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

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decline from 2.9 in 1989. BDHS data also indicate a high degree of agreement between husbands and wivesas to fertility preferences.The proportion of women who want to stop childbearing has increased substantially in Bangladesh overthe past decade. For example, the percentage of women with two children who want no more children hasrisen from only 39 percent in 1991 to 50 percent in 1993-94. Half of all currently married women age 10-49in Bangladesh say they want no more children and 12 percent either have been sterilized or say that theycannot have any more children. An additional 22 percent say they would like to wait two or more yearsbefore having their next birth. Thus, the vast majority of women want either to space their next birth or tolimit childbearing altogether. These women can be considered to be potentially in need of family planningservices.Unplanned Fertility. Despite the relatively high and increasing level of contraceptive use, BDHS dataindicate that unplanned pregnancies are still common. Overall, about one-third of births in the three yearsprior to the survey were reported to be unplanned; 20 percent were mistimed (wanted later) and 13 percentwere unwanted. If unwanted births could be eliminated altogether, the total fertility rate in Bangladesh wouldreach the replacement level of 2.1 births per woman instead of the actual level of 3.4.FAMILY PLANNINGIncreasing Use of Contraception. A major cause of declining fertility in Bangladesh has been thesteady increase in contraceptive use over the last two decades. The contraceptive prevalence rate hasincreased almost sixfold since 1975, from 8 to 45 percent of married women. Use of modem methods hasgrown even faster. Between 1991 and 1993-94, contraceptive use increased from 40 to 45 percent of marriedwomen and use of modem methods rose from 31 to 36 percent. Overall, there has been a steady growth inthe contraceptive prevalence rate with an average increase of about two percentage points a year.Pill Dominated Method Mix. In terms of "method mix," the dominant change since the late 1980shas been the large increase in the number of couples using oral contraception. The proportion of marriedwomen relying on the pill almost doubled in the last four years, from 9 in 1989 to 17 percent in 1993-94 andthe pill now accounts for40 percent of all contraceptive use. Conversely, use of female and male sterilizationhas stagnated or declined slightly since 1989 and now accounts for only 20 percent of all contraceptive use.This shift away from permanent methods to modem reversible methods has important implications for thefamily planning program in terms of cost, supply logistics, and method efficacy and is especially importantgiven the increasing proportion of women who say they want no more children.Aside from the pill and sterilization, use of injection, condoms, the IUD, periodic abstinence (rhythmmethod) and withdrawal have increased slightly since 1991, but none is used by more than 5 percent ofmarried women.Differentials in Family Planning Use. Differentials in current use of family planning by the fiveadministrative divisions of the country are large and indicate that Chittagong Division is still lagging. Morethan half of the married women in Khulna (55 percent) and Rajshahi (55 percent) Divisions and slightly lessthan half in Barisal Division (48 percent) are current users. In contrast, less than one-third (29 percent) ofthe married women in Chittagong Division are using a method of contraception. Intermediate ~s DhakaDivision with a contraceptive prevalence rate of 44 percent. Over the past decade, surveys have consistentlyshown a significantly lower rate of contraceptwe use among women in Chittagong Division and a generallyhigher rate among women in Rajshahi Division.Knowledge of Contraception. Knowledge of contraceptive methods and supply sources has beenxxii
almost universal in Bangladesh for some time and the BDHS results confirm this fact. For example, resultsindicate that just slightly less than 100 percent of currently married women age 10-49 know at least onemethod of family planning. Knowledge of the pill, female sterilization, and injection is almost universal,while more than 4 out of 5 married women know the IUD, condom, and male sterilization. Consideringtraditional methods, periodic abstinence is more widely known than withdrawal (65 vs. 50 percent ofcurrently married women).Knowledge about sources of supply for family planning methods is also widespread in Bangladesh.Almost all currently married women are aware of a source of a modem method. Moreover, B DHS data revealthat there are no significant differences in knowledge of methods and their sources of supply by backgroundcharacteristics of currently married women. Knowledge of at least one method, particularly a modemmethod, is universal among both urban and rural women, among women in all five divisions, and across allcategories of educational attainment. These results regarding family planning knowledge imply that littlemore can be done to improve general awareness of methods and sources and that further education andcommunication activities should focus on either increasing motivation to use and/or increasing the depth ofknowledge of methods and dispelling rumors that may inhibit their wider use.Family Planning Messages. One reason for the high level of contraceptive awareness is that familyplanning messages are prevalent. Almost half o f the women interviewed reported that they had heard or secna family planning message in the month prior to the survey. Radio is a more effective medium thantelevision, billboards or posters, which is related to the limited electrical coverage and low female literacyin Bangladesh. Two in five women had heard a family planning message on the radio in the month beforethe interview, compared with less than one in five who had