Bangladesh’s family planning services have become ‘weak’: Analyst

Bangladesh’s family planning programme has ‘weakened’ and is slipping on quality both in public and private sectors, an analyst has said.

“We need to take immediate measures,” Karar Zunaid Ahsan, senior monitoring and evaluation adviser to the health ministry’s Programme Management and Monitoring Unit, said on Wednesday.

He was speaking on the fertility and family planning situation in Bangladesh at the launch of the Bangladesh Demographic and Health Survey (BDHS) 2014 report and a policy discussion in Dhaka.

He said, between 1994 and 2014, family planning fieldworker visits to married women fell to 20 percent from 38 percent.

“Also, fewer women heard about family planning during this period and the proportion of married women exposed to family planning messages declined to 30 percent from 47 percent,” he said.

“Both these trends indicate poor programme planning, management and implementation,” he said, adding that it ran counter to the country’s global commitment to improve the quality of family planning services and reduce fertility rate to 1.7 by 2021.

State Minister for Health and Family Welfare Zahid Maleque, the chief guest of the event, acknowledged the weakness, saying “we have to reach women’s door steps”.

He regretted the government’s inability to reach family planning services despite being sought by women.

The policy discussion came on the heels of the government’s current exercise of drawing up the health sector’s next five-year programme.

The new plan would be prepared keeping in mind the targets of the sustainable development goals (SDGs).

Ishtiaq Mannan, a Save the Children director, gave an overview of the state of maternal health in the country, while a senior director of the ICDDR,B, Shams El Arifeen, spoke on newborn and child health. ICDDR,B Senior Director Tahmeed Ahmed spoke on nutrition.

Differential approach

After a rapid decline in fertility after independence, Bangladesh saw a decade-long fertility plateau between 1991 and 1999, with the total fertility rate (TFR) standing at around 3.3 children per woman.

Again, the TFR remained at 2.3 between 2011 and 2014, which, Zunaid Ahsan said, could indicate another fertility plateau just above the replacement level.

“This plateau may delay attaining a below-replacement fertility level and affect population stabilisation,” he said, suggesting the adoption of a “differential approach”.

It has come to light that fertility levels in Bangladesh tend to vary over geographical locations. Women in Sylhet, for instance, bear exactly one child more than women in Khulna or Rangpur.

Besides, 0.7 percent of the total fertility level is unwanted – meaning, wanted later or not wanted at all. In terms of regional variations, Sylhet has the highest level of unwanted fertility, followed by Dhaka and Chittagong.

“Such level of unwanted fertility and wide geographical variation clearly indicate that there is scope for further reducing the fertility level in Bangladesh by equitable coverage of family planning services,” he said.

He said there was need to emphasise “differential programming” instead of a single programme for the entire country.

He said the service readiness in both public and private sectors was “low”.

He attributed this to a lack of family planning guidelines and trained workers.

He suggested the government take a clear stand on preparing regional service packages and making communication material with specific target groups in mind.

The ministry of health and family welfare was expected to play a “stewardship role” in engaging the private sector, he felt.

“The ministry needs to set standards and put quality assurance process in place to ensure quality services both from the public and private sectors.”

Speaking at the event, USAID Director of the Office for Population, Health, Nutrition and Education Mellssa Jones stressed public-private partnerships for family planning services.