Justice-based approach needed in reproductive health

The 1994 International Conference on Population and Development (ICPD) in Cairo marked a major shift in global development by centring human rights, gender equality, and comprehensive sexual and reproductive health and rights (SRHR) in the pursuit of sustainability. It moved beyond population control to a people-centred, rights-based approach that emphasised equitable access to healthcare, education, women's empowerment, and reproductive autonomy. Countries were urged to provide universal SRH services, reduce maternal mortality, end gender-based violence, prevent child marriage, and uphold informed reproductive choice. As an early supporter, Bangladesh integrated ICPD principles into national policy, aligning them with the Millennium Development Goals (MDGs) and later the Sustainable Development Goals (SDGs). While progress has been made—particularly in lowering fertility, expanding family planning, and reducing maternal deaths—gaps in gender equality, disability inclusion, adolescent-friendly services, and social equity continue to hinder the full realisation of the ICPD vision.

Read more

The uneven scale of reproductive responsibility

Since the ICPD, the country has succeeded in reducing the total fertility rate (from 4.6 percent in 1990 to 2.0 percent in 2022) and maternal mortality rate (from 574 to 123 deaths per 100,000 live births between 1990 and 2020). These gains align with ICPD commitments, as well as MDG 5 and the SDGs. Government initiatives in midwifery training, institutional deliveries, emergency obstetric care, reducing inequality, ensuring universal SRH access, and advancing gender equality have played a role. The Adolescent Reproductive Health Strategy (2006) and the National Strategy for Adolescent Health (2017-2030) have been implemented. The government has also maintained a progressive stance on menstrual regulation and expanded post-abortion care to reduce unsafe procedures. Legal reforms—such as the Domestic Violence Act (2010) and the Child Marriage Restraint Act (2017)—signal a growing recognition of structural barriers to SRHR.

However, despite progress on quantitative targets, the country has been less successful in ensuring rights-based SRHR and addressing emerging issues, notwithstanding efforts by the government, UN agencies, and other actors. Initiatives to promote bodily autonomy, shift gender norms, and support informed choice have been limited. Family planning programmes have traditionally focused on women, with minimal male involvement, reinforcing the notion that reproductive responsibility lies solely with them. These programmes have also been target-driven, at times resulting in coercive practices to ensure contraceptive uptake. While contraceptive use initially rose, it has since plateaued, with ongoing issues such as stock-outs and provider shortages.

Child marriage, explicitly identified in the ICPD agenda as a major barrier to gender equality and health, remains widespread in Bangladesh. Over half of women aged 20-24 were married before 18, and 27 percent gave birth before the age of 19. Although the Child Marriage Restraint Act (2017) prohibits underage marriage, enforcement is weak and often undermined by social norms and legal loopholes allowing exceptions under "special circumstances." Persistent drivers such as poverty, gender inequality, and limited education continue to fuel early marriage—now compounded by digital platforms, including social media and mobile phones. Yet current initiatives have not adapted to these emerging challenges. Comprehensive sexuality education (CSE) remains largely absent or is delivered by underprepared or uncomfortable educators, constrained by persistent social taboos. These issues, combined with misinformation on social media, early sexuality, and restricted access to contraception for unmarried adolescents—despite growing evidence of premarital sex among them—make them vulnerable to early pregnancies, sexually transmitted infections, and exploitation. Moreover, although the ICPD calls for inclusion of marginalised groups, such as persons with disabilities and gender-diverse individuals, SRH programmes in Bangladesh often exclude them due to structural barriers and a lack of focus.

Read more

To reform Bangladesh's environment sector, focus on biodiversity conservation

While climate change was not originally a central theme of the ICPD, it has become an increasingly urgent concern. In flood-prone and disaster-affected regions, climate emergencies severely disrupt access to maternal health services, contraception, safe delivery, menstrual hygiene, and post-abortion care. These disruptions not only jeopardise health but also increase the risk of gender-based violence—including exploitation, early and forced marriage, and sexual assault—particularly in overcrowded shelters or during displacement. The breakdown of protective systems during crises further limits women's and girls' ability to make informed, autonomous reproductive choices. Despite these clear vulnerabilities, SRHR remains largely absent from climate adaptation and disaster risk reduction strategies. Without integrating SRHR and gender-based violence prevention into climate policies, the compounded risks to women, girls, and marginalised groups will remain unaddressed.

Three decades after Cairo, Bangladesh's progress in fertility reduction and maternal health is undeniable. Yet the deeper goals of the ICPD—centred on justice, equity, inclusion, and autonomy—remain unrealised for many. As Bangladesh approaches ICPD+30 in 2025, a paradigm shift is essential. The country must move beyond demographic targets to a rights-based approach rooted in reproductive justice. This requires dismantling systemic barriers and addressing social and gender inequalities that limit access and autonomy. CSE must be universal, context-appropriate, and delivered by trained educators. Family planning programmes should emphasise choice, dignity, and shared responsibility, actively engaging men and reaching underserved groups, including people with disabilities and gender-diverse individuals. SRH must also be integrated into climate and disaster resilience plans, particularly for vulnerable populations.

Dr Md Nuruzzaman Khan is research fellow at the University of Melbourne, Australia. He can be reached at [email protected].

Views expressed in this article are the author's own.

Follow The Daily Star Opinion on Facebook for the latest opinions, commentaries and analyses by experts and professionals. To contribute your article or letter to The Daily Star Opinion, see our guidelines for submission.