CPD-UNFPA
Programme on Population and Sustainable
Development
Paper 18 (Summary)
Achieving Replacement
Level Fertility in
Bangladesh: Challenges and Prospects
Professor
M Ataharul Islam, Professor M Mazharul
Islam and Professor Nitai Chakraborty
INTRODUCTION
Bangladesh has been passing through
a critical phase of fertility transition.
The level of fertility started to
decline in the mid-seventies, and
a rapid pace of decline was sustained
from the mid 1970s
until the mid
1990s. However, since then the
level of total fertility
has remained
unchanged at a level of 3.3,
which is above the replacement level
despite the significant growth
of the contraceptive prevalence rate.
This raises several questions: Does
this indicate plateauing of the
level of fertility? Is it consistent
with the increased level of contraceptive
prevalence rate during the same
period? Are there any other factors
associated with the level of fertility?
Is it consistent with other measures
of fertility? Is it attributable
to the beginning of
a change in
population momentum?
This paper makes an attempt to address
these issues of major concern to
the policy-makers and researchers.
OBJECTIVES
The main objectives of the study
are to-
· Examine the regional differentials
in the level of fertility by divisions
· Examine of the proximate
determinants of fertility;
· Identify key determinants
that accelerate or suppress the
reduction of fertility level in
Bangladesh;
· Look into the family planning
programmes in respect of the recent
shifts from door-step services
to static one-step centres;
· Examine the debate over
development versus family planning,
and
· Investigate the recent
changes in the method mix of FP
methods as well as the acceptance
and prevalence of different methods
in different age groups.
MAJOR FINDINGS
This paper focused on the exploration
of the reality underlying the plateauing
of fertility level during the
recent past. The major findings in
this regard are as follows:
·
The study indicates that since 1993-94
the TFR has stalled in the vicinity
of 3.3 due to population momentum
effects, shifting of childbearing
towards younger ages, shifting towards
adoption of a less effective method
mix, no substantial improvement
in child survival status and
a reduction
in postpartum infecundability period.
·
Unlike the situation in countries
where fertility decline followed
socio-economic development, the
level of fertility plateaued at
the pre-momentum phase in Bangladesh,
while in Taiwan, the plateauing
occurred after attaining replacement
level. The plateauing in Taiwan
has been observed at a level much
below the level of replacement,
while in Bangladesh, the plateauing
has occurred at a level much higher
than the replacement level.
·
The actual level of fertility in
Bangladesh in 1999-2000, after adjusting
for tempo effect, would be close
to 4, more precisely 3.9, as compared
to that of 3.8 in 1996-97. In other
words, there
has been a slight increase
in the level of fertility during
the recent past. The conventional TFR appears
gives a lower
figure due to an
upward shifting in the parity-specific
birth intervals. An increase in
the parity-specific birth intervals
causes a decline in the level of
conventional TFR.
·
It is alarming that the mean age
at marriage has been playing a role
in Bangladesh which is just
the opposite
to what happened in countries like
Taiwan. In Taiwan, during the demographic
transition, delayed marriage contributed
substantially
to the declining level
of fertility, while in Bangladesh,
the regions that are approaching
the replacement level are characterised
by a low age at marriage. On the contrary,
the regions that are lagging behind
in achieving the replacement level
fertility are characterised by
a higher age at marriage. However,
regions with low level of TFR in
Bangladesh have longer birth intervals,
which is just
the reverse in the regions
with high level of TFR. In other
words, delayed age at marriage
apparently
does
not contribute
to the
decline in the level of fertility,
but from the multivariate analysis,
it was observed that
a lower age at
marriage can be linked with increased
progression to next birth at short
intervals. This implies that although
the delayed marriage is not directly
associated with reduction in the
level of fertility, it can act through
increasing birth intervals to reduce
the level of fertility. This means
that lagging in regions like Sylhet
and Chittagong, in the absence of
delayed marriage, the level of fertility
would be even higher. On the contrary,
instead of lower age at marriage
in the leading regions like Khulna
and Rajshahi, if the age at marriage
could be
increased then the decline
in the level of fertility would
be much faster.
·
The study observed that during the
recent past, there
has been
a reversal
in the role of major contributors
of fertility, resulting in
an offsetting
effect on the overall level of fertility.
During the
1993-96 period, the median
age at first marriage, median age
at first birth and median duration
of breastfeeding declined, favouring
a higher TFR, while during the same
period, increases in the continuation
of oral pills, injectables and condoms
and median birth interval contributed
to a decline in TFR. Hence, during
the 1993-96 period, the stagnation occurred
due to the
offsetting effects of these
factors. Surprisingly, the stagnation
of the level of fertility during
the 1996-99 period can be attributed
to the same factors acting in opposite
direction. During
the 1996-99 period,
it was found that
an increase in median
age at marriage, median age at first
birth and median birth interval
all contributed to a lower TFR.
But a decrease in the continuation
of two major contraceptives, oral
pills and condoms, that constitute
almost two-thirds of the modern
method users, and a further decrease
in the duration of breastfeeding
contributed to an increase in TFR.
Hence, the country experienced another
stagnation during
the 1996-99 period.
The two periods of stagnation, opposite
in direction, during a short span
of six years, can be characterised
as follows: (a) the stagnation during
1993-96 period can be attributed
to the fact that the continued success
of family planning program in spacing
births was offset by
a reversal in
the socio-demographic factors such
as age at marriage and age at first
birth, and (b) the stagnation during
1996-99 period appears to be due
to a set-back in the continuation
of the two major modern methods of family planning programmes although
socio-demographic factors registered
an upturn.
