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

ConclusionThe Bangladesh <strong>Family</strong> <strong>Plann<strong>in</strong>g</strong> Programme was <strong>in</strong>itiatedby <strong>the</strong> government to reduce <strong>the</strong> rate of population growth.The programme made great progress until <strong>the</strong> mid-1990s,but, ow<strong>in</strong>g to erosion <strong>in</strong> political will <strong>and</strong> commitment<strong>and</strong> certa<strong>in</strong> systemic issues, <strong>the</strong> programme has s<strong>in</strong>ce <strong>the</strong>nbeen lagg<strong>in</strong>g beh<strong>in</strong>d. The rate of <strong>in</strong>crease <strong>in</strong> CPR amongmarried couples has slowed considerably s<strong>in</strong>ce <strong>the</strong>n,<strong>and</strong> <strong>in</strong>deed, decl<strong>in</strong>ed between 2004 <strong>and</strong> 2007. Amongthose us<strong>in</strong>g FP, most are opt<strong>in</strong>g for short-term methodsra<strong>the</strong>r than longer-act<strong>in</strong>g <strong>and</strong> permanent methods. Thecurrent programme is <strong>in</strong>efficient <strong>and</strong> <strong>in</strong>effective. Thereis an <strong>in</strong>adequate number of tra<strong>in</strong>ed providers <strong>and</strong> a lackof effective measures to improve job satisfaction. Also,<strong>the</strong>re have been problems with stock-outs of FP methods.Fur<strong>the</strong>rmore, <strong>the</strong>re is limited fund<strong>in</strong>g available for <strong>the</strong>programme; <strong>and</strong> worse still, <strong>the</strong> funds are not fully utilizeddue to weak implementation capacity.To achieve <strong>the</strong> desired <strong>in</strong>crease <strong>in</strong> CPR <strong>and</strong> fertilitydecl<strong>in</strong>e, <strong>the</strong> government should undertake a number ofmeasures. First <strong>and</strong> foremost, <strong>the</strong> political leadershipshould make a renewed commitment to conta<strong>in</strong> <strong>the</strong>country’s population growth rate. Second, <strong>the</strong> systemicproblems affect<strong>in</strong>g <strong>the</strong> programme should be addressedon an urgent basis. Third, <strong>the</strong> role of DGFP <strong>in</strong> provid<strong>in</strong>ggood-quality FP-related services needs to be rethought, aswas <strong>the</strong> case until <strong>the</strong> early 1990s, ra<strong>the</strong>r than <strong>in</strong>volv<strong>in</strong>gDGFP <strong>in</strong> various non-FP activities, which would <strong>the</strong>rebyenable it to achieve its primary goal of <strong>in</strong>creas<strong>in</strong>g CPR<strong>and</strong> <strong>the</strong> use of longer-act<strong>in</strong>g <strong>and</strong> permanent methods <strong>in</strong>br<strong>in</strong>g<strong>in</strong>g about <strong>the</strong> desired reduction <strong>in</strong> fertility. Fourth,both access to, <strong>and</strong> <strong>the</strong> quality of, FP services should beimproved by tra<strong>in</strong><strong>in</strong>g workers, <strong>in</strong>creas<strong>in</strong>g fieldworkervisitations, enhanc<strong>in</strong>g worker morale <strong>and</strong> job satisfaction,<strong>and</strong> ensur<strong>in</strong>g that <strong>the</strong>re is no stock-out. Fifth, servicedelivery <strong>and</strong> programme efficiency should be enhancedby mak<strong>in</strong>g better use of exist<strong>in</strong>g <strong>in</strong>frastructure, resources<strong>and</strong> personnel of both DGFP <strong>and</strong> DGHS to reach out to<strong>the</strong> underserved population groups. Sixth, effective publicprivatepartnerships should be established to maximize <strong>the</strong>use of exist<strong>in</strong>g resources, personnel <strong>and</strong> networks. Seventh,greater emphasis should be given to fur<strong>the</strong>r improv<strong>in</strong>g <strong>the</strong>child survival rate <strong>and</strong> <strong>the</strong> overall status of women, <strong>and</strong><strong>the</strong>reby promote FP use among non-users. Eighth, femaleeducation should be made a national priority to empowerwomen, which would deter <strong>the</strong>m from hav<strong>in</strong>g more than<strong>the</strong> desired number of children <strong>and</strong> offer <strong>the</strong>m attractivealternatives to childbear<strong>in</strong>g. F<strong>in</strong>ally, issues