Reducing Fertility in Bangladesh
Geographic area: Bangladesh Health condition: in the mid-970s, a Bangladeshi woman had more than six children on average. in combination with poor nutrition and lack of access to quality health services, this high fertility rate jeopardized the health of both the woman and her children. Beyond the health impact, high fertility and rapid population growth represented a major constraint to the country’s economic development and social progress. Global importance of the health condition today: More than 50 million women in the developing world who would like to limit or space their pregnancies do not currently use a contraceptive method. so, for example, about 6 percent of married women in india have this “unmet need.” in sub-saharan africa, where services are in relatively short supply, the unmet need is the greatest. Intervention or program: the Bangladesh family planning program has depended on a large cadre of female outreach workers going door to door to provide information, motivate clients, and provide commodities; the program has used mass media to stimulate a change in attitudes about family size. the program both contributed to and benefited from improvements in women’s status in Bangladesh during the past 30 years. Cost and cost-effectiveness: the program is estimated to cost about $00 million to $50 million per year, with about one half to two thirds of the funding coming from external donors. cost-effectiveness has been estimated at about $3 to $8 per birth averted, a standard measure for family planning programs. Impact: as a result of the program, virtually all women in Bangladesh are aware of modern family planning methods. the current use of contraceptives among married women increased from 8 percent in the mid-970s to about 60 percent in 2004, and fertility decreased from an average of more than six children per woman in 975 to slightly more than three. although social and economic improvements have played a major role in increasing demand for contraception, the provision of services and information has been shown to have had an independent effect on attitudes and behavior.
hether or not couples can limit the number of children they have has profound consequences. For the couples, having the family size they want can mean the difference between economic security and a precarious existence. For a woman and her current and future offspring, the level and pattern of childbearing are central determinants of health status because with each pregnancy and delivery come health risks, particularly in the poorest countries. For societies at large, demographic
patterns, particularly fertility rates, are among the most important factors affecting long-term prospects for economic growth and social development. Modern contraceptive methods make it relatively easy and safe for couples to limit the total number of children they bear and to time their pregnancies. Both permanent methods, including male and female sterilization, and temporary methods, such as hormonal methods (oral contraceptive pills, injectable hormones, and othReducing FeRtility in Bangladesh
ers) and barrier methods (condoms and diaphragms), have advantages and drawbacks for individual couples. But all are reasonably effective at reducing the chances of unintended pregnancy, and they confer few health risks, particularly compared with the baseline hazards associated with pregnancy and childbirth. Combined with changes in attitudes about the ideal family size, the availability of effective contraceptive methods through both public and private family planning services has changed the world. In the past 30 to 40 years, the average number of children borne by each woman (also known as the total fertility rate, or TFR) has declined steadily in the developing world, although with major differences in the rate of decrease across world regions. Between 1970 and 2000, the TFR in Latin America...
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