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Population Challenges for Bangladesh
On the occasion of the World Population Day which will be observed on July 11, 2012, A K M NURUN NABI offers an in-depth analysis to face up to the challenges posed by population growth.
Are there too many people in Bangladesh? Some will burst out in disgust and say, “What kind of a question is this? Of course, this nation is overburdened with too many people. Don't you see the crowd everywhere on the streets, buses, trains, offices, houses, markets, schools, colleges, universities, hospitals, and where not”? While others will protest and say, “Our population is not a problem at all; rather it is our wealth, as increasing supply of labour force brings remittances for the nation. Since the developed countries cannot replenish their labour force on their own because of their negative growth rate, Bangladesh has the opportunity to fill those gaps and earn foreign currencies by exporting its human resources”. This debate may go on. A population may become a strength or weakness depending on the socio-economic, politico-cultural and demographic characteristics and their management for the overall national development process. Let us examine some important issues related to the population dynamics of the country.
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A large population with high density, built-in population momentum and early marriage
Bangladesh, with an estimated population of over 150 million, is one of the most densely populated countries in the world. Close to 1,000 people live in one square kilometer area. This high population density is not a new phenomenon to the people of this region. Historically, Bangladesh has experienced a high density of population due to its developed technology and fertility of the soil. What is new to Bangladesh is that the abundance of resources and the developed technology are not there anymore to sustain its population size.
With a growth rate of 1.34 percent per annum, 1.8 to 2.0 million people are being added to the total population every year. This does not end here. The projection shows that the population is likely to grow up to 222 million around 2051, and stabilise at 250 million by 2081, even if replacement level fertility is achieved by the year 2015. Despite the substantial decline in the growth rate, the built-in population momentum due to young age structure in the population will keep forcing its number to increase very rapidly for years to come.
Currently, more than 35 percent of the total population is below 15 years of age and the largest proportion of young population ever is waiting to enter the reproductive age. Young mothers are contributing more to the total fertility rate (TFR) now than before. Contribution of Adolescent Fertility to TFR rose from 20.8 percent in 1991 to 23.3 percent in 2007. The estimated number of women of reproductive age is 40.8 percent, and will rise to about 48 percent by 2021. The pace of momentum is being accelerated by the practice of early marriage of girls. According to the BDHS 2007, the female median age at marriage is 15.3 years. Whereas the legal age at marriage for girls is set at 18 years. The figures show that 68 percent of the adolescent girls are married by the age of 18, and 55 percent of them are becoming mothers before reaching the age of 19 years.
Declining fertility with wide regional variations and high contraceptive discontinuation
The level of total fertility rate (TFR) has declined substantially from 6.3 in 1975 to 2.3 in 2011. However, wide variations exist across socio-economic groups and geographic regions. While Khulna, Rajshahi and Dhaka divisions have already reached the replacement level fertility, Sylhet, Chittagong and Barisal lag behind. The poor and less educated women have the highest fertility while the rich and educated (secondary completed or higher) have the lowest.
It is also observed that among women aged between 20-49 years, median age at first birth is more than two years higher for women in the highest wealth quintile (19.7 years), compared with those in the lowest wealth quintile (17.3 years). According to 2006 Bangladesh Urban Health Survey (BUHS), childbearing began earlier in the urban slums compared to the non-slum and District Municipality areas. In the slum areas, about two in three women (64 percent), aged 20-24 had become mothers before age 20, while the proportions were less than half in the non-slum (44 percent) and District Municipality areas (45 percent).
The contraceptive prevalence rate (CPR) has also increased significantly from 7.7 in 1975 to 61.2 in 2011. However, similar variations also exist in case of CPR. Although the contraceptive discontinuation rate has declined from 56 to 36 percent during the period between 2007 and 2011, it is still very high. The once globally famous family planning program of Bangladesh seems to be very weak due to the bifurcation of family planning and health. Only 20 percent of currently married women are exposed to field workers in a month. Women in Bangladesh generally complete childbearing by the age of 25, risking their lives for unintended pregnancies without protection due to improper method mix and unmet need for family planning methods. About two third of the women do not want any more children and their demands for family planning remain increasingly unmet. Unmet need for family planning methods is 12 percent. Campaign for behavior change communication (BCC) and advocacy for family planning are very inadequate.
Safe motherhood and nutrition with biased attitude towards urban, educated and rich people
The maternal mortality ratio (MMR) has declined from 574 in 1989 to 194 in 2010, indicating a progress in line with achieving the MDG target. However, still 35 percent of maternal deaths occur due to indirect causes. We have not been able to understand these indirect causes yet. The proportion of births attended by a skilled health worker is still low (32 percent). The antenatal care coverage of at least one visit is far behind the target (68 percent). The number of facilities has increased overtime, but they are not well equipped with adequate human resources. Health facilities are still inaccessible to the people of the lower strata. The success in maternal and child health seems to be biased towards urban, educated and rich segment of the people.
Women in the richest quintile are 7 times more likely to deliver in a facility compared to women in the poorest quintile. Women with at least a secondary education are 6 times more likely to use facilities for delivery compared to women with no education. Only 4.4 percent of births delivered at home are attended by medically trained providers, and 29 percent women seek treatment in a health facility for maternal complications. Women in the richest quintile are three times more likely to seek facility care for complications compared to those in the poorest quintile.
