Success of Family Planning Programmes in Bangladesh

Success of Family Planning Programmes in Bangladesh

The concept of governance had existed as a process of running a government or an organization, but in the late 1980s, 'Governance' has emerged by the intellectual as a representation of economic and social development concept. Governance means power, relationships and accountability such as who may influence, decide and how citizens and other stakeholders express their opinion and how these decisions make accountable. Governance may also refer to the exercise of economic, political and administrative authority to manage a country’s affairs at all levels.  The concept of ‘Good Governance’ has been established in the 1980s by the aid organizations such as International Finance Institutions (IFI’s), the World Bank, the IMF, UNDP, and OECD. They acknowledged good governance when institutions, principles are worked well entirely. In the mid-1990s transparency, accountability and participation were also added in the good governance characteristics.

Bangladesh is a typical developing country of South Asia with a large population, low per capita income. The country has dominated agriculture based economy which has moved into the market-based economy in the mid-1970s and received aid under the program of World Bank, IMF, and other donor agencies. The latest 2011 census of Bangladesh estimates a population of 149 million for the country implying an increase of 19 million since the census of 2001. In 1901, the area that is now Bangladesh supported a population of roughly 25 million and population growth was negligible. Historically, in the mid-1970s, a Bangladeshi woman had more than six children on average, in combination with poor nutrition and lack of access to quality health services; this high fertility rate jeopardized the health of both the woman and her children. Beyond the health impact, high fertility and rapid population growth represented a major constraint to the country’s economic development and social progress.

During this period, Bangladesh has taken the initiative of family planning from 1976 to reduce the birth rate, maternal mortality ratio, and the under-five mortality rate. Bangladesh has shown a great success in reducing the average number of children per woman of reproductive age. According to the Bangladesh Demographic Health Survey 2011 (BDHS-2011), the Total Fertility Rate (TFR) in Bangladesh is 2.3, a huge decline from 6.3 in 1976. Bangladesh currently has the lowest TFR in South Asia. On the other hand, the Bangladesh mortality survey shows a decline of 40 percent in maternal mortality rate between 2001 and 2010.
In the same period, infant mortality declined by 44 percent and child mortality by 35 percent. There is a positive relationship between the declination of maternal mortality and the successful delivery of family-planning measures, integration of maternal and child health with family planning, promotion of safe delivery measures, tetanus vaccination, and other health-care services. According to UNICEF, Bangladesh’s child mortality rate was 139 per 1000 live births in 1990, and it was reduced to 38 in 2015.

It can be said that the spectacular success in family planning explicitly is a result of good governance. The very characteristics of good governance are implicitly observed in the activities of family planning with the involvement of all sectors of the country. The Ministry of Health and Family Welfare is the main governmental organ to drive this initiative. With the help of United Nations Population Funds (UNFPA), World Health Organization (WHO), other international donors and national stakeholders, the government of Bangladesh formulated policy and process to achieve the objective of family planning. Participation of civil society, local leaders, both female and male counterparts of a family has been ensured. Bangladesh’s NGOs are among the most active in the world. NGOs increased their level of family planning services provision through the encouragement of Bangladesh Government. Private-public partnerships experiences ensure the good governance and the main element of the success of Family Planning sector. 

Family-planning programs had also recognized in the mid-1960s when Bangladesh was a part of Pakistan. The early programs could not work because of the government’s little attention to maternal and child health. In that time, policymakers focused only on the use of contraceptives. The government of Bangladesh learned from the failure and has taken a holistic approach that takes into account many other things in addition to the use of contraceptives with the support of WHO, NGO and the state cooperation on bringing immunization to the entire country. Health-focused NGOs in Bangladesh regularly organize immunization camps to create awareness and more involvement of people at the grassroots level. The government supplies the vaccines and NGO’s staffs immunize pregnant women and children. Most of the women of our country are aware of the fact that the tetanus vaccine provides them with protection against this deadly disease, so the overwhelming majority of women have had their vaccination. Many display a great eagerness to have their infants and young children immunized too and some even show up before the actual immunization dates. Many of them convince their neighbors of how important the vaccination is. This is a great picture of an effective, efficient and responsive system- the major component of good governance.

Promoting family planning concept all over the country was not an easy task. The Television channels, Radio, newspaper, and NGOs played a great role to establish a positive consensus towards family planning in a society consists of ninety percent Muslims and where oppression of women is perennial. The voice of men and women is equally treated in the process of implementation of activities of family planning. The most important thing is that government and NGOs cooperated in a coherent manner. In fact, Islam does not prohibit the use of birth-control measures, albeit it forbids infanticide. Since women’s and children’s health and the costs of raising children are important factors to consider, Muslim clerics in Bangladesh did not oppose to the promotion of birth control. That is true both at policymaking and the grassroots level. From 1976, the government started the delivery of family planning services through family welfare assistants. The government recruited people to reach out to the village women at their doorsteps.

The approach followed the example set by the International Center for Diarrheal Disease Research (ICDDR). They sent out health workers every two weeks to deliver messages about contraception, distribute contraceptives and motivate mothers to use them. The health workers addressed the women’s fears and discussed the possible side effects of contraceptive use. They also provided health-care services when needed. The approach proved to be successful, and evidently, the family-level support was crucial. 

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