seen a message on television. Moreover, almostall women who had seen a family planning message on television had also heard a radio message. Less thanone in ten women saw a family planning message on a billboard or poster in the month before the interview.Initiation of Contraceptive Use, There is evidence that the family planning program has beensuccessful in encouraging women to initiate contraceptive use earlier in their reproductive lives. BDHS dataindicate that over 40 percent of married teenage women have already used a family planning method at sometime. Moreover, survey results show that younger women are much more likely than older women to havestarted using contraception before having any children. These two findings imply that young women aremore likely to use contraception to space births, while older women use it to limit births.Unmet Need for Family Planning. Unmet need for family planning services has declinedconsiderably since 1991. Data from 1991 show that 28 percent of currently married women were in need ofservices, compared with 19 percent in the 1993-94 BDHS. Just over half of the unmet need is comprised ofwomen who want to space their next birth, while just under half is for women who want do not want anymore children (limiters). I f all women who say they want to space or limit their children were to use methods,the contraceptive prevalence rate could be increased from 45 percent to 65 percent of married women.Currently, 70 percent of this "total demand" for family planning is being met.Correct Use of Pill. Pill users are generally complying with accepted standards for use. All but asmall fraction were able to show interviewers a pill packet, almost all of which indicated that the pills werebeing taken in sequence. Moreover, almost all pill users said they had taken a pill in the last two days andtwo-thirds knew what to do if they forgot to take a pill for two days.Discontlnuation Rates. One challenge for the family planning program is to reduce the high levelsof contraceptive discontinuation. BDHS data indicate that half of contraceptive users in Bangladesh stopusing within 12 months of starting; one-fifth of those who stop do so as a result of side effects or healthconcems with the method. Discontinuation rates vary by method. Not surprisingly, the rates for the condomxxiii
Page 1: Demographicand Health Survey1993-19
Page 4 and 5: This report summarizes the findings
Page 6 and 7: 4.7 Reasons for Selecting Family Pl
Page 9 and 10: TABLESPageTable 1.1Table 2.1Table 2
Page 11 and 12: PageTable 5.5Table 5.6Table 5.7Tabl
Page 13 and 14: FIGURESPageFigure2.1Hguro2.2~gure2.
Page 15: Secretary,Ministry of Health & Fami
Page 19: 1993-94 BDHS TECHNICAL REVIEW COMMI
Page 23: SUMMARY OF FINDINGSThe 1993-94 Bang
Page 27 and 28: fully vaccinated, a vast improvemen
Page 29 and 30: CHAPTER 1INTRODUCTION1.1 Geography
Page 31 and 32: Fertility in Bangladesh is declinin
Page 33 and 34: Factors for Program SuccessNumerous
Page 35 and 36: Foundation, the Bangladesh Bureau o
Page 37 and 38: CHAPTER 2CHARACTERISTICS OF HOUSEHO
Page 39 and 40: Figure 2.2Distribution of De Facto
Page 41 and 42: EducationEducation is a key determi
Page 43 and 44: with no education and more men than
Page 45 and 46: The majority (69 percent) of househ
Page 47 and 48: ~l'able 2.9 Background characterist
Page 49: Access to MediaWomen were asked if
Page 52 and 53: for the whole country is 29 births
Page 54 and 55: Table 3.2 Fertility by background c
Page 56 and 57: Births per 1,000 Women3oo250 s ~Fig
Page 58 and 59: Figure 3.5Trends in the Total Ferti
Page 61 and 62: Table 3.9 Children ever born and li
Page 63 and 64: The data show that birth intervals
Page 65 and 66: Table 3.14 shows the percentage of
Page 67 and 68: CHAPTER 4FERTILITY REGULATION4.1 Kn
Page 69 and 70: Table 4.3 Differentials in knowledg
Page 71 and 72: Ever-use rates vary with the age of
Page 73 and 74: Table 4.7 Trends in current use of
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Table 4.8 Current use of fJ~,nily p
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Table 4.9 Trends in current use of
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Overall, 41 percent of respondents
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Use of Social Marketing BrandsBangl
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Table 4.16 Quality of pill usePerce
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Table 4.19 Use of condom brandsPerc
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Table4.21 StedlizationregretPercent
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The source a woman uses to obtain c
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Table 4.24 Reasons for discontinuat
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Table 4.26 Reasons for not using co
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Respondents were further asked whet
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Table 4.30 Contact with family plan
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CHAPTER 5OTHER PROXIMATE DETERMINAN
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Figure 5.1Trends in Proportion of W
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Table 5.4 Age at furst marriagePerc
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Table 5.6 indicates that a large ma
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5.7 Termination of Exposure to Preg
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Table 6.1 Fertility preferences by
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Table 6.2 Fertility preferences by
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6.2 Need for Family Planning Servic
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Table 6.5 Ideal and actual number o
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Table 6.7 Fertility planning status
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Table 7.1 Infant and child mortalit
