Inside
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The People Problem
DR. MOHAMMAD MAINUL ISLAM delves into the population problem and suggests ways to handle it.
Every year when the Population Day (July 11) approaches, people show an enthusiasm about the country's population problem. But after a while such discussions fade away, just like the government's population policies. Although high population is the prime problem of Bangladesh, population control has not been given due importance and neither has the government taken any effective steps in this regard. On the contrary, on June 2, 2010, in the Parliament, what the honorable Prime Minster said is really frustrating. She neither considers the population of one of the most highly dense countries of the world as a burden, nor is she concerned about the high growth rate of its population. She vowed to transform the population into skilled manpower -- which of course we all appreciate -- but without keeping it within a manageable and tolerable limit, is it really feasible? Is population in Bangladesh a development challenge or a development opportunity? The fact remains that, high population growth is a serious impediment towards the development efforts of the country and therefore it is crucial to realise the seriousness of the issue and to take necessary steps in this regard as uncontrolled population could very well spoil all development efforts. We must develop the nation but the increasing population of Bangladesh may act as a formidable obstacle.
Photo: Prito Reza
Population in Bangladesh and national budget:
There exist differences in opinion about the exact size of the population of Bangladesh and in this context the government and the UNFPA differ. Given the fact that the result of the census that took place between March 15-19 has not yet been published, it is difficult to ascertain the exact figure. But according to the UN Population Division, at the moment the population of Bangladesh is more than 16 crore (2008 revision). According to the Vision 2021 of the present government, by the end of 2020, population of Bangladesh will exceed 18 crore, of which 8.2% will be of over 60 years of age. In each square kilometer, 1,289 people will be living where the corresponding figure at present is 1,142 people. Growth rate of population will be reduced to 1.15% from 1.42% and every year there will be an addition of more than 20 lakh people.
Following this trend of population, in 2050 the population of Bangladesh is projected to reach as high as 22 crore. Therefore, we can be said to be moving towards an uncertain future and if we do not control population now, our future looks bleak. In spite of such an alarming situation, it is a matter of great regret that the population programmes of the country lack required momentum. In the national budget, we neither find any specific plan of action nor the required allotment. Such a negligence has also been reflected in the fiscal year 2012 national budget. Although in the 18(1) section of the constituency of Bangladesh, improving the nutritional as well as the health status of its citizens have been referred to as one of the primary duties of the nation, in the 1,63,589 crore taka budget of FY 2012, only 8,898 crore taka or 5.10% of the budget has been allotted to the health sector, which is about 7.5% of development and 4.2% non-development expenditure and 1.13% of gross domestic product (GDP), for the health and population sector. This allotment is even 0.90% lower than FY 2011 budget.
Although the budget speech has given importance to the health sector, when it comes to the question of allotment, such importance cannot be observed. Just like before, instead of social sector, infrastructure development has been given greater importance. As a result, improvement of health status and health care services will face various challenges. Against the backdrop of lagged behind health system, inefficient family planning, badly affected upazila hospitals from the scarcity of good doctors, and as a whole the deprivation of the mass population from efficient and modern health care services, the allotment given in the health and family planning sector is surprisingly low. No doubt, more budgetary allocation was needed in the sector, particularly for population control. However, we also do not observe any clear vision or clear cut strategies in the FY 2012 budget. In this context, even if agricultural production increases significantly, if the present growth rate of population continues, the target of self sufficiency in food can simply be considered as a fairy tale story.
Fertility and family planning
Currently, women in Bangladesh have an average of 2.7 children (BDHS 2007). Fertility has continued to decrease since the BDHS 2004, which reported Total Fertility Rate (TFR) as 3.0 children per woman. Fertility has declined steadily over the years, from over six children per woman in 1975 to under three children per woman in 2007 (Figure 1). Women in urban areas have 2.4 children on average, compared to 2.8 children per woman in rural areas. Fertility also varies with mother's education and economic status. Women with no education have an average of 3.0 children compared to 2.3 among women who have completed secondary school or higher. Fertility also decreases with household wealth. The poorest women have an average of 3.2 children -- one child more than women from the wealthiest households (2.2 children).
Figure 1: Trends in Total Fertility Rate (Number of Children per Women)
In Bangladesh, although knowledge of family planning is universal, only half of married women are currently using a modern method of family planning (Figure 3). Use of modern methods has increased dramatically since the 1980s, but has remained relatively stable since 2004. However, use of modern family planning varies by residence -- 52% of married women in urban areas, compared to 46% in rural areas.