relat<strong>in</strong>g tobetter governance <strong>and</strong> accountability should receive highpriority.The government should re-evaluate its exist<strong>in</strong>g FPprogramme, <strong>and</strong> adopt <strong>and</strong> effectively implement <strong>the</strong>strategies proposed above to make <strong>the</strong> programme moreefficient <strong>and</strong> susta<strong>in</strong>able. This would help accelerate <strong>the</strong>rate of <strong>in</strong>crease <strong>in</strong> CPR <strong>and</strong> ultimately achieve populationstabilization with<strong>in</strong> <strong>the</strong> shortest possible time. Provisionof good-quality FP services could save <strong>the</strong> lives of mo<strong>the</strong>rs<strong>and</strong> children. FP could prevent as many as one <strong>in</strong> everythree maternal deaths by enabl<strong>in</strong>g women to delaychildbear<strong>in</strong>g, avoid un<strong>in</strong>tended pregnancies <strong>and</strong> abortions,<strong>and</strong> stop childbear<strong>in</strong>g when <strong>the</strong>y have reached <strong>the</strong>irdesired family size. Thus, provision of good-quality FPservices could help Bangladesh achieve <strong>the</strong> targets underMillennium Development Goal 5 (improve maternalhealth). Moreover, FP use could help reduce poverty <strong>and</strong>promote economic growth by improv<strong>in</strong>g family wellbe<strong>in</strong>g,rais<strong>in</strong>g female productivity <strong>and</strong> lower<strong>in</strong>g fertility(for example, see UNFPA, 2010). F<strong>in</strong>ally, <strong>the</strong> governmentshould reposition <strong>the</strong> FP <strong>and</strong> RH programme as part ofits overall development agenda; o<strong>the</strong>rwise, its developmentobjectives will not be fully achieved to <strong>the</strong> detriment of <strong>the</strong>country as a whole.End Note1 In Bangladesh, about 50 per cent of <strong>the</strong> females younger than20 years of age are married compared with 33 per cent <strong>in</strong> India,25 per cent <strong>in</strong> Pakistan, <strong>and</strong> a much smaller percentage <strong>in</strong> o<strong>the</strong>rdevelop<strong>in</strong>g countries (GOB, 2004).2 For a more elaborate discussion of <strong>the</strong> evolution <strong>and</strong> developmentof <strong>the</strong> FP programme <strong>in</strong> Bangladesh, see Khuda, 1981 <strong>and</strong> 1984;Khuda et al., 1992, 1993a; Khuda <strong>and</strong> Barkat 1994; Khuda <strong>and</strong>Anwar, 2004; Khuda <strong>and</strong> Barkat, 2010; <strong>and</strong> Clel<strong>and</strong> et al., 1994.4 situation <strong>in</strong> which <strong>the</strong> dem<strong>and</strong> or requirement for an item cannotbe fulfilled from <strong>the</strong> current <strong>in</strong>ventory.5 lac is equal to 100,000.6 See also Khuda <strong>and</strong> Barkat, 1994; Khuda et al., 1994a, 1994 b <strong>and</strong>Khuda et al., 1997; Khuda <strong>and</strong> Anwar, 2004; Khuda <strong>and</strong> Barkat,2010; <strong>and</strong> UNFPA, 2010.7 1 crore is equal to 10 million.AcknowledgementsThe ma<strong>in</strong> f<strong>in</strong>d<strong>in</strong>gs of <strong>the</strong> draft paper were shared dur<strong>in</strong>gmeet<strong>in</strong>gs with officials concerned from <strong>the</strong> Governmentof Bangladesh, development partners, non-governmentalorganizations <strong>and</strong> <strong>the</strong> private sector. We are <strong>in</strong>debted to<strong>the</strong>m for <strong>the</strong>ir valuable feedback <strong>and</strong> useful comments. Weare especially <strong>in</strong>debted to Mr. Humayun Kabir, Secretary,M<strong>in</strong>istry of Health <strong>and</strong> <strong>Family</strong> Welfare (MOHFW), <strong>and</strong>his colleagues; Begum Dilruba, Additional Secretary <strong>and</strong>Director General, <strong>Family</strong> <strong>Plann<strong>in</strong>g</strong>, <strong>and</strong> her colleagues;<strong>and</strong> representatives of <strong>the</strong> World Bank, <strong>the</strong> Canadian<strong>International</strong> Development Agency (CIDA), <strong>the</strong> UKDepartment for <strong>International</strong> Development (UKAID), <strong>the</strong>United Nations Population Fund (UNFPA), <strong>the</strong> UnitedStates Agency for <strong>International</strong> Development (USAID),121