Management constraints on family planning programmes in Bangladesh

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In Bangladesh, family planning programmes cover only the official statement of programme objectives in terms of national demographic goals, and the determination of the overall targets of family planning acceptance
Mohammed Abul Kalam, PhD

 

Bangladesh’s population estimated to be 162.9 million in mid-2016 and will be 186.5 million in mid-2030; and 202.2 million in mid-2050 (Population Reference Bureau 2016). In 1973, when the country launched its First Five-Year Plan (1973-78), population was estimated to be 74.0 million and the rate of population growth was then 3.0 per cent per annum. In 1975, contraceptive prevalence rate (CPR) was reported to be 8.5 per cent (BFS, 1975) as against the present estimate of 52 per cent, (DHS, 1999) showing an average increase of 1.8 per cent per annum since then. In 1989, total fertility rate (TFR) and CPR were estimated at 4.9 and 32.0 per cent respectively (BFS and CPS, 1989). Corresponding figures in 1999 are 3.3 and 52 per cent respectively. Bangladesh has achieved this progress against the backdrop of low literacy rate (54 per cent), low status of women and low income per capita US $ 350 and so on. Now women (15-49 years) using modern methods of contraception are about 54 percent and all methods (both modern and traditional) are 62 percent (BDHS 2014).

According to Bangladesh Sample Vital Statistics 2016, the estimated crude death rate was 5.1 per 1,000 people. The rate was 5.7 in rural areas and 4.2 in urban areas. This rate has shown a decline from 5.3 in 2012 to 5.1 in 2016. The crude birth rate, which is the simplest measure of fertility, has been estimated at 18.7 per 1,000 in 2016 compared to 18.8 in 2015.  The child birth rate (CBR) fell from 18.9 in 2012 to 18.7 in 2016. The rural CBR, as expected, is higher than the urban CBR: 20.9 versus 16.1. The general fertility rate worked out to 69 per 1,000 women with a much higher rate (79) in rural areas compared to 57 in urban areas.

Male children show a somewhat greater decline in the infant mortality rate (IMR) (20.6 per cent) than their female counterparts (12.5 per cent). The decline in the IMR is more pronounced (17.6 per cent) in rural areas than in the urban ones (9.7 per cent). In conformity to with this decline in the IMR, the neo-natal mortality rate also fell from 21 deaths per 1,000 live births in 2012 to 19 deaths per 1,000 live births in 2016 without revealing any significant sex differentials. The area of residence did not influence the neo-natal mortality rate. The post-neo-natal mortality rate, which nearly remained static over the last three years, was around nine deaths per 1,000 live births. Child mortality was estimated to be 1.8 deaths per 1,000 children in 2016, which is marginally lower than the previous year’s rate. The rate, however, fell from 2.3 in 2012 to 1.8 in 2016, registering an almost 22 per cent decline in five years.  Under-five mortality, too, showed a similar decline, coming down from 42 deaths per 1,000 live births in 2012 to 35 deaths in 2016. The report said the maternal mortality ratio had shown a consistent fall over the last five years, from 2.03 maternal deaths per 1,000 live births in 2012 to 1.78 in 2016. The enumerated population showed a sex ratio of 100.3 in a total of 479,597 males and 478,316 females. The overall sex ratio has shown a moderate decline over the last five years from 104.9 in 2012 to 100.3 in 2016 (BSVS 2016).

 

The age structure of the population was still conducive to high fertility with 30.8 per cent of the country’s total population being under 15 years. The dependency ratio recorded a notable fall from 80 in 2002 to 54 in 2016, a decline of over 32 per cent in 15 years. The rates, however, remained constant during the last five years around 55. The survey found that the average household size had dropped from 4.5 in 2012 to 4.3 in 2016 and that Bangladeshi women were still dominated by men. This feature has been reflected in a high male household headship rate of 87.2 per cent in 2016, against 85.5 in 2012, showing a moderate increase over the last five years. The adult literacy rate of the population aged 15+ has shown an increase of about 19 per cent over the last five years, reaching to 72.3 per cent in 2016 from 60.7 per cent in 2012. The increase in the adult literacy rate was more pronounced (22.8 per cent) among females than among males (16.0 per cent) over this period. Life expectancy in Bangladesh has gone up by 2.2 years during the past five years, attaining an average of 71.6 years in 2016 from 69.4 years in 2012. A similar decline was noted in the infant mortality rate, from 33 per 1,000 live births in 2012 to 28 in 2016 (BSVS 2016).

