health System Response to Adolescent Health 4
2.4 Justification for an Adolescent Health Strategy 5
2.5 The Strategy Development Process 6
CHAPTER 3: Framework
3.1 The Vision 7
3.2 The Goal 7
3.3. The Time Frame 7
3.4 Guiding Principles 7-8
CHAPTER 4: Strategic Directions

SD1: Adolescent Sexual and Reproductive Health 9-11
SD2: Violence against Adolescents 12-14
SD3: Adolescent Nutrition 15-16
SD4: Mental Health of Adolescents 17-18
Cross Cutting Issue 1: Social and Behavior Change Communication 19-20
Cross Cutting Issue 2: Health Systems Strengthening 21-23
Vulnerable Adolescents and Adolescents in Challenging Circumstances 24-25
CHAPTER 5: Implementation
Implementation 26
Management and Coordination 26
5.1 The Role of the MoHFW 26
5.2 The Role of Other Ministries 26-27
5.3 The Role of Development Partners 27
REFERENCES 28-29
ANNEXURE 30-34
Mohammed Nasim, MP
Minister
Government of the People's Republic of Bangladesh
Message
Adolescence is a difficult transition period, they are "no longer children and not yet adults". This
period is characterized by physical, emotional and social changes that require understanding and
effective approaches to meet the specific needs of adolescents. Today's adolescents experience an
earlier onset of puberty and often have limited knowledge about their sexuality and the
consequences of sexual behavior; have high risk of pregnancy and pregnancy complications; and are
exposed early to sexually transmitted infections (STI).
Bangladesh recognizes that adolescents' health needs differ in many ways from those of adults.
Adolescents constitute more than one fifth of our population. While the government has been
providing support to female education, child marriage and adolescent pregnancy undermine the
wellbeing of girls and pose a challenge to the development of the country. The median age of
marriage is still below the legal age of marriage for the girls in Bangladesh and there has been no
significant increase observed in the median age of marriage between last two BDHS surveys. Indeed,
the contribution of the adolescent fertility rate to the total fertility rate has increased. Child marriage
and adolescent pregnancy remain high, about one-third of adolescents beginning childbearing
when they are in their teens which results in health complications for themselves and for their
children. Therefore, reducing child marriage/ adolescent pregnancy, limiting the frequency of
births, increasing the birth interval/ˆK‡kvi
birth evÜe
spacing¯^v¯’¨by
‡mevadopting appropriate family planning
methods and providing quality sexual and reproductive health services can have a crucial impact on
the lives of adolescents and the next generation.
Bangladesh has made notable progress not only in child survival but also in the maternal health over
the last few decades. Despite this remarkable progress, we still have numerous challenges, which
have to be addressed as we are committed to reduce child marriage and to ensure access to quality
adolescent friendly health services. The current limitation in making available quality adolescent
friendly health services and information impact the overall development of all adolescents and
ensuring they reach their full potential.
I want to congratulate the Directorate General of Family Planning and all stakeholders for
developing a comprehensive national strategy for adolescent health and I am hopeful that all
strategic issues will be addressed in next sector programme of the Ministry of Health and Family
Welfare.
Mohammed Nasim, MP
vii
Zahid Maleque, MP
State Minister
Government of the People's Republic of Bangladesh
Message
Adolescents constitute more than one-fifth of our population. They are the most vibrant, promising
and innovative group in society. However, they need to be given a solid education, information and
healthcare to ensure their future development. Bangladesh will be in a position to reap a
demographic dividend if we invest in and provide proper support to our adolescents to become
competent citizens of our country. Along with other ministries, the Ministry of Health and Family
Welfare is working relentlessly to improve the health status of adolescents in the country.
Child marriage and adolescent pregnancy is the most pressing adolescent health problem in
Bangladesh. According to Bangladesh Demographic and Health Survey, 2014 fifty nine percent of
women, aged 20-24 years, were married before the age of 18 years and 31 percent of 15-19 year old
adolescents have begun child bearing. The adolescent fertility rate, among those aged 15-19 years,
is 113 live births per 1000 women and this is the highest rate in South Asia. The honourable Prime
Minister Sheikh Hasina pledged to end child marriage under 15 years by 2021, and end all marriage
before age 18 by 2041, at the London Girl Summit in 2014. The government has developed a National
Plan of Action to stop child marriage in Bangladesh and also amended the Child Marriage Restraint
Law.
The Directorate General of Family ˆK‡kvi
PlanningevÜe ¯^v¯’¨‡mev
(DGFP) with the support of UNFPA developed
Adolescent Reproductive Health Strategy in 2006, which has now been revised to cover all
adolescent health issues through this new strategy document. I would like to congratulate the DGFP
along with UNFPA, UNICEF and WHO for following through the process of developing a
comprehensive strategy for adolescent health by addressing key issues such as adolescent sexual
and reproductive health, violence, mental health and nutrition among adolescents. I hope this
strategy will provide an opportunity for all relevant ministries to adopt a coordinated approach to
meet the health need of adolescents.
Zahid Maleque, MP
ix
Md. Sirazul Islam
Secretary
Medical Education and Family Welfare Division
Message
In Bangladesh more than one fifth of the total population is adolescents. Ensuring the health of all
adolescents therefore is crucial for both global and national development. The health sector of
Bangladesh has recognized the importance of addressing this issue, keeping in line the country's
commitment to meet the SDGs by 2030. Though Bangladesh has shown significant progress in
maternal and child health and family planning areas, adolescent health is yet to be fully addressed,
despite this significant population in the country.
Adolescents face many preventable or treatable health problems such as unwanted pregnancies,
pregnancy related complications, sexually transmitted infections, HIV/AIDS, lower respiratory tract
infections, abuse/violence and suicide. Half of all mental health disorders in adulthood appear to
start during early adolescence, mostly as a result of early warning signs being undetected and
untreated. The sexual and reproductive health needs of adolescents is a concern with low levels of
knowledge on SRH among adolescents, low rates of facility based deliveries, low antenatal and
postnatal care coverage and a high unmet need for family planning. There is, therefore, a need to
address these limitations if the country is to meet the health needs of adolescents. Moreover,
adolescents become vulnerable due to the lack of knowledge and skills such as sexual and
reproductive health, life skills, protective and legal measures and related services. They have limited
access to facilities and opportunities ˆK‡kvi
which canevÜe ¯^v¯’them
make ¨‡mevhealthy and productive citizen of this
country.
Currently, the Ministry of Health and Family Welfare (MoH&FW) has been implementing adolescent-
friendly health services through two wings – the Directorate General of Health Services (DGHS) and
Directorate General of Family Planning (DGFP). This National Adolescent Health Strategy, 2017-
2030, replaces the previous National Adolescent Sexual and Reproductive Health Strategy
developed by DGFP and UNFPA in 2006, and ensures a more holistic approach by focusing on the
overall health needs of adolescents.
I would like to appreciate and thank DGFP for taking the initiative and UNFPA, UNICEF and WHO for
providing both technical and financial support to this timely and crucial endeavor of developing the
National Adolescent Health Strategy 2017-2030. This strategy will build a momentum on evidence-
informed priority setting to achieve universal access to Sexual and Reproductive Health and Rights
under the framework of Sustainable Development Goals and beyond.
Md. Sirazul Islam
xi
Professor Dr. Abul Kalam Azad
Director General
Directorate General of Health Services
Message
Bangladesh has made significant improvements in the health and family planning sector in the last
few decades. Being a large and growing segment of the population, adolescents need information,
counseling, services and other support to ensure their development. Historically, adolescents'
health needs have been neglected based on the assumption that they will remain physically strong
during this transition period. Given the importance of shaping the country's future development and
the importance of adolescent health in ensuring this, Government of the People's Republic of
Bangladesh has been working at different levels of health facilities, not only to improve maternal and
child health but also to improve adolescent health.
The country's current adolescent population is approximately 36 million, which is more than the
total population of many countries. In Bangladesh, adolescents face many challenges as they are
physically, mentally and socially vulnerable. They become victims of child marriage, early and
unwanted pregnancy, abuse, under nutrition etc. - which expose them to life threatening risks and
then, to death. Those who survive, live with chronic morbidities, leading to the perpetuation of a
cycle of intergenerational poverty. Child marriage and adolescent pregnancy increases the risk of
maternal and child morbidity and mortality along with other problems. These challenging issues
need to be addressed if the adolescents of Bangladesh are to grow up to be healthy and productive
adults who will in the future present Bangladesh as a prosperous nation and country to the whole
world.
I would like to congratulate the MCH services unit of the Directorate General of Family Planning
under Ministry of Health and Family Welfare for taking this timely initiative when the first HPN
Sector programme of SDG era in Bangladesh is being started. I would like to thank our Development
Partners - UNFPA, UNICEF and WHO for coming forward with their support to us. I also would like to
thank colleagues from other Line Ministries, civil society partners and experts who work in different
areas of adolescent health and supported the development of this strategy. I firmly believe that the
National Adolescent Health Strategy 2017-2030 will be useful for our adolescents as well as for all
policymakers and service providers of our country.
Professor Dr. Abul Kalam Azad
xiii
Dr. Kazi Mustafa Sarwar
Director General
Message
Adolescence is a period of rapid development when major physical changes take place and
differences between boys and girls are accentuated through pubertal changes. As a substantial
component of the total population (22.4%), they are the future of this country. Therefore, we have to
emphasize on the healthy and productive development of our adolescents. Their reproductive
health needs vary greatly with age and marital status. As this generation reaches adulthood, their
attitude, behaviours, and practices concerning gender, health and life opportunities become crucial.
Adolescents face several health risks due to child marriage and early child bearing, under nutrition,
violence, drug use, STI/RTI and HIV/AIDS, inadequate education, discriminatory gender norms and
taboos, poverty etc. According to the Bangladesh Demographic and Health Survey 2014, the median
age at first marriage for women is 17.2 years; 31 percent of 15-19 year old girls have begun
childbearing; more than 64.4percent of 15-19 year old girls received antenatal care from medically
trained persons and 36 percent had facility-based delivery. Modern contraceptives are being used by
46.7% of 15-19 year old married girls and 17.1 percent have an unmet need for family planning. The
current adolescent (15-19 years) fertility rate is 113 live births per 1000 women. The children of
adolescent mothers are more likely to be of low birth weight and stunted (BMMS 2010).
ˆK‡kviofevÜe
The Ministry of Health and Family Welfare ¯^v¯’¨‡mev
Bangladesh has shown farsightedness in developing
the National Adolescent Health Strategy 2017-2030, which will create the necessary policy and legal
environment to promote adolescent sexual and reproductive health and development. This strategy
has covered many health issues in addition to sexual and reproductive health, and includes mental
health, nutrition, violence, social and behaviour change communication and rights which have a
strong influence over adolescent health. Given the difficult situation faced by most adolescents, MCH
services unit under Directorate General of Family Planning, with support from UNFPA and UNICEF,
and other international organizations, has started to provide adolescent-friendly health services at
district and union levels. I hope through this initiative we will able to ensure the health of
adolescents as detailed in the Sustainable Development Goals, by 2030.
I would like to express my sincere gratitude to UNFPA, UNICEF and WHO for their support in
developing the National Adolescent Health Strategy , 2017-2030 by extending their co-operation
towards adolescent health and development. I would like to request all Development Partners and
UN agencies to work with the MoHFW to address the needs of adolescents with a special emphasis
on their health issues. I believe this strategy will direct us in ensuring the effective, context-specific
and feasible implementat ion of all adolescent health related interventions in the present and next
HPN sector programmes.
Dr. Kazi Mustafa Sarwar
xv
Message from UNFPA, UNICEF and WHO
Adolescence is the period when an individual has to deal with significant physical, mental and
emotional changes as they begin the transit from childhood to adulthood. Given the vulnerability of
this life stage, it is crucial to ensure that adolescents are given the necessary services, information,
skills and opportunities, to develop their full potential to become productive, healthy and peace-
loving adults. Investing in the health of adolescents, including their sexual and reproductive health,
is also essential if a country is to capitalize on the demographic window of opportunity presented by
the adolescent population cohort and reap the benefits of a demographic dividend.
Bangladesh currently has more than one fifth of its total population consisting of adolescents. The
proportion of adolescents in the population is expected to grow in the coming years, making it
imperative for us to invest in their overall health and wellbeing. Not only the sheer size of this young
population cohort, but also the public health, economic and human rights drivers necessitate
investment in the health and development of adolescents at this time. Investing in adolescent health
will bring the triple dividend: benefit adolescents now, benefit them in the future and also benefit the
next generation.
The Government of Bangladesh is committed to ensuring the health of adolescents and making
adolescents aware of the significance of practicing healthy habits from a very young age. The
National Adolescent Health Strategy 2017-2030, developed under the leadership of the Ministry of
Health and Family Welfare, with support from UNFPA, UNICEF and WHO and in collaboration with
other key partners in the development sector, including adolescent groups, is a strong statement by
the Government of Bangladesh on the importance it attaches to meeting the health needs of this
critical population cohort.
In 2016, UN member states including Bangladesh unanimously embarked on the joint journey of
achieving the Sustainable Development Goals (SDGs) building on the progress made by the
Millennium Development Goals. In this era of SDGs, this initiative to develop the National Adolescent
Health Strategy (NAHS) is both timely and vital. Following the time-line of the SDGs as well as the
Global Strategy for Women's, Children's and Adolescents' Health, the NAHS will highlight the
necessary strategic directions and identify investments needed to provide a healthy transition for all
adolescents of Bangladesh by 2030.
We in UNFPA, UNICEF and WHO hereby commit to support the implementation of this strategy and
its action plan by providing technical assistance to the Government of Bangladesh to, ensure
evidence based interventions, maintain the quality of care and strengthen the health system to
guarantee the wellbeing and development of adolescents. We are of the conviction that this strategy
will provide the necessary guidance and underscore the directions that need to be taken by both
Government and non-government actors to meet the health needs of all adolescents of Bangladesh.
Iori Kato N. Paranietharan Edouard Beigbeder

