BIRTH CONTROL IN BANGLADESH
According to Human Rights Watch: “Bangladesh has been seen as a model for other countries for its success in reducing its birth rate, an achievement often attributed to its adoption of a model of using health outreach workers. The married girls interviewed for this report, however, seemed largely unreached by government efforts to promote family planning. Some NGOs working in the areas where interviews were conducted teach women and girls about family planning and contraception and may also provide contraceptive supplies, but these programs reach only a small proportion of women and girls, representatives from the NGOs told Human Rights Watch. Government hospitals and health clinics have programs that provide condoms, hormonal pills, and other forms of contraception, including hormonal injections and patches, but NGO workers said that fees charged for these supplies and services are a barrier for very poor people. [Source: “Marry Before Your House is Swept Away: Child Marriage in Bangladesh”,Human Rights Watch, June 9, 2015] Contraceptive prevalence rate: 62.3 percent (2014). This figure is the percent of women of reproductive age (15-49) who are married or in union and are using, or whose sexual partner is using, a method of contraception. [Source: CIA World Factbook, 2020]
Between 1970 and 1995 birth rates declined by 40 percent in Bangladesh while contraceptives use by married women increased from 3 percent to 40 percent. In rural areas in the 1990s around 60 percent of all women use contraception such as condoms and inter-uterine devices (IUDs). IUDs were the most popular method in the 1980s.
Contraceptive use (any method, women ages 15-49): 62 percent (2018, compared to 12 percent in Sudan and 84 percent in the United Kingdom) [Source: World Bank ]
Top method of contraception: the pill [Source: Birth Control Around the World onlinedoctor.superdrug.com ]
Types of birth control used (2015); female sterilization: 3.8 percent; male sterilization: 0.6 percent; pill: 32.5 percent; injectible: 14.1 percent; Implant: 0.9 percent; IUD: 0.6 percent; male condom: 3.0 percent; early withdrawal: 0.9 percent; rhythm method: 5.2 percent; traditional 1.4 percent total: 64.2 percent [Source: Trends in Contraceptive Use Worldwide 2015 — the United Nations un.org/en/development/desa/population/publications ]
Types of birth control used (1994): female sterilization: 8.5 percent; male sterilization: 1.1 percent; pill: 18.2 percent; injectible: 4.8 percent; IUD: 2.3 percent; male condom: 3.1 percent; early withdrawal: 2.4 percent; rhythm method: 4.9 percent; total: 46.5 percent [Source: Trends in Contraceptive Use Worldwide 2015 — the United Nations un.org/en/development/desa/population/publications ]
Family Planning in Bangladesh
The decline in the birth rate in Bangladesh has been achieved thanks largely to a grassroots birth control campaign and the unwavering support of the government. Bangladesh's Family Planning Association was founded in 1953 under a different name. In the early 1970s social planners coined the phrase: "Development is the best contraceptive." The idea was that by combating poverty, hunger and disease and providing housing and jobs fertility rates would decline.
Under military rule in 1976 population control was listed as a number one priority and many different kinds of family planning programs were allowed to be set up. Western aid groups have also set up many birth control programs in Bangladesh.
According to the “Worldmark Encyclopedia of National Economies”: “In the 1970s the government introduced population control and family planning initiatives, aided by various international organizations, including United Nations Children's Fund (UNICEF), United Nations Population Fund (UNFPA), and the World Bank. The fertility rate (the average number of children born to a woman) in Bangladesh declined from 6.8 babies per woman in 1965 to around 3 per woman in 1999. However, these population control initiatives were undermined by the fact that two-thirds of the population still lives in rural areas, where historically population growth was very high, and by the fact that almost two-thirds of the people in the country are illiterate. A number of issues still need to be addressed, including the supply of safe drinking water, malnutrition among children (which remains the highest in the world), early and forced marriages, and illiteracy among the population in general and women in particular. [Source: “Worldmark Encyclopedia of National Economies”, The Gale Group Inc., 2002]
Bangladesh's working-age population was increasing almost 1.5 million per year in the 1980s. This rate of population growth kept the people poor and the country dependent on foreign aid. Population control and family planning, therefore, were a top priority of the government and social workers. [Source: James Heitzman and Robert Worden, Library of Congress, 1989 *]
In the mid-1980s, there were indications that government and nongovernment agency efforts were beginning to pay off. Population growth had declined from 3 percent to 2.3 percent between 1961 and 1981. Contraceptive practices increased from 12.7 percent of eligible couples in 1979 to 25 percent in mid-1985. Of the methods available, sterilization was the most commonly sought in government plans through fiscal year 1990. A continuous demographic survey also showed a decline in fertility rates and an increase in the female marriage age. But undercutting this progress was the uneven application of the family planning program in rural areas, which constituted the most populous sections of the nation.
