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 About Bangladesh

Bangladesh Map Bangladesh, with an estimated population of 140 million and per capita income of US$4441, has the highest density of population in the world (948/sq. kilometre). Although poverty declined during the last decade by one per cent per year (59 % in 1999 to 49% in 2001 (HIES: 2001)2, more than 63 million people still continue to live below the poverty line. Following a very successful population programme (TFR fell from 6.4 in mid 1970s to 3.3 in 1994 and population growth rate declined from 3 per cent to 1.5 per cent over the same period), TFR plateaued for about a decade at 3.3 (1994-2002) and has finally started declining again and reduced to 3 in 2004 (BDHS: 2004)3. The demographic structure, particularly the young people (about 40% in age 15-24 years) will cause the population to continue to increase and stabilise at around 250 million in 2085: even if the replacement level is reached in 2020. Contraceptive Prevalence Rate (CPR) has increased to 58 per cent in 2004 from 48 per cent in 1994 (BDHS: 2004). The use of modern methods constitute 47 per cent, where pill is by far the most widely used method (26%), followed by injectables (10%), female sterilization (5%) and condom (5%). Uses of permanent and long-lasting methods such as, sterilization, IUD or norplant has declined and account for 12 per cent only. Discontinuation rate is also high and varies by method, ranging from 72 per cent for condom to 49 per cent for injectables and 47 per cent for pills. Unmet need for family planning has declined, from 15 per cent in 1999-2000 to 11 per cent in 2004. There are marked regional variations in the total fertility rate and contraceptive usage. Some key factors contributing to this phenomenon are low educational levels, continued son preference, high infant mortality, gender inequality, and poor status of women.

About a quarter of the population consists of adolescents. Some of the problems concerning adolescents include early age at marriage, high fertility and low levels of secondary and tertiary education. Maternal Mortality Ratio (MMR) among adolescents is almost double the national average (320/100000 LB) and the Infant Mortality Rate (IMR) is also 30per cent higher than national average (65/1000 live births; BDHS:2004). While official policy has aimed over the last five years to delay age at marriage has risen very slowly in Bangladesh and most girls are likely to marry by 18. This interrupts their education and disrupts personal developments for the future. Statistics show that approximately half of women in Bangladesh are less than 18 when they marry, and 58per cent of girls become mothers or pregnant with first child before the age of 20. Early marriage and early first birth therefore go hand in hand. Consequently, adolescent fertility in Bangladesh is still one of the highest in the world, with 135 births per 1000 women below 20 (BDHS: 2004). This has a direct impact on the country's total fertility rate. Young boys are also particularly vulnerable to STI/HIV/AIDS and drug abuse. Because of their curiosity, inadequate knowledge and peer pressure many boys get involved in unprotected sex/commercial sex and drug use. Access to appropriate SRH information and services for this group is inadequate.

Unacceptably high maternal mortality ratio (320-400 per 100,000 live births) and morbidity remains a serious concern in Bangladesh. About half of the pregnant women are malnourished (BMI < 18) and most of them suffer from anaemia and other ailments related to nutritional deficiency. An estimated 12,000 mothers die yearly from pregnancy related complications (BMMS: 2001)4. One fifth of all maternal deaths are due to obstetric causes related to abortion and its complications, 14per cent of pregnant women's deaths are associated with violence and injuries5. The morbidity is estimated to be 30 times higher than that of maternal mortality. The vast majority of deliveries (87.7%) take place at home and a Skilled Birth Attendant (SBA) is present at less than 14 per cent of all cases. Therefore, safe delivery at home with referral linkages, addressing "three delays" and management of complications and Emergency Obstetric Care (EmOC) services are critically important for saving women's life as well as the newborns.

Despite some progress in ranking of Human Development Index (HDI) (150 in 1999 to 138 in 2004) with HDI score of 0.509 (HDR: 2004)6, the status of women still remains low (0.49 GDI and 0.21 gender empowerment measurement - GEM). Women constitute majority of the poor and experience greater deprivation and vulnerability due to their subordinate position and low status in society that is in part due to the patriarchal value system. Women are largely involved in the informal sector and subsistence activities. Violence against women in forms of rape, assault, trafficking, and acid throwing due to dowry is prevalent. Several legal measures have been adopted to safeguard women's legal rights. Primary school enrolment rate for girls has increased to 86 per cent, with several special initiatives, such as girls' stipend, food for education and free schooling for girls, etc. Despite these provisions, loopholes in the existing law, lack of proper implementation are some of the impediments in ensuring women's rights in the society. Women's participation at the policymaking level and politics is still very low. Few women hold high position in the Government and private sector. Gender-based violence (GBV) in the country aggravates the built-in gender discrimination. Status of women is low also due to social inhibitions and socio-cultural stigma.

Bangladesh is still a low HIV prevalence country, but vulnerability is very high. Among the high-risk groups the prevalence is less than 1 per cent except Injecting Drug Users (IDUs) were it has reached 4per cent and in a small area in central Bangladesh it has reached 8.9 per cent. Surveillances also showed that there is high level of needle and syringe sharing among IDUs (active sharing 66.4 per cent in last injection). Syphilis sero - positivity is 11.9 per cent among IDUs and 9.7 per cent among Heroin Smokers (HSs). Other high-risk behaviours like low levels of risk perception/ knowledge on HIV transmission, and extremely low rates of condom use, among those most vulnerable to HIV exists (5th BSS 2004)7. Raising awareness on HIV prevention among general population and promotion of condom among youth and high-risk groups is paramount.

During the past decade Bangladesh has attained considerable gains in economic and social development. However, income-inequality persists which is also reflected in health status. MMR, for instance, is nearly twice as high for the poorest fifth (343) compared to the richest quintile (208). The poorer adolescents are about three times more likely to give birth than their wealthier peers. Poor health condition is more marked in the urban slums, which have continued to increase in number due to rapid urbanization (4% per annum). Regional variation also exists in terms of RH indicators, for instance, MMR in two selected divisions (Chittagong and Sylhet, 327 and 471 respectively) out of six, is almost twice as high as that of division with the lowest MMR (223 Rajshahi). These two divisions also have high fertility rate and low contraceptive use compared to other divisions.

The present population growth rate along with the population momentum and urbanization poses a major challenge. The Government of Bangladesh drafted the PRSP with due consideration to ICPD, Beijing Platform for Action and MDGs to meet the challenges. In order to strengthen health and family planning programme a policy shift now bifurcate health and FP services which was integrated earlier. It has reintroduced the doorstep services through the FP field workers. It is expected to enhance family planning field activities, which was stagnant during unification.

1. Bangladesh Economic Review, 2004
2. Household Income and Expenditure Survey, 2001
3. Bangladesh Demographic and Health Survey, 2004
4. Bangladesh maternal Mortality Survey 2001
5. HPSP PIP 1998-2003, Annex 8
6. Human Development Report 2004, UNDP
7. 5th Bangladesh Sero-Survailance Survey 2004

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