UNFPA Representative, a.i. WHO Representative UNICEF Representative
xvii
Acknowledgement
Adolescents are one-fourth of our population, full of promises and potential. However, they seldom
get access to information and services to meet their health needs. Lack of information on health puts
them at great risk of child marriage, adolescent pregnancy, unsafe abortion, RTI/STI & HIV/AIDS.
They are often the victims of violence and self inflicted injury. Substance abuse, depression and other
types of mental illnesses are also common among adolescents.
The Ministry of Health & Family Welfare (MoHFW) put emphasis on adolescent health through its 3rd
SWAP and included adolescent health in both the Maternal, Child, Reproductive & Adolescent
Health(MCR&AH) and Maternal, Neonatal, Child & Adolescent Health (MNC&AH) operation plans.
The Director General of Family Planning with the support of UNFPA developed the National Strategy
for Adolescent Sexual and Reproductive Health in 2006 for a 10-year period. The Directorate General
of Family Planning under the direction of MoHFW and with the support of UNFPA, UNICEF and WHO
along with Directorate General of Health Services and other stakeholders took the initiative to revise
the strategy in 2015. During the revision of the strategy in 2016, a core committee and eight
technical committees were formed and the strategy was renamed the National Adolescent Health
Strategy 2017-2030. The strategy was revised as a comprehensive strategy by incorporating sexual
and reproductive health, nutrition, mental health, including substance abuse and violence and
injury which were not included in the previous strategy. Other issues of adolescent health, such as
child marriage, STI/RTI & HIV/AIDS, were also included in this comprehensive document.
I would like to express my sincere gratitude to all members of the core and technical committees for
their relentless effort to revise the strategy on schedule. I also want to express my heartfelt thanks to
the MoHFW for their continuous support in arranging inter-ministerial meetings and kind approval
of the final draft of the document. I also would like to express my gratitude to UNFPA, UNICEF and
WHO for providing support in the process of developing the strategy.
I hope the strategy will meet the needsˆK‡kvi evÜe ¯^v¯’¨‡mev
of the adolescents in this country and that we will be able to
work together to bring positive changes in their lives.
Dr. Mohammed Sharif

Director (MCH Services) & Line Director (MCRAH)
xix
Abbreviations
AFHS Adolescent Friendly Health Services

AHS Adolescent Health Strategy
AIDS Acquired Immune Deficiency Syndrome
ARHS Adolescent Reproductive Health Strategy
ASRH Adolescent Sexual & Reproductive Health
BBS Bangladesh Bureau of Statistics
BCC Behavior Change Communication
BDHS Bangladesh Demographic and Health Survey
BMI Body Mass Index
BMMS Bangladesh Maternal Mortality Survey
CPR Contraceptive Prevalence Rate
CSO Civil Society Organization
DGFP Directorate General of Family Planning
DGHS Directorate General of Health Services
DH District Hospital
EmOC Emergency Obstetric Care
ESP Essential Services Package
FHI Family Health International
FSNSP Food Security Nutritional Surveillance Project
GBV Gender Based Violence
HDRC Human Development and Research Center
HIV Human Immunodeficiency Virus
HKI Hellen Keller International
HMIS Health Management Information System
ICDDRB International Center for Diarrheal Disease Research, Bangladesh
ICRW International Center for Research on Women
IFA Iron Folic Acid
JPGSPH James P Grant School of Public Health
MARA Most At Risk Adolescents
MCH Maternal and Child Health
MCWC Maternal & Child Welfare Center
MMS Multiple Micronutrient Supplementation
MoHFW Ministry of Health & Family Welfare
NASP National AIDS and STD Program
NGO Non-government Organization
RD Rural Dispensary
xx
RTI Reproductive Tract Infection
SBCC Social and Behavior Change Communication
SDG Sustainable Development Goal
SRH Sexual and Reproductive Health
SRHR Sexual and Reproductive Health and Rights
STI Sexually Transmitted Infections
TT Tetanus Toxoid
UH&FWC Urban Health and Family Welfare Center
UHC Upazilla Health Complex
UN United Nations
UNAIDS Joint United Nations Program on HIV/AIDS
UNESCO United Nations Educational, Scientific and Cultural Organization
UNFPA United Nations Population Fund
UNICEF United Nations Children Fund
UPHCSDP Urban Primary Health Care Service Delivery Project
VAW Violence against Women
WHO World Health Organization
xxi
CHAPTER
BACKGROUND
I
1.1. Defining Adolescence
Adolescence, a near universal life stage of the socialization process, is defined as a period of human
growth and development that occurs after childhood and before adulthood and, according to the UN,
includes those persons between 10 and 19 years of age (WHO 2014). Adolescence is a time of
transition involving multi-dimensional changes: biological, psychological, mental and social
(UNICEF, 2006). Biologically, adolescents experience pubertal changes and changes in brain
structure. Psychologically and mentally, adolescents' cognitive capacities mature and they develop
critical thinking skills. Adolescents also experience social change as a result of the multiple roles
they are expected to play in the family, community and at school. These changes occur
simultaneously but at a different pace for each adolescent depending on her/his gender, socio-
economic background, education and exposure to various other structural and environmental
factors (UNICEF, 2006). As a developmental phase in human life, adolescence is further divided into
early adolescence (10-14 years) and late adolescence (15-19 years). An understanding of these sub-
stages of development during adolescence is important from the perspective of policy planning as
well as designing and implementing adolescent related programmes.
1.2. Adolescents in Bangladesh

Bangladesh has a significant adolescent population. In 2011, more than one-fifth (20.5 percent) of
the total population, that is 30.68 million, were adolescents (BBS, 2011) and according to population
projections, both the percentage and absolute number of adolescents will continue to increase until
2021 (UNFPA 2015). It is only by 2031 there will be a decline in the adolescent population of
Bangladesh – highlighting the importance of ensuring this national adolescent health strategy is
comprehensive and meets the needs of all adolescents, especially the most vulnerable and
disadvantaged adolescents. The sheer number of persons in this population cohort, whose health
needs have to be addressed, also makes it imperative for this strategy to be effectively implemented.
This significant adolescent population presents a demographic window of opportunity, which, if
well harnessed and invested in, will contribute to the development of the country. Investment in
adolescent health will have an immediate and direct impact on Bangladesh's health goals and on the
achievement of the Sustainable Development Goals (SDGs), especially goals 3 (ensure healthy lives
and promote well-being for all at all ages), 4 (ensure inclusive and equitable quality education and
promote lifelong learning opportunities for all), 5 (achieve gender equality and empower all women
and girls), and 8 (promote sustained, inclusive and sustainable economic growth, full and productive
employment and decent work for all). Investments in adolescent health will also require supporting
programmes and services, which recognize the special needs of adolescents and ensure their needs
are addressed both comprehensively and sensitively.
01
1.3. The Social Context of Adolescent Health
Many adolescents, especially adolescent girls in Bangladesh, are not provided with optimal
conditions to develop their full potential and ensure their overall health in their transition into
adulthood. The challenges adolescents face, during this transitory phase, are due to a variety of
factors including structural poverty, lack of access to information and services, negative social
norms, inadequate education, social discrimination and child marriage and early child-bearing for
adolescent girls. Adolescents who are marginalized and especially vulnerable because of their living
conditions have a set of other, more varied, challenges which further exacerbate this transitional
process. Adolescents who live on the streets, in slum dwellings, in char and haor areas, adolescents
with disability, married and/or pregnant adolescent girls, adolescents who engage in sex work,
adolescent children of sex workers, adolescents in child labour, adolescents who are in detention
and adolescents who are refugees/live in refugee camps will need special interventions to meet their
overall health needs.
Adolescents continue to experience major constraints in making informed life choices: a significant
number of adolescents experience risky or unwanted sexual activity, do not receive prompt or
appropriate care and, as a result, experience adverse health outcomes. Adolescent girls also face
gender-based discrimination, evident in the practice of child marriage, the high rates of adolescent
fertility, the high prevalence of domestic violence, the increasing incidence of sexual abuse and
higher drop-out rates from secondary education due to the patriarchal social norms of Bangladesh.
Adolescent boys also face pressure to comply with prevailing norms of masculinity, which drives
them to risky behaviors such as unsafe sex, violence and substance use. All these factors have a direct
as well as indirect influence on the health and well-being of adolescents, and form an essential
component of the context within which health issues of adolescents should be understood.
02
CHAPTER 2
COMMITMENT AND RESPONSE TO ADOLESCENT HEALTH
2.1 Bangladesh's International Commitments to Adolescent Health

