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ICPD/15: Bangladesh Perspective
Intuitively, "population" in terms of its quality and quantity and "development" in terms of choices and freedom arc inter related and inter dependent. A country's potential for growth, and sustainable development is much' determined by the grow th and distribution of population as well as by its demographic structure and characteristics. Globally, all poor countries in general have some characteristics that are common amongst them: high fertility, high dependency in demography and low resource base in terms of natural and human capital. And the greatest disparities between developed and developing countries are in the areas of population and reproductive health indicators. Therefore, the north south divide between countries is not only about income but also a demographic divide with bulk of the world population located in the southern cone of the globe with South .Asia constituting a major share of them . Likewise, Bangladesh's Population dynamics, that is population growth, age structure, fertility and mortality also affect the human, social and economic development of the country. Hence efforts to slow down population growth, reduce poverty and to achieve economic and over all wellbeing are mutually reinforcing both in short and long term perspective. ICPD . Cairo '94 recognized that development is ultimate aim is to improve peoples choice and well being and it's a continuous process. As a result of ICPD the following axioms became the cardinal principles of development that put the entire of notion of development into a renewed perspective:
♦ Human beings should be at the center of sustainable development ♦ Each person has the basic right to a life free from hunger, poverty, ignorance disease and fear
♦ Empowerment of women should be viewed as a necessary precondition to ensure equitable development
♦ In the design and pursuit of appropriate development policies, population perspective should be treated as an integral part.
♦ Eradication of poverty, as an indispensable precondition for sustainable development demands holistic commitment, cooperation and collaboration of all concerned. Population, Development and ICPD
The International Conference on Population and Development held in Cairo 1994 under the auspices of United Nations was a watershed in the area of Population and Development. It adopted a Programme of Action in the field of Population and Development with a difference., paradigm to. usher the global population, related challenges. An important highlight of the new paradigm was to recognize the crucial link of Reproductive Health viewed in a comprehensive manner with development. To day we observe the 15 years of International Conference on Population and Development (ICPP/15) held in Cairo in 1994 which was an important landmark for redefining and addressing the issue of Population and Reproductive Health in a holistic manner. Since Cairo‘94, (occasionally termed as Cairo Consensus with a blue print for Sustainable Development) Bangladesh has made important gains in various ICPD targets and indicators that are globally acclaimed and well integrated in the government on going sector programme HNPSP. Most ICPD goals reached their culmination at the Millennium Declaration resulting from Millennium Summit that marked the Emergence of Eight Millennium Development Goals where 189 countries agreed to achieve time bound measurable targets related to poverty, hunger, education, health. Environment and Global Partnership. A complete account of Bangladesh's progress in each of these goals is beyond the scope of this supplement, however, this report aims to provide an up to date illustration of the issues related with population and reproductive health in brief. ICPD Programme of Action (POA) reckoned that at the macro level, huge population tends to overwhelm limited resources as population growth tends to overwhelm investment made on infrastructure and capital leading to poor capital formation. The rampant growth of population in Bangladesh adds more than 7 thousand new babies every day to the existing base population. A population with high child and youth dependency demands economic resources for provision of schools and health care. While the density of population tripled in the span of forty years, the dependency ratio would remain unfavorable notwithstanding fertility decline because of population momentum. The child dependency ratio declined by 1990 but youth dependency increased with ever increasing demand for more resource to generate education health and employment. This phenomenon had important bearing in growth of capital/worker in Bangladesh which hindered Bangladesh's entry into high value added production for domestic consumption as well as for exports. Bangladesh's achievement and prognosis in ICPD POA
Bangladesh has made considerable progress over the years in various socio-economic, health and demographic indicators since Mid 70's notwithstanding of challenging circumstances, i.c. high population density, low resource base and low income per capita. Between the period of 1950 -1975 population increased quite rapidly with average growth of 2.5 -3 % per annum. As a result with in the span of three decade, population doubled from 51 million in 1961 to 110 million in 1991. With an estimated population of 148-150 million, it has the highest density of population in the world (950 person/sq. kilometer). By 2020, the country population will be 40% urban and Capital Dhaka will be the second largest city in the world with a population of 18 million and highest primacy index among world’s urban metropolises. Although poverty declined rapidly during this period from 49 % in 2000 to 40% in 2005, near about 60 million people still continue to live below the poverty line that are mostly rural Following a very successful