Navigating Sexual and Reproductive Health Challenges of Adolescents and Women: Health System Adaptations against a Rising Sea and Changing Climate in Coastal Regions of Bangladesh

The changing climate and a rising sea have accelerated salinity intrusion in coastal surface and groundwater and had detrimental impacts on women’s sexual and reproductive health and rights (SRHR) in Bangladesh. We investigate how coastal adolescents and women are challenged in managing their SRH needs due to salinity intrusion and how the local health systems can be strengthened to meet such SRH demands. We implemented a cross-sectional survey in 135 clusters from 6 high-salinity and 3 low-salinity coastal unions and interviewed 6092 ever-married 15–49-year-old women. About 94% of female respondents experienced any health complications in the last 6 months. The child marriage situation is quite critical in coastal areas; about 75% of girls marry before the legal age of 18 and 33% marry even before 15. Cesarean delivery takes place in 61% of cases in high-salinity areas with 15% of babies reported smaller than normal at birth. In both high- and low-salinity areas, free or low-cost medicines, pediatric doctors, nutritional supplements, and mental health support are widely advocated by respondents for children. For women, the need for female doctors is crucial, with antenatal and postnatal care provision. Diagnostic tests at the sub-district level, specialized facilities for pregnant mothers in cyclone shelters, and low-cost medicine support for women are also demanded considering SRH-specific health conditions. Local SRH demand-driven policy and programs, health workforce strengthening, resource allocation for climate-resilient health systems, community participation in the health decision making, and climate change and health research are essential for achieving ‘climate justice’ for coastal adolescents and women in Bangladesh.