Family Planning

Family Planning motivates individual couples to decide the size and spacing of births in their families by using some form of artificial device. For most parents, family planning involves the regular practice of methods to avoid conception. Human population growth throughout the ages until recently showed a constant feature- the growth rate was about 0.002 percent per year. That is, per one million people, annual increase in number was just about 20. But the situation dramatically changed in the seventeenth century, coincident with advances in science, technology, agriculture, and medicine. Over the last 300 years the population in all the continents increased five times, from 500 million in 1650 to 2.5 billion in 1950. The increase occurred despite the scourge of disease and pestilence and in some cases famine. After the middle of the twentieth century, world population increased in a few discrete steps: by 1970 it reached the 3 billion mark, 4 billion in 1980, 5 in 1990 and in October 1999 the figure was 6 billion. Projection for the next 40 years is bleak- despite intensive efforts in controlling population, the world will see the figure rising to 9 billion by the year 2040!

The region that comprises Bangladesh shows some interesting population distribution patterns which are different from those in the rest of the subcontinent. Friedrich Burgdorfer's 'The World Atlas of Population published in 1957, when the world population was 2.5 billion, shows that the area of greatest population density in the subcontinent was a narrow strip that can now be delineated by two oblique lines joining Sunamganj and Bhola on the right, and Sherpur and Satkhira on the left. This narrow strip represented the densest population in the subcontinent and perhaps in any country in the world. Reasons for this extremely high level of reproductive prodigality are many- economic, social, climatic and cultural. This region has always been a high rainfall area with a mild climate. The deltaic contour led to high fertility of the land during monsoon flooding. Agriculture was easy and could be done with animal labour and primitive tools. And, despite high population density, per capita land was high so that people had a relatively easy life.

At the time of independence in 1971, the population of Bangladesh was 79 million. In 1951, the population was 44 million; in 1961 the population was 55 million. In 1981 it was 90 million, 110 million in 1991, and at present at the end of year 2000, it is estimated to be 130 million. That is, in 30 years since independence in population of Bangladesh increased by 50 million. Population density at present averages 900 persons per sq km, the highest among the country states of the world.

Data on population growth rate are reasonably correct since 1961 when the annual growth rate was 2.26% per year. In 1971 it was 2.48, in 1981 it decreased to 2.35, and in 1991 to 2.03. At present the growth rate has declined further to 1.8% per year. With decline of population growth rate, there has also been a reduction in the average number of children per woman during her reproductive lifetime- in the mid-1970s the figure was 6.3 children per woman while in the mid-1990s it was 3.3. When this value reaches 2.2, that is, when one couple leaves behind one pair of offspring, the country would achieve what is called replacement fertility level.

Table Trends in population growth in the region now comprising Bangladesh during the twentieth century

Year

Population (million) Population growth rate per year, %

1901

2.89

--

1911

3.15

0.87

1921

3.32

0.52

1931

3.56

0.68

1941

4.19

1.65

1951

4.49

0.50

1961

5.52

2.26

1971

7.94

2.48

1981

8.99

2.35

1991

10.98

2.03

2000

13.00

1.80

2008

14.66

1.39

Source 'Bangladesh Bureau of Statistics'.

High population growth became noticeable in the 1950s due to a lower death rate. This trend continued over the next 25 years during which period a vigorous family planning programme was instituted by the government. There are approximately 40,000 such workers now working mostly under government support, but a significant fraction is also supported by NGOs.

Most of the family planning activities of the country are supported by external funds. Major participants are the World Bank and UN organisations such as UNPF, UNDP, and WHO. Between 1972 and 1996, the contraceptive prevalence rate (proportion of married women using contraception) increased from a meagre 4% to 49%. In 1983, the common method was male or female sterilisation which accounted for 40% of contraception users. Admittedly, these people were the poor who preferred permanent fertility loss rather than continued use of other methods that might entail some cost. Gradually there was a decline in sterilisation and increase of contraceptive pills. Currently the different methods used by the people are: female contraceptive pill 42%, traditional methods 16%, female sterilisation 15%, male condoms 8% and male sterilisation 2%. Female injectable contraceptives are being tested but in most cases success is limited because of adverse side effects.

At present government spends approximately 100 million US dollars per year in family planning activities, about half of which is from its own resources and the rest from the donor community. This figure has to be increased about 2.5 times, that is, yearly expenditure has to be raised to 250 million US dollars in order to achieve replacement fertility within about 2005. This expenditure cannot be borne by the government for a long time. So many donors favour the strategy of shifting to service driven by demand, not by supply. That is, the government should not offer these services at a subsidised price but should slowly take to a market course and recover the cost from the users. This strategy is of course open to criticism because such endeavours in other countries and also in Bangladesh in the recent past, have shown that these tend to benefit mostly those who are economically better off, not the poor people. The vast poor population of the country may thus continue to either add to population or decline due to disease and hunger.

The government has since its entry into a market economy during the early 1990s taken a more holistic view on family planning by incorporating reproductive health components into the family planning programmes. Essential health services during pregnancy, during and after delivery, infant mortality reduction approaches, child survival enhancement, and sexually transmitted diseases are now important components of the country's family planning budget. The Fourth and Fifth Health and Population Projects of the 1990s injected very substantial funds into this extended spectrum of family planning activities. This has created the needed awareness and may also create demand for these services with overall improvement in use of these services. However, access of the poor to these services in terms of their affordability is a formidable task that must be addressed for its benefits to fall on the country's population control activities. [Zia Uddin Ahmed]