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

Figurewill exceed <strong>the</strong> rural population; <strong>and</strong> by 2051, <strong>the</strong> urbanpopulation will account for 64 per cent of <strong>the</strong> country’stotal population (GOB, 2006a).Dhaka, <strong>the</strong> capital of Bangladesh, is today one of <strong>the</strong>world’s largest metropolises. From a population of about14 million people now, Dhaka is expected to become <strong>the</strong>fourth largest city <strong>in</strong> <strong>the</strong> world, with a population of 23million by 2015 (Brockerhoff, 2000). Also, o<strong>the</strong>r smallertowns <strong>in</strong> Bangladesh have grown <strong>in</strong> size. While <strong>the</strong> annualgrowth rate of <strong>the</strong> rural population is about 1 per cent, it isabout 5 per cent for <strong>the</strong> urban population (United NationsPopulation Division, 1998).Dur<strong>in</strong>g <strong>the</strong> 1960s, fertility was quite high, with <strong>the</strong> totalfertility rate (TFR) exceed<strong>in</strong>g 7 children per woman. TFRdecl<strong>in</strong>ed to 6.3 <strong>in</strong> 1975, <strong>and</strong> rema<strong>in</strong>ed above 6.0 until 1981(Clel<strong>and</strong> et al., 1994). Between 1989 <strong>and</strong> 1993/94, TFRdecl<strong>in</strong>ed sharply from 5.1 to 3.4. However, <strong>the</strong> decl<strong>in</strong>e wasmuch slower <strong>the</strong>reafter; it stalled at about 3.3 dur<strong>in</strong>g <strong>the</strong>period 1994-2000. Thereafter, TFR decl<strong>in</strong>ed slowly to 3.0<strong>in</strong> <strong>the</strong> period 2001-2003, reach<strong>in</strong>g 2.7 <strong>in</strong> 2007 (see Figure1 <strong>and</strong> Table 1).There has been an extremely high level of adolescent fertility<strong>in</strong> Bangladesh s<strong>in</strong>ce <strong>the</strong> mid-1990s, with <strong>the</strong> adolescentfertility rate be<strong>in</strong>g one of <strong>the</strong> highest <strong>in</strong> <strong>the</strong> world. Onethird of adolescent married women aged 15-19 years havebegun childbear<strong>in</strong>g. Childbear<strong>in</strong>g among adolescents ishigher: (a) <strong>in</strong> rural than urban areas; (b) among those withno education than those with education; <strong>and</strong> (c) amongthose <strong>in</strong> <strong>the</strong> lowest wealth qu<strong>in</strong>tile than those <strong>in</strong> <strong>the</strong>higher wealth qu<strong>in</strong>tiles (NIPORT, Mitra <strong>and</strong> Associates<strong>and</strong> ORC Macro, 1994; 2005; <strong>and</strong> NIPORT, Mitra <strong>and</strong>Associates <strong>and</strong> Macro <strong>International</strong>, 2009).There are sharp differentials <strong>in</strong> fertility levels. Fertility islower <strong>in</strong> urban than rural areas by about half a child; lower<strong>in</strong> Khulna <strong>and</strong> Rajshahi divisions (where replacement ornear replacement-level fertility has been reached) than<strong>in</strong> Sylhet <strong>and</strong> Chittagong divisions (with TFRs rang<strong>in</strong>gbetween 3.2 <strong>and</strong> 3.7); lower among educated women(women who completed secondary or who have highereducation have reached near replacement-level fertility,or a TFR of 2.3) compared with a TFR of 3.0 amongwomen with no education; lower among women <strong>in</strong> <strong>the</strong>highest wealth qu<strong>in</strong>tile (who have reached replacementlevelfertility) than those <strong>in</strong> <strong>the</strong> lowest wealth qu<strong>in</strong>tile(TFR of 3.2) (NIPORT, Mitra <strong>and</strong> Associates <strong>and</strong> Macro<strong>International</strong>, 2009). Also, fertility is lower among limiters<strong>and</strong> spacers, those with access to mass media than thosewithout, ever-users of FP methods, work<strong>in</strong>g women,women belong<strong>in</strong>g to l<strong>and</strong>ed households, <strong>and</strong> thosebelong<strong>in</strong>g to households with an electricity connection,which is an <strong>in</strong>dicator not only of <strong>the</strong> economic conditionof <strong>the</strong> household but also its level of monetization (Khuda,2004; Neaz et al., 2004).There has been a slow but steady rise over <strong>the</strong> past 25years <strong>in</strong> <strong>the</strong> age at which Bangladeshi women marry, froma median age at marriage of 14.1 years for women now <strong>in</strong><strong>the</strong>ir late forties to 16.4 years for women now <strong>in</strong> <strong>the</strong>ir earlytwenties. 1 The median age at marriage is about two yearslower than <strong>the</strong> legal m<strong>in</strong>imum age at marriage for females.The median age at marriage is positively associated with<strong>the</strong> level of education <strong>and</strong> wealth status (NIPORT, Mitra<strong>and</strong> Associates <strong>and</strong> Macro <strong>International</strong>, 2009).Bangladeshi women beg<strong>in</strong> childbear<strong>in</strong>g early. On average,women have about one quarter of <strong>the</strong>ir children beforereach<strong>in</strong>g 20 years of age, more than half of <strong>the</strong>ir childrendur<strong>in</strong>g <strong>the</strong>ir twenties, <strong>and</strong> one fifth dur<strong>in</strong>g <strong>the</strong>ir thirties.The median age of women at <strong>the</strong> time of <strong>the</strong>ir first birthis only about 18 years. It is one year higher <strong>in</strong> urban (19years) than rural areas (18 years), about four years higheramong educated women (21 years) than those with noeducation (17 years), <strong>and</strong> two years higher among women<strong>in</strong> <strong>the</strong> highest wealth qu<strong>in</strong>tile (19 years) than those <strong>in</strong> <strong>the</strong>lowest wealth qu<strong>in</strong>tile (NIPORT, Mitra <strong>and</strong> Associates<strong>and</strong> Macro <strong>International</strong>, 2009).Figure1Trends <strong>in</strong> <strong>the</strong> total fertility rate <strong>in</strong> Bangladesh: 1975-200776.3655.14.3433.4 3.3 3.33 32.72101975 1989 1991 1993-94 1996-97 1999-2000 2001-03 2004 2007106