COX’S BAZAR, Bangladesh – Inside the bamboo shelter that functions as her home, Yasmin Ara sits quietly holding her infant son. Outside, neighbors carry heavy containers of water and sacks of rice along narrow streets, while children run between shelters. The flimsy construction of her home offers little protection against the upcoming monsoon rains, but today Ara is consumed with a different worry; documents for her baby.
Cox’s Bazar is the site of the world’s largest refugee camp, made up of at least 30 sub camps, and home to 1.3 million Rohingya refugees. The Bangladeshi city, a sprawling maze of improvised housing structures, dirt alleyways, and inadequate water and sanitation, is near the border with Myanmar, from which the Rohingya have fled since 2017. That year, military and paramilitary forces in Myanmar began purging the Rohingya Muslim population from the country, committing mass murder, destroying homes, kidnapping and torturing them.
Almost every girl and woman in Cox’s Bazar arrived there in a state of trauma, having survived or witnessed multiple incidences of sexual assault, rape, gang rape, murder through mutilation, or the burning alive of a neighbor or family member. The violence was perpetrated by the Myanmar army, as well as Myanmar locals, according to community leaders and refugees interviewed after the start of the violence in 2017. It is in that context that women in Cox’s Bazar now also grapple with agency and reproductive rights, navigating competing pressures from institutions, authorities, family and community, as they try to build new lives in the refugee camp.
We talked to various women in different camps of Cox’s Bazar for this piece. Most requested anonymity out of fear for their safety.
After getting married at 16, Ara tells Truthdig that she avoided health facilities throughout the pregnancy that quickly followed. Fear of registration procedures and questions about her marriage kept her away from clinics even as her delivery date drew near. She eventually gave birth at home without medical assistance.
Yasmin Ara holds her baby boy inside her shelter and home in Cox’s Bazar refugee camp. Photo: Kawsara Bibi
As she rocks her baby, Ara explains that she worried that questions and registration could expose the family to legal or administrative consequences related to underage marriage inside the camp. Her baby is still unregistered.
“I want my child to have documents,” Ara says, “but I am afraid to speak up.”
Such documentation isn’t merely administrative paperwork for the refugees living in the camps. Birth Information Notification (BIN) forms determine whether newborn children formally enter humanitarian systems and can then access food assistance and services.
“I am afraid to speak up.”
Various Rohingya women have reported being pressured to use intrauterine devices or IUDs to get BIN forms for their children. One mother said she was told by a nurse, “Your babies will not be counted unless you get the implant” — referring to an IUD.
The population of Cox’s Bazar has grown significantly over the past nine years thanks to births and a steady stream of refugees, and in that context, some Bangladeshi media outlets and social media accounts have expressed prejudice towards Rohingya women, stigmatizing them for the number of children some of them have.
While the Bangladeshi government, through its health ministry and the Sexual and Reproductive Health Working Group, stipulates that family planning should be “accessible and voluntary, based on informed choices, for everyone,” the women we talked to said the reality is much more complicated.
A Rohingya woman accesses healthcare services in Cox’s Bazar. Photo: Kawsara Bibi
Dependence on institutions impacts free choice
Reproductive healthcare inside the Rohingya camps operates through an extensive humanitarian network that reaches deep into everyday community life. Some 173 health facilities provide sexual, reproductive and family-planning services across the Cox’s Bazar refugee camps and surrounding host communities. These services are delivered through a combination of Bangladeshi and international organizations working with the Bangladeshi government and United Nations agencies. Major providers include Bangladeshi relief organization BRAC ; Bangladeshi NGO Research, Training, and Management International; Médecins Sans Frontières; the International Rescue Committee; Save the Children and CARE, with overall coordination led by the United Nations Population Fund (UNFPA).
Healthcare also extends beyond the clinics. Female community health workers navigate narrow dirt paths to conduct household visits inside the makeshift shelters. Women living in the camps tell Truthdig these visits are routine parts of camp life, and include sessions on topics such as pregnancy, childbirth, contraception, clinic services and maternal health.
