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Figurelaunch<strong>in</strong>g of <strong>the</strong> First Five-Year Plan of Bangladesh. ThePlan attached equal priority to population control <strong>and</strong> foodproduction. It marked <strong>the</strong> beg<strong>in</strong>n<strong>in</strong>g of a multisectoral <strong>and</strong>broad-based population control <strong>and</strong> FP programme <strong>in</strong> <strong>the</strong>country. At a meet<strong>in</strong>g of <strong>the</strong> National Population <strong>Council</strong><strong>in</strong> June 1976, population was declared as <strong>the</strong> number oneproblem for <strong>the</strong> country. The government emphasized <strong>the</strong>urgency of mak<strong>in</strong>g <strong>the</strong> FP programme an <strong>in</strong>tegral partof <strong>the</strong> development process. The base of <strong>the</strong> programmewas broadened by <strong>in</strong>tegrat<strong>in</strong>g maternal <strong>and</strong> child health(MCH) activities. O<strong>the</strong>r positive developments <strong>in</strong>cluded<strong>the</strong> recruitment <strong>and</strong> tra<strong>in</strong><strong>in</strong>g of fieldworkers; <strong>the</strong><strong>in</strong>troduction <strong>and</strong> subsequent availability of menstrualregulation services; <strong>the</strong> sett<strong>in</strong>g up of mobile sterilizationteams; <strong>the</strong> establishment of upazila (subdistrict) MCHcl<strong>in</strong>ics; <strong>the</strong> streng<strong>the</strong>n<strong>in</strong>g of IEC activities; <strong>the</strong> <strong>in</strong>volvementof multisectoral m<strong>in</strong>istries; <strong>and</strong> <strong>the</strong> <strong>in</strong>volvement of NGOs<strong>and</strong> <strong>the</strong> private sector. The programme was fur<strong>the</strong>rstreng<strong>the</strong>ned <strong>in</strong> subsequent plans. 2Programme after <strong>the</strong><strong>International</strong> Conference onPopulation <strong>and</strong> DevelopmentFollow<strong>in</strong>g ICPD, <strong>the</strong> government formed a nationalcommittee <strong>and</strong> developed <strong>the</strong> National Plan of Action forimplementation of <strong>the</strong> goals set <strong>in</strong> <strong>the</strong> ICPD Programmeof Action. Under <strong>the</strong> <strong>in</strong>tegrated approach of population<strong>and</strong> development, national policies on population, health,women, maternal health, HIV/AIDS <strong>and</strong> sexuallytransmitted diseases, children, <strong>the</strong> environment, food <strong>and</strong>nutrition were formulated; <strong>and</strong> strategies were developedfor economic growth, poverty reduction <strong>and</strong> socialdevelopment, reproductive health, population, health <strong>and</strong>nutrition (UNFPA/MOHFW/GOB, 2005).Major changes had been tak<strong>in</strong>g place <strong>in</strong> <strong>the</strong> FP <strong>and</strong> RHprogramme <strong>in</strong> Bangladesh even before ICPD. Follow<strong>in</strong>g<strong>the</strong> ICPD Programme of Action, however, <strong>in</strong>tegration ofFP with<strong>in</strong> <strong>the</strong> RH programme was fur<strong>the</strong>r streng<strong>the</strong>ned.In 1996, MOHFW published its Strategic Directions for<strong>the</strong> Bangladesh National <strong>Family</strong> <strong>Plann<strong>in</strong>g</strong> Programme:1995-2005, which focused on a client-oriented approach toexp<strong>and</strong> high-quality FP services <strong>and</strong> achieve replacementlevelfertility by 2010 (GOB, 1996). In <strong>the</strong> 2004 populationpolicy it was recognized that <strong>the</strong> high rate of populationgrowth <strong>and</strong> <strong>the</strong> resultant <strong>in</strong>crease <strong>in</strong> population sizeadversely affected <strong>the</strong> pace of development; thus, <strong>the</strong> policyemphasized <strong>the</strong> need for <strong>the</strong> o<strong>the</strong>r m<strong>in</strong>istries concernedwith population-related activities to become <strong>in</strong>volved. The2004 population policy is currently be<strong>in</strong>g revised <strong>in</strong> l<strong>in</strong>ewith <strong>the</strong> government’s <strong>in</strong>tention to implement a broadbasedresponse to <strong>the</strong> population crisis faced by <strong>the</strong> country.The goals of <strong>the</strong> draft revised 2010 population policy areto focus on improv<strong>in</strong>g <strong>the</strong> status of FP <strong>and</strong> maternal <strong>and</strong>child health, <strong>in</strong>clud<strong>in</strong>g RH services, <strong>and</strong> to improve <strong>the</strong>liv<strong>in</strong>g st<strong>and</strong>ard of <strong>the</strong> people.MOHFW is responsible primarily for provid<strong>in</strong>g <strong>the</strong>people of Bangladesh with health, population <strong>and</strong> nutritionservices through its two directorates – DGHS <strong>and</strong>DGFP – <strong>and</strong> one project, <strong>the</strong> National Nutrition Project.The M<strong>in</strong>istry’s activities are supplemented by those ofmany NGOs <strong>and</strong> <strong>the</strong> private sector, <strong>in</strong>clud<strong>in</strong>g <strong>the</strong> SocialMarket<strong>in</strong>g Company. DGFP provides <strong>the</strong> follow<strong>in</strong>g typesof services through its field-based network <strong>and</strong> facility-Figure2Trends <strong>in</strong> <strong>the</strong> CPR <strong>in</strong> Bangladesh: 1975-200770Percent6053.858.155.8504039.944.635.249.241.543.447.347.53025.330.823.231.22019.118.413.8107.75.001975 1983 1985 1989 1991 1993- 1996- 1999- 2003- 20071994 1997 2000 2004TotalModern Methods110