·
The statistical characteristics,
as revealed from location, dispersion
and skewness of age-specific fertility
rates, indicate an emerging pattern:
(a) fertility is tending towards
young age during the recent past,
(b) births are occurring at
a relatively lower span in recent
times, that is, the births are taking
place at shorter distance from the
central tendency of fertility, and
(iii) the fertility curve is now
less skewed to the right, indicating
that more births are taking place
within a shorter span now than before.
·
It has been observed that the role
of son-preference has diminished
to a large extent during the recent
past. This means that the level
of fertility is not high due to
son-preference according to the
findings of this study. However,
the emerging concern is the high
infant and child mortality rates.
From various indicators, it can
be concluded that unless child
survival is improved to a great
extent, it will act as a strong
barrier to attain the replacement
level fertility in Bangladesh. These
indications are clear from the recent
fertility patterns in the regions
where the fertility is approaching
replacement level at a rapid pace.
·
A review of age at marriage pattern
shows that over the last few decades
there has been little improvement
in the age at marriage. Teenage
childbearing is also very high in
Bangladesh. According to the 1999-2000
Demographic and Health Survey,
in more
than 90 per
cent of
cases marriage occurred
at an age below 20 years. As long
as marriage and children are universal
goals, no society can reasonably
expect to achieve
a replacement level
of fertility by only postponing
union and spacing births. Permanent
fertility reduction largely depends
on the desired completed family size
at the end of the reproductive life
span.
·
The study suggests that in the recent
years contraception has emerged
as the highest fertility-reducing
factor in Bangladesh. Until early
1990s postpartum infecundability
was the most important and strongest
fertility reducing factor in Bangladesh,
but by 1993-94 contraception had
become most important determinant
of fertility and its fertility-inhibiting
effect is steadily increasing. The
increasing effect of contraception
is evident from the declining trend
in the values of the index Cc from
0.931 in 1975 to 0.495 in 1999-2000.
On the other hand, the fertility
reducing effect of lactational infecundability
is gradually decreasing owing to
the declining trend in the lactational
amenorrheic period. It is to be
mentioned here that, although there
is an increasing trend in the impact
of the marriage component, reflecting
the effect of increased proportion
of non-married and/or increased
age at marriage, the rate of change
is very slow. The prevailing cultural
and social norm in Bangladesh is
unlikely to permit a change in the
proportion of
non-married
women beyond a
certain limit and the prospect for
an immediate rise in age at marriage
for females does not seem to be
very bright. It is to be noted that
the joint effect of marriage and lactational infecundability did
not change much over the period
1975 to 1994 as the declining effect
of lactational infecundability has
been offset by the increasing effect
of marriage. This leads to the conclusion
that the future reduction in fertility
in Bangladesh may largely be dependent
on increased use of effective birth
control methods. However, the problem
with the Bangladesh FPP is that
the current method mix is losing
its effectiveness due to decline
in the use of permanent or semi-permanent methods and increased
use of pills and traditional methods
with high failure rates.
·
As the projection shows, the
contribution of fertility to the
future growth of population will
continue until 2005-6, then the
growth of population will be largely
attributable to the population momentum.
The present status of plateauing
may continue for another four or
five years if the past trends continue
in the near future. However, it
is observed from number of children
born that the level of fertility
will decline eventually, once the
pre-momentum impact of
a young age
structure moves towards the middle
ages.
POLICY RECOMMENDATIONS
The
current problem of plateauing of
fertility needs special attention.
If the problem continues for a long
time then the process of attaining
the replacement level of fertility
will be delayed further and the
population momentum after attaining
the replacement level of fertility
will produce a much
larger population than expected
before the population is stabilised.
Some policy options are mentioned
below:
·
The most important policy option
for reduction of fertility as well
as for reduction of potential impact
of population momentum is to delay
marriage and increase birth intervals,
particularly the first birth interval.
· Improved education and
opportunities for females in income
generating activities can accelerate
the process of economic development
and thus the role of economic development
can be strengthened in a further
decline in the level of TFR.
· Delay in marriage can be
ensured through at least high
school education for girls. Opportunities
for income generating activities
for girls need to be created at
all levels in society. Teenage
marriage and teenage fertility need
to be socially discouraged due to
high risks involved with both health
and fertility.
· To improve the child survival
in Bangladesh, immunisation programmes
need to be extended effectively
in order to increase the extent
of full coverage of essential vaccines
to an optimum level. However,
immunisation
alone can not prevent all these
deaths. A large proportion of under
5 children appear to be malnourished
in Bangladesh and hence they become
easy prey to severe diseases. To
reduce the impact of malnutrition,
the programmes on alleviation of
poverty need to be strengthened.
Education for all children is
one step forward to provide these
children adequate knowledge about
their health and nutrition.
· The method-mix of contraception
can be made more effective through
encouraging longer-acting methods.
The current status of longer acting
methods, particularly, sterilisation,
is discussed by Islam and Chakraborty
(2001). It is essential to improve
the quality of care, because the
major reason for discontinuation
of methods such as oral pills, injectables
and IUD is side-effects. The birth
space can be effectively widened
through improving quality of care
in the family planning programmes.
There is still
an unmet need for limiting
child births among a moderately
large proportion of women, hence,
the programmes for sterilisation
need to be given renewed priority
to improve the effectiveness of
the method-mix.
· The most recent reversal
in the causes of stagnation in the
level of TFR indicates that the
continuation of some modern methods
have declined during the recent
past. This might be attributed to,
among other reasons, the recent
change in the door-step services
at the grass-roots level to one-stop
service being implemented through
the HPSP. The impact of the change
in the service delivery system on
the long-term use of contraception
in rural areas of Bangladesh needs
to be examined very carefully in
order to resolve the concerns of
different groups of users.
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Pages: 45
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