The total fertility rate in Bangladesh is 2.3 (PRB, 2016 World Population Data Sheet) and the fertility rate of the younger group among whom the concept of birth spacing is not yet popular, has, in fact, shown an increasing trend. The incidence if childlessness among currently married women has also declined.
These factors, along with the low rate of contraceptive use, the high drop-out rate in the use of temporary methods, the relatively high age of acceptors and the universal marriage a relatively young age indicate the magnitude of the problems reducing the total fertility rate.
Of great interest is the fact that while 54 per cent of currently married women aged 15-49 using modern contraception and 8 per cent traditional methods (BDHS, 2014) due to decline in the institutional capability of the service providing agency.
Against this background, it is logical to wonder whether the target of reducing fertility rate to replacement level is a feasible goal, especially given the prevailing conflicting signals at the policy level.
In respect of population growth, the policy is to continue to promote the attainment of small family size on a voluntary basis and a reduced population growth aligned with replacement fertility level, while efforts to make available the knowledge, means and opportunity to practice family planning will be intensified. The family planning component in the Health, Nutrition and Population Sector Program, however, is designed mainly as a means to promote maternal and child health care and effectively avoids mention of the family planning program as a direct intervention to reduce fertility.
It was in June 1976 that the government spelt out in its policy outline 'the urgent need for total orientation of the strategy for making population control and family planning an integral part of social mobilization and national development efforts.' The population policy statement, however, is ambiguous with respect to two issues in the current debate. The first is whether or not acceptable economic and social development can be achieved without a reduction in the currently high levels of fertility and population growth rates.
The second is whether or not the government is justified in intervening in the free choice of couples to determine the size of their families.
In not being explicit about its position on these issues, the government's current position is not inconsistent with one that favours no direct action on fertility reduction that includes modifying the fertility preference of couples. In view of these two ambiguities, no clear directions are being provided to the governmental and non-governmental agencies responsible for implementing the family planning program. As a result, there is little activity to respond effectively to the large unmet needs for contraception, especially among the poor. The current population policy, however, does not have a strong and explicit fertility reduction objective that includes modifying the fertility preferences of households. Moreover, its ambiguity with regard to the role of the government in the fertility decision making of couples is weakening the implementation of the family planning program in the field. The planning commission just formulates five-year plan to guide activities and resource allocation. Unless the current population policy is clarified and strengthened to include an explicit fertility reduction objective through government guidance and support, it is not likely that rapid and sustained fertility declined will occur to reinforce the gains that could be achieved from the economic and social reforms now in place.
In the light of the current situation, public policy and population must address two basic issues: the first, the effects of population growth on economic and social development and the second, the role of the government in fertility decision making.
While there is continuing debate about the effects of population of development in the international community, the concern over continued rapid population growth in Bangladesh must be viewed in the context of circumstances the country finds itself in at present. The circumstances include high levels of poverty, serious unemployment and underemployment, poor education, health and nutrition sector performance, and severe resource constraints, including a debt burden. Under these circumstances, the most salient concerns relate to the impact of continued rapid population growth and high fertility on (i) current household welfare, particularly among the poor who constitute the large majority of the population; (ii) the future quality of human resources, which is a critical aspect of the future capacity of the economy to support a growing population at higher standards of living; and (iii) full employment at rising real wages, which is a critical factor in alleviating poverty.
At the household level, lower fertility would not only provide direct health benefits to the mother, but would also provide poor households would added opportunities to invest more resources and time per child to improve health, nutrition and schooling performance. With greater investment in human capital, the prospects for economic and social mobility of their children are enhanced, thus breaking the inter-generational cycle of poverty.
At the aggregate level, rapid fertility decline and slower population growth could reduce the pressure to expand basic health, nutrition and educational services to accommodate an otherwise rapidly growing population, such reduced pressure could provide added opportunities for increasing the coverage and improving the quality of such services. Moreover, rapid fertility decline eventually translates itself into reduced growth of the population of working ages, thus reducing the pressure to expand employment to accommodate to new entrants to the labor force. Such reduced pressure provides added opportunities for both improving human and physical capital, leading to full employment at higher productivity and real wages. Thus, in all the above concerns, fertility reduction can be instrumental in achieving rapid economic and social development, especially those aspects that have a direct bearing on the poor. Such a proposition should guide the formulation of a new population policy.
The second issue of public policy that should be clarified is whether or not the government is justified in intervening in the free choice of couples to determine the size of their families. This issue needs to be clarified because of the strong views expressed sometimes that the determination of the number of children should be left entirely to individual couples. The constitutional provision on the rights of spouses to found a family in accordance with their faiths and the demands of responsible parenthood is often used to support such a view.
While the government is justified in intervening in fertility, decision making of couples based on the above arguments, the type of intervention to be pursued would depend upon the costs and effectiveness of the intervention. One important aspects of cost may be noted. In a society that values freedom of choice, interventions that involve coercion would entail very high social cost that would make such interventions politically and morally unacceptable.
In the context of the current Bangladesh situation where the top governmental leaders enjoy wide popular support, all that might be needed to modify fertility preferences might be for the government to endorse the social goal of a small family. Within such a goal, couples are free to determine the actual number of their children and the means to achieve their desired family size. The family planning program could then be designed to support the overall achievement of such a social goal in addition to its primary objective of improving maternal and child health. In designing such a program, additional resources must be allocated to accommodate those who will be persuaded to modify their fertility goals in line with the newly endorsed social goal, in addition to meeting the needs of those couples who have already decided to reduce their fertility.
In sum, a stronger population policy with an explicit fertility reduction objective must be formulated in the line described above. Such a policy should be properly viewed as an integral component of the overall development strategy to achieve the national goals of poverty alleviation full employment, equity and social justice and sustainable growth.
Mohammed Abul Kalam, PhD, is ex-Head, Department of Medical Sociology, Institute of Epidemiology, Disease Control & Research (IEDCR).
Email: med_sociology_iedcr@yahoo.com