population program since 1976, TFR fell from 6.4 in mid 1970s to 2.7 in 2007 and population growth rate declined from 3 per cent to 1.5 per cent over the same period. TFR plateaued for about a decade at 3.3 (1994-2002) and finally started declining again which delayed the fertility transition. The demographic structure, particularly the young people (about 40% in age 10-24 years) will cause the population to continue to increase and will stabilize at around 230 million in 2050, a 50% increase of today's population even if replacement level (NRR-l)is reached in 2015. Contraceptive Prevalence Rate (CPR) for married women in Bangladesh has increased from 8 percent in 1975 to 56 per cent in 2007 (BDHS: 2007). The use of modem methods constitutes 48 per cent, where pill is by far the most widely used method (29%). followed by injectable* (7%). female sterilization (5%) periodic abstinence (5%) and condom (5%). Uses of permanent and long-lasting methods such as, sterilization for both male and female, IUD or Norplant have declined and account for 12 per cent only. Discontinuation rate is also high and vanes by method -49 per cent for injectablcs and 47 percent for pills. Unmet need for family planning which was 11 per cent in 2004 further increased to 17% in 2007 due to Rll commodity stock out. In Bangladesh every successive government attached importance to population challenges since 1976. This marked the beginning of a broad based pro poor multi-sectoral family planning program which eventually led to a social movement for improving the status of women involving private sector and NGOs as well. Some of the country's main population and development challenges include: Source of Figures: UNFPA and World Rank
• Reduction of Maternal Mortality is the comer stone of Country's PRSP-II and Health and population sector program HNPSP (2003-2011). Maternal mortality ratio in Bangladesh is estimated to be 290/ 100000 live birth in 2007 which declined from 574/100,000 in 1990 registering about 50% decline in 17 years. It is low in South Asian Standard except Sri Lanak and still accounts 10-12 thousand maternal death per year through out the country which is largely preventable. One of the key challenges for rapid reduction of maternal mortality is the rigid and phenomenal trend of early marriage and general practice of home delivery among the households. UNFPA Bangladesh provide support to the government through 64 Maternal and Child Health Centers (MCWCs) by building capacity to provide Emergency Obstetric Care and Maternal health vouchers to poor pregnant women.
♦ Providing reproductive health services for young people is crucial for opening the demographic window and augmenting the dividend in the coming decades.. About a quarter of the population consists of adolescents with very poor access to RH services as reflected in high Adolescent fertility rate (127/1000). Maternal Mortality Ratio (MMR) among adolescents is almost double the national average (320/100000 LB) and the Infant Mortality Rate (IMR) is also 30 per cent higher than national average (65/1000 live births; BDHS:,2004), Almost 56% girls between the ages 15-19 gets married by the age of 19. While official' policy has aimed to implement minimum age for marriage at 18 years where UNFPA is also providing advocacy support through media and religious leaders, Age at marriage has risen only very slowly in Bangladesh and most girls are likely to be married by 18. This interrupts their education and disrupts any plans they have for the future.
♦ Increasing skilled attendance at birth is one of the major thrust of the Health Nutrition and Population Sector Programme (HNPSP) where UNFPA is providing technical and policy support. As 90% of all births take place at home this is an essential intervention that will not only bring safe deliveries to women where they live but increased awareness of their right to quality care. Today 4,500 community-based Skilled Birth Attendants (CSBA) have been trained and are working in the community, conducting normal deliveries and referring complicated cases. Since the most common cause of maternal deaths in Bangladesh is PPH, skilled birth attendants have been trained on active management of third stage of labour including immediate administration of oxytocics. Through a government led 18 months training programme, skilled attendance at birth has increased to 20% in 2007.
♦ RH services in the midst of rapid urbanization is now the new frontier of challenges as because, aocording United Nations Population Division, Dhaka ranked 22nd among worlds 30 largest cities and will be 4th largest city by 2015. Overall, urban population which was 8% in 1971 now constitute about 30% and will be 40% in 2015. The annual growth rate of rural population is 1.2 % while urban population is growing at a rate of 5% per annum and rate of urbanization is 6% per annum. Considering all metropolitan cities, the density is 3600/ sq-Km which is five times higher than rural density. Dhaka city alone carrying 5058 person per sq-Km in 1995.
Increasing landlessness, underemployment in rural areas perceived job prospect by rural poor are driving the rural -urban migration. As such, the explosion of slum dwellers around the city has become a perennial problem for the provision of basic public utility services for the city dwellers.
Charting progress- Key ICPD indicators
Indicator 1990 - 95 2005 - 07
Proportion of population living in povert y(%) 59 40
Total fertility rate (lifetime births pa women) 3.4 2 7
Maternal mortality ratio (deaths pa IO0.OU0 live births) 554 290
Infant mortality rate (deaths pa 1,000 live births) 87 52
Childs undo five mortality (deaths per 1,000 live birth*) 133 6$
Net enrolment m elementary school (%) 60 90
Cortraceptnx prevalence rate; marned women. rn<^ 45 5b
Births attended by skilled health personnel (%) 9 20
EDITED by; fauhid Alam. UNFPA. talnm