ased service delivery po<strong>in</strong>ts, <strong>the</strong> Maternal <strong>and</strong> ChildWelfare Centres (MCWCs): FP, exp<strong>and</strong>ed programmeon immunization, antenatal care, postnatal care, normalvag<strong>in</strong>al deliveries, Caesarean-section deliveries, behaviouralchange communication, adolescent RH services, menstrualregulation, screen<strong>in</strong>g for <strong>and</strong> treatment of sexuallytransmitted <strong>in</strong>fection (STI), <strong>and</strong> STI prevention through<strong>the</strong> provision of condoms. DGHS affords preventive <strong>and</strong>curative health-care services, <strong>in</strong>clud<strong>in</strong>g management of <strong>the</strong>HIV/AIDS programme with fund<strong>in</strong>g from <strong>the</strong> GlobalFund to Fight AIDS, Tuberculosis <strong>and</strong> Malaria, with no<strong>in</strong>volvement of DGFP <strong>in</strong> <strong>the</strong> latter programme underwhich it imports condoms separately <strong>and</strong> distributes thosefree of charge, unlike <strong>in</strong> <strong>the</strong> FP programme where a dozencondoms are sold for Tk. 1.20. The National NutritionProject manages <strong>the</strong> country’s nutrition programme.The Health <strong>and</strong> Population Sector Programme (HPSP)was formulated as part of <strong>the</strong> Fifth Five-Year Plan (1998-2003), keep<strong>in</strong>g <strong>in</strong> view <strong>the</strong> pr<strong>in</strong>ciples of <strong>the</strong> Health <strong>and</strong>Population Sector Strategy, which called for a s<strong>in</strong>gle <strong>and</strong><strong>in</strong>tegrated sector for both health <strong>and</strong> population (GOB,1998). The ma<strong>in</strong> objective of HPSP was to ensure universalaccess to essential health-care services of acceptable quality<strong>and</strong> to fur<strong>the</strong>r slow <strong>the</strong> population growth rate. TheEssential Services Package, delivered through differentlevels of <strong>the</strong> primary health-care system (community, union,upazilla <strong>and</strong> district levels), <strong>in</strong>corporated RH services,<strong>in</strong>clud<strong>in</strong>g FP; child health <strong>and</strong> immunization; control ofselected communicable diseases; limited curative care <strong>and</strong>behavioural change communications. The HPSP targetswere not achieved (Streatfield et al., 2003). The Health,Nutrition <strong>and</strong> Population Sector Programme (HNPSP)was launched <strong>in</strong> 2003 (GOB, 2004a). Adolescent healthbecame a major part of <strong>the</strong> Essential Services Package underHNPSP, <strong>the</strong> targets of which are to: (a) <strong>in</strong>crease CPR from54 per cent <strong>in</strong> 2003 to 72 per cent by 2011; (b) reduce <strong>the</strong>discont<strong>in</strong>uation rate of contraception from 44.5 per cent <strong>in</strong>2007 to 20 per cent by 2011; <strong>and</strong> (c) <strong>in</strong>crease <strong>the</strong> uptake oflonger-act<strong>in</strong>g <strong>and</strong> permanent methods – voluntary surgicalcontraception: 1,750,000; IUDs: 2,300,000; <strong>and</strong> implants:1,050,000 (GOB, 2008a). However, <strong>the</strong> targets are quiteoverambitious, <strong>and</strong> hence are not likely to be achieved.With one year left of HNPSP, <strong>the</strong> M<strong>in</strong>istry has begun <strong>the</strong>process of design<strong>in</strong>g its next five-year health, population<strong>and</strong> nutrition programme. The Health, Population <strong>and</strong>Nutrition Sector Strategic Plan (HPNSSP) has identified<strong>the</strong> key <strong>in</strong>terventions required to accelerate <strong>the</strong> pace of<strong>the</strong> health, population <strong>and</strong> nutrition sector, so that it willbecome more responsive to clients’ needs, more efficient<strong>in</strong> <strong>the</strong> delivery of services <strong>and</strong> more effective <strong>in</strong> provid<strong>in</strong>gkey services for poor people. It is proposed that various FP<strong>in</strong>terventions would be revitalized to achieve replacementlevelfertility by 2016 by giv<strong>in</strong>g priority to: (a) efforts todelay age at marriage <strong>and</strong> age of childbear<strong>in</strong>g; <strong>and</strong> (b)<strong>in</strong>crease <strong>the</strong> use of long-term <strong>and</strong> permanent methods(GOB, 2010b).In recogniz<strong>in</strong>g <strong>the</strong> threats posed by HIV/AIDS, <strong>the</strong>government developed a comprehensive policy on HIV/AIDS <strong>and</strong> STD-related issues <strong>in</strong> 1997 <strong>in</strong> order to furnishnecessary guidance <strong>and</strong> support <strong>in</strong> address<strong>in</strong>g <strong>the</strong>seissues. MOHFW has overall responsibility for HIV/AIDS programmes, <strong>and</strong> o<strong>the</strong>r related m<strong>in</strong>istries supportits activities. There is an STD/AIDS network consist<strong>in</strong>gof more than 135 NGOs <strong>and</strong> private organizations,which is work<strong>in</strong>g actively to coord<strong>in</strong>ate <strong>and</strong> streng<strong>the</strong>nHIV/AIDS-related activities. HIV/AIDS <strong>and</strong> STDsurveillance was set up <strong>in</strong> 1998 to monitor trends <strong>in</strong>HIV <strong>in</strong>fection <strong>and</strong> risk behaviours for HIV transmissionamong <strong>the</strong> most vulnerable population groups (<strong>in</strong>ject<strong>in</strong>gdrug users, commercial sex workers <strong>and</strong> men who have sexwith men) <strong>and</strong> among <strong>the</strong> bridg<strong>in</strong>g population (transportworkers). Targeted <strong>in</strong>terventions are be<strong>in</strong>g implementedwith high-risk <strong>and</strong> bridg<strong>in</strong>g population groups (UNFPA/MOHFW/GOB, 2005).AchievementsThe Bangladesh <strong>Family</strong> <strong>Plann<strong>in</strong>g</strong> Programme has become asocial movement. It received <strong>the</strong> country’s highest politicalcommitment until <strong>the</strong> mid-1990s. The programme has<strong>the</strong> support of <strong>the</strong> elite, <strong>in</strong>clud<strong>in</strong>g journalists (Khuda et al.,1994a). Also, <strong>the</strong> role of religious leaders is, by <strong>and</strong> large,positive (Khuda, 2004).Knowledge of FP methods is almost universal amongBangladeshi couples. In <strong>the</strong> context of such a favourablepolitical <strong>and</strong> religious environment, <strong>the</strong> FP programme<strong>in</strong> Bangladesh achieved commendable success until <strong>the</strong>mid-1990s. From only about 4 per cent of married couplesus<strong>in</strong>g FP <strong>in</strong> <strong>the</strong> 1960s (Sirageld<strong>in</strong> et al., 1975; Stoeckel <strong>and</strong>Chowdhury, 1973; Azhar <strong>and</strong> Hardee, 1977), CPR