Cohort profile: A prospective cohort study on newlywed couples in rural and poor urban Bangladesh

Sexual and Reproductive Health and Rights (SRHR) aim to enhance quality of life through safe sexual experiences, reproductive autonomy, and protection against gender-based violence. However, existing SRHR research and interventions in low- and middle-income countries like Bangladesh predominantly focus on women, often understating men and neglecting the nuanced contextual issues faced by married couples. This study contributes to filling this gap by examining SRHR dynamics among newlyweds in rural and poor urban areas of Bangladesh, especially focusing on marital satisfaction, fertility preferences, and post-marriage adaptation mechanisms. Employing a prospective cohort design across four Health and Demographic Surveillance Systems (HDSS) managed by icddr,b, the study spans from November 2021 to March 2025, with data collection starting in December 2022. Of the 2011 newlywed couples identified, 666 who met eligibility criteria (married for ≤6 months, first marriage, and no pregnancy history) were enrolled. Participants will undergo six quantitative interview sessions over a two-year period. Additionally, 44 in-depth qualitative interviews were conducted with 22 purposefully selected couples. Demographic data reveal that a significant proportion of husbands (67.3% in rural areas, 71.8% in poor urban areas) are aged 20-29 years, while a majority of wives (67.9% in rural areas, 84.8% in poor urban areas) are adolescents. Education levels varied, with a higher proportion of poor urban husbands lack formal education compared to their rural counterparts (7.2% vs. 3.0%), while no significant variation was observed among wives (0.6% vs 1.0%). Arranged marriages are more common among rural couples (80%) compared to those in poor urban areas (50%). Moreover, poor urban participants tend to marry at a younger age than the rural participants, with poor urban wives marrying earlier than rural wives (60.4% vs 39.7%). This pioneering study provides valuable insights into the SRHR needs of newlywed couples in Bangladesh. The findings will be instrumental for designing targeted interventions aimed at improving SRHR service utilization and enhancing overall well-being, particularly in rural and poor urban areas of the country.