As a signatory to the Child Rights Convention and a proponent of the International Conference on
Population and Development (ICPD), the Beijing Platform for Action and, more recently, the SDGs
Bangladesh has made important commitments to address the issue of adolescent health in the
country. These commitments have, in the recent past, translated into results and the country has
seen significant improvements in select health indicators including the maternal mortality rate,
neonatal and infant mortality rates and adolescent malnutrition rates. Given the significant number
of adolescents in the country and their potential role as change agents, any improvement in their
health status could trigger an accelerated achievement of the other goals and targets outlined in the
SDGs as well as the ICPD Programme of Action and thereby contribute to Bangladesh meeting its
commitments to the international community.
2.2 Legal and Policy Responses

The Bangladesh Constitution
The Constitution of Bangladesh guarantees the right to healthcare and medical treatment for all its
citizens, irrespective of age, sex, caste, creed and colour. Making comprehensive and quality
healthcare services available is the responsibility of the State and the Government of Bangladesh
has, through various laws and policies, highlighted the importance they attach to addressing the
health of adolescents.
Laws/Acts of Bangladesh to Ensure Adolescent Health
A number of laws are in places, which directly or indirectly contribute to addressing the overall
health and wellbeing of adolescents. These include the Children Act 2013, which includes provisions
relating to the protection and treatment of children and trial and punishment of child offenders, the
Women and Children Repression Prevention Act 2000 (amended in 2003) and the Human
Trafficking Prevention and Deterrence Act 2012 enacted to regulate offences including sexual
harassment, rape, trafficking, kidnapping, dowry against women and the Child Marriage Restraint
Act 1929 (amended in 1983) enacted to restrain child marriage and ascertain the legal age of
marriage, among others.
Policies of Bangladesh Supporting Adolescent Health
The Government of Bangladesh has recognized the importance of ensuring adolescent health and
has incorporated this issue in several of its policies. These include the Bangladesh Population Policy
of 2012, which has the objective of raising awareness among adolescents on family planning,
reproductive health, reproductive tract infections and HIV/AIDS. The National Health Policy of 2011
similarly has objectives and strategies which are comprehensive and include addressing adolescent
03
health through its focus on ensuring good quality health for all citizens of Bangladesh irrespective of
their age, sex, caste, creed, colour and/or place of residence. The Bangladesh National Children
Policy of 2013 places significant attention on adolescent development including the development of
the girl child. The policy focuses on making quality services, including health services, available to all
children and adolescents of Bangladesh. In addition to these policies, the Education Policy of 2010,
the Child Labour Elimination Policy of 2010 and the Nutrition Policy of 2015 all contribute to
addressing adolescent health issues.
2.3 The Health System Response to Adolescent Health

Interventions of the Government Sector
The Ministry of Health and Family Welfare (MoHFW) has the primary responsibility for addressing
the health needs of adolescents and providing quality services for same. The Directorate General of
Health Services and Directorate General of Family Planning both have an Operational Plan for
addressing adolescent health. Adolescent health related programmes under the purview of the
MoHFW include the provision of Adolescent Friendly Health Services (AFHS), school health
programmes, counseling and raising awareness among adolescents on reproductive health issues
and preventing STIs and HIV/AIDS through education and treatment services. The nutritional
supplement programmes for pregnant adolescent mothers, introducing skilled birth attendants and
the expansion of Emergency Obstetric Care (EmOC) services including 24 hour delivery centres,
immunization programmes for adolescent girls and establishing referral linkages between school
health clinics and other health facilities are other initiatives which will directly contribute to
improving the overall health of adolescents.
A number of other ministries are also directly responsible for addressing adolescent health issues.
The Ministry of Local Government, Rural Development and Cooperatives, under the Urban Primary
Health Care Project (UPHCP) provide adolescent health services in a majority of municipalities and
all City Corporation areas. The Ministry of Education has included adolescent health issues in the
formal school curricular and the Ministry of Social Welfare, through its centers for street children
and juvenile delinquents, is providing valuable support, including the health related services, to
extremely marginalized groups of adolescents. Legal support and skills training provided to women,
including adolescent girls, by the Ministry of Women and Children's Affairs, and the youth advocacy,
along with provision of livelihood training and peer education through Youth Clubs, of the Ministry
of Youth and Sports, are other important initiatives which deserve special mention.
Role of Development Partners
Development Partners, including UN agencies and bilateral and multilateral donors, have a long
history of working in the area of adolescent health. Among UN agencies, UNFPA, WHO, UNICEF and
UNAIDS in particular have play a key role in working together with the MoHFW to address
adolescent health issues. The focus of these agencies differs, but together they encompass all facets
of adolescent health, including education, nutrition, rights, empowerment as well as systemic issues
such as monitoring progress and promoting adolescent participation. The role of bilateral donors
has primarily been to provide technical as well as financial support through their partners. Along
with UN agencies, these bilateral agencies have played a valuable role in highlighting the importance
of adolescent health issues and ensuring the availability of services to meet the health needs of
adolescents.
Civil Society and the Private Sector Support to Adolescent Health
Non-governmental Organizations (NGOs) played a pioneering role in providing adolescent friendly
health services in Bangladesh. A majority of NGOs primarily focused on the provision of health
04
education, raising awareness on health issues, the delivery of health services for adolescents and the
provision of peer education and life skills for capacitating adolescents to claim their rights. A large
number of NGOs – both local, national and international have been involved in designing and
implementing interventions related to adolescent health. Many of these interventions have used
innovative approaches and have been truly responsive to the needs of adolescents. Several NGO
supported programmes have been particularly successful in addressing the health needs of highly
marginalized groups such as adolescents living on the street, adolescents employed in risky jobs and
adolescents working in hazardous environments.
It is important to note that despite extensive engagement of NGOs, their impact in addressing
adolescent health issues has been limited. While the reasons for this are manifold, a key factor has
been that these interventions are not at a large enough scale to generate a critical national response.
Moreover the lack of coordination and collaboration between civil society organizations has also
contributed to difficulties in ensuring the availability of a holistic response to meet the health needs
of all adolescents.
2.4 Justification for an Adolescent Health Strategy

The first Adolescent Reproductive Health Strategy (ARHS) for Bangladesh was developed in 2006
with the following goal: “By 2016, all adolescents will have easy access to information, education and
services required to achieve a fulfilling reproductive life in a socially secure and enabling environment”.
This strategy was valid for a period of 10 years until the end of 2016. Given the effectiveness of this
policy and associated action plan in ensuring that adolescent sexual and reproductive health needs
were addressed through the health sector, it was decided to develop a strategy, with a broader focus
on overall adolescent health, to be implemented beyond 2016.
The focus on adolescent reproductive health in the previous strategy, while appropriate for the said
time period, would not have effectively captured the varied health needs of adolescents in the
present context. Therefore in order to better respond to the overall health needs of adolescents, the
MoHFW decided to develop a comprehensive adolescent health strategy, which would include
sexual and reproductive health as a key component. The broader focus would thus be a paradigm
shift in approaching adolescent health because it adopts a combination of strategies to support
health promotion, prevent ill health and provide curative care and services to meet adolescent
health and development needs.
The current strategy focuses not only on adolescents but also on their social environment, including
families, peers and communities. Importantly, the strategy proposes a convergent model of health
promotion and service delivery, which will actively engage adolescents through primary health care
providers and platforms within community spaces such as schools and adolescent clubs to secure
and strengthen mechanisms for access. The strategy also moves away from a 'one-size-fits-all'
approach to addressing the specific needs of adolescents in different contexts and aims at instituting
effective, appropriate and accessible service packages to address the range of adolescent health and
development needs. To implement this paradigm shift, four strategic thematic areas were identified
as priority for Bangladesh. These include adolescent sexual and reproductive health; violence
against adolescents; adolescent nutrition; and mental health of adolescents. Social and behaviour
change and health systems strengthening were identified as cross cutting issues, which will
contribute to the effective implementation of the above-mentioned thematic areas.
2.5 The Strategy Development Process

The process of developing the National Adolescent Health Strategy (NAHS) commenced in late 2015
under the leadership of the Maternal and Child Health (MCH) Services unit of the Directorate
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General of Family Planning (DGFP), MoHFW. At the request of DGFP; UNFPA, UNICEF and WHO
agreed to support the strategy development process together with input from other Development
Partners, government agencies and Civil Society Organizations (CSO) who have been working in the
field of adolescent health.
A core committee, consisting of members of the MoHFW, the three UN agencies and key CSOs, was
formed under the guidance of the Director General (DG) of the DGFP. In addition, relevant technical
committees were formed to provide expert input in identifying key thematic areas and related
strategic directions. The technical committees worked on the thematic areas and forwarded their
input to the core committee for vetting and finalization of each focus area.
Several divisional level consultations and workshops were held to validate the draft thematic areas
and identify key priority issues under each theme. The thematic areas were revised subsequent to
the consultations and presented to the core committee for their review and approval. The priority
issues under each thematic area were reviewed and refined by the technical committees and all
sections amalgamated to develop the overall strategy document. The overall draft strategy
document was presented to the inter-ministerial committee for their approval and revised
subsequent to their comments.
This final version of the strategy is an outcome of several divisional level consultations, workshops,
technical meetings and input from policy makers, programme planners, researchers, academicians,
adolescents, and community and opinion leaders. Most significantly, the strategy development
process included the participation of adolescents during the consultation phase and their input will
also be sought in the development of the associated action plan.
06
CHAPTER
FRAMEWORK
3
3.1 The Vision
By 2030, all adolescent boys and girls of Bangladesh, especially those who are most vulnerable, will
be able to enjoy a healthy life.
3.2 The Goal

By 2030 all adolescents will lead a healthy and productive life in a socially secure and supportive
environment where they have easy access to quality and comprehensive information, education and
services.
3.3. The Time Frame

