From Taboo to Touchscreen: Reimagining Adolescent Sexual and Reproductive Health in Bangladesh
Adolescence is a critical period of rapid development, where timely and youth-friendly health information can shape lifelong well-being. In Bangladesh, nearly one-fifth of the population are adolescents, a segment confronting barriers to SRH information and services shaped by cultural norms, privacy concerns, and limited access to youth-centered resources. This qualitative study examines Mukhorito, a mobile app designed to foster peer communication, interactive learning, and secure access to SRH information within secondary schools across three districts in Bangladesh.
Rationale for a Digital Solution
Bangladesh has pursued a national strategy to improve adolescent health, including school-based SRH education and the training of peer educators. With rising smartphone ownership among youth and a push toward digital health solutions, Mukhorito was developed to complement government programs. The app offers eight domains—ranging from puberty and nutrition to gender discrimination, child marriage, and safe motherhood—presented in self-paced, interactive modules. Features such as in-app quizzes, class leaderboards, and a moderated school chat room create a space for peer dialogue that extends beyond traditional classrooms. This study qualitative focus aims to understand how such digital tools shape knowledge, attitudes, and SRH service uptake among adolescents.
Methods in Brief
The Mukhorito intervention was studied using qualitative methods within three secondary schools in the Feni district, including a boys’ school, a girls’ school, and a coeducational school. Researchers conducted in-depth interviews, focus group discussions, and key informant interviews with ninth-grade students, peer leaders, teachers, and GoB program officials. Data collection occurred from March to June 2024, with interviews conducted in private settings to ensure confidentiality. An inductive thematic analysis of translated transcripts facilitated a nuanced understanding of how the app’s interactive features influenced learning, peer dynamics, and perceived barriers to adoption.
What Participants Experienced: Opportunities and Gains
Participants consistently highlighted the value of Mukhorito’s structured content. The eight-topic organization was praised for its ease of navigation, enabling students to quickly locate information on SRH topics. Stories embedded in each topic made content relatable, enhancing comprehension and retention. A ninth-grade peer leader summarized this: the app helps you know where to find information quickly, while stories contextualize topics in a relatable way.
Beyond knowledge, the app fostered a discussion-friendly environment. A school-based chat room and moderated online sessions created a safer space for adolescents to raise concerns about SRH with peers and leaders, reducing fear and stigma. Teachers noted observable shifts: students who once concealed topics now discussed them more openly, marking a gradual dismantling of some taboos. In parallel, Mukhorito helped cultivate leadership skills—participation in online sessions and task-based activities encouraged initiative and confidence among young users.
Importantly, the study found an impact on attitudes and behaviors. Reduced embarrassment during SRH lessons and greater willingness to engage with sensitive topics suggested a positive cultural shift within classrooms, families, and peer groups. Some participants even reported using new knowledge to educate siblings and peers, indicating a potential cascading effect on community health literacy.
Barriers to Adoption: Infrastructure and Economics
Despite promising gains, the study identified significant constraints. Limited access to personal smartphones, shared devices, and inconsistent network connectivity hindered consistent app use. Visiting families and guardians often restrict nighttime or home access to phones, while data costs and power outages pose ongoing challenges in rural contexts. These barriers underscore the necessity of solutions that work offline or with low bandwidth, and that incorporate cost-effective access strategies.
Towards Scalable, Sustainable Impact
Actionable insights from participants emphasize integration with the national school health program, starting from lower secondary grades (sixth to tenth) to build progressive SRH literacy. Visual and interactive content, including short dramas or animations, could boost engagement and retention. Several stakeholders urged offline features to overcome connectivity gaps, and suggested closer alignment with government initiatives for scale-up and sustainability. The study also points to the value of continuous user-centered design, allowing content to evolve with feedback from adolescents, teachers, and health officials.
Conclusion
The Mukhorito app demonstrates that a well-designed digital SRH intervention can complement existing government programs, expand access to information, and empower adolescents to discuss and address reproductive health concerns more openly. Addressing technical, financial, and infrastructural barriers is essential for broader reach. With offline capabilities, multimedia content, and formal integration into the national adolescent health strategy, Mukhorito has potential to contribute to healthier, more informed generations of Bangladeshi adolescents. Future research should examine long-term behavioral outcomes and explore adaptations for different age groups and regional contexts.
