Worried lives : poverty, gender and reproductive health of married adolescent women living in an urban slum in Bangladesh

The thesis is concerned with the lives of married adolescent women in an urban slum in Bangladesh, and how the injustices of a harsh political economy impact on their bodily health and shape their reproductive experiences. My contribution in the thesis is to clearly demonstrate how political economic inequalities and social conditions - 'structural violence' contribute to adverse reproductive health experiences for poor married adolescent women. These disparities compel married adolescent women to make pragmatic choices, which puts their bodies and reproductive health lives at risk. The parameters that determine married adolescent women's well-being and reproductive health are rooted in power relations and lack of access to political and economic resources. I argue that the term 'reproductive health' cannot be addressed without first addressing the context of extreme poverty, hunger and violence threatening men and women's survival. Social and economic justice needs to be integral to solutions to improve the health of poor women and men. The study is located in an urban slum in Dhaka, the capital of Bangladesh. The city has undergone immense transformation with industrialization and the migration of rural families into the city looking for food, shelter and jobs. Ethnographic fieldwork was carried out for fourteen months, and case studies, in-depth narratives and long-term participant observations provide rich empirical data. In addition, a survey was carried out to gather general background information, including young women's reproductive histories. Urban slum dwellers constitute thirty per cent of total fourteen million population of the city. Extremely poor urban migrants are unable to find affordable housing. They set up or rent shack settlements built on vacant or disused government/private land, on the margins of the city - usually in flood prone areas, never knowing when they might be forcibly removed. Most of the slum dwellers live on less than US $63 a month, holding onto insecure jobs, with many permanently unemployed. Young married women in the slums are extremely vulnerable in this unpredictable and insecure urban landscape because of their age, gender and poverty. Chronic deprivation, harsh political and economic conditions and suffering are part of an everyday existence for poor married adolescent women and their families living in slums. This raises many important questions: what do we mean by reproductive health experiences when we look at their lives? Can we separate reproductive health experiences from other aspects of their lives, the material, social and politicaleconomic? How do the broader global, local and socio-cultural, political and economic factors affect health and reproductive health experiences and behaviour? How do young women make sense of and act in this dynamic and difficult urban environment with what reproductive health outcomes? What multiple effects might structural and social inequalities have on married adolescent women lives and their reproductive health experiences? The thesis illustrates how conditions of poverty, unequal class, and gender and power relations structure risk for young women and leave them with few options. This is evident in the context of reproductive and sexual health negotiations and fertility behaviour. Poor married adolescent women construct a 'political economy of the body' and pragmatically acquiesce with decisions made by others, such as, unsafe sex, too many pregnancies, and forced abortions, even though they may violate their sense of bodily integrity and well-being. Health care services are dismal and fragmented. Abortions may be through legal or illegal means and are understood to further jeopardize young women's health. Such pragmatism puts their bodies at risk, but gains them advantages and limited power within their social situation. I demonstrate how disparities of power operate in the lives of poor married adolescent women and critically shape health meanings, reproductive health experiences and practices. It is imperative we acknowledge and address the inequalities within Bangladesh, as well as examine the global inequalities between the rich countries and poor countries all of which create an underclass, who are unable to realize their health potential. I maintain that unless issues of social and economic justice are tackled, in the long term, 'reproductive health, ' and health in general, will not improve for the poor.