The speed with which population is growing, and the pervasive consequences of this growth, pose a serious challenge to Bangladesh. The population explosion does not have the sharpness and visible urgency of a cyclone or a sudden onslaught by an enemy, but its effects are even more far-reaching. Intellectual awareness of the causes and effects of overpopulation as well as introduction of population slogans for motivating the donor agencies are not enough. The problem is to generate the emotional commitment necessary to take the matter out of the halls of intellectual speculation and into the area of organised action. Over the past four decades, concern with the problem of overpopulation has spread around the country but none of the family planning programmes have matched the proportions of the problem.
Family planning (FP) was introduced in Bangladesh in 1950s through the voluntary efforts of social and medical workers. The government adopted FP as a government-sector programme in 1965. The policy to reduce fertility rates has been repeatedly reaffirmed by the government of Bangladesh since independence in 1971. In 1976 the government declared the rapid growth of the population as the country's number one problem and adopted a broad-based, multi-sectoral FP programme along with an official population policy. All the governments, even many NGOs, adopted mass FP programmes but could not achieve the set target. Absence of dedicated field workers and leadership as well as integration of health and FP programme are the main reasons for the failure of FP programme.
Young people (below 16 years) make up 42% of total population and reproductive women aged between 16 and 48 years number 38% of all women. As life expectancy is increasing the size of the elderly population is increasing, thereby increasing the dependency burden. The number of the school age population has decreased to 33.1 million as against 34.2 in 2001, while the working age population (15-62 yrs) increased to 132 million, and will increase to 178 million by 2017, aggravating further the strained labour market. It is apprehended that the population density will be 4,167 persons per square mile in 2021 as against the present density of 2,592 persons.
Rural-urban difference in fertility is quite substantial. Total Fertility Rate (TFR) for rural women is about 3, and that of urban woman is 2.4. It was 3.4-3.2 during 1991-2000 followed by sharp decline by 0.6 during this decade. Rural-urban population distribution is 73:27. In recent years, rural-urban migration has increased steadily. Almost 85% of the rural migrants are absorbed in four main cities. Death matters no less than birth, indeed more, to demographers. The decline in deaths, particularly among infants, means more babies will live to grow up. So a country's population becomes more youthful, as in the case now in Bangladesh.
Population growth momentum has started and various pressures have been generated. If Bangladesh can achieve NRR = 1 by 2016 (which was planned to be achieved in 1998), population will stabilise by 2070 at around 230 million, followed by stationary population in next 12-15 years. The population, it is expected, will reach 230 million by 2044 if the present trend of growth continues. So NRR=1 by 2016 cannot be achieved.
FP programmes were geared to provide contraceptive methods among all eligible couples before 1992, which was diverted to ensure maternal and child health care/services. This caused an increase in the population and unplanned families. Earlier, FP field officials went to door to door to give the message of family planning and its services, including distribution of pills and condoms to the couples directly, and motivated the couples to accept IUD, sterilisation or other permanent methods. But the FP programme is now concentrated only on maternal and child health issues.
Women in Bangladesh are the main stakeholders in the population and FP programme/methods. They are shy to talk about it with their family members, and in most cases they do not know about contraceptive usage and its availability. FP programmes at the field level became inactive in 1992 due to integration. It may be mentioned that illiteracy, ignorance, shyness and poverty deprive the women of all sorts of facilities, including access to clinics or pharmacies to buy the contraceptives. They need to depend on their husbands. Door to door approach of FP services should be reintroduced immediately to achieve NRR=1 by 2016.
Population momentum is coming from low-income families, who comprise 55% of the society. Infant mortality and maternal mortality rates are the highest among them. Their Total Fertility Rate (TFR) is higher than that of the upper, middle and high-income groups. They have very little access to education beyond primary level, health care services and other benefits. The objectives of the population policy are to reduce TFR and increase the use of FP methods among eligible couples by raising awareness about FP. Birth rate may decline through FP programme efforts reinforced by non-family planning measures like female education, skill training, use of media etc.
Managing population requires planned actions, including balanced distribution of rural-urban migrants, relocation of industries from the cities, and increasing people's mobility. Bangladesh has quite a number of programmes to reduce birth and death rates but none to influence migration. The government policy is to provide food, social security and shelter for the disadvantaged, including the elderly, destitute and physically and mentally retarded persons. It puts emphasis on regulating and reducing rural-to-urban migration, ensuring safe drinking water etc. Necessary steps need to be taken to achieve these objectives by attaching FP activities in all development programmes as part of the project.
Bangladesh suffers because of population density, poor land-man ratio (1:16 decimals), slow economic growth, massive unemployment and huge working age population relative to the size of job market. Though the government and NGOs have identified over-population as the number one problem, there is no significant attempt to make them skilled or bring them in the mainstream development activities. Huge investments have been made in FP programmes, but we could not achieve the objective of those programmes till date. However, family planning and population issues must continue to be priorities. If we are serious about saving women's lives as well as achieving overall development, family planning must remain at the centre of the agenda.
A separate ministry and budget should be introduced for launching meaningful FP activities, like door to door approach to educate the people about FP services, distributing contraceptives and motivating them to accepting permanent birth control programmes. The upazila and union parishads may be involved for intensive execution of programmes. An effective FP programme cannot achieve its goal through the FP personnel alone. A concerted effort by all -- political institutions, policy makers, technocrats, community leaders, related ministries etc -- should be ensured. The population explosion was not given due importance for the improvement of the programme as a whole. More emphasis, therefore, has to be given on achievement of demographic goals with the help of effective organisational structure along with efficient management system.
The writer is a former Joint Chief, Planning Commission. Email: [email protected]