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BANGLADESH UNIVERSITY OF HEALTH SCIENCEDEPARTMENT OF EPIDEMIOLOGY

FERTILITY TRENDS IN THE BANGLADESH

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Introduction:

At the beginning of the 20thcentury, the total population of Bangladesh was less than 30 million. The annual growth rate of the population was less than 1 percent until 1951, when the population reached about 44 million (Bangladesh bureau of statistics, 1998). From the early 1950s, mortality started to decline while fertility remained high until the 1970s. owing to the changes in fertility and mortality rates, from the 1950s the population started to grow at an unprecedented rate, reaching an all-time high (about 2.5% per year) in the 1960s and 1970s. The growth rate then started to decline in the 1980s and is currently about 1.2% per year. The Bangladesh population policy indicates that the population should stabilize at 210 million by 2060, if replacement level fertility is reached by 2010. This estimates of future population science is reasonably consistent with the World Bank projection from 1994 (BOS et al., 1994), and the UN projections 1996 revisions (UN 1996), both of which estimated on mid 21stcentury population of 210 million. The main source behind the decline in the population growth rate of Bangladesh in the 1980s and 1990s was a remarkable decrease in fertility during the period. In the early 1970s, the TFR was about 7 children per woman, and an estimated 2.7 children per woman obtained by BDHS 2007. In the 2011 BDHS, ever-married women were asked to provide retrospective information on all their live births. To encourage complete reporting, each woman was first asked about the number of sons and daughters living with her, the number living elsewhere, and the number who had died. She was then asked for a history of all her births, including the month and year in which each child was born, the childs name, sex and, if dead, the age at death, and, if alive, the current age and whether the child was living with the mother. The TFR is so surprisingly low that quality of the data is being questioned. The aim of the chapter is to unmark genuine trends from the BDHS 2011data. Its aim is to reach the firmest possible conclusions about the timing, magnitude, and nature of fertility decline in Bangladesh.

Age specific and total fertility rate:Age-specific and total fertility rates for the survey are calculated directly from the birth history data along with the general fertility rates and crude birth rates. The total and age-specific fertility rates are for the three-year period before the survey, a period covering principally the calendar years 2009-2011. The total fertility rate (TFR) is the sum of the age-specific rates and is a useful measure of the level of recent fertility. It represents the number of children a woman would have by the end of her reproductive years if she were to bear children at the currently observed age-specific rates. The total fertility rate for the three-year period before the survey is 2.3. Bangladeshi women have a pattern of early childbearing.

Fertility measures are calculated directly from the birth history data. Although information on fertility was obtained from ever married women, estimates are presented for all women regardless of marital status. Data from the Household Questionnaire on the age structure of the population of never-married women are used to calculate all-women rates. This procedure assumes that women who have never married have had no children.

TABLE: CURRENT FERTILITY:

Age groupUrbanRuralTotal

15-1991128118

20-24121165153

25-2995111107

30-34585556

35-39192221

40-44466

45-49143

TFR (15-49)2.02.52.3

GFR769791

CBR20.623.322.6

Notes: Age-specific fertility rates are per 1,000 women. Rates for age group 45-49 may be slightly biased due to truncation. Rates are for the period 1-36 months prior to interview. TFR: Total fertility rate expressed per woman GFR: General fertility rate expressed per 1,000 women age 15-44, CBR: Crude birth rate expressed per 1,000 population

Figure 1 Trends in Age-Specific Fertility Rates

200

1,000women150

100

Per

Births50

0

15-1920-2425-2930-3435-3940-4445-49

Age group

1999-2000 BDHS2004 BDHS2007 BDHS2011 BDHS

BDHS 2011

Fertility in Bangladesh has been declining since the 1970s. The TFR declined sharply from 6.3 births per woman in 1971-75 to 5.1 births per woman in 1987-1989 (Table 4 and Figure 3), followed by another rapid decline in the next decade of 1.8 births per woman to reach 3.3 births per woman in 1995-97. The TFR declined further by

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One child per woman during the current decade to reach 2.3 births per woman. So, following a decade long plateau in fertility (1993-94 to 2004) at around 3.3, there has been a steady and encouraging decline in each subsequent DHS (9 percent between 1999-2000 to 2004; 10 percent between 2004 and 2007 and almost 15 percent between 2007 to 2011). Between 2007 and 2011 the decline in fertility was greater in urban areas (17 percent) compared to the rural areas (11 percent).

Bangladeshs current health sector program, the Health, Population and Nutrition Sector Development Program (HPNSDP) 2011-2016 aims to reduce fertility to 2 births per woman by 2016. Khulna (1.9 births per woman) has reached that level already, and Rajshahi and Rangpur are very close (2.1 births per woman) (Figure 2).

Table 4 Trends in current fertility rates

Age-specific and total fertility rates (TFR) among women age 15-49, various sources, Bangladesh, 1975 to 2011

Survey and approximate time period

1975198919911993-1994 1996-1997 1999-2000200420072011

BFSBFSCPSBDHSBDHSBDHSBDHSBDHSBDHS

Age group(1971-1975)(1984-1988)(1989-1991) (1991-1993) (1994-1996) (1997-1999) (2001-2003)(2004-2006)(2009-2011)

15-19109182179140147144135126118

20-24289260230196192188192173153

25-29291225188158150165135127107

30-342501691291059699837056

35-3918511478564444413421

40-44107563619181816106

45-493518131463313

TFR 15-496.35.14.33.43.33.33.02.72.3

Note: For the 1975 and 1989 BFS surveys, the rates refer to the 5-year period preceding the survey; for the other surveys, the rates refer to the 3-year period preceding the survey.The BFS and BDHS surveys utilized full birth histories, while the 1991CPS used an 8-year truncated birth history.