This strategy will span over a period of 15 years (2016 to 2030) in line with the Sustainable
Development Goals. The strategy will be revisited periodically to review and assess its relevance in a
rapidly changing context.
3.4 Guiding Principles

The National Adolescent Health Strategy is based on human rights principles, and highlights the
right of all adolescents, those between the ages of 10 and 19 years, to attain the highest standard of
health. Detailed below are the human rights and other principles that will guide the implementation
of this strategy:
Universality and Inalienability
The right to health will be universal and inalienable for all adolescent boys and girls of Bangladesh.
They will be entitled to access health related information and services regardless of their gender,
age, class, caste, ethnicity, religion, disability, civil status, sexual orientation, geographic divide or
HIV status.
Indivisibility
The right of adolescents to their health has equal status over other rights and will not be positioned
in a hierarchical order. The right to adolescent health will not be compromised at the expense of
other rights.
Interdependence and Interrelatedness
The right to adolescent health is interdependent and interrelated with other rights and as such will
depend, either wholly or in part, on the adolescent's ability to realize their other rights to meet their
physical, mental and social needs. For example, the realization of an adolescent's right to health may
depend on the realization of her/his right to education or information.
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Equality and Non-discrimination
All adolescents, despite their heterogeneity, are equal as human beings and no one should suffer
discrimination on the basis of gender, age, class, civil status, ethnicity, geographic divide,
(urban/rural), religion, region, disability, sexual orientation and/or HIV status. All adolescent health
programmes should therefore respect the diverse needs of adolescents and ensure there is no
discrimination in access to essential quality health services.
Participation and Inclusion
All adolescents will have the right to participate in and access information and services, which will
contribute to their health. Health services and programmes will therefore be participatory, with
increasing scope for active engagement of and expression by adolescents in relation to decision-
making. Health services and programmes will also take into account adolescents' felt needs, issues
and rights; help them to develop their self-esteem and take responsibility for their wellbeing and
relationships.
Capacity Development and Leadership
In addition to the above mentioned human rights principles, this strategy will also be guided by the
principle of developing the capacity and leadership skills of service providers. This will ensure that
the next generation of health service providers can engage themselves in the development of
innovative and effective interdisciplinary approaches to promote adolescent health and provide
services with the primary goal of reducing health inequities.
08
CHAPTER
STRATEGIC DIRECTIONS
4
SD1 Adolescent Sexual and Reproductive Health
Problem Statement
Adolescents of Bangladesh, both those who are unmarried and married, have low levels of
knowledge and limited access to information and services on sexual and reproductive health and
rights (SRHR).
Context
The sexual and reproductive health (SRH) status of adolescents in Bangladesh, both those who are
unmarried and married, remains an area of concern for the country. Low levels of knowledge on SRH
and STI/HIV, high prevalence of child marriage, correspondingly high levels of adolescent fertility
and limited access to quality and age appropriate information and services are challenges, which
need to be addressed through adolescent health programming. It is envisioned that interventions
which provide quality, age appropriate information and services to adolescents, on their SRH and
rights, beginning with the very young adolescent (10-14 years) and continuing until they become
adults (18 years onwards) will contribute to improving the SRH status of adolescents in the country.
Bangladesh does not have any nationally representative data, which assesses knowledge levels on
SRH and rights among the adolescent population. While this poses a challenge, there are other
sources of data, notably those that measure comprehensive knowledge on HIV, which points to the
low levels of knowledge among adolescents. According to UNAIDS Bangladesh, only 12.8 percent of
adolescents and youth have comprehensive knowledge on HIV (UNAIDS 2016). The BDHS (2014),
which highlights that only 12 percent of ever-married adolescents had comprehensive knowledge
about HIV/AIDS, is further testimony to the low levels of knowledge on SRH issues among
adolescents.
A low level of knowledge, often as a result of the unavailability of accurate information, is often
linked to poor SRH outcomes. Globally, it has been established that the provision of quality, age
appropriate comprehensive sexuality education has a positive impact on SRH, reducing STIs/HIV
and unintended pregnancy (UNESCO 2015). Studies have also shown that comprehensive sexuality
education contributes to building communication, negotiation and relationship skills, and positive
gender attitudes – which not only impact on SRH but also mental health. In the current context,
while a range of SRH related education programs are being implemented by both government and
non-government agencies in parts of Bangladesh, there is a lack of consensus with regard to course
content. Importantly, much of the content does not cover the six priority areas of sexuality
education proposed by UNESCO. Furthermore, anecdotal evidence and consultations conducted for
the development of this strategy revealed that the delivery of the content remains weak, with
teachers often skipping the chapters, or asking students to study them at home.
09
A significant concern for Bangladesh is the prevalence of child marriage and the corresponding high
levels of adolescent fertility. With the highest adolescent fertility rate in South Asia, at 113 live births
per 1000 women aged 15-19 years, there is a critical need for Bangladesh to ensure the availability of
interventions to reduce adolescent fertility levels (BDHS 2014). These interventions need to start
before marriage, so that young girls have adequate knowledge on SRH and can better plan their
pregnancies. According to the BDHS (2014) the Contraceptive Prevalence Rate (CPR) among
married adolescents is 51 percent and the unmet need for family planning is 17 percent – the former
lower than the national average by 11 percentage points and the latter higher than the national
average by 5 percentage points.
Encouragingly, it is important to note that the use of antenatal care services from a medically trained
provider and facility based delivery are at 64 percent and 36 percent respectively, both which are on
par with the national averages for these two indicators. While these indicators show gradual
increase over the years, there is room for improvement, especially in light of the fact that adolescent
pregnancies lead to higher maternal morbidities – where adolescent mothers are more likely to
experience complications during pregnancy and are less likely to be prepared to deal with them
(BMMS 2010). Additionally, the under-five mortality rate of children born to mothers below 20 years
is 66 deaths per 1000 live births, much higher than 49 deaths per 1000 live births for those with
mothers between the ages of 20-29 years (BMMS 2010). Children born to adolescent mothers are
also more likely to be underweight – thus contributing to the perpetuation of nutrition related
morbidities. Aside from the obligation to prevent child marriage, there is also a need to ensure the
SRH status of married adolescents – so that their CPR is increased, the unmet need for FP reduced,
facility based delivery and antenatal care services by a medically trained provider increased and the
infant/under-five mortality rates of children born to them is reduced.
There is a lack of data on the prevalence of RTI, STI and HIV among adolescents in Bangladesh but
they – especially adolescent girls – continue to be vulnerable, both socially and economically, to HIV
and STI infections. According to WHO (2013), globally about one-seventh of all new HIV infections
occur during adolescence, which makes it imperative for Bangladesh to continue with its
interventions which specifically target the very young adolescents, so that they are equipped with
the necessary information and knowledge and made less vulnerable. The national policy and
strategy aimed at preventing and responding to HIV/AIDS and STIs as well as the National AIDS/STD
Program (NASP), are well placed to meet the emerging needs of adolescents in relation to
HIV/AIDS/STIs prevention. At the same time, given the lack of data on the prevalence of
HIV/AIDS/STIs among the adolescent population and the low levels of knowledge among
adolescents, the focus on HIV prevention should continue to be for both community based and most
at risk adolescents (MARA).
Finally it is important to address the issue of unmarried adolescents, who fall outside the existing
reproductive health care services system, given the regulation that SRH services are available only to
married women and eligible couples (Ainul et al., 2016). Meeting the SRH needs of unmarried
adolescents, not only by providing them with information, as is the current practice, but also by
making relevant services available and accessible to them becomes imperative if the Government of
Bangladesh is to meet the SRH and rights of all adolescents. While there is limited documented
evidence, it is known that services to meet the SRH needs of adolescents, including those who are
married, are piecemeal and ad hoc. The recent systematic analysis of the effectiveness and gaps of
existing adolescent SRH interventions and programs, conducted by Population Council, revealed
that health services are not tailored to meet the SRHR and needs of unmarried adolescents (Ainul et
al., 2016), highlighting the need to do so and ensuring the special needs of the most vulnerable
adolescents are taken into account.
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Given this background, and the significant population of adolescents in Bangladesh, where a
majority of adolescent girls are given in marriage before the age of 18 years, meeting the sexual and
reproductive health needs and rights of this group becomes imperative. These needs can be met by
ensuring the provision of quality and age appropriate sexuality education starting with the very
young adolescent, the delivery of quality age and gender appropriate SRH information and services
and mobilization of the community to accept the importance of meeting the SRH and rights of all
adolescents, irrespective of their marital status. The delivery of comprehensive sexuality education
and SRH information and services should be in accordance with international standards, adapted to
suit the current context of Bangladesh. Investing in the SRH needs of adolescents in Bangladesh will
not only contribute to improving the overall health and wellbeing of this population cohort but also
to reaping the demographic dividend. An adolescent population which has the necessary knowledge
on SRHR and can make informed decisions with regard to their SRH, especially about the desired
number of children, the use of modern family planning methods and birth spacing, will also lead to
reductions in the country's adolescent fertility rate, which is a significant concern to the country.
Strategic Objectives
1. To create an enabling environment at all levels – national and local – by strengthening
legislation, policy development and implementation
2. To integrate and strengthen age appropriate comprehensive sexuality education
programmes at all academic and training institutions
3. To improve the sexual and reproductive health status of adolescents by engaging a range of
evidence based and effective interventions
Key Strategies
1. Enable evidence based advocacy for comprehensive policy and programme development,
investments and implementation
2. Promote age appropriate comprehensive sexuality education, which are on par with
international standards, through all academic and training institutions
3. Build capacity for the delivery of age and gender sensitive sexual and reproductive health
services which includes HIV/STI prevention, treatment and care
4. Create a robust system for data collection/analysis on the sexual and reproductive health of
adolescents, including unmarried adolescents, to inform policy and programming
SD2 Violence against Adolescents

