The use of modern contraceptive methods is closely tied to the success of family planning programmes carried out by the government of Bangladesh.
The success of these programmes has garnered appreciation as well as interest from around the globe due to their outstanding success in increasing the contraceptive prevalence rate (CPR).
Particularly, the fact that a Muslim-majority country characterized by higher poverty, a lower literacy rate, and a lower level of women’s autonomy has achieved this remarkable feat has astounded researchers and policy makers all over the world.
Bangladesh has managed to increase its CPR 7 times over in less than forty years, from 8 per cent in 1975 to 62 per cent in 2014. This has had far-reaching consequences and has improved the lives of countless.
Not only has the total fertility rate (TFR) decreased from 6.3 children per woman in 1975 to 2.3 children per woman in 2014, it has also led to big declines in maternal mortality (from 574 per 100,000 live births in 1990–91 to 170 in 2013) as well as infant mortality (from 88.0 per 1000 live births in 1993–94 to 38.0 in 2014).
Despite these remarkable results, the increasing trend of CPR has stalled which has resulted in a declining trend in TFR as well. As we have seen, increasing the CPR is therefore crucial in keeping the population increase of the country at a manageable rate.
Moreover, increasing in the CPR is important in achieving the health related targets of Sustainable Development Goals (SDGs) by reducing pregnancy and pregnancy related outcomes.
The government of Bangladesh has set a target to increase CPR 75 per cent by 2021 in order to achieve the below replacement level of fertility (i.e., less than 2.1 children per woman).
The CPR current stands at 62.4 per cent. In order to achieve the target, both the government and the private sector has to work together to ensure access to contraceptives as well as widespread dissemination of knowledge.
Studies have consistently shown that urban areas have a higher prevalence of contraceptive use than rural areas. Therefore, more effort should be put into increase the CPR in rural areas.
In rural areas, several factors affect the use of contraceptives such as age, religion and women’s participation in the family decision-making process. Particularly, adolescent women have higher use of contraception than older women because of their greater awareness about both preventing unwanted pregnancy and their desire to postpone childbearing. Women belonging to older demographics have a lower CPR due to preconceived ideas about health complications arising from use of contraceptives.
It is clear that in both urban and rural areas, the prevalence of contraceptive use is further determined by factors pertaining to the socioeconomic status of the women as well as their education background.
Women with higher education tend to have higher CPR as they are more aware about the negative consequences of having more children on both maternal and child health.
Women who are employed also have a higher CPR as having more children might have negative consequences on their career. Employed women are also likely to have more autonomy at home, resulting in having a greater say in family decision making process.
Access to media has also been shown to increase contraceptive use among couples as it helps spread awareness on maternal and child health and the negative consequences associated with having more children.
Studies have also shown that the visit of family planning workers to women living in rural areas makes contraceptive materials more accessible to women. Moreover, the visits help to address the fears that women have of the side effects of contraceptive use. It ensures that women in remote regions are not denied access to contraceptive methods.
While we need to raise awareness on the importance of using contraceptives as well as their effectiveness and different methods available, we must also focus on improving other socioeconomic factors for women in order to boost the CPR.
We must ensure that more girls and women have access to education. We must also ensure the participation of women in the workforce.
The bottom line here is that ensuring women’s autonomy and development has far-reaching consequences in each sector of maternal and child health. These in turn help to ensure the overall progress of the country’s development initiatives.
As mentioned above, these factors are crucial to increase the CPR of the country in order to achieve the SDG targets by 2030. Widespread campaigns must be conducted across all forms of media in order to disseminate knowledge on contraceptive methods and their effectiveness.
Access to contraceptives must be ensured for each and every demographic, particularly marginalized sections of the population. Finally, the stigma associated with the use of contraceptives must be lifted through mass education and media campaigns.
Synthia Kainath Nur is working with Bangladesh Post