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Bangladesh’s Path Forward

It’s been called a success story. But for millions, Bangladesh’s family planning agenda remains unfinished. Here’s a path to close the gaps.

A remarkable demographic transition. 

A rapid decline in fertility. 

A lifesaving expansion of sexual and reproductive health and rights.

By any measure, Bangladesh has achieved historic progress in expanding access to voluntary contraception for nearly half a century. The percentage of married women of reproductive age who are using family planning increased sevenfold in less than 50 years.

Increase in Contraceptive Use

The percentage of married women ages 15–49 who are using any method of contraception

When given options, many women in Bangladesh are choosing to have fewer children.

Decrease in Total Fertility Rate

The number of children that would be born to a woman if she were to live to the end of her childbearing years and bear children in accordance with age-specific fertility rates of the specified year

What drove these historic changes? And how can we work together to keep Bangladesh’s family planning progress from stalling?

A Commitment to Family Planning from Day One

Bangladesh was the tenth most populous country in the world when it achieved independence in 1971. The government of Bangladesh set out to address what it saw as urgent, interconnected threats to families and the young nation: rampant poverty, limited food and resources, devastating rates of infant and child death, and mounting population pressures. Bangladesh took swift action to enhance family planning education and services.

Frontline health workers greet and counsel family planning clients. Photos courtesy of Bangladesh’s Directorate General of Family Planning archive.

 

A cornerstone of Bangladesh’s strategy to bring contraceptive options to people’s doorsteps was the deployment of a massive cadre of female frontline health workers (called “family welfare assistants”) who provided contraceptive counseling and services to women where they live.1 Between 1976 and 1980, when it was uncommon for women in Bangladesh to work outside of the home, the government recruited 22,500 women from local communities as family welfare assistants. These frontline health workers became a symbol of empowerment in communities and revolutionized family planning service delivery for hard-to-reach women and families.

For the next 50 years, public and private-sector stakeholders, policymakers, health care providers, religious leaders, researchers, academics, international donors, media agencies, and organizations teamed up to achieve family planning milestones. Bangladesh has leveraged the power of these partnerships—including with organizations like Pathfinder—to transform its health systems, generate new evidence, and remove barriers that keep women and girls from exercising their right to contraception and sexual and reproductive health care.

For nearly half a century, Pathfinder has worked with dedicated partners in Bangladesh to drive historic progress in family planning. For example, in the 1970s, Bangladesh hosted its first National Family Planning Conference and developed its First Five-Year Plan (1973–1978) with support from Pathfinder. In the 1980s, USAID awarded Pathfinder Bangladesh a grant for a national community-based distribution project—Pathfinder’s first ever country-specific funding agreement. Through the following decades, Pathfinder enhanced the capacity of public and private health care providers, hosted cross-country learning exchanges for Bangladesh officials, and enabled hundreds of millions of women and young people to access contraceptive services in Bangladesh’s facilities and communities. Today, Pathfinder’s strong partnership with the government continues through the Accelerating Universal Access to Family Planning project, called Shukhi Jibon in Bangladesh, funded by USAID and led by Pathfinder.

 

Bangladesh’s achievements demonstrate what’s possible when generations of women gain the health care, knowledge, and support they need to achieve their desires for smaller, healthier, more educated, and more prosperous families. Bangladesh’s longstanding investment in family planning has paid off. And Pathfinder is proud to be a part of this progress.

But Bangladesh’s success story is far from over.

Action Is Needed Now

Today, Bangladesh’s family planning agenda remains unfinished. The truth is that progress is stalling. The percentage of women currently using modern contraceptives decreased from 54 percent in 2014 to 52 percent in 2017–18. And in Chittagong, Dhaka, Mymensingh, and Sylhet—the divisions where Pathfinder focuses our work—this percentage lags even further behind.

Decline in Modern Contraceptive Prevalence Rate

The percentage of currently married women using modern contraceptives (nationally)

Nearly half of all pregnancies in Bangladesh (49%) are unintended.2 Inequities persist across hard-to-reach geographic areas and age groups, blocking millions of people from exercising their right to high-quality contraceptive information and services.

