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OP-ED: Charting progress - Bangladesh and its state of health

  • Published at 03:16 pm October 7th, 2021
web-hospital health
File photo of a hospital ward in Dhaka Mehedi Hasan/Dhaka Tribune

The decline in fertility rate was not unique to Bangladesh. But compared with neighbouring countries, the process had started later, and the decline had been steeper

At the beginning of the 1970s, with 75 million people packed in a delta the size of many small American states or smaller European countries, the then East Pakistan was described by a western journalist as a country where people are crammed in like matchsticks in a box. 

Five decades on, Bangladesh has added another 90 million or so more people to its citizenry. 

That’s a lot of people, but nowhere near what many demographers expected five decades ago. 

Donor agencies and international organizations typically projected that the new country would see its population double before the end of the century, and perhaps add another 100‑150 million by the 2020s. 

The reason there are around 165 million Bangladeshis instead of 250-300 million is because Bangladeshi women have had far fewer children over the past decades than expected by demographers. 

In the early 1970s, each Bangladeshi woman had, on average, seven children. By the late 2010s, the number had dropped to two. 

The decline in fertility rate was not unique to Bangladesh. 

But compared with neighbouring countries, the process had started later, and the decline had been steeper —from having one of the highest fertility rates in the region, it now has one of the lowest (Chart 1).

One reason why women used to have many more children in the past is because many of the newborns did not survive beyond infancy. 

In the then East Pakistan, of every thousand infants, around 150 perished. 

By 2019, the number had dropped to almost 25. 

Again, this positive development is not unique to Bangladesh. Again, Bangladesh had started later than neighbours, and is making significant progress (Chart 2)

One key reason why children survive more than in the past is because of immunization and preventative public health measures. 

For example, hardly any child aged 12-23 months was immunized for measles in the early 1980s. 

By the late 2010s, most were. Again, Bangladesh wasn’t alone in achieving this feat, but it started after others and achieved relatively more (Chart 3).

Not only do the children have higher survival odds, they are also expected to live far longer. 

In 1971, a newborn Bangladeshi would not have been expected to see the country’s golden jubilee. 

A Bangladeshi born in 2019, on the other hand, is expected to live for more than 72 years. 

Again, the rise in life expectancy is not unique to Bangladesh. 

But again, the process had started later in Bangladesh, and the pace of achievement has been faster (Chart 4).

One could cite other indicators of immunization or access to sanitation and so forth, but the pattern is pretty clear. 

In the early 1970s, Bangladesh was a laggard in terms of health outcomes. 

By the late 2010s, this was no longer the case. 

Before the Covid-19 pandemic, the average Bangladeshi had similar health outcomes as other countries in tropical Asia, even though the Bangladeshi earned less than half to three‑quarters of the income of their neighbours

Macroeconomic stability allowed successive post-1975 governments to improve people’s lives. 

The 165 million Bangladeshis, on average, earn three times as much as the 75 million East Pakistanis. They also live far healthier lives. This is an achievement worth celebrating. 

But it’s also worth stressing that Bangladesh is still has a long way to go. 

The rise of the country’s garments industry, employing millions of women, is well known. 

But less than a third of Bangladesh’s workforce is women, whereas in Vietnam the fraction is closer to half.

One disturbing reason why Bangladesh still lags behind is because it still leads in an insidious indicator —adolescent fertility. 

Shockingly, even in 2019, there were 80 births per 1,000 girls aged 15‑19 years (Chart 5). 

All the achievements of the past decade means little if we still expect so many children to raise children of their own.


Jyoti Rahman is an applied macroeconomist. His analyses are available at www.jrahman.substack.com.

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