Malnutrition is a serious problem, especially for women and children. Dietary intake of both children and adults is severely deficient in micronutrients that aggravate the problem. About 35 percent and 21 percent women suffer from Chronic Energy Deficiency (BMI <18.5) in rural and urban areas, respectively. Among under five children, 41 percent are underweight (low weight-for-age), 12 percent are severely underweight, and 36 percent are stunted. Birth weight is very low (30 percent).
Rapid urban growth with growing urban poverty, vulnerability and exclusion
Bangladesh has been experiencing a remarkable rate of urban growth since its independence. The proportion of urban population in Bangladesh has increased from 5.2 percent in 1961 to 25.1 percent in 2008, and most of the urban growth is taking place in the major cities of the country (Dhaka, Chittagong, Rajshahi and Khulna). Dhaka alone contain just about one-third of the total urban population and the four largest cities account for over half of the total. Not only has it been experiencing rapid urban growth, the country also has produced the fastest growing mega city in the world. The projection shows that by 2050, 57% of people will be living in cities in Bangladesh. One estimate indicates that by 2015, Dhaka may become one of the densest cities of the world.
The rate of population movement is much higher than the national population growth rate. This high rate of population movement and resulting pace of urbanisation could be regarded as a driving force of modernisation and centre of economic growth and development. However, that is not the case with Bangladesh as urban centres in Bangladesh grew out of context without sufficient concomitant social and economic development. Cities are growing rapidly and unevenly with growing urban poverty, vulnerability and exclusion. The national population growth rate is 1.34 percent per annum, while the national internal migration rate is 4.5 percent. For Dhaka, the in-migration rate is about 6.0 percent. In most of the cases, the poor and homeless migrants to cities are accommodated in the slums and shanties. The urban growth rate is 3.5 percent per annum, while the slum growth rate is 7.0 percent.
More than 35.24 percent live in slum areas of six major cities. Out of 9,048 slums identified in six cities, 75 percent are in Dhaka and accommodate around 63 percent slum people. Though Bangladesh has the highest population density in the world (at 2,600 persons per square mile), the population density in the slums was roughly 200 times greater, at 531,000 persons per square mile. The proportion of the population of Dhaka living in slums has increased from 20 percent to 37. Some studies have reported even a higher figure of urban people living in slum areas in Dhaka city (47 percent). As a result, cities and towns are in a state of chronic poverty and poor health condition with limited access to safe water, shelter, employment, food, livelihoods, sanitation and drainage system, mismanagement of household and solid waste, poor transportation systems and air pollution.
A growing elderly population with a broken link
The proportion of population aged 60 years and above has increased over time as a result of the rise in the expectation of life at birth. Due to declines in the fertility and mortality rates, numbers of young people will not increase. Because of increasing life expectancy, results of improved health services, education and technology, ageing population will increase. The current growth rate of the elderly population supersedes the annual growth rate of the whole population of Bangladesh. Numbers of elderly people will increase six-fold by mid-century, creating a large burden on the health system, especially for chronic illnesses.
Population aged 60 years and above is likely to exceed the population aged below 15 years in 2046. The elderly population will face many difficulties due to poverty, disintegration of family and community support networks, changing family structure, social and cultural norms, inadequate health care facilities and poor transportation. The decrease in the relative size of the working age tax base to the growing demands for healthcare by the elderly group should be a major concern.
Demographic dividend and window of opportunity for Bangladesh
As a result of declining population growth and consequent changes in age structure, the proportion of working age population is increasing and offering a window of opportunity, referred to as the 'demographic dividend'. The 'demographic dividend' is defined as the potential economic benefit offered by changes in the age structure of the population during the demographic transition, when there is an increase in working age population and an associated decline in the dependent age population. The 'demographic dividend' leads to opportunities for growth in output per capita due to increasing proportion of working-age group in total population, increasing the ratio of producers to consumers.
Although the demographic transition creates the demographic dividend, it also brings significant challenges with it. Among these are the areas of education, health, nutrition, ageing, inequality, housing, food, social and political unrest, status of women, and employment. The potential gains from the “demographic dividend” will be at risk due to continuing poverty and poor living standards. It should be noted that demographic dividend is not prearranged. Rather it is an opportunity provided by the age structural transition. Meeting future challenges depends on ability to take advantage of the window of opportunity offered for a plausibly tiny period for once in a life-time with pertinent economic and social policies.
Economic returns are not the sole function of demographic dividend. Three interconnected mechanisms are responsible for demographic dividend, resulting in economic return: Labour Supply, Savings, Human Capital. All these mechanisms, however, depend on the external and internal economic settings and policy environment of the country. If appropriate policies are not formulated demographic dividend might, in fact, be a cost, leading to unemployment and an unbearable strain on education, health and old age security. To reap the benefit of the demographic dividend, the transition from basic traditional subsistence food consumption to modern non-food consumption through rapid reduction of poverty is one precondition because without this appropriate national development strategy for population management and planning is not possible.
Since people in a society are both producers as well as consumers, any development process should consider the demographics of population, i.e., its structure, composition, distribution, behaviour pattern, attitude, values, norms, beliefs, practices and the whole life-style pattern. The number of people, the speed of growth, the quality of life, the pressures on them, etc. are influenced by environmental, economic, political and social conditions. People influence these conditions by the decisions they take. Therefore, we need to take the population issue as a central point for national development to face the population challenges.
A K M Nurun Nabi is Professor and Project Director, Department of Population Sciences, University of Dhaka. He can be reached at akmnnabi@yahoo.com