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

MarriageA review of the role of these factors in fertility decline in Bangladesh suggests that marriage pattemshave not changed to an extent that would noticeably reduce fertility. While age at marriage among womenhas risen by about one year over the past decade (see Table 5.4), age at first birth has changed less, about halfa year (see Table 3.12). This is possibly because in the past more girls were marrying very young, at whichage their ability to bear children (fecundity) was not fully developed. Thus, the impact of the marriage delayon fertility is dampened. So, the situation persists that more than half of Bangladeshi girls have married andproduced their first child while still teenagers. Indeed, by age 20, one in four has already had a second child.In regard to possible policy interventions, there is little historical evidence that legislation of age ofmarriage has been effective in delaying early marriage, but there are other avenues such as the provision ofopportunities for education and employment outside the home for young women that are likely to result indelayed marriage. More important is the need to extend the interval between marriage and first birth, thusdelaying the timing of the first birth. This suggests the need for a more concerted family planning effortfocused on newly married couples.BreastfeedingBreastfeeding patterns have not changed in ways which would contribute to fertility decline. Indeed,the proportions of children being partially or fully breastfed have remained remarkably stable over recentdecades, and the durations continue to be among the longest anywhere. Experience elsewhere, however,suggests that as societies become more modem and urban, and as women become more involved in wageemployment, supplementation is increasingly common and the effect of breastfeeding on the delay of thereturn of fecundity after childbirth (i.e., on postpartum amenorrhea) is seriously reduced. There is someevidence that this is beginning to happen in Bangladesh (Salway et al., 1993).The area in which policy may be required then, is not encouraging initiation of breastfeeding, orreinforcing the lengthy duration of breastfeeding, but in minimizing the proportion of infants beingsupplemented too early. Currently, less than one-third of children are exclusively breastfed until the WHOrecommended age of 4-6 months (see Table 8.13). While very few are given solid or mushy foods until afterthis age, far too many newbom infants are being given infant formula, or other types of supplementary milkand liquids (see Table 8.14). Appropriate policy would be to discourage early formula feeding.AbortionAs a theoretical determinant of fertility, abortion was not measured in the BDHS; however, a briefreview is presented here. Menstrual regulation services have expanded in recent years. The Governmentreporting system indicates that official numbers of menstrual regulations rose from several thousand in 1979to 100,000 in 1993 (BAPSA, 1993). If the undocumented estimate of 500,000 or more abortions (official plusunofficial) is correct, then this practice could be reducing the total fertility rate by as much as 0.5 childrenper woman.This review of marriage, breastfeeding, and abortion suggests that changes in these factors have notplayed a key role in the fertility decline. Instead, the rapidly increasing level of contraceptive use is the mostimportant factor influencing the decline of fertility in Bangladesh.134