Calverton, MD. Early marriage and childbearing remain major obstacles to further fertility decline in Bangladesh. More than half of women marry before age 15. This is the highest rate of early marriage in Asia and among the highest worldwide. Nevertheless, fertility in Bangladesh is now on the decline after a ten-year stagnation. According to the 2004 Bangladesh Demographic and Health Survey (BDHS), women now have an average of 3.0 children, down from 6.3 in the 1975 Bangladesh Fertility Survey and 3.3 in the 1999-2000 BDHS.
Greater investments in education and employment for rural women are some of the much needed interventions to encourage later marriage and childbearing, the report finds. Without these actions, Bangladesh is not likely to achieve its goal of replacement fertility by 2010.
Contraceptive use continues to increase in Bangladesh. Currently, 58 percent of married women are using a contraceptive method, compared to 54 percent in 1999-2000. Oral contraceptives are the most popular method, followed by injectables. Use of long-term and permanent methods has declined, however. Currently, only 12 percent of contraceptive users rely on long-term methods, compared to 30 percent in 1991. Reversing this decline is a priority.
"Global experience shows that the most successful family planning programs include substantial use of long-term methods," says Ahmed Al-Sabir of the Ministry of Health and Family Planning, "these are safe and highly effective methods that can be used by most married women."
The BDHS also found that more efforts need to be made to improve pregnancy and childbirth safety for Bangladeshi women. Only 49 percent of pregnant women receive at least one antenatal care visit from a trained doctor, nurse, or midwife-compared to 33 percent in 1999-2000-and 44 percent received no antenatal care at all.
Only one in seven women (13 percent) who gave birth in the last five years was attended by a trained provider. Postnatal care is also uncommon. Only 18 percent of mothers received a check-up from a health professional within six weeks of delivery, according to the survey. These findings suggest that neither communities nor traditional birth attendants are changing long held birthing practices or making use of both emergency and routine obstetric care facilities. Programs are needed both to build the skills of traditional birth attendants and to encourage families to request care from health professionals for care throughout.
Other survey findings show that child health continues to improve in Bangladesh. Vaccination coverage has increased significantly; almost three-quarters of the children age 12 to 23 months now receive the recommended immunizations, compared with 60 percent in the 1999-2000 survey. The child mortality rate, or the risk for a child to die between the ages of 1 and 5, declined by 20 percent in the last four years, from 30 to 24 deaths per 1,000.
Despite these encouraging trends, however, Bangladesh is still far from achieving one of its Millennium Development Goals of a two-thirds reduction in under-5 mortality. Infant mortality has not changed since the 1999-2000 survey and remains as high as 65 deaths per 1,000 live births, with almost two-thirds of them dying in the first month of life. Yet only 17 percent of babies are seen by a health professional within 6 weeks of delivery. Only about one in five babies with symptoms of acute respiratory infection (ARI) are taken to a health care professional for treatment. Furthermore, many children in Bangladesh are malnourished. Over 40 percent are short for their age, and almost half are underweight. Malnutrition is worse in rural areas and among children whose mothers are less educated.
Long-term and sustained efforts are needed to address these problems. Targeted messages and information for families must promote health care for newborns, exclusive breast feeding for the first 6 months of life, and early professional treatment for the symptoms of ARI. Improvements are also needed in service delivery and the quality of care provided to newborns and their mothers.
About the 2004 Bangladesh DHS survey:
This survey is the fourth DHS survey implemented in Bangladesh; the others took place in 1993-1994, 1996-1997 and 1999-2000. Field work was carried out between January and May of 2004 and the BDHS data are based on interviews with 11,440 women age 10 to 49 and 4,297 men age 15 to 59, from the six divisions of the country. The 2004 BDHS was conducted under the authority of the National Institute for Population Research and Training (NIPORT) of the Ministry of Health and Family Welfare (MOHFW) in collaboration with Mitra and Associates, a local research firm. ORC Macro provided technical assistance as part of its international Demographic and Health Surveys Program, and funding was provided by the United States Agency for International Development.