A healthcare worker (right) discusses reproductive healthcare services with a Rohingya woman inside her shelter in the refugee camp. Photo: Kawsara Bibi
“One day, … a volunteer, told me about menstrual regulation,” a young woman called Nurbahar, who already had four children, told Naripokkho, a Bangladeshi women’s activist organization. “After discussing it with my husband, I decided to do (it). I am healthy now and take family planning birth control pills,”
Many of the women we spoke with also described learning about reproductive healthcare through such outreach workers, as well as clinic counselling, rather than through formal education spaces like schools.
However, they said that such access to healthcare did not automatically produce agency. They repeatedly noted how, within healthcare spaces, the inferred connection between registration procedures and contraception impacted their reproductive choices.
The women told us they understood family planning and contraception to be connected to administrative processes, documentation, camp procedures and other services, and so felt uncertain if participation in reproductive healthcare was truly voluntary.
A nurse provides a reproductive healthcare consultation inside a health facility in the refugee camp. Photo: Asiya Alijahan
In a 2025 review conducted by UNFPA and Bangladesh’s Sexual and Reproductive Health Working Group, an inter-agency task force documented 48 reports involving 36 women alleging coercive family planning practices linked to registration procedures.
The Working Group recognized that some Rohingya women were “coerced into accepting long-acting reversible contraceptives (LARCs), notably implants or IUDs, as a precondition for receiving Birth Information Notification (BIN) forms and other essential services.” Other services, including health, nutrition, and registration, have also played a role in reinforcing the coercive dynamic, the Working Group noted. The Women’s Refugee Commission confirmed that coerced contraception “appeared to be widespread.”
The research program, Gender and Adolescence: Global Evidence, noted that humanitarian staff sometimes discourage mothers with one child already from having more children.
The real weight however, of the gap between agencies’ written policies and actual practices becomes even clearer when women in Cox’s Bazar describe to us how compromised meaningful consent already is given the power inequalities between themselves and the aid providers they depend on.
Information and language gaps undermine real choice
A lack of information further undermines women’s agency in the refugee camps. Research indicates a significant lack of practical knowledge of family planning, with one representative study of young Rohingya refugee women finding that only 27% of respondents could accurately name a contraceptive brand.
“I feel afraid to speak openly during consultations.”
Several women we talked to described confusion around the differences between implants, injections and long-acting contraceptive methods. They said that although discussions about family planning and birth spacing were common, they often felt unclear about how particular methods worked or how much choice they realistically had in accepting or refusing them.
Women Truthdig spoke with also said they did not always feel comfortable asking questions during consultations. Language barriers, low literacy levels and limited privacy, they said, often further complicated communication and informed decision making.
“I feel afraid to speak openly during consultations, because I can’t trust that what I say will remain confidential,” one woman told us, adding that she feared if others heard about her early marriage and pregnancy, it could affect her husband.
Family and community power dynamics also impact agency
Navigating reproductive decisions within broader camp authority structures can also impact decision-making, women told us. Camp leaders known as Majhis — informal and almost always male community leaders who often act as intermediaries between households, humanitarian organizations and camp authorities — frequently influence how communities access services, so their opinion about an adolescent marriage, for example, can potentially impact that person.
Reproductive decisions frequently pass through overlapping layers of family authorities, religious leadership, community structures and humanitarian systems rather than remaining private household matters.
Jannat Ara sits in the entrance of her shelter holding family planning pamphlets provided during healthcare sessions. Photo: Asiya Alijahan
Jannat Ara prepares food outside her makeshift shelter of plastic tarpaulins and bamboo. Married at 15 and currently pregnant with her second child, she tells Truthdig how reproductive decisions inside the household are rarely made independently by women.
Discussions about pregnancy, childbirth and general healthcare often take place between older relatives and her husband rather than with her directly, she said.
Although she attended several health sessions during her first pregnancy, she said she struggled to openly discuss her own concerns or future plans.
Adolescent girls have the lowest levels of reproductive autonomy.
“Sometimes I want to wait (before having more babies),” she says quietly, “but it is difficult to speak up.”
Adolescent girls have the lowest levels of reproductive autonomy, particularly during the first years of marriage when their dependence on husbands and mothers-in-law is greatest. Only 15% of married adolescent girls reported being able to make their own family planning decisions.
A lack of voice and the various tensions around reproduction also impacted Rohingya women when they were in Myanmar. There, they faced restrictions on movement, marriage and reproduction, including limits on the number of children a couple could have. Those experiences continue to shape how families understand fertility and reproductive control today.