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Matlab area of Bangladesh. Infant m
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Table 7.4 Infant and child mortalit
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Column 3 of Table 7.5 shows the pro
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Table 8.1 Antenatal carePercent dis
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Pregnant women who seek antenatal c
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Table 8.4 Place of deliveryPercent
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5 percent were assisted by doctors,
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59 percent of children 12-23 months
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Trends in Vaccination CoverageA gen
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Overall, just over one-quarter (28
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Figure 8.4Percentage of Children un
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Prevalence of BreastfeedlngTable 8.
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The results shown in Table 8.13 ind
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The median duration of breastfeedin
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Table 9.2 Age differences between s
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When data on current contraceptive
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The data indicate that when husband
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There is a high degree of agreement
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Table 10.1 Distance to public servi
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All but a tiny fraction of family p
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MarriageA review of the role of the
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Unmet Need for Family PlanningThe f
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Family Planning Outreach/Satellite
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should be organized on a priority b
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REFERENCESArnold, Fred. 1990. Asses
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APPENDIX ASAMPLE IMPLEMENTATION
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APPENDIX BESTIMATES OF SAMPLING ERR
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The Jacknife repeated replication m
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Table B.2 Sampling errors - Nationa
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Table B.4 Sampling errors - Rural s
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Table B.6 Sampling errors - Chittag
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Table B.8 Sampling errors - Khuhaa,
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APPENDIX CDATA QUALITY
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Table C.1 Household age distributio
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C.2 FertilityThe low level of ferti
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Figure C.1Births by Calendar Year,
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This cursory inspection of the qual
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APPENDIX DQUESTIONNAIRES
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HOUSEHOLD SCHEDULENow we uoutd like
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NO.GUESTIONS AND FILTERS19 What is
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182
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SECTION 1.RESPONDEHTBS BACKGROUNDSK
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NO.QUESTIONS AND FILTERSCOOING CATE
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211 Now I would like to talk to you
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221CONPARE 208 WITH NIJI4BER OF BIR
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SECTION 3:COBTRACEPTION301 I No~ (
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NO.315 QhJch method are you using?3
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NO.J320B IQUESTIONS AND FILTERSSHOW
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NO.QUESTIONS AND FILTERSCODING CATE
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331 I would like to ask some questi
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SECTION 4A.PREGNANCY AND BREASTFEED
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430 Are you still braastfeedingCNAM
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442H442I442JAmong the I~rsons with
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BANELA~ BIRYHNEXT-TO'LAST BIRTHNAME
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RO. J501 JOUESTIORS AND FILTERSSECT
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SECTION 7.HUSBAND'S BACKGROUND, RES
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INTERVIEWER'S OBSERVATIONS(To be fi
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218
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SECTION 1.RESPONGENT'S BACKGROUND10
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~[CT|ON 2.REPROOUCTIOMNo. I 043ESTI
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SKIPRo. I QUESTIONS AND FILTERS I C
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NO. IQUESTIONS AND FILTERSCODING CA
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NO,502CHECK ]15:SECTION 5.FERTILITY
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INTERVIEWER'S OBSERVATIONS(To be fi
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i. GENERAL DESCRIPTIONNO.OUESTIONS
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HO.QUEST lOllSL19 t~hat services do
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NO.QUESTIONS CCOING CATEGORIES SKIP
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iO.9QUESTIONS COOING CATEGORIES SXI
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