Source: 1975 BFS (MOHPC, 1978:73); 1989 BFS (Huq and Cleland, 1990:103); 1991 CPS (Mitra et al., 1993:34); 1993-94 BDHS (Mitra et al., 1994:24); 1996-97 BDHS (Mitra et al., 1997:30); 1999-2000 BDHS (NIPORT et al., 2001:32); 2004 BDHS (NIPORT et al., 2005:50) ; 2007 BDHS (NIPORT et al., 2009:50)

Births per woman

Figure 2 Trends in Total Fertility Rates by Division, 2007 and 20114.03.7

3.23.1

3.0

2.82.82.8

2.32.22.4

2.1

2.0

2.01.9

1.0

0.0BarisalChittagongDhakaKhulnaRajshahiSylhet

2007 BDHS2011 BDHS

Note: Rajshahi includes Rangpur divisionBDHS 201

Figure 3 Trends in Total Fertility Rates, 1975-2014

COMPARISSION OF THE TFR OF BANGLADESH 2014 WITH THE PREVIOUS YEARS:

YEAR200020012002200320042005200620072008200920102011201220132014

TFR2.852.782.723.173.153.133.113.093.082.742.652.62.552.52.45

CAUSES OF DECREASE FERTILITY RATE:

1. Use of family planning: Overall, 61 percent of currently married women in Bangladesh are currently using a contraceptive method. The majority of women use a modern method (52 percent) and 9 percent use traditional methods. The pill is by far the most widely used method (27 percent), followed by injectable (11 percent), female sterilization (5 percent), and condoms (6 percent). About one percent of women mentioned the use of male sterilization, IUDs, and implants.

2. Woman empowerment.

3. Socio-economic changes

4. Education: increasing access to primary and secondary education, Particularly for girls;

5. Gender: an overall improvement in the status and role of women;

6. Economic situation: better economic conditions, following a rise in income-generating activities and employment opportunities, Particularly for women (for example in garment factories);

7. Nutrition and housings e increasing cost of sustaining a large Family, such as providing food, housing, clothing, school fees;

8. Public awareness: improved access to the mass media.

WHEN BANGLADESH WILL GET NRR-1?

The main objective of Bangladesh Population Policy 2004 was to achieve Net ReproductiveRate (NRR) = 1 by 2010 in order to have a stable population by 2060. But as it has not beenPossible to achieve NRR = 1 by 2010 as targeted originally, it is now imperative to update theCurrent population policy to accelerate the related activities Current Bangladesh NRR is 1.03 to achieve NRR 1 Bangladesh have to do following steps. They are:Ensure services through existing Health and Family Welfare Centers in districts, upazillas, and unions, including Satellite and Community Clinics in the community;Continue providing door-to-door services to all eligible couples, especially to the poor, and ensure mechanism for referral from the field level. Also establish e-reproductive services;Bring newly-weds, adolescents and parents of one or two children under the coverage of family planning services on a priority basis;Identify couples with unmet needs for health and family planning information and services, and ensure delivery of those services;Encourage all eligible couples to accept family planning methods through informed choice and voluntarism;Make all-out efforts to popularize and establish the slogan No more than two children, but one is better;Undertake behavior change communication (BCC) programs to encourage the seeking of prenatal, natal and postnatal services;Ensure providing information and advice in favor of late marriage and having children with adequate birth intervals;Encourage the affiliated non-government organizations to expand their programs on health, nutrition and population in areas where these services are absent;Formulate gender sensitive strategies for both men and women in all government and non-government activities;Womens skills development through imparting appropriate education and vocational training, and ensure their participation in economic activities;Encourage institutions/organizations involved in womens development to participate in activities pertaining to family planning and reproductive health;Create gender equality among boys and girls in terms of access to health services, nutrition, education and employment.

CONCLUSION:

The most notable demographic change in Bangladesh has been the countrys unique and drastic decline in the total fertility rate since the 1970s. The e TFR decline has resulted from strong governmental engagement and support in the fields of population, family planning, health, education, and employment. Its most salient causes were efficient family planning programs and important socioeconomic changes, including an increase in female education and employment, and a wider-spread access to mass media. As a result of high fertility rates in the past, however, a very high proportion of the population is currently at reproductive age which will lead to a further population increase (population momentum). The current population growth occurs primarily in urban areas resulting in an exacerbated urbanization trend. Bangladesh also faces an ageing population as a result of a decrease in crude birth and mortality rates. The proportion of elderly within Bangladeshs population is projected to increase to 26 percent in 2100. This shift towards an older population will be accompanied by an increase of chronic and degenerative diseases, posing a challenge to the health and social protection systems.

REFERENCES:1. BDHS-2011 data2. Population dynamics in Bangladesh by- Annett Fleischer, Melanie Lutz, Jean-Olivier Schmidt3. http://ageingasia.org/wp-content/uploads/2015/07/Bangladesh-Population-Policy-2012.pdf4. http://gsdl.ewubd.edu/greenstone/collect/ewunewsc/index/assoc/HASH0176/73ddf065.dir/07.03.2010_NA_304.6_Population%20explosion-%20a%20prime%20national%20problem.pdf5. www.indexmundi.com----tfr rate of Bangladesh