Family relationships, including support from husband and mother-in-law, often influence women’s reproductive healthcare decisions. Photo: Umme Kulsum
Mothers-in-law are influential figures in Rohingya refugee camps, often pressuring women with constant questions about pregnancy timing, women told Truthdig.
“My mother-in-law always asks when I will have a child, and it makes me feel stressed,” one woman said.
Many women also feel ashamed or afraid to discuss contraception openly inside households. Pronatalist expectations remain strong, with many families seeing children as a way to maintain continuity after decades of persecution and displacement. Neighbors also often make assumptions about women using long-term contraception and make negative comments about family planning, women told us.
“After marriage, people keep asking when you will have a child. People say, ‘Maybe she has health problems,’ ‘maybe she cannot have children’ or ‘maybe she does not listen to her husband if she uses contraception,’ … and you can feel embarrassed,” one woman told Truthdig.
Childhood marriage to address economic and educational shortfalls
Material poverty intensifies these pressures. World Food Program contributions of US$12.50 per refugee per month were reduced last year to US$6.50. Such precarity is a contributing factor to high child marriage and early pregnancy rates. Only able to eat once a day, or once every few days, families feel pressured to send their children off into marriage earlier.
Many women manage household duties while navigating social, financial and health-related challenges. Photo: Umme Kulsum
Educational opportunities are also limited. Just 8% of girls aged 15 to 18 are enrolled in an educational program. Household responsibilities, pressure to marry, lack of female teachers and limited family support are key barriers against teenage girls continuing to study. Funding shortfalls last year forced UNICEF to close thousands of schools in Rohingya refugee camps, and Rohingya are excluded from public schools in Bangladesh’s mainstream system to prevent their long-term integration.
Just 8% of girls aged 15 to 18 are enrolled in an educational program.
Because the Rohingya refugee camps are considered temporary, the refugees also lack access to formal employment opportunities. In this context, child marriage can be seen as a strategic decision.
Several women told Truthdig that early marriage makes it especially difficult for girls to discuss health concerns openly because their opinions are usually ignored, and family expectations are seen as more important than their personal preferences.
In one survey of adolescent Rohingya brides, 80% of participants had given birth or were pregnant within the two years prior to the survey. Pregnancy, domestic labor, childcare responsibilities and family expectations frequently accumulate simultaneously.
“After marriage, I had to manage housework even when I was not physically strong,” one adolescent bride told Truthdig.
Difficulties being heard by sexual health institutions
We visited various clinics and consultation rooms in Cox’s Bazar. The waiting areas outside many of them feature complaint boxes. However, various women told us that the complaint systems can be difficult to navigate. They don’t know who to direct complaints to, nor how to follow-up. Information about the process is lacking, they said, and several of the women told us that such uncertainty discourages them from reporting confidential concerns.
“We do not always know where to complain or who will listen to us,” one woman told Truthdig.
Many women in the camp have to dedicate their time to childrearing, amid precarious living conditions. Photo: Umme Kulsum
Several women said formal complaints sometimes require repeated follow-up before resulting in support. Their experience of the system has reduced their confidence that the process could lead to meaningful change. Others worried that educated or influential individuals could deny responsibility or manipulate situations after complaints were submitted.
“Even after reporting problems, sometimes nothing changes.”
“Sometimes women feel afraid to speak because they think it may create problems later,” one woman said. Women told Truthdig they worried that complaints about service providers could lead to tension with influential figures including Majhis, health workers, nongovernment organizations, or formal camp authority administration, such as the Camp in Charge office.
Because healthcare access, dispute mediation, documentation and aid systems remain deeply interconnected, many women said that lodging complaints or expressing concerns involved practical risks. Dependence on camp systems, fear of retaliation and weak feedback mechanisms also discourage reporting. Hence, documented complaints likely represent only a fraction of existing problems in the camp. The women we talked to repeatedly stressed that silence should not be mistaken for satisfaction.
“We complain, but often nobody tells us what happens afterward. Even after reporting problems, sometimes nothing changes,” one woman said.
Rohingya women have to make their reproductive healthcare decisions while navigating these overlapping systems of authority as well as economic survival. In order for them to have meaningful reproductive autonomy, they need to be heard and to have a say in those systems.
Ishrat Bibi of Rohingyatographer also contributed to this piece.
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