Problem Statement
Patriarchal gender norms as well as the hierarchical social system in Bangladesh contribute to
the practice and justification of violence against adolescents, especially adolescent girls, which
leads to various discriminatory and harmful practices including child marriage and domestic
violence.
Context
As a patriarchal and strongly hierarchical society, the prevalence of violence is a common and
socially accepted phenomenon in Bangladesh. Violence affects children, adolescents and adults alike
with girls and women disproportionately experiencing violence – be it from persons known to them,
the wider community or complete strangers. A clear manifestation of violence against adolescents,
11
especially adolescent girls, is the high prevalence of child marriage in Bangladesh – according to the
most recent BDHS (2014) 59 percent of women aged 20-24 years were married before the age of 18.
While there is no nationally representative or documented data on violence experienced by
adolescent boys, anecdotal evidence and small-scale studies point to violence experienced by
adolescent boys as well.
It is important to note that Bangladesh has seen a decreasing trend in the prevalence of violence
against girls and women in the recent past but nevertheless violence and its consequences remain a
concern for the country. The Violence against Women Survey (BBS 2015b), highlighted that 42.8
percent and 28.4 percent ever married adolescents aged 15-19 years reported physical or sexual
violence during their lifetime and in the last 12 months respectively. Importantly, with regard to
non-partner violence, in this same survey 27.8 percent of all interviewed girls and women,
regardless of their marital status, have experienced violence in their lifetime. Worryingly, the rates
for non-partner violence were highest among adolescent girls (15-19 years) where 30.9 percent had
experienced physical violence in their lifetime and 11.2 percent experienced physical violence in the
last 12 months. Rates of non-partner sexual violence was second highest among the adolescent age
group (15-19 years) for both during their lifetime - 3.4 percent and in the last 12 months - 3.1 percent
(BBS 2015b). What this data suggests is that adolescent girls, regardless of their marital status,
continue to be vulnerable to all forms of violence which then makes it imperative to put in place
preventive mechanisms, from both a socio-economic and a health perspective.
As mentioned at the outset, child marriage, defined as any marriage before the age of 18 years, is a
clear indicator of discriminatory gender norms and violence against adolescents. Bangladesh has
the highest rate of child marriage and adolescent fertility in South Asia. Child marriage in
Bangladesh is overwhelmingly among adolescent girls and the median age at first marriage for
women aged 20-24 years is 17.2 years (BDHS 2014). Closely linked to child marriage, is the high
adolescent fertility rate of 113 live births per 1000 women aged 15-19 years. According to the BDHS
(2014), 31 percent of adolescents aged 15-19 years have begun childbearing, about 1 in 4 has given
birth, and another 6 percent were pregnant with their first child. While there is no established data
on the prevalence of child marriage among adolescent boys, such marriages have been anecdotally
documented in rural areas and among certain communities albeit in much lower numbers.
A significant problem in Bangladesh is the lack of nationally representative or scientifically reliable
data on the prevalence of violence against adolescent boys. A study conducted in four districts of
Bangladesh revealed that 9.8 percent of school going adolescent boys reported experiencing sexual
violence and for a majority of them the perpetrators were other boys from school (HDRC 2015). In
this same study only 4.2 percent school going adolescent girls reported experiencing sexual violence
but it is important to read this data with caution because one possible explanation for this lower
percentage is that adolescent girls did not report sexual harassment as violence given the
pervasiveness, the acceptance of this practice and the fear of social stigma. Still for all a key message
from this finding is that adolescent boys also experience violence and, while there is a dearth in
nationally representative data, there is a need for the implementation of interventions to prevent
violence against adolescents.
According to BDHS (2011), women aged 20-24 years who were married before 18 were more
accepting of domestic violence than women married after 18 years – highlighting the intricate links
between a culture of violence, child marriage, adolescent fertility and the potential health
consequences. It is also important to note that adolescent boys often also face the pressure to
conform to the prevailing hegemonic masculinity ideal, which can then drive them to perpetrate
violence and engage in risky behaviors such as unsafe sex and substance use.
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Violence against adolescents, both boys and girls, is serious social issue for Bangladesh and its
aspirations to meet the SDGs by 2030: if one fifth of the population is at risk of experiencing GBV, it
will affect the country's possibility of reaping the demographic dividend. Moreover, it is also an
economic and a health issue because experiences of violence and exposure to violence often lead to
both mental and physical consequences such as low self-esteem, depression and physical injury.
The economic cost associated with violence against adolescents goes beyond the immediate costs
which the health sector has to bear because adolescents who experience and witness prolonged
violence may also not be as well equipped to contribute to the economy of the country. In this
context, it becomes crucial for the health sector to prevent the practice and the acceptance of
violence through innovative educational and awareness raising interventions which highlight the
consequences of violence, so that adolescents can enjoy a life free of violence. The health sector
response to GBV needs to identify the specific health needs of adolescent boys and girls and ensure
the availability of information and services to meet these needs effectively.
1. To promote positive social norms which address age and gender based discrimination and
violence, including child marriage by engaging and influencing policy makers and key
stakeholders
2. To empower adolescents, especially adolescent girls, by providing them with life skills to
stand up for their rights, including their rights to fully and freely consent to marriage
3. To strengthen health and social protection systems to provide services to meet the needs of
the most vulnerable adolescents
Key Strategies
1. Enable evidence based advocacy and communication at national and local level to raise
awareness on the issue of age and gender based discrimination, child marriage and its
consequences
2. Build the capacity of the health and social protection sector to respond to age and gender
based violence and child marriage prevention by providing effective and efficient services
3. Develop and implement evidence based programmes to prevent and mitigate the
consequences of age and gender based violence, including child marriage
4. Create a robust system for data collection/analysis on the prevalence of age and gender
based violence to be used to inform policy and programming
SD3 Adolescent Nutrition

Problem Statement
Malnutrition, micronutrient deficiencies and other nutrition related diseases among
adolescents, particularly adolescent girls contributes to the perpetuation of intergenerational
malnutrition.
Context
Adolescence is a period of rapid physical, mental and emotional growth, characterized by the
development of the brain and related cognitive capacities which are the foundation of overall health
and wellbeing. The nutritional requirements during adolescence is significant and a key requisite to
13
attain optimum growth in this important stage of life. A well-nourished adolescent girl will have a
multi-generational impact because a healthy, mature and well-nourished woman, is more likely to
deliver babies with appropriate birth weight. A strong start in life is essential to break the
intergenerational cycle of undernutrition and a well-nourished adolescent is also more likely to lead
a healthy life during adulthood, with fewer risks of non-communicable diseases in later life. The
global review on adolescent nutrition (WHO, 2005) suggested that the main nutritional issues of
adolescents in low- and middle-income countries are undernutrition and associated deficiencies
which often originate during childhood.
According to the Bangladesh Demographic Health Survey, 2014, the prevalence of
thinness/underweight (Body Mass Index less than 18.5) among married-adolescents of 15-19 years
old is very high at 31 percent. Moreover with 13 percent prevalence of short stature (less than
145cm), women are at greater risk of mortality and complications during delivery and also
increased likelihood of delivering babies with low birth weight. Research also shows that adolescent
pregnancy and lactation leads to poor linear growth and fat depletion in new born children (Rah et
al., 2008). Other assessments and studies which focus on adolescents and women of reproductive
age show that stunting and anaemia are also major health concerns. Nationally, 29 percent of
adolescent girls are short for their age with notable differences between urban and rural areas at 21
percent and 30 percent respectively (FSNSP, 2013).
The most immediate cause of undernutrition in Bangladesh remains inadequate dietary intake of
nutrient rich foods. While current nationally representative data among adolescents in Bangladesh
is still scarce, a study conducted in 1998 showed that among urban school girls in Bangladesh, only 9
percent and 17 percent met the Recommended Dietary Allowance (RDA) for energy and protein,
respectively (Ahmed et al., 1998). Gender based discrimination is widely recognized as a primary
underlying cause of under nutrition in Bangladesh (Sen and Hook, 2012). Recent data (FSNSP, 2013)
shows that, in times of food scarcity, women are the first to deliberately sacrifice their own food
intake in order for other household members to have enough food. It is important to note that
adolescent unde rnutrition is inextricably linked to persisting gendered discrimination and social
norms, particularly child marriage, adolescent pregnancy and the level of a girl's education.
According to the BDHS (2011), levels of child under nutrition fall with increasing education level of
mothers, as well as maternal height thus highlighting the importance of education. And it has been
found that irrespective of socio-economic class, there is a positive correlation between
education/literacy and nutrition and dietary diversity (IFPRI, 2013).
Finally, another emerging spectrum of malnutrition, is the rising levels of overweight and obesity
among adolescents. According to BDHS (2014) the prevalence of overweight and obesity among
married adolescents increased from 3 percent in 2007 to 7 percent in 2014. This means that
Bangladesh has to start addressing the double burden of under nutrition/malnutrition and
overweight/obesity among adolescents – among both those who are married and unmarried.
1. To reduce under nutrition and anaemia among adolescent girls (pregnant and non-
pregnant) and boys
2. To reduce the risk of low birth weight babies, pregnancy related complications and
nutritional risks among adolescent girls
3. To reduce micronutrient deficiencies such as Calcium, Vitamin D and Iodine deficiency
among pregnant adolescent girls
4. To improve lifestyles and reduce the risks of overweight and obesity among all adolescents
14
Key Strategies
1. Mainstream nutrition education and promotion and hygiene education including hand
washing into the health care system, education system as well as other systems which reach
out-of-school adolescents.
2. Establish programmes that promote dietary diversification, dietary adequacy, fortified
foods and nutrition security through community and school based interventions.
3. Strengthen the capacity of service providers to deliver effective nutrition counselling and
services to all adolescents, with a special focus on raising awareness on the consequences of
child marriage and meeting the nutritional needs of pregnant adolescent girls.
4. Provide and promote micronutrient supplementation (i.e. IFA and MMS), consumption of
fortified foods and de-worming at health facilities, schools, and workplace.
5. Conduct community based awareness campaigns on the importance of good nutrition,
healthy foods and the consequences of malnutrition, anaemia and obesity on the overall
development and growth of adolescents.
6. Promote and improve access to sports and physical activity in the community, schools and at
the workplace.
SD4 Mental Health of Adolescents

