Birth rate drops

Birth rate in urban areas has come down significantly, raising hope that the country will soon achieve the replacement level which refers to a woman having two children.

According to the Bangladesh Urban Health Survey 2013 (BUHS-2013), birth rate per woman in urban slums declined from 2.5 in 2006 to 2.0 in 2013 while for non-slum women it dwindled to 1.7 compared to 1.9 in 2006.   

Birth rate in semi-urban areas (other urban areas) is 1.7 per woman, says the survey released on Tuesday.

Health and population experts believe this improvement is outstanding considering the government's inadequate family planning activities.

“Replacement level of births among slum women is surprisingly well,” said Kanta Jamil, monitoring and evaluation advisor in the Office of Population, Health and Nutrition and Education, USAID.

Although the survey did not identify the reasons behind reduced birth rates in slums, Jamil said several factors such as the growing popularity of two-child family, easy access to contraceptives, presence of NGO workers creating awareness of family planning  in urban slums, lack of space in slum houses must have contributed to the improving trends.

According to the Bangladesh Demographic Health Survey 2011 (BDHS-2011), the total fertility rate in Bangladesh is 2.3, a significant decline from 6.3 in 1975.

Ubaidur Rob, country director of the international NGO, Population Council, thinks Bangladesh is very close to the replacement level.

He said replacement level of births in urban slums is remarkable considering the prevalence of poverty, illiteracy and poor sanitation in those areas.

The projection that Bangladesh's population would stabilise after it reaches the peak of 22 crore in next 20 years could now be revised.

“I think the stabilisation [equal birth and death rate] would occur after the population reaches 18 to 18.5 crore,” the population expert said.

Citing BDHS-2011 data, Rob said total fertility rates in Chittagong and Sylhet divisions were 2.8 and 3.1 per woman respectively but were close to 2.1 in other divisions.

“Birth rate is expected to come close to 2 in Chittagong and Sylhet by now,” he told The Daily Star.

The change in behavioural pattern among urban slum population, as found in BUHS-2013, is noteworthy.

Contraceptive prevalence rate in the slums increased from 58 percent in 2006 to 70 percent in 2013 whereas in non-slum areas it increased to 65 percent from 63.

There are issues of concern, however.

Teenage pregnancy (15-19) in the slums is 21 percent that saw no change since 2006, says the survey.

Most couples rely on short-term contraceptive methods like pills and condoms that have higher use-failure rate than long-acting and permanent methods like IUDs, implants and sterilisations. 

Although 60 percent of women do not want any more children, only 5-7 percent of them use a long-acting or permanent method of contraception. 

 Experts say it is high time the government cleared up misconceptions about long-acting methods of contraception.

Interventions must be in place to reduce teenage pregnancy that has a direct link with maternal and child health, said Jamil.

The BUHS says 50 percent under-five children in slums are stunted.

Ubaidur Rob said birth rate decline leads to improvement of health and education status provided that income levels rise.