slowly<strong>in</strong>creased dur<strong>in</strong>g <strong>the</strong> 1970s (K<strong>in</strong>gdom of Ne<strong>the</strong>rl<strong>and</strong>s,1978; Mia et al., 1978; Bhuiyan, 1980; Khan et al., 1977;Khan, 1981; Khuda, 1981). In 1993/94, CPR <strong>in</strong>creasedto 44.6 per cent, i.e. an almost six-fold <strong>in</strong>crease comparedwith 1975. Thereafter, <strong>the</strong> rate of <strong>in</strong>crease slowed, <strong>and</strong> <strong>in</strong>fact decl<strong>in</strong>ed from 58 per cent <strong>in</strong> 2004 to 56 per cent <strong>in</strong>2007 (see Figure 2 <strong>and</strong> Table 1).The achievements until <strong>the</strong> mid-1990s can be attributed tostrong political will <strong>and</strong> commitment s<strong>in</strong>ce <strong>the</strong> launch<strong>in</strong>gof <strong>the</strong> First Five-Year Plan of Bangladesh until <strong>the</strong> mid-1990s, <strong>the</strong> <strong>in</strong>crease <strong>in</strong> <strong>the</strong> dem<strong>and</strong> for FP services, <strong>the</strong>provision of such services by <strong>the</strong> FP programme, <strong>and</strong>socio-economic development (for example, see Clel<strong>and</strong> etal., 1994; Caldwell et al., 1999; Khuda et al., 2001; <strong>and</strong>UNFPA, 2010).111
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Family Pla
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ForewordThe Asia <
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Part 1Part 1Asia <
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Ensuring that <str
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of methods for all, in</str
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and undertake <str
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Report on the Regi
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SESSION 1: Changin
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that improving <st
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at a hospital would be offered post
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Bounkoung Phichit, Deputy M
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medicines
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Thus, while knowledge of modern met
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Hon. Mr. Malakai Tabar, Chairman, P
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curricula. If the
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dialogue as well as regional <stron
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BackgroundGlobal development effort
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TableTable1EventNational policyYear
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A third observation is that reporte
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TableTable2Current Contraceptive Pr
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Figure(-1.2), Cook Island</
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FigureTableTable3Trends in<
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Nam. Nearly all economies i
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2008 2009% Bilateral % Multilateral
Page 70 and 71: family planning wi
Page 73 and 74: IntroductionFamily
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Page 77 and 78: FigureFigure1Oceania and</s
Page 79 and 80: next 25 years, however, TFR fluctua
Page 81 and 82: FigureFigureFigure2Total fertility
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Page 96 and 97: The concept of “unmet need” has
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Page 123 and 124: Most FWAs who were recruited two to
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Page 131 and 132: ConclusionThe Bangladesh Fa
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assistance from UNFPA and</
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in CPR. Likewise,
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International supp
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in development has
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__________ (2007). Population <stro
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170
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TableTable2What has the</st
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174
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per cent of women reported us<stron
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is provider bias that such methods
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TableTable7skewed distribution of h
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TableTable8TableTable9182
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that of the nation
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TableTable12 7some policies that ex
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The system guides the</stro
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FigureFigure4Total donor expenditur
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FigureFigureagain
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Impact of family plannin</s
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marketing of contr
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United States Agency for In
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200
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acceptable. From an NGO perspective
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FigureThis trend of limited donor f
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Figureto have the
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FigureFigure5Percentage change <str
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FigureFigure6Desire to limit childb
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coordination betwe
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the 1980s
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Policy Management.__________ (n.d.,
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218
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Population Activities (UNFPA) for a
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where family plannin</stron
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Thus an objective assessment of <st
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226