Problem Statement
Mental ill health is an important but under-recognized and neglected public health problem. It
especially affects adolescents in Bangladesh who do not have access to effective public mental
health services due to scarcity of skilled workforce, inadequate financial resource allocation and
social stigma.
Context
Like many other countries across the world, awareness about mental health, mental illness and
acceptance of treatment for it are very low in Bangladesh, primarily due to social stigma and
superstition. The report of the National Mental Health System in Bangladesh (WHO 2007), showed
that 16.1 percent of the adult population (aged 18 years or older) of Bangladesh suffer from some
form of mental disorder. A systematic review on the mental health situation of Bangladesh revealed
that the overall prevalence of mental ill health varied from 6.5 to 31 percent among adults and from
13.4 to 22.9 percent among children (Hossain et al., 2014). Importantly, similar to data on the SRH
status of adolescents, there is limited data on the mental health situation of adolescents. Much of the
available mental health related statistics focuses on adults and children of the country and therefore
it is difficult to critically assess the mental health status of adolescents in the country. The wide range
in the reported prevalence estimates strongly suggests that mental disorders constitute a significant
public health problem in Bangladesh.
As mentioned above, the dearth of information on the prevalence of mental health problems among
adolescents, poses a challenge for developing interventions to support the mental health of
adolescents. While comprehensive mental health assessments of adolescents are rare in
Bangladesh, in their study into the prevalence of depression, Nasreen et al., (2013) concluded that
depressive symptoms were common among adolescents in Bangladesh, with a predominance
among adolescents living in urban slums and adolescent girls. They also found that reproductive
health problems and sexual abuse were associated with depressive symptoms for girls. However,
more than 80 percent of depressed adolescents sought no help, indicating the need for accessible
15
adolescent friendly services such as community-based counselling. A needs assessment survey
among urban adolescents done by BRAC and Population Council (Amin 2015) showed that
individual factors associated with depression included marriage, childbearing, experiences of
harassment, drug use, poor performance in school and experience of disasters/conflict during
childhood. This same study showed that adolescent girls who have never been pregnant had less
symptoms of depression than those who had been pregnant and were mothers. Moreover, women
who had experienced adolescent pregnancies are more likely to report signs of moderate to severe
depression.
In addition to mental health concerns, drug related problems are gradually becoming a key concern
in Bangladesh from a social, economic and, more importantly, health perspective. According to the
Department of Narcotic Control of Bangladesh (1995), 1.5 million Bangladeshi's were involved in
abusing drugs of various kinds. However, there is a serious lack of research and data on how drug use
affects adolescents and the impact it will have on their overall wellbeing and future health.
In order to get a comprehensive understanding of the mental health needs of adolescents, it is
important to situate adolescence within the dynamic sociological, cultural and economic realities of
their life. In this regard paying special attention to the needs of very young adolescents, who are not
in a position to make 'informed choices' is very important. This period, between 10 and 14 years also
represents a key opportunity for health promotion and the prevention of unhealthy behaviour that
increases the risk of mental health diseases and other potential non-communicable diseases. Finally,
addressing issues such as early childhood development, parenting, domestic violence, sexual abuse
especially by family members etc. are also of importance when looking into meeting the mental
health needs of adolescents.
1. To integrate the mental health agenda within primary health care services and other
relevant health and education services
2. To promote mental health and prevent mental ill health by implementing a range of evidence
based interventions and screening for common mental illnesses and suicidal behaviour as
per the provisions of primary mental health care
3. To create an enabling environment for mental health services including counselling and to
develop the capacity to provide effective services at all levels of facilities
Key Strategies
1. Enable evidence based advocacy for comprehensive programme development to promote
mental health among adolescents and reduce stigma against mental ill health
2. Develop skills among adolescents to deal with stress, manage conflict and develop healthy
relationships
3. Develop the capacity of the health sector to address mental health issues as per the
provisions of primary mental healthcare and to screen for anxiety, stress, depression and
suicidal tendencies
4. Promote school and facility level interventions which include counselling and management
of mental health disorders through linkage with the national mental health programme
5. Create a robust system for data collection/analysis on mental health issues including
substance use, to inform policy and programming
16
Cross Cutting Issues
CCI 1 Social and Behavior Change Communication
Problem Statement
Adolescents face challenges in voicing their concerns and are often given limited decision making
power. Social and Behavioural Change Communication (SBCC) programmes which can empower
adolescents to participate in decision making processes and ensure they seek appropriate health
information and services need to be scaled up and strengthened. In order to ensure adolescents
are able to participate in decision making processes, SBCC programmes moreover need to focus
strongly on changing the attitudes and behaviours of gatekeepers, including parents, family
members, teachers and service providers to respect adolescents' opinions, needs and interests.
Context
Meeting the overall health needs of adolescents, given the stigma, myths and taboos associated with
adolescent health issues, is a challenge in Bangladesh. Adolescents have some access to information
relating to their health, but this information is not provided through means that have the power to
change existing negative behaviours, maintain positive behaviours and adopt more responsible and
effective behaviours, which will contribute to health promotion. As a result, there is a need to
collaboratively adopt an effective SBCC campaign if we are to ensure the health of all adolescent boys
and girls of Bangladesh.
A recent research conducted in Bangladesh, by the International Centre for Research on Women
(ICRW), found adolescents lack access to health facilities, particularly to meet their sexual and
reproductive health needs (ICRW 2014). This study further affirmed what is often commonly
known: the underlying reasons cited by adolescent girls for not accessing SRH services include
embarrassment, superstition, lack of knowledge and the obstacles posed by older family members.
These obstacles, including shame and stigma associated with being sexually active and the threat of
violence, are often due to gendered norms, which as mentioned in the above sections, also lead to
issues of child marriage, inadequate nutrition, adolescent pregnancy, and school dropouts. In
another study, ICDDR'B (YEAR?) found that adolescents face many health problems and often do not
have access to adequate information to address these problems or even know who to approach.
Equally importantly, this study also revealed that most girls don't have any knowledge about
menstruation before they experience it given the taboos around menstruation.
This lack of access to accurate and reliable information and the various taboos and myths which are
commonplace, necessitates a comprehensive approach to addressing adolescent health and social
wellbeing, by ensuring effective SBCC interventions for each of the above mentioned thematic areas.
SBCC is the systematic application of interactive, theory based and research driven communication
processes and strategies to address “tipping points” for change at the individual, community and
social levels (FHI360, 2011). The effective implementation of this NAHS will require SBCC strategies
which focus on the 'tipping points' and ensure that adolescents are empowered to voice their
opinions and seek the services they require to maintain their overall health.
1. To ensure political commitment and adequate resources to support SBCC interventions
2. To promote social mobilization and ensure wider participation, coalition and ownership of
issues which affect adolescents among community members
3. To use SBCC interventions to bring about changes in knowledge, attitudes and practices
among specific audiences.
17
Key Strategies
1. Development of messages and materials for communication and advocacy through sound
research.
2. Utilize ICT (including call centres) and media to reach adolescents, key community
members, parents and guardians.
3. Develop the capacity of respective institutions and systems to design, plan, implement and
monitor SBCC interventions.
CCI2 Health Systems Strengthening

