With a pledge to ensure the reproductive health rights of everyone, World Population Day is being observed across the globe on Sunday.
Without any migration, contraception and education play the biggest role in transposing the population in a positive or negative direction, according to experts.
Bangladesh is the ninth most populous country in the world with a growth rate of nearly 1%.
According to the UN’s projection, Bangladesh’s population will reach its peak in 2053 with a population of 192.78 million, after that it will start to decrease.
However, the trend is not unexpected as the growth rate has decreased over the past 60 years from 3.23% in 1967.
Despite the rising population number, people have gradually become involved in using different types of contraception methods for birth control as a measure of family planning.
Contraceptive Prevalence Rate in Bangladesh
The Contraceptive Prevalence Rate (CPR) among Bangladeshi women aged between 15 and 59 years is 63.9%, according to the latest Bangladesh Demography and Health Survey (BDHS).
Bangladesh targeted to achieve a CPR of 72% by the year 2015, however, the target is not set to be achieved by the year 2030, according to Matiur Rahman, the additional director of the Directorate General of Family Planning.
According to the latest Sample Vital Registration System (SVRS) report, urban women are more likely (64.7%) to adopt family planning methods than their rural counterparts (63.1%). Women, aged between 35 and 39 years, account for the highest — 68.7% — in using contraception.
The trend of family planning has also increased gradually over the years, as according to the BDHS report, 79% of the population were interested in any type of family planning in 2017-18.
Despite the successes, Bangladesh still lags behind to achieve the target as the current total fertility rate (TFR) stands at 2.03% according to the BDHS survey, in comparison with the desired 1.7% -- meaning on average Bangladeshi women conceive 0.6% more children than they want.
Stigma around permanent methods
The most popular contraception method among women is the oral pill followed by injections and condoms.
The oral pills have variation and most of the users depend on emergency contraceptive pills, said Dr Rooh-E-Zakaria, who teaches Obstetrics & Gynaecology at Dhaka’s Shaheed Suhrawardy Medical College Hospital.
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“We always suggest going for long term methods, which are both safe and widely available. But most of the users prefer pills, as they are easily accessible. But it’s not a permanent solution,” she told Dhaka Tribune.
According to the assistant professor of the Suhrawardy Medical College, pills come with severe side effects as their key function is “to control hormones”.
Users of contraceptive pills are exposed to hypertension, kidney-related complications and even cancer, says Dr Zakaria.
But the stigma around permanent methods is too high, she says as people are usually afraid of “inserting an object in the uterus”.
The government’s Directorate General of Family Planning says they run extensive campaigns on long-term methods.
Matiur Rahman said: “We run scrolls on all television channels. Moreover, our field-workers conduct door-to-door awareness campaigns as well, which now has been somewhat disrupted amid the pandemic. All upazila health complexes and community clinics are equipped with the best family planning services."
According to the demography and health survey, injections (14.7%) are the most popular among long term methods followed by permanent sterilization (1.7%) and intrauterine devices (1.1%).
However, a significant part of the population (1.5%) relies on traditional methods, like the rhythm method due to ease and perception of no health hazard.
But it’s also a cause for unwanted birth.
Some 8% of the births in 2018 were unwanted, according to Professor Mohammad Mainul Islam of the Populations Science Department at the University of Dhaka, who says the number is expected to change amid the pandemic.
“One of our researches show reproductive and fertility care was severely disrupted during the pandemic. The result can go both ways; births can increase or decrease,” he told Dhaka Tribune
According to Professor Islam, the effect of increasing usage of contraceptives is multifold.
“We have progressed in several human development indices but we have failed in child marriage, even today 59% of our girls are married off before 18. Safe contraception method has a big contribution towards ensuring mortality rate among young mothers,” he added.
Although, Dr Zakaria says permanent methods are not advised for young women but there is no health risk in choosing a long term method.
Contraception rights and women empowerment
The UN emphasizes having the liberty of choosing contraception methods, as it is seen as an important right for women.
According to the BDHS 2018 report, the husband and wife take the decision together on using a family planning method in 78% of families while the number was 16% and 7% respectively in case of the decisions taken by the woman and man.
Although the official figures are commendable, there are doubts whether it reflects the actual scenario, says Aditi Sabur of the Women and Gender Studies Department at Dhaka University.
“Studies showed that women do not have much liberty in family planning decisions, especially in the lower socio-economic group. The data might be true for the educated and urban population but I cannot say the practice is unequivocal across the board,” she said.
Freedom of contraception can be a way of empowering women, says Aditi before adding this alone is not enough.
“… our perception towards family planning is very wrong, as culturally and socially childbearing or contraception are seen as factors related to women only, which is simply not correct. Even the methods promoted are for women, not men, but the responsibility lies on both equally.”
Bangladesh will witness a decline in population after 2053, but by 2100 it will be the 25th most populous country with 81 million people.