This is especially true for Bangladesh’s young people, who experience high rates of early and unintended pregnancy and limited use of modern contraceptives.

It is time to close these remaining gaps and strengthen our collective resolve to write the next chapter in Bangladesh’s remarkable family planning story. To protect Bangladesh’s hard-won gains, advance sexual and reproductive rights, and achieve Bangladesh’s family planning goals, we should follow the lead of USAID’s flagship family planning project in Bangladesh.

Three Priorities to Accelerate Progress

Launched in 2018, the Accelerating Universal Access to Family Planning project, known as Shukhi Jibon in Bangladesh and funded by USAID, advances innovative, scalable solutions for increasing access to and uptake of voluntary family planning where the need is greatest, including urban slums, communities with growing refugee populations, and regions devastated by climate change-induced floods and natural disasters.

To date, Shukhi Jibon, which is led by Pathfinder, has reached more than 14.6 million couples and nearly 1 million adolescents across four geographic divisions with family planning information and services, including contraceptive methods that will result in an estimated 12.7 million couple years of protection. Three key priorities underpin Shukhi Jibon’s most significant contributions and offer a clear path for accelerating progress to achieve Bangladesh’s family planning goals:

1. Strengthening Bangladesh’s Qualified Family Planning Workforce

Shukhi Jibon supports the government of Bangladesh to grow and strengthen its cadre of skilled, responsive, and respectful providers who deliver high-quality family planning services in facilities and communities. In addition to bolstering Bangladesh’s national family planning training institutes and improving coordination among public and private-sector family planning workforces, Shukhi Jibon ensures family planning service providers and health facility managers become fully competent and comfortable providing client-centered care in their service delivery environments. In fact, Shukhi Jibon is the first project to support public-sector family planning service providers by integrating mentorship into Bangladesh’s existing service delivery supervision system the government’s own personnel.

LEARN MORE about the project’s powerful approach to Mentorship and Supportive Supervision (M&SS).

 

2. Focusing on Communities

Lasting change starts in communities. In a country where 50 percent of births occur at home, and far too many people continue to struggle to access family planning services at distant health facilities, Shukhi Jibon implements numerous community-based interventions that connect people to their health system. The project works collaboratively with local leaders—religious leaders, youth leaders, and the government’s massive cadre of frontline health workers, among others—to engage communities, build a groundswell of support for family planning, expand contraceptive choice, and deliver contraceptive information and services to people where they live. At the heart of this work is a commitment to inclusivity. Shukhi Jibon conducts activities in hard-to-reach areas, from remote villages to urban slums, and strengthens family planning services for marginalized populations, diverse ethnic communities, and ready-made garment workers. No community can be left behind.

LEARN MORE about the project’s Community-Based Postpartum Family Planning approach, which brings a critical intervention to women’s doorsteps.

 

3. Prioritizing Adolescents and Youth

Bangladesh’s adolescent and youth population—one of the largest and fastest-growing in the world—has urgent and varied needs for contraceptive services. Yet a strong tradition of early marriage and childbearing, set against a backdrop of conservative social and gender norms, means adolescent and youth sexual and reproductive health and rights (AYSRHR) has historically been overlooked in national family planning programs. Shukhi Jibon is working to change this. The project teams up with the government and other local partners to ensure young people can access accurate, unbiased AYSRHR information and services at 1,659 public-sector health facilities. And this is just one piece of the puzzle. Shukhi Jibon’s multi-pronged approach advances cost-effective solutions that enhance providers’ responsiveness, facility readiness, community engagement, and young people’s service-seeking behavior and contraceptive uptake—all of which can be scaled up across Bangladesh. To date, nearly 1 million adolescents have accessed sexual and reproductive health services at facilities supported by Shukhi Jibon. And more than six million young people have received sexual and reproductive health information through the project’s expansive digital health initiatives.

LEARN MORE about Shukhi Jibon’s digital health solutions that bridge physical distances and connect young people to the quality AYSRHR information and services they need.

 


Sources:

[1] Bangladesh’s Family Planning Success Story: A Gender Perspective
[2] Guttmacher, 2017