Figure 2: Trends in Use of Contraception (Percentage of currently married women currently using a modern method of family planning)
BDHS 2007 reveals that 17% of married women have an unmet need for family planning (the percentage of married women who want to space their next birth or stop childbearing entirely but are not using contraception) of which about 7% for spacing and 11% for limiting.
Bangladesh Population Policy (2004) and National Health Policy (2009) refer to ensure adequate availability and access of reproductive health services, especially family planning services to all including information, counseling and services for adolescents. But in reality, availability of contraceptives and access to required services at the grassroots level are inadequate. Twenty percent of currently married women age 15-49 were visited by a fieldworker for family planning services in the six months before the survey as reported, the picture is not impressive at all. Although three in four women reported a satellite clinic in their community in the three months before the survey (BDHS 2007), about only one-third visited the clinic.
Age at marriage, age at first birth and teenage fertility
Although the legal age of marriage in Bangladesh is 18 years for women currently, half of women aged 25-49 were married by age 15. Also, it is evidenced that childbearing begins early in Bangladesh -- half of women aged 25-49 had their first birth by age 18 and 12% had their first birth by age 15 (BDHS 2007). Age at first marriage and first birth has increased in recent years. Women who are 20-24 had their first marriage at a median age of 16 and their first birth at a median age of 19. Early/child marriage is now widely recognised as a violation of children's rights, a direct form of discrimination against the girl child who as a result of the practice is often deprived of her basic rights to health, education, development and equality. In this regard, as the use of law as a means of regulating early marriage is in no way sufficient, the government should be encouraged to create a policy environment that supports later marriage, through legal reform, and affirmative policies and programmes on behalf of women who are vulnerable.
Child mortality, maternal mortality and nutrition
There has been impressive decline in child and maternal mortality, which continue to decrease in Bangladesh. The infant mortality rate for the five years before the survey (2002-2006) is 52 deaths per 1,000 live births and the under-five mortality rate is 65 deaths per 1,000 live births (BDHS 2007). This is significantly lower than the rates of 65 and 88 reported in 2004 (BDHS 2004). Maternal mortality declined from 322 in 2001 to 194 in 2010, a 40% decline in the last nine years (Bangladesh Maternal Mortality Survey, BMMS 2010). Currently, just over half of Bangladeshi women receive some antenatal care from a medical professional such as a doctor or nurse/midwife (BDHS 2007). The large majority of Bangladesh's births occur at home -- only 15% occur in a health facility, which is not impressive at all. Sixty-three percent of the births are assisted by untrained traditional birth attendants (TBA), while 11% are assisted by trained TBAs. Greater use of facilities of delivery and management of obstetric complications are required to reduce the risk of maternal death.
Bangladesh children and women face nutritional challenges. According to the 2007 BDHS, 43% of children under five are stunted or too short for their age which indicates chronic malnutrition. Stunting is more common in rural areas (45%) than urban areas (36%). Seventeen percent of children are wasted (thin for height), and 41% of children are underweight. Stunting is most common in the poorest households, where more than half of children are too short for their age. Although stunting and underweight have decreased since 2004, wasting has increased slightly.
Women's poor nutritional status has also been evidenced in BDHS 2007 where 30% of women are thin (BMI <18.5), and 12% are moderately and severely thin (BMI <17.0). On the other end of the spectrum, 12% of Bangladeshi women are overweight or obese (BMI =25.0).
Women's empowerment:
In Bangladesh, half of the total population is women. Based on their employment, freedom of movement, participation in household decisions and health outcome, the situations of women are reflected in Bangladesh Demographic Health Surveys (BDHS). One-third of currently married women age 15-49 were employed of which mostly earn cash, while 14% are unpaid. Although most of the women decide with their husbands how their earnings are spent, 12% of women who earn cash report that mainly their husbands decide how their earnings are spent (BDHS 2007). Regarding freedom of movement, two-thirds of women can go alone to a health centre or hospital, while 16% can go to a health centre or hospital if accompanied by their children. Eighteen percent of women cannot go to a health care facility alone or accompanied by their children. In case of participation in household decisions, Bangladeshi women contribute to many household decisions. Fifty-six to 64% of women participate in decisions concerning their own health care, daily and major household purchases and visits to family and friends. About one-third of women participate in all four of these decisions but 17% participate in none of them. Women who participate in more household decisions are more likely to use family planning than women who participate in no decisions. Only 43% of women participating in no decisions use a method of family planning compared to 61% of those who participate in all five decisions. Women who participate in more decisions are also more likely to receive antenatal or delivery care from a medically trained provider.
