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Bangla women gets the contraceptive message loud and clear

Johara Khatun, 25, is an example of Bangladesh's success at population control. Married for eight years, she has only one child, aged five.

Johara and her husband live in a village of thatched huts in Jamalpur district, in northern Bangladesh, which is connected to the highway to Dhaka by a bumpy dirt track. Poor agriculturists, they work from dawn to dusk and just about make ends meet.

Both know about contraception. Johara says she learnt about birth control methods from the health workers who regularly visit to advise the villagers about the importance of keeping families small.

With some 11.5 million women using one kind of contraception or the other, the average size of families has reduced in Bangladesh -- an achievement that has been applauded by international organisations.

The United Nations describes the country's population programme as a ''reproductive health and family planning revolution,'' taking place for the last 20 years. In a recent survey of economic progress in developing member countries, the Asian Development Bank was all praise for it.

''Bangladesh has attracted wide attention by achieving remarkable success (in reducing fertility levels), beating a swathe of unfavourable factors including poverty, low level of urbanisation... Non-farm employment, breaking of intellectual and social isolation of villages...'' it said.

The total fertility rate has shrunk to 3.3 children per woman from the 6.3 of 1975, according to the Bangladesh Demographic and Health Survey. The country's present population is an estimated 120 million, a little less than half of whom are women.

The survey revealed that contraceptive prevalence has increased six fold from 8 per cent in 1975 to 49.9 per cent in 1997. And with 90 per cent of the users being women, the pill and tubectomy are the favoured.

A World Bank study said, ''Bangladesh is among the world's 20 poorest countries where fertility decline has begun despite social, economic and institutional circumstances that are unfavourable to reproductive change.''

The credit for putting the brakes on population growth must go to the government and hundreds of non-governmental agencies which have fanned out across the mainly-rural country. Some $ 12 million is spent every month by the government on its birth control programme, which is bankrolled mainly by the World Bank.

The government has trained nearly 25,000 family welfare assistants to take the contraception message to every village home. Their work is supervised by some 4,500 family inspectors, and as many family welfare visitors, all of whom are volunteers.

NGOs are also hard at work. Some 12,000 women health workers belonging to 382 independent groups are engaged in the rural areas in community-based delivery initiatives. The pill and condoms are distributed free and retailed in pharmacies.

Bangladesh's successful population policy also focuses on mother and child, health care delivery, NGO and community participation, and dissemination of information on good health practices like sanitation, immunisation and education.

The government programme was formulated by the National Population Council headed by the prime minister, and it has woven in the experience of NGOs whose programmes have shown that women engaged in income generating activities have a strong desire for small families.

But gains in family planning are offset by the still alarmingly high birth rate (10,000 babies are born daily) and the widespread problem of malnutrition. A staggering 93 per cent of children under five are malnourished, suffering from dietary deficiency diseases like goiter and anaemia, even though only half the population lives under the poverty line.

The government has been providing food supplements to women and children under five in six thanas (sub-districts) since 1996 under the Bangladesh Integrated Nutrition Programme, a brain child of the UN children's agency, UNICEF.

Project officials hope the BINP would increase the child survival rate in Bangladesh, which in turn would lead to improvements in women's health and lower birth rates -- a view supported by Farida Akhtar, a prominent women's activist who is very critical of the government's population programme.

''There is no such thing as family planning in Bangladesh,'' she said, ''In all developing countries, the programme that is in operation is population control.''

According to her, while family planning gives couples a choice of contraceptive methods, population control policies are formulated with the aim of restricting family size according to the socio-economic and class status of those targeted.

''Poor people are worst affected,'' she said.

The NGOs, she says, have made the poor women the targets of change. According to her, population programmes are a 'violation' of women's rights -- a view shared by women's activists worldwide who have raised the issue of gender discrimination in population control.

They all agree that only empowerment through education and self-reliance can change the situation of neglect, deprivation and repression faced by women.

UNI

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