Family planning programme: A success story

"Family Planning a success in Bangladesh" observed by the executive director of United Nations Fund for Population Activities, (UNFPA) Dr. Babatunde Osotimehi on 29 May during the Women Deliver Conference participated by 150 countries with the attendance of more than 3,000 delegates, the largest assembly of the decade.

While briefing the crowded press about Bangladeshi family planning workers, the Executive Director reiterated, "I have seen these people working in the remotest part of the country providing services. Bangladesh had trained more health and family planning workers than any other country and the decline of the total fertility rate to 2.3 children per women from the one-time 6.5 was a great success. The contraceptive use rate had increased to 61 percent in four years and the unmet need declined to 12 percent from 18 percent."

He added, "it empowers women and girls to make positive, productive choices, to seek education and to stay in school, to participate fully in society and to contribute to the economy". The UNFPA Chief made a clarion call to all countries "to intensify investment in family planning ".

Family Planning Programme in Bangladesh is a success story. Prime Minister Sheikh Hasina accepted the UN Award trophy on 20 September 2010 for remarkable achievement in attaining MDG particularly reducing child mortality by halves. The success of family planning programme of Bangladesh has appeared to be a model for third world countries. It has been termed as "success under a challenging environment".

The secrets of such a success story of Family Planning Programme in Bangladesh are many. In precise, these are a) Continuous political commitment of governments, b) Collaboration of government and non-government organisations in service delivery with innovations, c) Capacity building of the field level workers and their commitments, d) Acceptance of the programme by religious groups, e) Intensive BCC campaign, f) Support of development partners, g) Intensive monitoring and supervision of the programme by senior management.

Although Bangladesh is in track to attain millennium demographic goals by 2015, more investments and initiatives are needed to achieve other demographic attainments within the target period as envisaged in the national population policy framework. For this purpose, this programme needs more investment and adequate mobilization of domestic resources to strengthen and diversify the programme activities. Massive significant investment would be required to intensify the family planning programme in hard to reach areas and underserved localities. For this purpose, there must be strategic interventions with multi-dimensional approaches.

The National Population Policy and National Health Policy are announced. Health Population Nutrition Sector Development Program (2011-2016) is functional with 32 Operational Plans of which 7 are under Directorate of Family Planning. The Sixth Five Years Plan also envisaged pragmatic approaches to contain the population growth within the limit. Thus, there must be meaningful efforts for strengthening the programme at the field level with the availability of trained service providers, adequate supplies of contraceptives and continuous communication network and constant monitoring of the programme at the grassroots level.

There should be sufficient trained workforce with significant reduction of absenteeism and by restricting quick turnover of service providers. The existing 3,719 HFWCs, 97 MCWCs, 471MCH-FP Clinics and 30,000 makeshift satellite clinics operated by DGFP with support of 179 NGO Clinics must develop as centres of excellence gradually to uphold the image of this flagship programme of Bangladesh. The existing rate of User's Fee, demand-side financing and health insurances schemes could be revisited so that dependence on donors' support is reduced substantially by phases.

In Bangladesh, the density of population is 1 thousand and 15 persons per square kilometre with the population size of around 15 crore. The total population of Peoples' Republic of China is around 130 crore but the density of population is only 144 persons and in India, density is only 418 persons per square kilometre. Thus, the nation must contain population growth for the sake of affordability.

To attain the objective of stationary population and to ensure the replacement level of fertility (Net Reproduction Rate-1), the acceptance rate of contraceptives should be increased to 72 percent. For this purpose, programme should be extended to hard to reach areas with uninterrupted contraceptive supplies and extensive promotion of long acting methods and male contraception.

The IUD (Intra-Uterine Device), hormonal friendly method should be popularized with its production within the country. In China, maximum users of contraceptive are IUD (40%) and IUD factories are established like cottage industry with state patronage. Other long acting methods like non-scalpel vasectomy, implanon should be popularized with trained service providers. The use of condom in Bangladesh is 1% only although this is one of the safe methods to prevent HIV/AIDS and other sexually transmitted diseases.

Infrastructure base for domestic production of contraceptives has not developed in Bangladesh due to the non-committal attitude of the government. Contraceptive Plant by EDCL at Khulna and efforts of Social Marketing Project for production of condom might not be capable of meeting the future needs of the nation.

To attain the sustainability in contraceptive supply and build up a base for domestic production of electro medical equipment and accessories, public-private partnership could be taken as a model in addition to provide required budgetary allocation to health and population sector. It might be pointed out that only 4.1 percent of budgetary resources have been allocated in the budget of 2013-2014 fiscal years to the health and population sector in comparison to 10.6 percent for public administration and 11.3 percent for education and technology. In fact, the budget speech delivered on 6 June highlighted the recruitment of few employees but did not attach importance to the strengthening family planning the programme with production of contraceptives as future strategic road map towards sustainability.

Secretary General of United Nations Ban Ki-moon in his message once observed, "We must mainstream productive health and rights into all development and poverty reduction plans. Investing in universal access to reproductive health is a crucial investment in healthy societies and a more sustainable future".

It is necessary to draw attention to one of the critical and alarming challenges, that is, the teenage pregnancy. This reproductive sexual behaviour among adolescents is increasing rapidly, adversely affecting the family and the society as well. Ideally, everyone should be mentally and physically mature enough to enter into the reproductive life. Thus, adequate IEC activities with parental counselling and vigilance should be strengthened in family and in educational institutions with the support of the family planning programme.

The strengthening of family planning programme with financial and technical resources is obviously a dividend for future. Hope, the World Population Day 2013 would be observed on 11 July throughout the country with the commitment to make this successful programme sustainable.

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Dhiraj Kumar Nath is a former secretary and adviser to the caretaker government.