Urbanisation and migration:
Urban population in Bangladesh is growing more rapidly than the population as a whole. In 1970, the urban population was only 7.6% whereas in 2010 it was 27.1%. In 2030, it is projected to reach 39.3% (World Population Prospects: The 2008 Revision, UN Population Division). That means that in near future (by 2040), half of the total population will live in cities. Different sources confirm 40% of the city residents are slum dwellers currently. Providing health and other services to these people will be a great challenge. It can be noted that urbanisation and internal migration are interrelated. With the increasing trends of population, people are directed to cities. In 1974, the number of migrants was 2.43 million which accounted for 3.44 percent of the total population of Bangladesh. The estimated life time migration rate for the period of 1981-1991 was 10.44 and for the period of S1991-2004 was 9.34% which indicates that population movement has increased in manifolds. Latest Sample Vital Registration System (SVRS) 2008 of Bangladesh Bureau of Statistics reports that currently in-migration rate in Bangladesh is 30.62 per 1000 population where urban and rural in-migrants are 51.69 and 16.64 respectively. Higher migration occurred in urban areas than in rural areas. For balanced distribution of population, necessary support and intervention based on regions or locality are required.
Age structure, youth and old aged population
Currently, the average age of Bangladesh population is 24.5 years (World Population Prospects: The 2008 Revision, UN Population Division). A large number of young people -- 20.1% is aged 15-24 years. National Foundation of Youth of Bangladesh (NFYB) reports there are 450 million people aged 18-35 years. This large number of young/youth population can be a demographic bonus if they can be handled rightly with proper actions. Otherwise this portion of population will be a burden for the country. Based on the Labor Force Survey 2005-2006, population engaged with work or looking for work is 40.6% in those aged 15-29, whereas 53.53% are in the 30-64 age group. In case of under employment or people who worked less than 35 hours in a week, 24.53%, most of them are female (68.25%). To overcome this situation, scope of more employment opportunities are essential.
Latest World Population Prospects: The 2010 Revision of UN Population Division (2011) shows the percentage of total population in Bangladesh by age groups/sex where the shape of population pyramid is changing over time (Figure 3). In 1991 and 2001 Census, population aged 60 and above was 5.4% and 6.1% respectively in Bangladesh. Due to declining birth rate and increasing life expectancy at birth, age 60 and above population will reach 8% in 2030 where as the life expectancy at birth in 2020 and 2030 will be 69.7 and 72.5 years respectively (World Population Prospects: The 2008 Revision). Government will face a huge challenge in dealing with the issue of increasing number of elderly in coming days. Old-age pensions and other social security support should be provided which will not be easy to handle for Bangladesh being a developing country with low income.
Figure 3: Population by Age groups/Sex in Bangladesh (Percentage of total population)
Note: The dotted line indicates the excess male or female population in certain age groups. Age groups are in percent of the total population in 1950, 2010, 2050 and 2100, respectively.
Source: United Nations, Department of Economic and Social Affairs, Population Division (2011): World Population Prospects: The 2010 Revision. New York
Population and poverty
Poverty alleviation is a huge challenge for the development of the country. The importance of poverty reduction for the development of population cannot be over emphasised. According to the Household Income and Expenditure Survey, in the year 2000, 48.9% of the population was below the poverty line, which has come down to 40% in year 2005/06. On the contrary, in 1995/96, the corresponding figure was as high as 50.1%. A very recent Household Income Expenditure Survey 2010 of the Bangladesh Bureau of Statistics (BBS) reports, Bangladesh has cut down its poverty by about 8.5 percentage points since 2005. Almost 13 million people were lifted out of poverty during this period. According to this survey, poverty in the country has declined to 31.5% from 40% in 2005. About 17.6% people are now living below the poverty line, with about 21% of the population living in the urban areas and 35.2% in the rural areas. The per capita income rose by 72% from 2005. In 2005, the monthly per capita income was Tk. 1,486. The survey also revealed national poverty rates at 31.5%, a decline of 8.5 percentage points from 2005. About 21% of urban population is poor while the figure is 35.2% for rural areas.
Household Income and Expenditure Survey for 2005 also refers to a declining trend of absolute poverty (2122 k.cal/capita/day) since 1991-92 at national level. It was estimated at 47.7%, 47.5%, 47.5%, 44.3 % and 40.4% in 1991-92, 1995-96, 2000 and 2005 respectively whereas the number of persons falling below the absolute poverty line was estimated at 49.7 million, 51.6 million, 55.3 million and 56.0 million in 1991, 1995-96, 2000 and 2005 respectively. This contrasting feature was due to higher population growth rate than the rate of poverty reduction during this period.
