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  • Title: Distribution system in Bangladesh spurs decline in growth.
    Journal: Popline; 1992; 14():4. PubMed ID: 12317623.
    Abstract:
    Fertility reductions in Bangladesh have contributed to a reduction in population growth from 2.5% between 1981 and 1991 to 2.3% in 1991. The average density of 800 persons/sq. km means competition for resources in a subsistence level economy. There is scarcity of land, food shortages, and an abundance of labor. Rapid socioeconomic development is not possible even with an average annual economic growth rate of 3.7% because of population growth. Birth control has doubled to 18.6% in 1991. Sterilization is no longer the primary means of contraception. Contraceptive usage increases are more widespread among young women who are spacing births. A recent study reports that fertility declines are due to increases in the expansion of family planning field workers over the past decade. Home distribution is considered compatible with sociocultural traditions. In 1990, there was 1 field worker/856 married women of reproductive age. 120 private voluntary organizations and the government provide contraceptive services. In 1989, 40% of pill and condom users obtained their supplies from commercial channels. This is possible because of the successful social marketing available through 130,000 commercial retail outlets. Nongovernmental organizations have also been given the freedom to operate independently from government programs. The International Center for Diarrheal Disease Research contributed to the contraceptive effort by field testing in Matlab, Aboynagar, and Sirajganj the introduction of door-to-door injectable contraception services and the building of satellite clinics. The information, education, and communications (IEC) activities also contributed to the 95.4% of women knowledgeable about at least 4 methods of contraception. Kantner and Noor reported that 14.4 million births were averted due to an increase in marriage age (from 16.3 years in 1974) to (17.7 years in 1989). Program efforts are being accelerated because of the 45% of the population that is presently under 15 years of age but will be reaching reproductive age shortly. This acceleration is needed to just maintain the total fertility rate of 4.6 live births/woman. The target is to achieve 50% contraceptive use by 1997 from its present level of 40%, which means 21.9 million averted births. 70% contraceptive use is needed for replacement level fertility. International donor support is still needed.
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