In 1985 there were reported only 3,716 family planning facilities in the country and a total of 15,619 family planning personnel, of whom 4,086 were male in a country where the females were traditionally reserved when discussing sexual matters with men. Even when they were physicians, men were reluctant to discuss sexual matters with women. From 1980 to 1985, only about 55 percent of national family planning goals were achieved.
Girls, Child Marriages and Contraception
According to Human Rights Watch: “Researchers have found that 70 percent of women who married as children in Bangladesh did not use contraception prior to childbirth, compared to 49 percent of women who married as adults. The majority of girls interviewed for this report became pregnant soon after they married, because they had no information about or access to family planning, because their husbands or in-laws demanded that they become pregnant, or because they themselves felt that they needed to have children as soon as possible. Schools in Bangladesh do not provide any education on family planning, let alone assistance to students in obtaining contraceptive supplies. The most effective way to ensure that all young people have the information they need about puberty, family planning, and contraception would be to include this information in the standard mandatory school curriculum like any other examinable subject, according to UNFPA. [Source: “Marry Before Your House is Swept Away: Child Marriage in Bangladesh”,Human Rights Watch, June 9, 2015]
“Many girls do not learn about family planning from their mothers or other family members. Abida N.’s daughter married at age 13 and had a son 2 years later. “She didn’t know anything about contraception, and I didn’t tell her anything,” Abida said. “We didn’t have this knowledge.” “I’m the mother— how can I talk to her about these things?” said Farhana B., whose daughter married at 14 and had a child 2 years later. “I feel shy. Even my own mother would never talk to me about this.” “Girls don’t really understand [about family planning],” an NGO worker said. “Usually their husbands decide. They usually end up having children very soon. Children usually come in a very unplanned way.”
“Lakshmi S. married at 12 years old and now, at age 18, has a 6-year-old son and a daughter who she cradled during the interview who was one month and 6 days old. “My in-laws didn’t really want babies, but I didn’t understand how to take medicines to not have a child. I was very young, so I just got pregnant,” she said. “My in-laws weren’t asking for kids, but I didn’t understand how not to have them,” said Nabila C., who married at 14 and had a daughter when she was 15. “If I knew how, I would have waited another two or three years.”
“Even when girls manage to get access to contraceptive supplies, they do not necessarily know how to use them correctly in order to prevent pregnancy. “My husband didn’t want me to take pills, so I was hiding it from him,” said Nafisa K., who is not certain about her age but thinks she is about 14 or 15. She has been married for a year and 7 months and has a 10-month-old daughter. “I took them from my mother without her knowing— they were hers. I didn’t take them every day— I don’t know how to take them.”
“In addition to a lack of information about family planning and access to contraception, married children also often face pressure from their husbands and in-laws to get pregnant immediately—and may fear negative consequences, including abandonment and divorce, if they fail to produce children. “My husband wanted a child right away,” said Rekha H., who married at age 12. “I had no information about contraception. I didn’t know anything [about contraception] or use anything.” At age 17 or 18, Rekha has 2 sons, and says she and her sister, who married at age 11, both have health problems she believes are a result of early pregnancy. “We feel weak and we can’t work properly,” she said. “They’ve already asked me to have children,” Azima B., who is 14 and married a year ago, said of her in-laws. “I am thinking I will have to have children. I live in their house— I have to keep them happy. My husband has also asked me to have children. I said I wanted to wait for two years, but they said, ‘No, you should have children now.’ So I guess I will have to have children now.”
Social Marketing and Supermarket Style of Family Planning
In 1974 the Social Marketing Co. was founded. It is a nonprofit organization whose goal has been to provide contraception at affordable prices. In the early 2000s it was the largest such organization in the world, dispensing about 150 million condoms and 10 million monthly packets of birth control pills a year. Today the company is more diversified, sell foods, drinks and medicines as well as contraceptives.
The "Supermarket style" of combating birth control proved to be successful. Family planing centers were established in which women were educated about different birth control methods and given the means to pursue them. There were no draconian one-child a law like in China or sterilization clinics like in India.
The success of the family planning has been the result of Bangladeshis of self realization and talking about and addressing family planning issues that affect their lives. Bangladeshis realized that overpopulation was to blame for many of their problems: food shortages, disease, a lack of housing and something had to be done about it. Land had been subdivided so many times that families had difficulty surviving.
