Image: Umme, a community health worker in Kutupalong Refugee Camp, Bangladesh. (Md. Dipu/CPI)
Kutupalong Refugee Camp in southeastern Bangladesh shelters one of the world’s largest displaced populations. Most residents fled Myanmar in 2017. Almost a decade later, families are still raising children in bamboo and tarpaulin shelters, on shrinking rations, inside a perimeter they cannot cross. Escalating conflict, violence and persecution in Myanmar push tens of thousands more Rohingya to seek shelter as refugees in Bangladesh each year.
Rohingya family planning has become one of the quieter tests of how health services can work in a setting like this. The clinical side is simple enough. Trust is the hard part.
Community Partners International (CPI) supports more than 200 Rohingya community health workers in Kutupalong Refugee Camp doing outreach across sub-camps 1W and 4, alongside a health post in sub-camp 1W. Every morning, those workers walk the lanes to visit families at home.
The numbers suggest it is working. In January 2026, 77.43% of couples of reproductive age in CPI’s catchment were using at least one form of contraception. In 2022, the figure stood at 32.34%.
When CPI began work here, choice barely existed. “Availability was largely limited to short-term methods such as condoms, oral pills, and injectables, and both awareness and community acceptance remained low,” says Sumaiya Akter, a Bangladeshi midwife supported by CPI.
Sumaiya has watched that shift. “Couples come in asking for a wider variety of choices, and we’re seeing genuine interest in implants, not just the usual daily pills or injections,” she says.
Research from the period confirms the earlier picture. A 2022 study found that 44% of participants had poor knowledge of family planning and that 46% held a negative attitude toward it. Those figures match what her team met every day. “People don’t have the right information, so the rumors spread very fast and it affects everyone by scaring them,” she says.
Progress came slowly at first. Families hesitated for months under pressure from relatives, religion and custom. “Early on, getting anyone to try it was almost impossible unless we sat down with them repeatedly to explain things to them,” Sumaiya says.
Today, Rohingya family planning in these camps includes long-acting options alongside the short-term ones. But the methods were never the obstacle.
The World Health Organization defines a short birth interval as conception within 24 months of a live birth. Real consequences follow for mother and child. A 2024 review links short intervals to low birthweight, preterm birth, small size for gestational age and neonatal mortality. It also associates them with maternal anemia, high blood pressure, placental abruption, placenta previa and uterine rupture.
Those risks are not abstract in Kutupalong. “In Kutupalong and the nearby camps, we see so many families having babies back-to-back without enough time to recover,” Sumaiya says. Malnutrition compounds the danger, so difficult births and underweight babies follow.
Because of that, the team presents Rohingya family planning as maternal and newborn care first. “That is why our team doesn’t just talk about birth control. We focus on keeping mothers healthy and helping babies survive, so families realize spacing out pregnancies is really about protecting their loved ones,” Sumaiya says.
Umme has worked in camp health outreach for nine years, four of them as a sexual and reproductive health worker. Her week runs six days. Each morning starts at the office with a team meeting, then moves into the field.
“My daily activities include door-to-door visits to discuss antenatal care, postnatal care, mortality, birth planning, family planning, and providing daily referrals,” she says.
Osman covers three blocks and has worked across all 31 in his camp. He arrived in August 2017 and joined the program the following January. His day runs from 8:30 a.m. to 4 p.m., though the job rarely stops there.
“We act as a bridge between the community and health facilities,” he says. When someone needs care, he writes a referral slip and points them toward the health post. Friday is his official day off. Even then, his phone stays on for deliveries and ambulance calls. Umme does the same, coordinating with team leaders and focal points from home.
Rohingya family planning depends on conversations that outsiders rarely get to have. Shared language is the first reason why.
“Because I am one of them, they understand me faster and trust me more,” Umme says.
Osman describes the same advantage. “When I speak to them in our language, they trust me and believe the positive things I tell them more than they would an outsider,” he says. Discretion matters just as much. “People trust me because I keep their personal information confidential,” he adds.
Both workers open a visit in the same careful way. They show an ID card, introduce themselves and request a few minutes to talk. Only then does the conversation turn personal.
Sumaiya sees the difference this makes from the clinic side. “They can visit homes, sit down privately, and talk through sensitive religious and social concerns in complete confidence,” she says.
Objections have shifted over the years. Early on, resistance was mostly religious. Rumors were everywhere too. “In the beginning, there were many rumors, especially about the COVID-19 vaccine and potential side effects of contraception,” Osman says. People sometimes got angry.
Now the questions are more practical. “Women worry that methods like injections or implants will make them feel weak, nauseous, or dizzy, making it hard for them to manage their households,” Umme says. Some also fear irregular bleeding or weight loss.
Her answer avoids overselling. “I explain that every person’s body is different. If one method doesn’t suit them, we can try another, like condoms or oral pills,” she says. She tells women that early discomfort usually settles within two or three months. If it does not, she refers them back for a check-up.
