Family Planning in Asia and the Pacific - International Council on ...

BackgroundAs is <strong>the</strong> case <strong>in</strong> many develop<strong>in</strong>g countries, Bangladeshcan trace its official family plann<strong>in</strong>g (FP) programmeback several decades, i.e. to 1960, although voluntary FPprogramme efforts had started even earlier <strong>in</strong> <strong>the</strong> early1950s. S<strong>in</strong>ce that time, <strong>the</strong> programme has gone throughdifferent phases. It achieved commendable success until <strong>the</strong>mid-1990s; however, <strong>the</strong> pace of success slowed <strong>the</strong>reafterow<strong>in</strong>g to <strong>the</strong> erosion of political will <strong>and</strong> commitment to <strong>the</strong>programme. Not surpris<strong>in</strong>gly, <strong>the</strong>refore, <strong>the</strong> pace of successhas slowed, result<strong>in</strong>g <strong>in</strong> a stall<strong>in</strong>g <strong>and</strong>/or near stagnation <strong>in</strong>fertility decl<strong>in</strong>e <strong>in</strong> Bangladesh. Although <strong>the</strong>re has been nochange <strong>in</strong> official policy regard<strong>in</strong>g <strong>the</strong> need to conta<strong>in</strong> <strong>the</strong>rate of population growth, <strong>the</strong> commitment of <strong>the</strong> politicalleadership has weakened considerably. This, <strong>in</strong> turn, hasaffected <strong>the</strong> commitment of <strong>the</strong> officials concerned withprogramme implementation.In 1994, <strong>the</strong> United Nations organized <strong>the</strong> <strong>International</strong>Conference on Population <strong>and</strong> Development (ICPD)<strong>in</strong> Cairo. The Programme of Action (POA) adopted bythat Conference recommended, among o<strong>the</strong>r th<strong>in</strong>gs, thatgovernments should meet <strong>the</strong> family plann<strong>in</strong>g needs of<strong>the</strong>ir populations as soon as possible <strong>and</strong> should, <strong>in</strong> allcases by <strong>the</strong> year 2015, seek to provide universal accessto a full range of safe <strong>and</strong> reliable family plann<strong>in</strong>g services(for example, see UNFPA, 1995). ICPD accorded dueimportance to women's health <strong>and</strong> rights, <strong>and</strong> accord<strong>in</strong>gly,made FP part of <strong>the</strong> overall reproductive health (RH)agenda. However, ICPD failed to clearly operationalizehow FP was to be made an <strong>in</strong>tegral part of <strong>the</strong> RHprogramme, especially <strong>in</strong> countries such as Bangladesh,which has two health (RH) agenda. However, ICPDfailed to clearly operationalize how FP was to be made an<strong>in</strong>tegral part of <strong>the</strong> RH programme, especially <strong>in</strong> countriessuch as Bangladesh, which has two separate directorates –<strong>the</strong> Directorate General of Health Services (DGHS) <strong>and</strong><strong>the</strong> Directorate General of <strong>Family</strong> <strong>Plann<strong>in</strong>g</strong> (DGFP) –offer<strong>in</strong>g RH services <strong>in</strong>dependently of each o<strong>the</strong>r, withoutany effective coord<strong>in</strong>ation <strong>and</strong> cooperation between <strong>the</strong>two directorates.The purpose of <strong>the</strong> present case study on Bangladeshis to review <strong>the</strong> status of <strong>the</strong> country’s FP programme,<strong>in</strong>clud<strong>in</strong>g <strong>the</strong> knowledge <strong>and</strong> practice of contraception<strong>and</strong> <strong>the</strong> service delivery system. The study (a) identifiesachievements of <strong>the</strong> Bangladesh FP programme; (b)highlights various gaps faced by <strong>the</strong> programme; <strong>and</strong> (c)identifies Bangladesh-specific strategies for renewed focus<strong>and</strong> <strong>in</strong>creased <strong>in</strong>vestment <strong>in</strong> FP.A review of (a) relevant