“How many children you have already?”
“Four,” mumbles Noor Fatima, a 25-year-old Rohingya refugee, from inside her hut in the Balukhali refugee camp.
“What will you do if there is another one?” asks family planning volunteer Kulsum in reply.
Noor Fatima shrugs.
“If Allah gives, then what can I do?”
Kulsum, an energetic Bangladeshi woman who goes by the one name, is used to hearing this line.
“Allah wants us to do things ourselves and not to look at him with folded arms,” Kulsum counters.
Selling the virtues of contraception to this conservative community, where big families are normal and few know about birth control, is not easy.
“[Noor Fatima] said she will not take any contraceptive, because children are the will of Allah,” Kulsum tells the ABC.
Four out of five women that Kulsum and offsider Shaheen Akhtar meet say the same thing, and Kulsum finds it difficult to process.
“I told her that there is limited space in camps, life is difficult here,” Kulsum says.
“You have a small house here. How can you raise so many children here?”
The refugees’ impact is real. In just three months, the landscape along the Myanmar border has been radically transformed.
The 620,000 Rohingya Muslims who’ve arrived here since late August have carved often-precarious terraces into the once-green hills.
From atop the rises, a multi-coloured collage of tarpaulin roofs stretches in every direction.
Last week the Red Cross revealed the Balukhali camp’s water table was dropping so rapidly, some areas could go dry before new deep bores can be dug.
Bangladesh and Myanmar have entered negotiations for the refugees’ repatriation, but few expect a speedy solution to their statelessness.
Public health official Dr Pintu Bhattacharya thinks the Bangladesh Government’s family planning program should be extended to refugees.
Under the scheme, local men and women are paid small stipend for undergoing voluntary sterilisation.
“The maximum I have seen in one family? Nineteen children,” he says.
“Minimum is six to seven.
“If we do not have this program among refugees then we will have more pregnancies, more newborns and more population.”
“A small family will have good access to health services and has food security as well,” he says.
“We can use those permanent methods if Bangladesh government gives permission to us. In my opinion, we must use it.”
Would it fly?
At a tent clinic in Balukhali, refugee Noor Alam arrives with his wife Tasmin, and two of their eight children in tow.
He’s heard of the idea, but isn’t enthusiastic.
“There was an announcement about the sterilisation in our camp,” he acknowledges. But then he adds that he “decided to opt for temporary contraception, for my wife”.
The father of eight does agree however, that more children would mean more hardship.
“We will face more difficulties if we have more children here, because we have very small place,” he says.
“That’s why I have decided to use contraception.”
“I’m happy, no more children,” says his wife Tamsin, after receiving a shot of ‘depo’ — an injectable contraceptive that lasts for three months.
A chance to be a child
Supervising the injections is Dr Mohammad Rakibullah, who explains that there’s another critical reason for normalising contraception.
Child marriage he says, remains extremely common among the Rohingya.
“Fifteen or 14 years,” Dr Rakibullah says. “These things are happening.”
Indeed, Noor Alam, the father of eight who has come so his wife can receive a contraceptive injection, tells the ABC he’s looking for a husband for his 15-year-old daughter.
“Allah and our Prophet tell us that we need to get our grown up children married as early as possible,” he explains.
It’s an attitude that volunteer Kulsum is working hard to change.
“I feel happy when I am able to convince them to take contraceptive methods,” she says.
What keeps her going are refugees like Humaria Begum, for whom fleeing to Bangladesh is an opportunity to escape more than persecution.
“People back in Myanmar consider using contraceptive methods bad,” Ms Begum tells the ABC, after Kulsum has given her the contraceptive pill.
“People there used to criticise these methods.
“They even suspected girls who had travelled outside their village of using contraceptives.
“It was normal to have 13, 14 children in a family there.”
Humaria Begum has three children and doesn’t want any more.
“It’s hard here,” she says.
“I am facing trouble in raising these kids. I don’t want more.”
Kulsum says she’ll persist with trying to explain that to other refugees, like Noor Fatima.
“I feel unhappy when I can’t convince them,” she says.
“We need to visit them again and again to make them understand.”