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Nobel Laureate economist Amartya Sen in one of his writings said, "It took the world population millions of years to reach the first billion, then 123 years to get to the second, followed by 33 years to the third, 14 years to the fourth and 13 years to the fifth billion, with the promise of a sixth billion to come in another 11 years". This shows how fast world population has been rising over time. The problem of population growth has been amply put forward by another Nobel Laureate in economics, Paul Samuelson: "The problem is no longer that with every pair of hands that comes to the world there comes hungry stomach. Rather it is that, attached to those hands are sharp elbows". Late economist Mahabubul Huq, who was the architect of Human Development Index (HDI), said in late 1980s: "If all the people of the world are accommodated into the United States, the population density there would not be as high as it is now in Bangladesh". Bangladesh was then (although little less now) a land of ticking-bomb!
Historically speaking, population growth was dubbed as Bangladesh's number one problem. It has also been labelled as a liability, not asset, in the absence of qualified manpower. The successive governments have done all that could be done to arrest the growth rate through propagating family planning since the Pakistan days. Those efforts paid huge dividends in terms of fertility reduction, household size and generation of economic surplus. But of late, the momentum for controlling population through family planning seems to have lost its steam. Newspaper reports run stories galore on the lack of access to facilities among willing couples and shortage of materials in the market. Extension works seem to have weakened with the passage of time. Meanwhile, the World Population Day passed off silently. Has family planning become passé?
Since 1989, July 11 has been marked as World Population Day. It is a day when attention is focused on the urgency and importance of population issues. Malthus argued that population increases by geometric progression while food production rises by arithmetic progression. The mismatch between population and food growth rates brings insurmountable sufferings to human beings through famines. The theme of the World Population Day this year was: "Family Planning is a Human Right".
"Family planning as a human right views people not as passive beneficiaries, but as active agents in planning their families and shaping their lives. Family planning is widely considered as a foundation for a range of rights, built upon the explicit identification of individuals as rights-holders and governments and other entities as duty-bearers that are responsible for delivering these rights".
There is no denying the fact that Bangladesh has made commendable progress in reducing population growth rate from as high as about 3.0 per cent per annum in the 1970s to 1.2 per cent in recent times. The role of family planning in this demographic revolution can hardly be forgotten. The development puzzle that Bangladesh is ascribed to owes much to the reduction in fertility. Drawing upon data of Drs Asa Torkelsson and Sathya Doraiswamy of UNFPA-Bangladesh, we know that contraceptive Prevalence Rate (CPR) increased from 7.7 per cent in 1975 to 62.4 per cent in 2014; and Total Fertility Rate (TFR) has been reduced from 6.3 to 2.3 per woman in the same period. However, the sad story is that, roughly 4.0 million women of reproductive age are allegedly not using any contraceptives despite their eagerness to avoid pregnancy for at least two years.
The same source also indicates that more than half of some 35 million adolescent girls, comprising about one-fifths of Bangladesh population, still get married before the legal age of 18. Such a large cohort of young people, argue the authors, represents an opportunity for growth, development and innovation. These girls enter into married life without the necessary information and knowledge about sexual and reproductive health, jeopardising their rights, health and wellbeing. The adolescent fertility rate of 113 live births per 1,000 among girls and women aged 15-19 remains the highest in South Asia. The Bangladesh Demographic Health Survey (BDHS) 2014 shows that 31 per cent of adolescents aged 15-19 have begun childbearing; about 25 per cent had given birth, and another 6.0 per cent were currently pregnant with their first child.
In Bangladesh, the use of contraceptive among married adolescent girls remains low at 51 per cent, as revealed by the above-mentioned source, which is lower than the national average of 62 per cent. Furthermore, the unmet need for family planning is highest among married adolescent girls, at 17 per cent compared to 12 per cent among women aged 15-49. Moreover, women during the first two years after a birth have a high unmet need for contraceptives at 44 per cent.
Despite the progress made in tackling the ticking-bomb by reducing TFR and increasing CPR, formidable challenges loom large on the horizon. These include the following (paraphrased): Young married females, especially adolescents, are under-served; geographic inequalities in contraceptive use prevail probably due to shrinking outreach activities; low use of effective methods of contraception such as long-acting methods and insufficient post-partum and post abortion contraception; absence of a structured urban family planning service delivery system and limited contribution of the NGO sector to CPR. In addition, the shortage of skilled workforce and its management is a continuous challenge, especially in the remote rural hard-to-reach areas.
"Henceforth, to minimise inequalities in different variables and respond to the SDG (sustainable development goal) call to leave no one behind, additional efforts are needed to move FP programme towards more effective, longer lasting and lower-cost clinical and permanent methods. FP services should be widely available, accessible and affordable for all. Bangladesh's current health policies set a clear agenda for ensuring availability and accessibility to effective and safe family planning services for all citizens. In order to ensure zero unmet need for family planning, the government should strengthen effective partnerships with all stakeholders across civil society to create an enabling environment for women and girls in accessing wider contraceptive choices".
The UNFPA top brasses of Bangladesh remind us that the right to family planning permits the enjoyment of other rights, including the rights to health, education, and the achievement of a life with dignity. They further reckon that an informed rights-based approach to family planning is the most cost-effective intervention for tackling maternal death in Bangladesh. Ensuring universal access to reproductive health services, including family planning, can ultimately speed up Bangladesh's progress towards poverty reduction and achievement of SDGs.
It can fervently be hoped that top priority would be attached to family planning in the policy discourse, given that every year 2.0 million people with sharp elbows are added to the titanic total of over 160 million. There is no room for complacency.
Abdul Bayes is a former Professor of Jahangirnagar University and now adjunct faculty at East West University.