Rural Family Planning Workers
Birth control devices have been dispensed in rural areas of Bangladesh by an army of around 35,000 female volunteer field workers, who travel from village to village providing medicine and advise in family planning. They have given out condoms, birth control pills and other contraceptives. The program has been successful in part because the field workers are regarded by the villagers as one of them. [Source: John Ward Anderson, Washington Post, August 26, 1994]
The program began in the 1970s when female worker fanned out across the country to villages and slums. The first workers had a difficult time. Many Bangladeshis were shocked by the sight of unescorted women traveling around on their own. People spat on them and threw rocks at them. Over time the workers were accepted, in part because although many Muslim clerics were against birth control they didn't organize any opposition.
Another reason the program was successful was that the field workers sought out village women rather than visa-versa. One family planning expert told the Washington Post, "In Bangladesh, women are not comfortable going out to get services. They don’t go out to shop, they don’t feel comfortable talking about family planning or their sex life with a man, and therefore our program brings services to their doorstep of the woman."
The woman worked for the Bangladesh Rural Advancement Committee, Concerned Women for Family Planning and other organizations. Some programs offered a free sari if they got sterilized.
Preference Boys
Sex ratio in Bangladesh: at birth: 1.04 male(s)/female
0-14 years: 1.04 male(s)/female
15-24 years: 1.01 male(s)/female
25-54 years: 0.92 male(s)/female
55-64 years: 0.97 male(s)/female
65 years and over: 0.89 male(s)/female
total population: 0.97 male(s)/female (2020 estimated)
[Source: CIA World Factbook, 2020]
At one time the sex ratio was 106 males to 100 females. According to a UNICEF study there are 2 million missing females. South Asia is the only region in the world where there are fewer women than men. In many places, boys are given more food than their sisters. On average, females die earlier than males, the opposite of the norm in the rest of the world. Some die of malnutrition and risky pregnancies.
Based on census figures, a 2000 Report on Human Development in South Asia study estimated there were as many as 80 million missing females in South Asia. The low number of women are at least partly the result of female infanticide, abortion of female fetuses and the fact that young girls are fed less than boys. The number of girls has been decreasing. According to the 2001 census, there were 927 girls for every 1,000 boys below the age of six, compared to 945 in 1991 and 962 in 1981 and 972 in 2001. Normally there are 960 girls are born for every 1,000 boys.
According to the “Worldmark Encyclopedia of Nations”: “Infant mortality is approximately seventy-five per one thousand live births. Life expectancy for both men and women is fifty-eight years, yet the sex ratios for cohorts above sixty years of age are skewed toward males. Girls between one and four years of age are almost twice as likely as boys to die. [Source: “Worldmark Encyclopedia of Nations”, Thomson Gale, 2007]
Abortion and Menstrual Regulation in Bangladesh
Abortion in Bangladesh is illegal under most situations, but menstrual regulation is often used as a substitute. Bangladesh is still governed by the penal code from 1860, where induced abortion is illegal unless the woman in danger. Historically, abortion has been prevalent, especially during the years following the Bangladesh Liberation War. For example, in 1972, the law allowed for abortion for those women who has been raped during the war. In 1976, the Bangladesh National Population Policy unsuccessfully attempted to legalize abortion in the first trimester. [Source: Wikipedia]
Since 1979, menstrual regulation has been the favored alternative to induced abortion, and it is legally permitted because pregnancy cannot be established. In 2012, the Drug Administration for Bangladesh legalised the combination of mifepristone and misoprotol for medical abortion. [ Part of the family planning program in Bangladesh since 1979, menstrual regulation is a procedure that uses manual vacuum aspiration to make it impossible to be pregnant after missing a period. It is simple and can be done with inexpensive equipment. Its procedure also goes without the use of anaesthesia.
A study about menstrual regulation in 2013 studied 651 consenting women from 10 different facilities in Bangladesh, who were seeking menstrual regulation and were about 63 days or less late of their menstrual cycle. They were given about 200 mg of mifepristone, followed later by 800 mg of misoprostol. The researchers found that 93 percent of the women had evacuated the uterus without the use of the surgical intervention, and 92 percent of the women were satisfied with the pills and the rest of the treatment.
Although menstrual regulation centers are centralized and free of charge, many women still lack access due to socioeconomic barriers and social stigma. Centers charge additional fees if the pregnancy is beyond 10 weeks, and many women are unaware of menstrual regulation or face male opposition to the procedure. As a result, some women turn to illegal abortions.
Image Sources: Wikimedia Commons
Text Sources: New York Times, Washington Post, Los Angeles Times, Lonely Planet Guides, Library of Congress, Bangladesh Tourism Board, Bangladesh National Portal (www.bangladesh.gov.bd), The Guardian, National Geographic, Smithsonian magazine, The New Yorker, Time, Reuters, Associated Press, AFP, Wikipedia and various books, websites and other publications.
Last updated February 2022