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

<strong>in</strong> urban (67%) than rural areas (49%). Between 1985 <strong>and</strong>2005, primary school enrolment <strong>in</strong>creased by about twotimes (from 10 million to 16 million) <strong>and</strong> secondary schoolenrolment <strong>in</strong>creased almost three-fold from 2.6 million to7.4 million (Government of Bangladesh (GOB), 2009).Income per capita is only about US$ 700 annually, withsharp <strong>in</strong>equity <strong>in</strong> <strong>in</strong>come distribution. A large proportion(31.5%) of <strong>the</strong> population lives below <strong>the</strong> poverty l<strong>in</strong>e(GOB, 2011). The poverty is more acute <strong>in</strong> rural areas <strong>and</strong>urban slums than elsewhere. The current government hasplaced elim<strong>in</strong>ation of poverty <strong>and</strong> <strong>in</strong>equity at <strong>the</strong> forefrontof its development strategy. In <strong>the</strong> FY 2010/11 budget, <strong>the</strong>government allocated 14.8 per cent of <strong>the</strong> total development<strong>and</strong> non-development budget <strong>and</strong> 2.5 per cent of totalGDP for social security <strong>and</strong> social empowerment (GOB,2010a). The aim is to br<strong>in</strong>g down <strong>the</strong> poverty rate from40 per cent <strong>in</strong> 2008 to 15 per cent by 2021. The socialsafety net measures also partly address <strong>the</strong> needs of <strong>the</strong>elderly population by provid<strong>in</strong>g a select number of suchbeneficiaries with a monthly allowance of Tk. 300 (US$ 1= almost 75 taka) (Khuda, 2011).There has been a considerable rise <strong>in</strong> <strong>the</strong> HumanDevelopment Index (HDI). Accord<strong>in</strong>g to Bongaarts <strong>and</strong>Watk<strong>in</strong>s (1996), HDI for Bangladesh rose by 45.5 percent between 1960 <strong>and</strong> 1980. Between 1980 <strong>and</strong> 2007, it<strong>in</strong>creased by 1.86 per cent per annum from 0.328 to 0.543,giv<strong>in</strong>g <strong>the</strong> country a rank of 146th out of 182 countries(UNDP, 2009).Because of ris<strong>in</strong>g population size, <strong>the</strong> l<strong>and</strong>-to-person ratiocont<strong>in</strong>ues to worsen. The size of <strong>the</strong> average farm is smallernow than previously had been <strong>the</strong> case, <strong>and</strong> l<strong>and</strong>lessnessis <strong>in</strong>creas<strong>in</strong>g as is <strong>the</strong> number of marg<strong>in</strong>al farmers. Thissituation has reduced <strong>the</strong> dem<strong>and</strong> for household labouron <strong>the</strong> farm. As a result, <strong>the</strong>re has been <strong>in</strong>creas<strong>in</strong>g ruralto-urbanmigration, especially to <strong>the</strong> capital city Dhaka(Alam <strong>and</strong> Khuda, 2010).The male labour force participation rate (LFPR) hasrema<strong>in</strong>ed almost unchanged at about 56 per cent from1974. However, <strong>the</strong> female LFPR, which was quitenegligible until 1985/86, <strong>in</strong>creased to 29 per cent of <strong>the</strong>total <strong>in</strong> 2005/06 (Khuda, 2010). Part of <strong>the</strong> <strong>in</strong>crease <strong>in</strong>female LFPR is due to changes <strong>in</strong> def<strong>in</strong>itions used <strong>in</strong> <strong>the</strong>different censuses <strong>and</strong> labour force surveys, while part of<strong>the</strong> <strong>in</strong>crease is real, reflect<strong>in</strong>g <strong>the</strong>ir <strong>in</strong>creased participation<strong>in</strong> <strong>the</strong> labour force. In 2006, <strong>the</strong> garment <strong>in</strong>dustry furnishedjobs for 4.5 million people <strong>in</strong> urban areas, 80 per cent ofwhom were females, mostly young <strong>and</strong> unmarried (ADB,2006). The number has <strong>in</strong>creased s<strong>in</strong>ce 2006 because offur<strong>the</strong>r expansion <strong>in</strong> <strong>the</strong> garment sector. There is evidenceof poverty-driven female employment, result<strong>in</strong>g frompoor household economic conditions <strong>and</strong> high rates offemale headship (Rahman, 1986; Safilios-Rothschild <strong>and</strong>Mahmood, 1989; BIDS, 1990; Rahman <strong>and</strong> Hossa<strong>in</strong>,1991).Notwithst<strong>and</strong><strong>in</strong>g that women <strong>in</strong> Bangladesh are adisadvantaged group, <strong>the</strong>ir status has improved. Ingeneral, women now have greater freedom of movement,an enhanced role <strong>in</strong> household decision-mak<strong>in</strong>g, relativefreedom from more patriarchal structures than before, <strong>and</strong><strong>in</strong>creased ability to use contraceptives (see, for example,Khuda et al., 1990a; 1990b; 1993b; Schuler <strong>and</strong> Hashemi,1994; Islam et al., 2000; <strong>and</strong> NIPORT, Mitra <strong>and</strong>Associates <strong>and</strong> Macro <strong>International</strong>, 2009).There has been a considerable <strong>in</strong>crease <strong>in</strong> access to massmedia, both pr<strong>in</strong>t <strong>and</strong> electronic. Ideational changesresult<strong>in</strong>g from <strong>in</strong>creased access to <strong>the</strong> media have fosteredmodern outlooks <strong>and</strong> attitudes <strong>in</strong> general <strong>and</strong> thoserelat<strong>in</strong>g to FP <strong>and</strong> RH <strong>in</strong> particular. The <strong>in</strong>fluence ofmodernization has helped to change <strong>the</strong> high fertilitynorms, even among <strong>the</strong> poor, who <strong>the</strong>mselves haveexperienced <strong>in</strong>creases <strong>in</strong> contraceptive use <strong>and</strong> decl<strong>in</strong>es <strong>in</strong>fertility over time, though much less so than <strong>the</strong> relativelywell-off. Among <strong>the</strong> poor, two forces operate to depressfertility norms. One is poverty-led because of <strong>the</strong> poor’s<strong>in</strong>ability to ma<strong>in</strong>ta<strong>in</strong> a large family, while one <strong>the</strong> o<strong>the</strong>r isaspiration-driven: people be<strong>in</strong>g imbued with modern ideas<strong>and</strong> attitudes (see also Caldwell et al., 1999; Khuda et al.,2001).<strong>Family</strong> plann<strong>in</strong>g programmeEvolution <strong>and</strong> developmentFP activities <strong>in</strong> Bangladesh have been carried out <strong>in</strong> threedist<strong>in</strong>ct phases. Phase 1 activities were largely voluntary,with <strong>the</strong> sett<strong>in</strong>g up of <strong>the</strong> <strong>Family</strong> <strong>Plann<strong>in</strong>g</strong> Association <strong>in</strong>1953 by a group of dedicated social workers who realized<strong>the</strong> adverse consequences of rapid population growthon <strong>the</strong> society’s development efforts. Subsequently, <strong>the</strong>sevoluntary activities received some limited support from <strong>the</strong>government.Phase II activities began <strong>in</strong> 1960, with <strong>the</strong> governmenttak<strong>in</strong>g some broader steps to check <strong>the</strong> populationgrowth rate. Population control was made <strong>the</strong> officialpolicy <strong>in</strong> <strong>the</strong> First Five-Year Plan of Pakistan (1960-1965). A sizable cadre of FP personnel was recruited; anumber of cl<strong>in</strong>ics were set up; a tra<strong>in</strong><strong>in</strong>g-cum-research<strong>in</strong>stitute was established; <strong>and</strong> <strong>in</strong>formation, education<strong>and</strong> communication (IEC) activities emphasized cl<strong>in</strong>icbasedcounsel<strong>in</strong>g <strong>and</strong> dissem<strong>in</strong>ation of knowledge aboutcontraceptives by physicians <strong>and</strong> paramedics.Phase III activities were <strong>in</strong>itiated <strong>in</strong> 1973 with <strong>the</strong>109