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Figureeconomic growth durin
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TableTable1TableTable2For spac<stro
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eflect a provider bias (e.g., <stro
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The Indonesian delegation was very
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than in ensur<stro
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in-country <strong
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(Ministry of Healt
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242
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244
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FigureTrends and p
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TableTable3Unmet need for contracep
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TableTable5TableTable6TableTable725
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TableTable8TableTable9Malaysia, abo
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previously mentioned is based on fo
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TableTable16births and</str
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FigureFigure3TRF54.5Scatter plots o
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ReferencesAng, Eng Suan (2007). Stu
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Demographic data sheet: population
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population size, with just 336,000
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NuptialityIn Myanmar nuptiality is
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FigureIn Myanmar, birth-spac<strong
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Scope of coverage and</stro
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FigureIn Myanmar, out of six select
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equirements. The Min</stron
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according to <stro
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Adolescent sexual and</stro
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FigureHIV/AIDS. An HIV-positive wom
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National Population PolicyMyanmar i
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Linkages with o<st
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TableTable4Achievements of Myanmar
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monitoring <strong
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Nay Pyi Taw, 26 October 2010.53 Sit
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292
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TableTableA296
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dispense and adm<s
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(1) I am against a
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FigureFigureFigure3Use of modern co
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FigureFigure7Traditional method use
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Figureprojection, and</stro
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Figure 11 summarizes the</s
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correlating <stron
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Figurethe use of c
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FigureFigure15Sexual behaviour <str
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track the distribu
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Figureservices, which should <stron
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FigureFigureFigure18 Population <st
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National Statistics Office, <strong
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TableTable11326
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TableTable19Laws and</stron
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worker and hours w
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334
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336
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includin</
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TableTable1Contraceptive prevalence
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These results suggest that about 70
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2 The (period) TFR is the</
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346
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FigureThe existence of traditional
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Guinea case by <st
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The establishment of provin
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provide family plannin</str
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Figurelegal requirement nor a condi
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FigureTableTable5TableTable6Figure4
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modern method and
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married or in unio
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Figureolder. Both the</stro
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TableTable15The immediate past Nati
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out that the “ne
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Commodity securitySupply cha<strong
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is able to achieve. In Papua New Gu
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Qualitative assessments by a number
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increasin<
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service delivery poin</stro
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Population: Views from Men
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1545-1730Day 2: December 9Session 2
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Day 3, December 10Session 50830-100
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15Mr. Tong Sithen1
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54Ms. Shadiya IbrahimAssistant Repr
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93Mr. Melkie AntonProject OfficerUn
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131Dr. John P. SkibiakDirectorRepro
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International <str
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