Bangladesh is planning to introduce voluntary sterilization in its overcrowded Rohingya camps after efforts to encourage birth control failed.
More than 600,000 Rohingya have arrived in Bangladesh since a military crackdown in Myanmar in August triggered an exodus.
Most live in desperate conditions with limited access to food, sanitation or health facilities and local officials fear a lack of family planning could stretch resources even further.
Cox’s Bazar family planning head Pintu Kanti Bhattacharjee said there was little awareness of birth control among the Rohingya.
“The whole community has been deliberately left behind,” he said, citing a lack of education in Myanmar, where the Rohingya are denied access to many services.
Large families are the norm in the camps, where some parents have up to 19 children and many men have more than one wife, Bhattacharjee said.
District family planning authorities have launched a drive to provide contraception, but say they have so far managed to distribute just 549 packets of condoms among the refugees, who are reluctant to use them.
They have asked the government to approve a plan to launch vasectomies for Rohingya men and tubectomies for women, Bhattacharjee said, but they are likely to face an uphill struggle.
Many of the refugees said they believe a large family would help them survive in the camps, where access to food and water remains a daily battle and children are often sent out to fetch and carry supplies.
Others had been told that contraception was against the tenets of Islam.
Farhana Sultana, a family planning volunteer, said that many of the women she spoke to believe birth control is a sin.
“In Rakhine [State], they did not go to family planning clinics, fearing the Myanmar authorities would give medicine that harms them or their children,” Sultana said.
Sabura, a mother of seven, said her husband believed the couple could support a large family.
“I spoke to my husband about birth control measures, but he is not convinced. He was given two condoms, but he did not use them,” she said.
Bangladesh has for years run a successful domestic sterilization program, offering 2,300 taka (US$27.70) and a traditional lungi garment to each man who agrees to undergo the procedure.
Every month, 250 people undergo sterilization in Cox’s Bazar.
However, performing the permanent procedure on non-Bangladeshi nationals requires final approval from a committee headed by the health minister.
The idea is particularly contentious given the sensitivity of the issue in Myanmar. The widespread perception that the Rohingya population is mushrooming is a key source of the tensions.
Rights activists working in the camps in Bangladesh said some believed pregnancy provided protection against rape or other attacks in Myanmar, where the military has been accused of sexual violence against Rohingya women and girls.
Bangladesh officials say that about 20,000 Rohingya women are pregnant and 600 have given birth since arriving in Bangladesh, although this might be an underestimate, as many births take place with no formal medical help.
“Sterilization of the males is the best way to control the population,” Bhattacharjee said. “If a man is sterilized, he cannot father a child even if he marries four or five times.”
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