Bangladesh News

The on-going slow pace of family planning programme has made it hard to attain the fifth Millennium Development Goal (MDG), which aims at reducing the (TFR) to 2.2 percent by 2010.

The TFR, which was 3.4 percent in 1993-94 and 3.3 percent during 1996-2000, came down to 2.7 percent in 2007, according to the Bangladesh Demographic Health Survey 2007.

But the family planning programme, which is completely dependent on donors and a major factor in reducing the TFR, has been showing a sluggish achievement for some time, creating uncertainty in achieving MDG-5, experts said.

Failure in management at all levels of the programme has only added to that uncertainty.

According to Wikipedia, the TFR of a population is the average number of children to be born to a woman over her lifetime if she were to experience the exact current age-specific fertility rates through her lifetime and survive from birth through the end of her reproductive life. It is obtained by summing the single-year age-specific rates at a given time.

The Bangladesh Demographic Health Survey 2007 said the overall contraceptive use declined by 2 percentage points in the last three years from 58 percent in 2004 while a two-decade long increasing trend in use of injectable contraceptives declined to 7 percent last year from 10 percent in 2004.

“There were shortages of supply of different popular contraceptives in the country even last year and since the logistics supply is totally import based, a huge number of eligible couple were forced to abstain from using contraceptives for its unavailability,” said Dr Morshed Chowdhury, a public health expert.

The public sector is the predominant agent in the family planning programme, providing contraceptive methods like oral pills and condoms and consultation to one in two users, but its most important agents–the government field workers–can reach only one in five users.

The contribution of the public sector in providing modern family planning methods continues to decline, becoming 7 percentage points lower last year than in 2004, according to the survey.

The use of field workers to supply contraceptives decreased to 20 percent last year from 23 percent in 2004 as some 8,152 posts including family welfare assistants, family welfare visitors, doctors, deputy director and assistant director have been lying vacant currently.

This has decreased door-to-door visits by the field workers in rural areas.

Besides, services for providing the long-term methods like the intra-uterine device (IUD) and injection at the union health centres are not satisfactory.

Recruitment in the family planning programme has remained halted for the last 12 years because of bureaucratic tangle. At the same time, those who were recruited during early 1970s are awaiting retirement while many of these aged workers do not have the physical stamina and interest in door-to-door visits.

“Presently some 600 posts of field workers are lying vacant which has resulted in poor service at the field level and the number of vacant posts will increase by 200-300 every year as most of the field workers are awaiting retirement,” said Ahmed Al Kabir, former chief of party of Urban Family Health Partnership.

The number of family welfare visitors will also be halved within five years, which will make the programme a failure, experts fear.

Director General of the Directorate General of Family Planning Quamrun Nessa Khanam, however, told The Daily Star that around 5,000 field level workers would be recruited soon and that they would be able to provide field level service within four months.

But the fact is that these people will work to increase awareness about the contraceptive methods among the people while the issue of unavailability of these methods remains.

The government should ensure adequate supply of the contraceptive methods, experts said, adding that more service providers on the clinical side should also be recruited and trained.

But the 12 training institutes for family welfare visitors have remained almost non-functional for the last 12 years.

The family planning programme got a boost in the 1980s following increase in the demand for long-term and permanent contraceptive methods. The supply of these methods was ensured in collaboration with the government and non-government organisations. The donor agencies also took this sector as a priority sector.

But in the middle of the 1990s the momentum of the programme began to slow down as programmes taken at that time emphasised more on the short-term methods and gradually shifted to other issues like maternal health and child health. The door-to-door service stopped soon after introduction of the Health and Population Sector Programme in 1999 and the family planning programme suffered a major setback.

The programme further stumbled when the health sector was merged with it at the upazila level. Because of this merger family planning activities received less importance that caused static TFR.

In 2003, however, family planning was separated from the health sector and since then it has shown a little improvement because of the increase in use of modern contraceptive methods.

Experts observe that the most important thing is to regain the momentum the programme had generated in the 1980s. A sustainable, long-term and effective programme is needed for its success, they said.

“As family planning involves behavioural change we cannot force people. We should rather strengthen the motivation programme and increase door-to-door services,” said Dr Halida Hanum Akhter, director general of Family Planning Association of Bangladesh.

The government should plan well ahead. Collaboration between the government and the NGOs in terms of both planning and implementation is important for this while the donor money for this sector should be utilised effectively and timely, experts said.

If the government is committed to improve the family planning situation in the country, it should openly discuss the issue with the stakeholders. The private-public partnership should be strengthened, they added.