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

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