Problem Statement
A comprehensive strategy, to meet the overall health needs of adolescents, where multi-faceted
factors need to be taken into consideration will challenge the capacities of the existing health
system. Therefore, implementing a new strategy will require further strengthening of the health
system to meet the goals detailed in the strategy.
Context
The concept of adolescent health has to be understood from a multi-dimensional perspective and an
effective response to meeting the health needs of adolescents require a multi-sectoral and multi-
disciplinary approach. As such, the effective implementation of adolescent health programs will
depend on a coordinated approach and is the collective responsibility of a range of line ministries,
departments and agencies, non-governmental organizations, the private sector, religious
authorities, communities, families and individuals. However, as the focal Ministry for adolescent
health, the Ministry of Health and Family Welfare has the overall responsibility to ensure its systems
are strengthened and can meet the health needs of this large population cohort. This strengthening
of the health sector response to adolescent health needs to be conducted through a systematic
process, which applies at the national, district and sub-district health facility levels, in line with the
Essential Services Package (ESP) of the Government of Bangladesh.
The WHO Health Systems Framework (WHO 2007) refers to six building blocks of a health system
that need to be strengthened if we are to ensure the availability of effective services which meet the
health needs of adolescents and thereby improve their health status. These building blocks include
leadership/governance, healthcare financing, health workforce, health information systems, access
to essential medicines and service delivery. The effective implementation of this National
Adolescent Health Strategy will require each of these building blocks to be strengthened and for the
Ministry of Health and Family Welfare to play a lead role in this process.
Leadership and Governance will entail the Ministry ensuring the effective implementation of this
strategy and corresponding action plan, in addition to playing an effective oversight and regulatory
role. This leadership role also entails setting standards for quality of care to minimize variability,
ensuring equity in access to services, improving the quality of services and meeting the rights of
adolescent clients who are seeking health services. The capacity of health managers at all levels in
strategic positions should be increased to play this essential oversight and leadership role.
Key Strategies
1. Capacity building of health personnel in strategic leadership positions to develop and
manage services for adolescents
2. Strengthen partnerships with all relevant actors at the highest level – both government and
non-government – to deliver effective services which meet adolescent health needs
18
3. Provide leadership in mainstreaming adolescent SRH services at all levels of service
provision according to the ESP
Healthcare Financing recognizes the importance of ensuring adequate budget allocation to meet the
special needs of adolescents. The Government of Bangladesh has a responsibility to increase
financial resources to provide comprehensive, equitable and quality healthcare services for all
adolescents – especially those who are most marginalized and vulnerable. Healthcare financing also
entails mobilizing resources including through public private partnerships and through support
from Development Partners to ensure the availability of quality adolescent health programmes.
Key Strategies
1. Evidence based advocacy to increase budgetary allocation to provide SRH information and
services at national, district and sub-district level to adolescents
2. Establish mechanisms to mobilize financial resources through effective partnerships with
Development Partners and the private sector
3. Improve efficiency and accountability in resource allocation and utilization
The capacity of the Health Workforce will need to be strengthened to meet the health needs of
adolescents, which will differ from the needs of the general population. The health workforce should
be competent, responsive, efficient and, more importantly, sensitive to the specific needs of different
groups of adolescents. In addition to having an effective mix of staff, it is also important to ensure the
health workforce receives adequate training to provide adolescent friendly health services through
pre-service curriculum revision, on the job training, mentorship and effective supervision.
Key Strategies
1. Capacity building of health providers to be sensitive to the needs of all adolescents, including
those who are unmarried, through pre service, in service and on the job training
2. Provide health service personnel with training on counselling for adolescents and capacitate
them to adopt non-judgemental attitudes when working with adolescents
3. Strengthen quality assurance and monitoring mechanisms to ensure consistent quality in
the delivery of services
A robust Health Information System will underpin the effectiveness of all building blocks of health
systems strengthening since quality data and information are essential for policy development,
health financing, programme design, service delivery, governance and regulation and human
resource development. The collection of age and gender disaggregated individual level data, health
facility level data, population level data and public health surveillance are underpinned through this
strategy since this data will help identify problems and needs, make evidence based decisions and
allocate resources optimally – so that adolescent health needs are effectively addressed.
Key Strategies
1. Strengthen the Health Management Information System (HMIS) to collect age and gender
disaggregated data on issues which pertain to adolescents
2. Engage in evidence based advocacy using the data from the HMIS to provide improved and
more effective services to meet the health needs of adolescents
3. Ensure the effective use of the HMIS data to continuously improve the quality of care and
service delivery
19
The building block of Access to Essential Medicines calls for medicines to be available in the health
facilities at all times, in adequate amounts, appropriate dosage, with assured quality and at a price
which is affordable to adolescents, especially those who are most vulnerable. Given the focus on
adolescent sexual and reproductive health, adolescent nutrition and mental health – essential
medicines should, in addition to the list of 14 medicines stipulated by WHO, also include
contraceptives, nutritional supplements such as iron folate and other relevant drugs. While ensuring
the availability of essential medicines, this strategy calls for a key focus on making these medicines
available for free or at low cost – given the target group under consideration.
Key Strategies
1. Ensure the availability of essential medicines, supplements, vaccines and technology at all
health facilities at national, district and sub-district level
2. Facilitate equitable access to all essential medicines and medical technology by putting in
place systems to meet the needs of the most vulnerable adolescents
3. Establish linkages with institutions offering quality assurance of all medicines and
commodities needed for adolescents
Service Delivery is the building block, which is closest to the persons who will benefit from health
systems strengthening and is an immediate output of the inputs into the health system. Effective
service delivery, which is affordable and of high quality, from the Government, NGOs and the private
sector in rural as well as urban areas, will be essential if adolescents are to feel motivated to use
health services in their locality. The dimensions of service delivery that need special attention when
addressing the health needs of adolescents include quality of care, person centeredness, continuity
and accessibility. In addition comprehensiveness, coverage, coordination, accountability and
efficiency should also be the focus of the strategy when strengthening the health system to meet the
health needs of adolescents in Bangladesh.
Key Strategies
1. Strengthen the service delivery mechanism to ensure the quality of care and
comprehensiveness along with other essential dimensions
2. Establish minimum standards for delivery of services to be adhered to by the Government,
NGOs and the private sector
Vulnerable Adolescents and Adolescents in Challenging Circumstances
As special adolescent population groups, vulnerable adolescents and adolescents in challenging
circumstances, have a range of needs which will specifically need to be addressed through the above
mentioned Strategic Directions (SDs) and Cross Cutting Issues (CCI). This special group of
adolescents include but are not limited to adolescents who live on the streets, in slum dwellings, in
char and haor areas, adolescents with disability, married and pregnant adolescent girls, adolescents
who engage in sex work, adolescent children of sex workers, working adolescents, adolescents who
are in detention, adolescents living in areas prone to natural disasters and adolescents who are
refugees/live in camps. Given the population density of Bangladesh and the significant population
of adolescents, vulnerable adolescents and adolescents living in challenging circumstances, amount
to a significant number. However, data of these special adolescent population groups is often not
available or, when it is, not reliable. It is important to note that, given the vulnerabilities of these
groups of adolescents, adopting a holistic approach when addressing their needs, is paramount for
their wellbeing.
The Constitution of the People's Republic of Bangladesh guarantees social security and public
assistance to vulnerable populations – including the sick, unemployed, aged, widowed, orphaned
20
and those with disabilities. The Ministry of Social Welfare has the primary responsibility for
ensuring the overall wellbeing – including ensuring equal access to education and health – of these
vulnerable groups, including those who are mentioned above. While the Ministry of Social Welfare
administers a number of safety net programmes which look into meeting the needs of vulnerable
groups, it lacks a focus on the special needs, especially the health and educational needs, of these
adolescents. This limitation can be attributed to the lack of data on these groups, a poor
understanding of their issues/needs as well as inadequate resources to meet their needs.
Despite the limited data on these vulnerable adolescents and adolescents living in challenging
circumstances, it has been established globally that when it comes to the health of these groups it is
imperative to allocate resources and conduct tailored programmes. These programmes should not
only address their health needs but also take into consideration issues of affordability and
accessibility of the health services that are made available. Many of these adolescents come from the
socio-economically most disadvantaged segments of society and therefore their health needs will
need to be understood through a more holistic and broader perspective. For example, when working
with street children, it is essential to explore options of providing them with shelter, schooling, food
and psychosocial support – as a basic minimum – if their overall health needs are to be met (Clarke
2016).
The wide acceptance of child labour (which includes adolescents who work), put the physical and
mental development of these adolescents at risks (UNICEF 2010).A study conducted by Population
Council (Amin, 2015) among urban adolescents revealed that approximately one third of all
adolescents are engaged in paid employment with adolescent girls on average working 40 hours per
week while adolescent boys work 50 hours per week. Adolescent girls in sex work are even more
vulnerable – because aside from this being a fundamental violation of their rights – they are also
vulnerable to trafficking, sexually transmitted infections and unwanted pregnancies. Poor mental
health and elevated levels of moderate to severe depression are also important areas of concern
among urban adolescents (Amin2015), highlighting the need to specifically focus on addressing
these needs among urban adolescents.
Low levels of knowledge on sexual and reproductive health and rights due to lack of access to
information sources, high levels of child marriage and adolescent fertility are also issues faced by
adolescents living in urban areas, including in slum dwellings (Duttaet al., 2015). In relation to
adolescents with disabilities, while there is some data on the prevalence of disability among
children, the figures vary and are not disaggregated by age. For example in Bangladesh, estimates of
children with disabilities range from less than 1.4 percent to as much as 17.5 percent (UNICEF
2014), highlighting the difficulties in estimating the prevalence of disability among adolescents. The
higher vulnerability of adolescents with disabilities, when compared with their peers, in accessing
education, information on health, sexual and reproductive rights (and rights in general) and their
vulnerability to higher incidence of violence including sexual violence makes it important to address
disability as a cross cutting issue. Another important consideration for adolescents living with
disability, is to cater interventions to meet the specific health needs according to the type of
disability. Moreover, as a signatory and ratifying State to the United Nations Convention of the Rights
of Persons with Disability (UNCRPD), the Government of Bangladesh, has an obligation to meet the
needs of persons with disability.
In light of the above, ensuring the availability of interventions to address the special needs of this
vulnerable group will be a priority for the health sector. Within these vulnerable groups of
adolescents, it is crucial to identify those who are furthest behind and reach them first. In addition,
the interventions for this group of adolescents will need to be multi-sectoral and require a
collaborative effort by all actors of the development sector.
21
Key Strategies
1. Develop a system for data collection/analysis on vulnerable adolescents with a special focus
on their health issues and needs, to inform policy and programming
2. Strengthen the health service delivery mechanism to ensure the provision of specialised
services, which meet quality standards and comprehensiveness, to meet the needs of all
vulnerable adolescents
3. Identify specific interventions, under each of Strategic Directions and Cross Cutting Issues
mentioned above, which should be implemented for vulnerable adolescents
4. Establish linkages and develop a network among all development actors, who work with
vulnerable adolescents to meet their varied and specialised needs
5. Support interventions which assist vulnerable adolescents and bring them into the
mainstream and provide them with their basic rights such as right to education, health,
social welfare and decent employment when they are of age
22
CHAPTER
IMPLEMENTATION
5
The implementation of the National Adolescent Health Strategy will require a concerted and
coordinated effort among all relevant partners in the field of health. Of primary importance is the
engagement of all key Ministries who will have to collaborate with the MoHFW and play a supportive
role. In addition to these Ministries and the associated units, Development Partners and Civil Society
will also have to play a crucial role in the implementation of activities which will contribute to
meeting the goal outlined in this strategy. In order to coordinate these different actors and to ensure
the effective implementation of activities, establishing a 'Management and Coordination' structure
becomes imperative. This 'Management and Coordination' structure will fall under the direct
purview of the Directorate General of Family Planning as the principal custodian for the
implementation of the National Adolescent Health Strategy. The functions of the 'Management and
Coordination' structure are detailed below.
Management and Coordination
Adolescent health requires a multi-sectoral, multi-disciplinary and multi-dimensional approach if
we are to effectively meet the needs of all Bangladeshi adolescent boys and girls. Therefore the
effective implementation of this strategy will depend on the collective responsibility of government
ministries, departments and agencies, civil society organizations, the private sector, religious
authorities, communities, families and adolescent themselves. All these bodies have a strategic and
complementary role they need to play in the next 15 years.
5.1 The Role of the MoHFW

The MoHFW holds the primary responsibility for ensuring the health of adolescents. They will have
the onus of delivering services, which meet the varying health needs of adolescents and providing
health related information. Both the Directorate General of Health Services and Directorate General
of Family Planning under MoHFW have an Operational Plan for Adolescent Health and the
implementation of this Operational Plan will be crucial to achieve the goal of this national strategy.
5.2 The Role of Other Ministries

The implementation of the NAHS will require the collaboration of a number of other Ministries. All
these Ministries will need to both work with the MoHFW and each other – so that a holistic approach
to adolescent health becomes a reality for Bangladesh. Other focal Ministries include Local
Government, Rural Development and Cooperatives; Education; Social Welfare; and Women and
Children Affairs. All these Ministries, through the various programmes implemented by them, will
contribute to addressing the health needs of all adolescents. Detailed below are a few key
programmes, which will need to be continued in collaboration with the MoHFW:
! The Ministry of Local Government, Rural Development and Cooperatives: the provision of
adolescent health services in municipalities and all City Corporation areas;
23
! The Ministry of Education: inclusion of adolescent health issues in the formal school
curricular;
! The Ministry of Social Welfare: establishment of centres to meet the health needs of street
children and juvenile delinquents;
! Ministry of Women and Children Affairs: the provision of services and skills training for
young women and adolescent girls.
5.3 The Role of Development Partners

