Bangladesh 1993-1994 Demographic and Health ... - Measure DHS

CHAPTER 11IMPLICATIONS FOR POLICY AND STRATEGIESKim StreatfieldS. Jahangeer HaiderS.R. ChowdhuryThe most important finding from the 1993-94 Bangladesh Demographic and Health Survey (BDHS)is undoubtedly the continuation, indeed acceleration, of fertility decline. Fertility has been virtually halvedover the past two decades, a fall equal to three-quarters of the decline needed to achieve replacement levelfertility. Attention must now be given to whether conditions are conducive to further declines in fertility. Inthe present context, there has been little change in a number of factors which can affect fertility, namelymarriage patterns, breastfeeding, and abortion; the driving force behind the decline in fertility has been therapid rise in use of family planning, in particular temporary modem methods.In this chapter selected findings from the BDHS will be reviewed on the prospects for further fertilitydecline, especially trends in the desired number of children, or idea/family size. This in turn influences thelevel of unmet need for family planning. The potential to satisfy this unmet need depends, among otherthings, on the extent and quality of family planning services. The BDHS findings indicate where theseservice issues may be addressed and improved.The desired number of children implicitly relates to numbers of surviving children and so tends tobe sensitive to the level of child survival. The BDHS indicates recent improvement in child survival, butprimarily in the neonatal period. This will be discussed in the light of persistent low levels of all safemotherhood indicators, except for tetanus toxoid immunization of pregnant women.This chapter then, examines whether current policies that influence fertility and maternal and childhealth require modification, or whether new national or subnational policies and strategies are required inorder to achieve the national population goals.ILlFertilityWhile fertility has fallen dramatically, a variety of measures suggest that Bangladeshi couples wantto reduce their fertility still further. The vast majority now regard the ideal family size as two or threechildren, with a mean of 2.5 (see Table 6.5). A notable change that has occurred over recent years is thegrowing pmportion of women (more than one in three) who state that they want fewer children than theyalready have. In fact, if couples could control their fertility such that they gave birth only to "wanted"children, the total fertility rate would now be 2.1 rather than 3.4 (see Table 6.8). The national goal is 2.1children per woman, which is replacement level fertility (GB, 1994:6).The fact that ideal family size varies little among subgroups is encouraging. Even for women withsix or more children, ideal family size does not exceed 3.0 (see Table 6.8). Predictably, women withsecondary education want fewer children (2.2), but even illiterate couples desire smaller families (2.6).In attempting to understand and predict fertility change, there are a number of behaviors affectingchildbearing that are amenable to policy. These include marriage patterns, breastfeeding and supplementation(which affect birth intervals), and the use of contraception and induced abortion to space or limit births.133