Given the current status of economy, such an increase of population will have several adverse implications for our socio-economic development. Any delay in achieving its demographic goal means a heavy time-penalty and serious implications for Bangladesh’s socio-economic development. Due to population increase, the number of landless people in absolute number will increase tremendously further aggravating the poverty situation. The total arable land space will be attenuated further. This will have an obvious adverse impact on per capita food production and food availability of the growing population. Thus, the economy will have to create more job opportunities to employ its working age population to generate income and thereby, alleviate poverty. Lastly, increase in population will adversely affect both GDP and GNP growth per capita.

In Bangladesh, planning of family planning program covers only the official statement of program objectives in terms of national demographic goals, and the determination of the overall targets of family planning acceptance.

The activities involved in the implementation of family planning programs are much more complex and require a deliberate input from management concerned into the programs with emphasis on actual achievement of results. Identified crucial elements related to problems of management pertain to the level of policies and others to program execution.

There can be little doubt that one of the most pressing problems for the developing countries of the world today is that of curtailing population growth. Bangladesh is now firmly committed to a policy of population control. The reasons for the failure vary from country to country but in Bangladesh, organisational, administrative and managerial factors, such as lack of proper management techniques, inefficient system for family planning activities, lack of proper evaluation and feedback, lack of coordination, bureaucratic inertia, inconsistent administrative and management structure, problem with organisational setup, lack of specification of tasks and objectives, loosely integrated with development plan, top-down process of family planning delivery system, etc., have contributed to the poor results achieved. Answers to these problems are needed to translate various policy options into program strategies in order to accelerate program performance.

It is being increasingly recognised that population concerns of the country so far have been handled by the policymakers, with occasional assistance from experts in the field. However, family planning management as a specialised perspective and discipline has yet to be incorporated in policy formulation and program execution. And most of the officers working at the Directorate of Family Planning are experienced in administration and not trained in demography and population sciences with a very few exceptions. There are no senior officers at any departments with population/demographic backgrounds. A good numbers of officials from the administrative cadre (Jont/Additional Secretaries) are working at the Directorate in different positions and they don’t like to stay there any more- just waiting for further postings.

However, management issues at the policy level which must be addressed include appropriate steps to make population concerns a priority area through allocating resources and personnel; strengthening institutional and personnel structure, among others, by devising appropriate mechanisms of family planning programs, and coordination with various multi-sectoral agencies; placement of senior officials in key policy making and executive positions, avoiding too frequent turnovers; streamlining administrative and financial procedures for expeditious operations; manpower planning for the program; defining the modalities of NGO operations in light of gaps in the official programs: planning and management of external funding and donor relations, keeping in view the crucial needs of the programs; and the like.

There is a need for Bangladesh to recognize the population problem for what it is. At the national level this is a problem which saps national resources, and leads to the maintenance of poverty and the persistence of illiteracy, with all its attendant ills.

What is being advocated is not a reduction of national numbers and consequent power or prestige, but a balancing of the development of the human numbers with national resources and national capabilities, so that the people of Bangladesh would be able to attain their full genetic and social potential and contribute fully to the country and the world. The attainment this goal is being thwarted in Bangladesh by wrong approaches to development and by a rapid increase in the numbers of the people; hence the need for balanced, integrated and comprehensive population and people-oriented development programs.

The writer is former Head, Department of Medical Sociology,

Institute of Epidemiology, Disease Control & Research (IEDCR)

Dhaka, Bangladesh

E-mail: med_sociology_iedcr@yahoo.com

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