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Can We Afford 140 Million?

By Nasrin Sobhan
***Bangladesh has achieved some success in its birth control programme, but the situation calls for the adoption of drastic measures, unless we want to be faced with major economic and social disaster.
Dhaka It to a common
Bight to sec a ragged woman on the street with two small children
her arms and another baby ob viously on the way. Such a woman would be grateful to be taught a quick, safe and effective way to practise birth control. She can rtd herself of the burden of endless childbearing with Its accompanying poverty. Ill-health, malnutrition and general misery, and ensure a better life for her child at the same time.
Babies In China are spared the miserable fate of the majority of Bangladeshi babies. The average Chinese baby Is well-fed and well-clothed. When he grows older he can look forward to schooling and a steady job. He will never have to stand on the streets and beg or hunt for a job where there are none to be had. or dte prematurely of malnutrition or disease. One of the reasons for his better standard of living Is that he is an only child, a result of China s vigorous and stringent family plan -ning programme.
liiere are many dimensions to family planning pro-grammea: organisational infrastructure. a sufficiency of trained personnel and family planning clinics throughout the country, availability of. and access to materials and funds for the agencies involved in family planning, efficient dis iribnlion methods and storage facilities for contraceptives, and adequate education of the population by way of publicity via the media of television and radio, and counselling programmes for young couples and persons of childbearing age.
However. a large part of the success of any family planning programme must be attributed to the birth control methods offend by the government.
In China the most commonly used methods of birth control include pills, different type's of IUDs and condoms. However, there are now a number of other techniques which are being researched and used.
Among the new contraceptive methods offered to women
1. Norplant or sub-dermal Implantation, where 6 pieces of the compound levonorgestrel are Implanted under the skin of the arm. The Implant Is effective for approx tmatcly five years. There be can be amenorrhea and irregular bleeding In some cases, but it ts a popular method both In China and Indonesia.
2. Female sterilisation by the occlusion method. A mixtun- of qiiinoqutnc and carbolic acid is Injected Into the fallopian tubes. This causes corrosion of the tubal epithelium, and prevents pregnancy. This procedure Is however, almost impossibk- to reverse.
3. Once a month injcctables for women. In this process certain contraceptive drugs such as mcgcslrol acetate are injected once a month. They arc normally used In combination with oestrogen to prevent bleeding. Research is under way to Increase dosages so as to render them effective for longer periods
4. Long lasting oral pills, taken once a month.
5. Ru 486 or abortion plH. to be used the morning after The research on these pills has been completed They will be Issued as soon aa clearance is obtained from the Ministry of Health to be put Into use.
6. The morning-after or post-coital pill, used with norcphystyron. These arc oral pills with a higher dosage, and are used daily for Iwo weeks. These arc distributed widely in the factories and other workplaces. and arc also available in pharmacies and shops. They arc not only effective, but arc in great demand in China especially in cases where couples live and work in separate cities. and are able to meet only during holiday periods
Abortion by the vacuum suction metlvKl la also widely available.
Recently, there has been increased research and emphasis on male contraceptive mctlKxls. These methods have the advantage of being simple, effective and safe It Is the opinion of experts tn Bangladesh I hat tlwy are par ticuiarly significant In tlrclr potential for iim- tn Bangladesh.
I. The first of these ts a new prcMsshire called the non scalpel vasectomy A pointed clamp I* riM-d to puncture the scrotum and lb< vim is ligated. Siner then- ts no surgery, the patient Is able to walk out of the clinic and resume normal life Immediately A tliousand sets of these instruments have been presented to the Bangladesh government for use in the family planning programme. Experts believe that this method can be both eflec the and popular.
2. Chemical occlusion : a semi-solid polymer Is Injected into the van. The substance solidifies tn lire vas and prevents the passage of sperm. The polymer, which is sometimes found to have toxic side effects. is soon to be replaced by a silicon rubber compound. Research Is still being conducted Into this technique, and a limited number of subjects have been tested. WHO is interested In organising a workshop to popularise this method. It is fairly safe, and there have been reports of a 100% recovery rate after removal of the silicon plug.
3. A long-acting testosterone Injection which can be taken once a week. This product ts still In the clinical trial stage. WHO ts into its 2nd year of research, part of which Is aimed at altering the compound so that It can be given once a month.
4. Male anti-fertility drug Gossypol. This ts still being studied because gossypol (-) has been found to have toxic side-effects.
While the Importance of effective planning and tmplementation at government level cannot be overemphasised, It Is also Imperative to have an efficient monitoring system to oversee the birth control programme and to ensure Its sue cess at all levels from the el ties to the villages The moot toeing agency at the lowest level could be the union council itself, or a committee set up by the council, which would be responsible for encouraging the population lo follow the family planning directives of the government. The Grameen Bank policy, which has proved so effective In other areas could be used a* the model for a system of In centtves where unions achlcv ing a successful lowering of the birth rate would be rewarded with money for development projects, and other forms of asstslame.
In China, for example, part of the monitoring process is carried out by old ladies in every neighbourhood committee, who have lists of the names of all women of childbearing age In the area. They go round the houses every month to cheek If the women have had their menstruation on schedule or not. If not. appropriate mea sures are taken to ensure that the goal of the single-child family is adhered to.
Bangladesh hits a population of I 14 million tn an area of ap proximately 55000 square miles. It is estimated that by the end of the century the population will have reached 140 million. For a country of this size and bearing In mind the pressing nature of Its economic problems, any further growth In the population would be nothing short of catastrophic.
Bangladesh has achieved some success 1n Its birth control programmes, but the situation calls for the adoption of drastic measures, unless we want to be faced with major economic and social disaster on an unprecedented and tin
A freelance Journalist. Ms. Nasreen Sobhan notv Hues In liegIng with her Bangladeshi diplomat husband.