All Development Partners, including UN agencies, bilateral and multilateral donors and civil society
have a long history of supporting the health sector, with a special focus on adolescent health. These
partners will need to continue in their concerted efforts to address the issue of adolescent health by
focusing on the different aspects, including education, rights, empowerment, systems strengthening
and participation. In addition, academia, research institutions, and media also have a catalytic role
to play in promoting adolescent health by generating evidence and disseminating this evidence to
the broader community.
The overall responsibility for the implementation of the NAHS at the national and sub-national level
rests with the MoHFW. Under the leadership of the MoHFW, both DGFP and DGHS need to take the
key responsibility for the related components. The MoHFW will establish relevant Committees with
sectoral representation to ensure quality implementation at divisional and district levels. At
divisional, district and upazila level similar multi-sectoral coordination mechanisms will need to be
established where DGFP and DGHS will ensure the delivery of services at community level to the
most vulnerable and marginalized adolescents. The effective management and coordination of the
NAHS will ensure that all Bangladeshi adolescents benefit from this strategy and, in line with the SDG
principle, 'no one is left behind'.
24
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Nutrition
Nutrition in adolescence: issues and challenges for the health sector. World Health Organization
2005, Geneva,and whqlibdoc.who.int/publications/2005/9241593660 eng.pdf
Rah JH, Christian P, ShamimAARzooUT, Labrique AB, Rashid M, 2008. Pregnancy and lactation
hinder growth and nutritional status of adolescent girls in rural Bangladesh. J Nutr. Aug;
138(8):1505-11. https://www.ncbi.nlm.nih.gov/pubmed/18641198
Hellen Keller International (HKI) and James P. Grant School of Public Health (JPGSPH). (2014). State
of food security and nutrition in Bangladesh: 2013. Dhaka, BD: HKI and JPGSH.
Andrew Marble and Heidi Fritschel. Global food policy report International Food Ploicy Research
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Ahmed, F., M. Zareen, M.R. Khan, C.P. Bann, M.N. Haq and A.A. Jackson, 1998. Dietary patterns,
nutrient intake and growth ofadolescentgirls in urban Bangladesh. Public Health Nutr. 1: 83-92.
www.jpma.org.pk/PdfDownload/2220.pdf
Gender-Inclusive Nutrition Activities in South Asia : Mapping Report. World Bank, Washington, DC.
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Agriculture, Income, and Nutrition Linkages in India: Insights from a Nationally Representative
Survey: Priya B, Derek H, Suneetha K. IFPRI Discussion Paper 01195. July 2012. Washington DC.
http://www.ifpri.org/publication/agriculture-income-and-nutrition-linkages-india
National Institute of Population Research and Training (NIPORT), Mitra and Associates, and ICF
International. 2013. Bangladesh Demographic and Health Survey 2011. Dhaka, Bangladesh and
Rockville, Maryland, USA: NIPORT, Mitra and Associates, and ICF
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National Institute of Population Research and Training (NIPORT), Mitra and Associates, and ICF
International. 2016. Bangladesh Demographic and Health Survey 2014. Dhaka, Bangladesh,
andRockville, Maryland, USA: NIPORT, Mitra and Associates, and ICF International.
https://dhsprogram.com/pubs/pdf/FR311/FR311.pdf
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Mental Health
Hossain MD, Ahmed HU, Chowdhury WA, Niessen LW, and Alam DS. Mental disorders in
Bangladesh: a systematic review. BMC Psychiatry. 2014; 14: 216.. doi: 10.1186/s12888-014-
0216-9
C4D:
Institutionalizing Participation in Development, by James. Blackburn with Jeremy
Holland;Intermediate Technology, 1998,
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Youth Participation: Unicef's Experience Working with Young People, Programme Experience Series,
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Community Mobilization through Women's Groups to Improve the Health of Mothers.BADAS, Ekjut,
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Child Marriage in Bangladesh:Findings from a National Survey2013,Plan International
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national-survey
A Field Guide to Designing a Health Communication Strategy. Baltimore, MD. JohnsHopkins
Bloomberg School of Public Health, Center for Communication Programs. March 2003.
Fact for Life. Fourth Edition. UNICEF. New York. 2010.
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Global Tuberculosis Control. WHO Report, 2011.
whqlibdoc.who.int/publications/2011/9789241564380_eng.pdf
26
ANNEXURE
Member of the Core Committee

(not according to seniority)
Designation Organization
1 Sheikh Md. Shamim Iqbal DGFP Chairperson
Director General
2 Dr. Mohammed Sharif DGFP Co-Chairperson
Director (MCH Services) & Line Director (MCRAH)
3 De. Jahangir Alam Sarker DGHS Co-Chairperson
Director (PHC) & Line Director (MNC&AH)
4 Dr. Muhiuddin Osmani MoHFW Member
Joint Chief, Planning Wing
5 Md. Ferdous Alam DGFP Member
Director IEM
6 Dr. Md. Mainuddin Ahmed DGFP Member
Line Director CCSDP
7 Pranab Kumar Neogi DGFP Member
Director (Finance) & Line Director (FSDP)
8 Prof. A H M Enayet Hossain DGHS Member
Line Director NCD
9 Dr. A B M Muzaharul Islam DGHS Member
Line Director, NNS
10 Dr. Md. Anisur Rahman DGHS Member
Line Director, NASP
11 Special Advisor UNFPA Member
12 Ubaidur Rob Population Council Member
Country Director
13 Prof. Dr. Rowshan Ara Begum OGSB Member
President
14 Dr. Md. Golam Shahjahan DGHS Member
Program Manager (A &SH)
15 Dr. Riad Mahmud UNICEF Member
Health Specialist, MNH
16 Eshani Ruwanpura UNFPA Member
Program Specialist
17 Dr. Muhammad Munir Hussain UNFPA Member
National Professional Officer
27
Designation Organization
18 Dr. Rabeya Khatoon WHO Member
National Professional Officer
19 Dr. Ikhtiar Uddin Khondaker Plan International Bangladesh Member
Health Advisor
20 Dr. Rudaba Khondker GAIN Member
Country Manager
21 Noor Mohammad PSTC Member
Executive Director
22 Dr. Shimul Koli Hossain DGFP Member Secretary
Program Manager (A & RH)
Technical Committees
Name Designation Organization
1. Dr. Md. Abul Hossain Project Director MoWCA
MSPVAW
2. Dr. Md. Anisur Rahman Deputy Director, NASP DGHS
3. Dr. Nurun Nahar Program Manager DGFP
CCSDP, UNit
4. Shalina Akther Deputy Director, MIS Unit DGFP
5. Md. Abdus Salam Deputy Chief, Bureau of Health Education DGHS
6. Dr. Md. Shamsul Karim Program Manager DGFP
FSDP Unit
7. Zakia Akhter Deputy Director, IEM Unit DGFP
8. Dr. Md. Jaynal Haque Assistant Director, MCH Services Unit DGFP
9. Dr. Shafiur Rahman Deputy Program Manager (A & SH) DGHS
10. Dr. Nasreen Khan Technical Support on Nutrition to MoHFW
Additional Secretary (PH &WHO)
Country Focal Person for Nutrition and SUN
11. Prof. Sameena Chowdhury Professor, Gynae & Obs OGSB
12. Md. Mahbubul Alam Deputy Program Manager DGFP
FSDP Unit
13. Dr. Lima Rahman CoP, HIV Program Save the Children
14. Dr. Khan Moududur Rahman Professor, Nutrition INFS, University of
Dhaka
15. Md. Aman Ullah Deputy Program Manager DGHS
NNS
16. Anuradha Narayan Chief, Nutrition Section UNICEF
17. Dr. Suchi Karim Gender & SRHR Specialist BRAC University
18. Md. Moniruzzaman National Consultant, NCD WHO
19. Professor Ferdousi Begum Professor Gynae & Obstetrics SSMC&H
20. Azizul Alim Deputy Program Manager, MNH DGHS
21. Dr. Naimun Nessa Assistant Director, MCH Services Unit DGFP
22. Dr. Abu Sayeed Hasan Technical Officer, FP UNFPA
28
Technical Committees (contd.)

23. Shireen Hussain Specialist, C4D UNICEF
24. Mushfiqa Zaman Satiar Advisor, SRHR & Gender Embassy of the kingdom
of the Netherland
25. Dr. Zeba Mahmud Country Manager Alive & Thrive
26. Dr. Md. Mustafizur Rahman Country Director Micronutrient Initiative
27. Dr. S M Shahidullah Country Director Ipas
28. Dr. Iftekhar Rashid Nutrition Specialist USAID
29. Rashida Parveen Sr. Program Manager, Edu Prog BRAC
30. Roshni Basu Gender & Development Specilist UNICEF
31. Myang Sari Nutrition Specialist UNICEF
32. Dr. Syeda Nabin Ara Nitu Technical Specialist-SRHR Plan International
Bangladesh
33. Shakil Mahmud Chowdhury Manager –Adolescent Development Save the Children
34. Dr. Ireen Akhter Chowdhury Nutrition Officer UNICEF
35. Sigma Ainul Program Officer Population Council
37. Dr. Ana Islam Project Manager-EC SRHR Plan International
Bangladesh
38. Israt Jahan Baki Technical Officer UNFPA
39. Dr. Ferdousi Begum Project Management Specialist USAID
40. Dr. Farzana Bilkis NPO, Nutrition & Food Safety WHO
41. Dr. Fariha Haseen Associate Professor, Dept. of Public BSMMU
Health & Bio-Informatics
42. Dr. M Ziya Uddin HIV/AIDS Specialist UNICEF
43. Dr. Shahana Nazneen Consultant Innovation for
Poverty Action
44. Fatema Laizu CARE
45. Dr. Md. Jahangir Hossain Program Manager CIPRB
46. Mahbuba Haque Kumkum PSTC
29
Technical Committees (contd.)

47. Jamila Akhter Child Protection Specialist UNICEF
48. Dr. Selina Amin Save the Children
49. Dr. Kollol Chowdhury DSK
50. Ismat Jahan Head, Trauma Counseling Center MSPVAW, MoWCA
51. Dr. Nahid Ahmed Chowdhury ASRH/FP Advisor NHSDP
52. Babul Adhikary PIACT Bangladesh
53. Mohiuddin Ahmed Sr. Communication Specialist BKMI
54. Md. Muniruzzaman GAIN
55. Dr. Subir Khiang Babu Program Manager, UBR RH-STEP
Inter-ministerial Committee
1. Additional Secretary, Ministry of Health & Family Welfare Chairperson
2. Additional Secretary (FW & Prog), Ministry of Health & Family Welfare Member
3. Director General, Directorate General of Family Planning Member
4. Joint Chief (Planning), Ministry of Health & Family Welfare Member
5. Representative, Ministry of Women and Children Affairs Member
6. Representative, Ministry of Youth & Sports Member
7. Representative, Ministry of Education Member
8. Representative, Ministry of Information Member
9. Representative, Ministry of Social Welfare Member
10. Representative, Local Government Department Member
11. Representative, Ministry of Law, Justice and Parliament Affair Member
12. Representative, Ministry of Homes Member
13. Representative, Ministry of Religious Affairs Member
14. Representative, DGHS Member
15. Line Director, MCRAH OP, DGFP Member
16. Deputy Chief (Health / FW) Member Secretary
30

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National Strategy For Adolescent Health 2017 2030 1

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National Strategy For Adolescent Health 2017 2030 1

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National Strategy for

Adolescent Health 2017-2030

ˆK‡kvi evÜe ¯^v¯’¨‡mev

Ministry of Health and Family Welfare

MCH Services Unit

CHAPTER 2: Commitment and Response to Adolescent Health

CHAPTER 4: Strategic Directions

Md. Sirazul Islam

Professor Dr. Abul Kalam Azad

Dr. Kazi Mustafa Sarwar

Iori Kato N. Paranietharan Edouard Beigbeder

Dr. Mohammed Sharif

AFHS Adolescent Friendly Health Services

ˆK‡kvi evÜe ¯^v¯’¨‡mev

1.2. Adolescents in Bangladesh

2.1 Bangladesh's International Commitments to Adolescent Health

2.2 Legal and Policy Responses

2.3 The Health System Response to Adolescent Health

2.4 Justification for an Adolescent Health Strategy

2.5 The Strategy Development Process

3.2 The Goal

3.3. The Time Frame

3.4 Guiding Principles

SD2 Violence against Adolescents

SD3 Adolescent Nutrition

SD4 Mental Health of Adolescents

CCI2 Health Systems Strengthening

5.1 The Role of the MoHFW

5.2 The Role of Other Ministries

5.3 The Role of Development Partners

Member of the Core Committee

Name Designation Organization

Name Designation Organization

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