Effective and timely design of policies and their effective implementation is crucial to alleviate poverty for the betterment of population. In addition to the already existing Food for Work (FFW), VGD, VGF, OMS, Old Age Support Scheme, Social Security for the Retarded and Physically Handicapped programmes, the government has to undertake newer schemes to protect the vulnerable population, with a view to the overall improvement of the population of the country.
Population and climate change
According to recent Global Climate Risk Index (CRI) 2010 by Germanwatch, Bangladesh is one of the mostly affected countries from extreme weather events covering 1990 to 2008. In this regard the population trends will expose more people to climate change impacts in future. Bangladesh is already beginning to experience climate change impacts, especially in coastal areas. As we know, many of the policies affect population trends. For instance, voluntary universal access to good quality reproductive healthcare services and meeting the demand of family planning can play an important role on climate change adaptation and mitigation in Bangladesh. But these have not yet been incorporated into comprehensive climate change solutions. The government and non-government organisations must address the needs for reproductive health and family planning following the Program of Action ofICPD (International Conference on Population and Development), Cairo, 1994 that marked fundamental shift in the motivation for population-related policies by improvement of individual well-being. This will not only improve the health and well-being of the population but also slow the growth of GHGs and reduce human vulnerability to climate change impacts. The population trends are closely related to the growth by GHGs that cause climate change. But climate change models likely undervalue the impact of demographic trends on GHGs emissions growth as only population size is considered but not made for compositional changes within the population it grows.
As the Bangladesh population is becoming gradually more urban and older, household sizes are getting smaller. These changes have to be truly accounted for in climate change models although energy consumption patterns differ between rural and urban population, younger and older populations, and large versus fewer household sizes. Future population growth in Bangladesh could accentuate climate change whereas a reduction in growth rates would help mitigate climate change speeding up poverty reduction and development. We sincerely hope that the government of Bangladesh will take effective steps associated with population: how population factors are linked to climate changes' causes and effects, and how they can be a component of addressing the challenge. Understanding the complex relationship between population and climate change and examining the links between population size and other factors related to mitigation and adaptation should be the priority in addressing climate change and its consequences. Analysing population dynamics can illuminate who is most vulnerable, why, and how interventions can most effectively reach them.
Recommended strategies towards population control
This is the right time to formulate policies and strategies in the context of population and for its effective implementation. However, without changing the outlook towards population and without thorough modifications of the plan of action, no targets can be achieved. Through detailed discussion and consultation, a new Population Policy has to be designed and clear cut strategies have to be formulated. At the same time, rigorous steps should be taken for the effective implementation of those strategies:
Photo: PRITO REZA
--To reopen the previously established Family Planning Ministry and to strengthen its capacity.
--To take necessary steps to popularise the slogan, “Not more than Two Children, One is Even Better” and to encourage the mass population.
--To recruit skilled manpower at field-level for home visit, to provide services and to bring discipline in administration.
--To encourage to marry at older age, to have children later and to have sufficient gap between two children. In this context, steps can be taken to provide special facilities, e.g., health insurance to the parents of one child.
--To take necessary steps to provide financial benefits at an increasing rate to those adopting permanent and long term methods of family planning.
--To improve the quality of service by improving the standard of health and family planning centres at Union level.
--To expand the activities of Satellite clinic while satisfying mother-child health care at village level.
--To change the method of communication for conveying information about family planning for newly wed couples. To utilise TV channels, cell phones, radio, etc., as the means of communication on priority basis and to increase public awareness at individual level and also to increase interpersonal communication.
--To incorporate the eligible couples living in slums, barrages, char-land and remote areas within the realm of service provision and to satisfy their requirements.
--To incorporate reproductive health, mother and child health, vulnerable people's education and employment into social safety net programmes.
--To give priority to population control and health sector in the allocation of national budget.
--To implement PPP in health sector and to effectively plan population control policies.
--To take necessary steps towards poverty alleviation through population control and to mitigate the consequences of climate change through acceleration of development efforts. Controlling the size of population and to emphasise examining the links between population size and other factors related to mitigation and adaptation should be the priority in addressing climate change and its consequences.
In conclusion, we can say that, for the development of the country, it is not only important to control the size of the population, but also to develop/improve the quality of it through education, training and other skill development mechanisms. Both the government as well as the opposition have to consider it as a challenge for the nation and to come forward to attain this target of population control and human resource development. The strategies and policies of the present government in the context of population control are still not quite clear. Integrated initiative is imperative to reduce the high rate of population growth and to improve the quality of manpower. In this regard, strong political commitment and the effective and timely implementation of such commitment are crucial.
Mohammad Mainul Islam, PhD, is Assistant Professor in the Department of Population Sciences of the University of Dhaka (E-mail: mainulbdcn@gmail.com, mainul@pku.edu.cn).