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  • Title: Bangladesh: population control versus health.
    Journal: Lancet; 1984 Jun 30; 1(8392):1458-9. PubMed ID: 11644287.
    Abstract:
    A report from Bangladesh discusses problems related to that country's population policies. The rate of population growth continues to exceed targeted goals, despite strong support for contraception programs by the government and organizations such as the United States Agency for International Development. Some foreign donors have raised questions about the current campaign to encourage sterilizations among the rural poor by offering incentives of goods, money, and food. Another area of major concern is the allocation of available funds to population control to the detriment of other health needs, particularly maternal and child health. Bangladesh's 2.4% annual rate of population increase has not declined much in the past decade despite increasing efforts to reduce population growth. Barring catastrophe, the population may increase from 90 million in 1981 to near 150 million by the year 2000. The attention to population control has caused concern about health care, particularly for children, women, and the rural poor, to be relegated to the sidelines. The poor and the landless, who are most threatened by increasing competition for scarce resources, have not responded to incentives andpropaganda. The population growth rate target of 1.78% for the end of the 2nd 5-year plan would have required 38% of couples to be continuous contraceptive users, but in 1983 the prevalence of modern contraception was under 15%. Some large aid agencies have become irritated by resistance to population control programs. In 1982, US$60 million was committed to population control alone from all sources. Other efforts to promote family planning have included trying to influence the local government to adopt strong fertility disincentives, as well as incentives for accoptors of contraception, particularly sterilization, and for health workers who recruit new acceptors. The incentive approach has resulted in a diversion of resources away from health and toward population control. Incentives of all kinds now account for 20% of US Agency for International Development funds in the field. Through 1983, about 6% of rural women and 1% of rural men had been sterilized. Several attempts have been made to integrate health and population control since an influential report backed by the Ford Foundation appeared in 1976, but success has been limited at the local level. Some health interventions advocated for poor countries would be unacceptable in the donor countries. The Netherlands and Scandinavian countries appear to be concerned that current measures for population control could provoke a backlash, and are angry that the poor and landless are prime targets for what are viewed as socially discriminatory tactics. Neglect of care for women andchildren is a shortsighted strategy, since the fewer the children who die, the greater the liklihood that a woman will use effective family planning. Equity of distribution is a key to the Bangladesh population issue, and it is argued that the current population control approach is a way of side-stepping far harder questions of dominance by rural and urban elites and hierarchal social structures, which really determine who lives and who dies.
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