documents, strategies <strong>and</strong>assessment reports, all of which have been referenced<strong>in</strong> <strong>the</strong> present paper, <strong>and</strong> (b) <strong>the</strong> 2007 BangladeshDemographic <strong>and</strong> Health Survey (BDHS) <strong>and</strong> earlierBDHSs <strong>and</strong> predecessor surveys for <strong>the</strong> period 1975-2007 was undertaken <strong>in</strong> order to obta<strong>in</strong> an <strong>in</strong>-depthunderst<strong>and</strong><strong>in</strong>g of <strong>the</strong> Bangladesh FP programme. Inaddition, <strong>in</strong>terviews were held with relevant stakeholders,such as officials from <strong>the</strong> M<strong>in</strong>istry of Health <strong>and</strong> <strong>Family</strong>Welfare (MOHFW), <strong>the</strong> Directorate General of <strong>Family</strong><strong>Plann<strong>in</strong>g</strong> (DGFP), <strong>in</strong>ternational donors <strong>and</strong> bilateralagencies, non-governmental organizations (NGOs) <strong>and</strong><strong>the</strong> private sector.Country sett<strong>in</strong>gDemographic challengesBangladesh is <strong>the</strong> seventh most populous country <strong>in</strong> <strong>the</strong>world <strong>and</strong> <strong>the</strong> fifth largest <strong>in</strong> <strong>Asia</strong>, with a population ofabout 160 million people. The annual rate of populationgrowth currently is about 1.4 per cent; <strong>in</strong> o<strong>the</strong>r words,about 2 million new faces are added to <strong>the</strong> populationannually. Accord<strong>in</strong>g to government estimates, <strong>the</strong>population of Bangladesh under vary<strong>in</strong>g assumptions willrange from about 170 million to 184 million by 2020, <strong>and</strong>from 218 million to 294 million by 2050 (Government ofBangladesh (GOB), 2006a). Accord<strong>in</strong>g to United Nationsestimates, <strong>the</strong> population of Bangladesh is projected(under <strong>the</strong> medium variant) to <strong>in</strong>crease to 185.6 millionby 2020, <strong>and</strong> fur<strong>the</strong>r to 222.5 million by 2050 (UnitedNations, 2010).Bangladesh is <strong>the</strong> most densely populated country <strong>in</strong> <strong>the</strong>world, with <strong>the</strong> exception of some small isl<strong>and</strong> states. Itspopulation density of around 1,000 persons per squarekilometre is projected to <strong>in</strong>crease (under <strong>the</strong> mediumvariant) to 1,289 persons per sq km by 2020, <strong>and</strong> fur<strong>the</strong>rto 1,545 persons per sq km by 2050 (United Nations,2010).About one third of <strong>the</strong> total population is younger than15 years of age, <strong>and</strong> <strong>the</strong> elderly population (60 years <strong>and</strong>older) accounts for about 6 per cent of <strong>the</strong> total population,<strong>in</strong>dicat<strong>in</strong>g a high dependency ratio. The elderly populationis projected to rise to 8.2 per cent <strong>and</strong> 21.2 per cent of <strong>the</strong>total population <strong>in</strong> 2020 <strong>and</strong> 2050 respectively. Women <strong>in</strong><strong>the</strong> reproductive age group are projected to <strong>in</strong>crease from55.8 per cent of <strong>the</strong> total population <strong>in</strong> 2010 to 56.7 percent <strong>in</strong> 2020, <strong>and</strong> <strong>the</strong>n decl<strong>in</strong>e to 45.9 per cent <strong>in</strong> 2050(United Nations, 2010).Accord<strong>in</strong>g to <strong>the</strong> 1974 census, only 9 per cent of <strong>the</strong>population at that time lived <strong>in</strong> urban areas; that proportiondoubled to 18 per cent <strong>in</strong> 1988. Currently, about 30 percent of <strong>the</strong> total population lives <strong>in</strong> urban areas. By 2025,<strong>the</strong> urban population is projected to <strong>in</strong>crease to 40 per centof <strong>the</strong> total population; by 2031, <strong>the</strong> urban population105