$1 investment will return $20

To address the population and development challenges in Bangladesh we have to focus on the issue of putting people first to build better lives. And for better lives, good health and economic growth are two corner stones. Relationship between health and economic growth is mutually reinforcing. The report of Commission on Micro-economics and Health found that spending on health brings a six- fold return on investment.
In the development-health nexus, universal access to reproductive health should be regarded the most important factor. Evidences show that poor reproductive health severely hinders educational attainment, diminishes personal capability and productivity, socio-economic development and adds to cost of health care. It is a leading cause of death and disability, particularly for women and children.
Women are important contributors to global economy, and about 39% of labour force in Bangladesh are women. Poor health causes poor labour supply and lost wages. A maternal death means family members need to do the work done by her, which might reduce their own ability to explore other income generating opportunities.
Reproductive health situation in our country shows:  Maternal Mortality Rate (MMR) 1.94/1000 (7000/year), neonatal mortality 32/1000 live births(80000/year), Contraceptive Prevalence Rate 62%, unwanted pregnancy about 30%, estimated number of unsafe abortion about 5 lacs, limited available data on reproductive tract infection shows high prevalence among high risk group, HIV/AIDS prevalence is also growing.
About 30% girls get married by 15 years and 60% by 18 years. Among the young women aged 15-19 years, 27% have given birth and 6% are pregnant. Contraceptive use and antenatal care is lower among them. Annual number of new cervical cancer cases is about 17,686 and annual number of death due to cervical cancer is 10,364.
These figures evidently show that our sexual and reproductive health programmes are lagging behind in implementation, particularly in targeting the most sexually active group, namely youth.
So, we need more investment of resources in reproductive health sector. It is widely recognized that $1 investment in key interventions of reproductive health generates $20 in benefit.
Improved sexual and reproductive health directly underpins Millennium Development Goals (MDGs) 3–8 and indirectly affects the achievement of goals 1 and 2:
1.    “Eradicate extreme poverty and hunger”
Smaller families and wider birth intervals as the result of contraceptive use allow families to invest more in children's nutrition and health, and can reduce poverty and hunger of the household. At the national level, fertility reduction may enable accelerated social and economic development.
2.    “Achieve universal primary education”
Families with fewer children, and children spaced further apart, can afford to invest more in each child's education. This has a special benefit for girls, whose education may have lower priority. Access to contraceptives helps not to become pregnant and drop out of school.
3.    “Promote gender equality and empower women”
Attaining reproductive health is a human rights issue. Controlling whether and when to have children is a critical aspect of women's empowerment. Women who can plan the timing and number of their giving births also have greater opportunities for work, education and social participation outside the home. Improvement of women's status and greater equality are important for human welfare and economic development.
4.    “Reduce child mortality”
Prenatal care and the ability to avoid high-risk births (e.g., those to very young women and those spaced closely together) help prevent infant and child deaths. Reduced child mortality and subsequent lower fertility rate increase participation in workforce and per capita GDP(due to change in age structure of the population).
5.    “Improve maternal health”
Preventing unplanned and high-risk pregnancies and providing care in pregnancy, childbirth and the postpartum period save women's lives. Sound reproductive health improves quality of life.
6.    “Combat HIV/AIDS, malaria and other diseases”
Sexual and reproductive health care includes preventing and treating sexually transmitted infections, including HIV/AIDS.
7.    “Ensure environmental sustainability”
Providing sexual and reproductive health services, and avoiding unwanted births, may help stabilize rural areas with slow rural- urban migration and balance natural resource use to meet  the needs of the controlled population.
8.    “Develop a global partnership for development”
Affordable prices for drugs to treat HIV/AIDS and a secured supply of contraceptives would greatly advance reproductive health programs, and are especially needed in the least-developed countries.
Higher education leads to lower fertility and higher income. Delayed age of marriage and delayed childbirth prolongation of replication cycle result in population control. So we should invest more in education , particularly for women.
Increased financing is needed to strengthen the health system. Use of contraceptive by all couples, universal delivery by skilled birth attendants preferably in hospitals and availability of and accessibility to emergency obstetric care is essential. World Bank estimates that ensuring skilled care at delivery and access to emergency obstetric care would reduce maternal death by 71 percent. For ensuring skilled service, we require adequate governance, stewardship and financing.
What we need now is the political will and action to make universal access to reproductive health a reality. So let us invest in reproductive health by making reproductive health, including family planning, a priority in national budget and putting efforts to strengthen the health system. This will improve human capital and productivity now and for generations to come.

The writer is Professor, Obstetrics and Gynaecology, Sir Salimullah Medical College, Dhaka, Email: fbegum9@gmail.com