Reducing Fertility in Bangladesh

Reducing Fertility in Bangladesh Case 13.

HUMAN RIGHTS

We have come to realize that fertility and family size involve two fundamental rights:

A woman’s right to limit or space her children.

A family’s right to determine its size and timing of children.

Modern contraception provides a way of ensuring these rights.

Risks and Needs

• There are considerable health risks to women who have had several pregnancies.

• Larger families have greater economic risks, due to children to support and health issues.

• Modern contraceptive methods are very safe for most women, but many women in developing countries who would like to limit their families do not use contraceptives. This is known as the “unmet need.”

Bangladesh: Will It Work?

In the mid-1970’s, the birth rate in Bangladesh would lead to a population doubling every 30 years, in one of the poorest countries that ranked 7th in population. The first coercive attempts at family planning failed miserably.

Then at that time, 1975, after a disastrous famine, a new approach was taken. Challenges were the low level of education and status of women, the belief that large families were best, and the lack of access to family planning.

Elements of a Successful Program

1. Young married women were deployed as outreach workers. Known as Family Welfare Assistants (FWAs), there number eventually reached about 40,000. They were to visit 3-5 villages over a two month period & became well recognized and received by rural women.

2. As wide a range of methods as possible were made available to meet most reproductive needs. This “cafeteria approach” was supported by a well-managed distribution system.

Elements of Success (cont.)

3. Over 4,000 family planning clinics were established in rural areas. These could deal with difficulties and provide long term or even permanent contraceptive methods.

4. Information and education were employed to change cultural norms about family size, to provide information about contraception and encourage spousal communication.

Program Impact

The programs objectives were fundamentally realized. A) The number of women who had used contraceptive rose from 14% to 70% over a 20 year period. B) The provision of a wide range of methods made contraception more acceptable. C) And fertility declined from about 6.3 children in the1970’s to 3 in 2005.

Other contributing factors were an increase in secondary school enrollment, especially of girls, and the new employment opportunities for women.

Remaining Tasks

· Costs for outreach workers (FWAs) is relatively high, and a fixed site approach has been adopted, with FWAs going to remote areas.

· Declines in the fertility rate have slowed. So the best outreach strategy is not yet decided .

· Initial attention to contraceptive advances may have led to a slight increase in deaths due to pregnancy complications.

Outcomes and Lessons

There is now seems to be greater communication between husbands and wives

about family planning and family size.

There has been a cultural change about the optimal family size.

A dramatic decrease in fertility was achieved, beyond any other country of comparable GNP.

Coercion has been avoided and couples needs have been considered as paramoun

Case 13.

HUMAN RIGHTS

We have come to realize that fertility and family size involve two fundamental rights:

A woman’s right to limit or space her children.

A family’s right to determine its size and timing of children.

Modern contraception provides a way of ensuring these rights.

Risks and Needs

• There are considerable health risks to women who have had several pregnancies.

• Larger families have greater economic risks, due to children to support and health issues.

• Modern contraceptive methods are very safe for most women, but many women in developing countries who would like to limit their families do not use contraceptives. This is known as the “unmet need.”

Bangladesh: Will It Work?

In the mid-1970’s, the birth rate in Bangladesh would lead to a population doubling every 30 years, in one of the poorest countries that ranked 7th in population. The first coercive attempts at family planning failed miserably.

Then at that time, 1975, after a disastrous famine, a new approach was taken. Challenges were the low level of education and status of women, the belief that large families were best, and the lack of access to family planning.

Elements of a Successful Program

1. Young married women were deployed as outreach workers. Known as Family Welfare Assistants (FWAs), there number eventually reached about 40,000. They were to visit 3-5 villages over a two month period & became well recognized and received by rural women.

2. As wide a range of methods as possible were made available to meet most reproductive needs. This “cafeteria approach” was supported by a well-managed distribution system.

Elements of Success (cont.)

3. Over 4,000 family planning clinics were established in rural areas. These could deal with difficulties and provide long term or even permanent contraceptive methods.

4. Information and education were employed to change cultural norms about family size, to provide information about contraception and encourage spousal communication.

Program Impact

The programs objectives were fundamentally realized. A) The number of women who had used contraceptive rose from 14% to 70% over a 20 year period. B) The provision of a wide range of methods made contraception more acceptable. C) And fertility declined from about 6.3 children in the1970’s to 3 in 2005.

Other contributing factors were an increase in secondary school enrollment, especially of girls, and the new employment opportunities for women.

Remaining Tasks

· Costs for outreach workers (FWAs) is relatively high, and a fixed site approach has been adopted, with FWAs going to remote areas.

· Declines in the fertility rate have slowed. So the best outreach strategy is not yet decided .

· Initial attention to contraceptive advances may have led to a slight increase in deaths due to pregnancy complications.

Outcomes and Lessons

There is now seems to be greater communication between husbands and wives

about family planning and family size.

There has been a cultural change about the optimal family size.

A dramatic decrease in fertility was achieved, beyond any other country of comparable GNP.

Coercion has been avoided and couples needs have been considered as paramoun

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