Osman goes into similar detail on the products themselves. He explains which pill suits mothers with babies under six months, and why. Accuracy protects credibility, and credibility is the whole asset.
Rohingya family planning is rarely a choice one person makes by herself. Sumaiya is direct about the constraint. “Cultural and religious beliefs remain significant factors, compounded by gender dynamics where women possess minimal decision-making autonomy,” she says.
So the program works with the people who shape household decisions. Male workers counsel husbands. Couples are counseled together. Community leaders, known as “Majhis,” take part as well.
“Imams even speak during Friday prayers, explaining family planning as a way to ensure the health of mothers and children, such as spacing births so a mother can breastfeed for a full two years,” Osman says.
When someone refuses outright, he returns rather than pushes. Some families tell him it is God’s business. “I tell them that while Allah provides, He also gives us the wisdom to choose a path that keeps our families healthy and safe,” he says. Then he asks them to think it over.
Sumaiya credits religious leaders with much of the progress. “When they explain how maternal health and caring for your family fit directly into Islamic values, the stigma really drops, and families feel much more comfortable accepting these services,” she says. Osman puts it more plainly: “Our success is really a result of the collaboration between us volunteers, the Imams, and the Majhis.”
Rohingya family planning looks different in every household. Ayesha’s* family had a plan from the start.
“We wanted two children. One daughter to become a teacher and a son to be educated,” she says. After her second child, she went to the clinic and chose an implant. Health workers had already been visiting for months. “She came to my house. The sisters come every week to hold meetings and talk to us,” she says.
Trust came from manner as much as message. “Because she explained the path clearly. I felt I could trust her, so I spoke to her openly,” Ayesha says.
She describes the change in terms of fear, not method. “I feel good. I don’t have the fear anymore. Before, I was always afraid of getting pregnant again too soon. Now my body feels healthy, and I can take care of my children in peace.”
Yusuf*, 29, made a different calculation. He has one child, aged two, and lost his job at the camp. Five people share his shelter, including his parents. “They didn’t give my parents a separate shelter, so we all live together in my house. It is crowded and difficult,” he says.
“Rations have been reduced, which is a major problem,” he adds. His wife delivered by C-section and is still recovering. Together they chose a short-term method. “Since she had a C-section and still has pain, it is better to wait,” he says.
He hears the old arguments from neighbors. “Some think family planning is only for the poor, or they think that in a refugee life, it is better to just leave it to God,” he says. His own verdict is short: “It has changed. I feel peace now.”
Both now talk to others. Ayesha’s sister-in-law chose an implant after hearing about hers. Yusuf raises the subject with men who dismiss it. That secondhand persuasion may matter more than any counseling session.
The scale of the shift is easier to see in the monitoring data than in any single story. Among 3,248 couples of reproductive age in CPI’s catchment in January 2026, 77.43% were using condoms, an implant, an injectable or oral contraceptives. That covers 6,496 people. Four years earlier, the equivalent figure was 32.34%.
Put differently, uptake has more than doubled since 2022. “Over time, the numbers show a steady increase in service uptake,” Sumaiya says.
The demand pattern has shifted too. Implants and injectables have gained the most ground, largely because both offer privacy and long-term protection. Sumaiya reports a clear split by age and parity. Younger women with fewer children lean toward implants, while older women with more children tend to prefer injectables.
Geography tracks effort. Acceptance runs highest in the blocks where outreach and counseling are most intensive. Where coverage thins, behavior change slows. Umme and Osman both attribute the change to repetition, and to families hearing the same message from workers, majhis, and imams alike.
Plenty has not changed. Newly married couples and highly conservative households remain the hardest to reach. Patriarchal decision-making still limits what many women can choose.
Rohingya family planning faces quieter threats, too. “Our health post staff and community workers deal with a massive workload, so burnout and turnover are constant risks,” Sumaiya says. Supply is the other worry. A delayed contraceptive shipment can undo months of persuasion.
Sumaiya argues that while service models are transferable, trust cannot be imported. “The most vital lesson is that you cannot build real trust without community health workers who actually belong to the community.” Those workers cross cultural and religious lines that outside teams cannot. Framing care around family well-being, rather than clinical instruction, does the rest.
She also thinks the work is widely misread. “A common misunderstanding is the perception of family planning as a simple matter of handing out supplies. In reality, it’s about earning trust and changing mindsets step by step,” she says.
That is the part a supply chart will never show. Rohingya family planning works here because Umme still returns to families who once turned her away, and because Osman goes back a second and third time. Behind every method chosen sits someone the family already trusted.
*Name changed to protect privacy
Community Partners International (CPI) strengthens, equips and connects local organizations in Myanmar, Bangladesh and Thailand providing health and humanitarian services to conflict- and poverty-affected communities.
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