In the first instalment of a three-part series, Dhaka Tribune explores the socioeconomic factors preventing family planning from becoming widely acceptable to lower income groups
Bhanu Begum, a 32-year-old mother of seven may seem hale at first glance, but her appearance belies her infirmity that comes with numerous childbirths.
Married at the age of 17, Bhanu’s first childbirth bore twins – Masud and Masum, now 15-years-old. At the time of her marriage, birth control was a prospect she was unfamiliar with. But after bearing so many children, the childbirths have taken a toll on her, and prevent her from any physically exhausting work.
Monowara, a 37-year-old who has five children of her own, also suffers from pain, fatigue, and headache.
The cases of Bhanu and Monowara are regrettably all too common among lower-income groups, where the birth rate is significantly higher and family planning remains an almost taboo concept.
Bhanu's eldest are 15-year-old twins. Her next child is 14 years old, the next 11, 10, and nine years old respectively. The youngest is nine months old.
Monowara's children are aged 22, 15, 11, nine, and seven years old respectively.
Bhanu and Monowara are residents of Tibet slum in Tejgaon Industrial Area. There are far too many families not only in this slum, but also in Korail slum and other parts of the city, who share the same beliefs and grow uncomfortable when discussing contraceptives.
Many Bangladeshis harbor superstitious beliefs and are skeptical about family planning. A common belief is that “God will provide.”
When Bhanu was asked why she does not use contraceptives, she claimed to use them after she got married, but her husband Md Motalib and his family asked her to stop taking them, as they were afraid they would prevent her from her daily chores.
Bhanu was asked if she knew of the health hazards arising from giving birth to so many children in such a short time, she appeared uninformed.
She said: “Sometimes my hands and legs feel like they are on fire. I get dizzy and weak as excruciating headaches assail me. I feel incapacitated, and cannot do any strenuous work.”
To similar queries, Monowara replied: “My husband said that having so many children is a blessing from God. But I started to grow weak and sick after the birth of my fourth child.”
Dr Nurun Nahar Begum Rosy, program manager of the Clinical Contraception Services Delivery Program under the Directorate General of Family Planning, said: “The government is taking a lot of initiatives for birth control, but thousands of people migrate to Dhaka every day. Most of them become part of the floating population who are very difficult to track,”
Reaching out is hard, but rejections harder
At Surjer Hashi Clinic in Mowchak, there were barely any patients.
Selina, who came in with her five-month-old infant, said she had come for contraceptives, but the clinic could not provide her with anything citing lack of supplies.
The clinic’s manager, Nasima Akhter, claimed the number of visitors to the clinic has declined somewhat.
“For the past few months, we have been having trouble providing help to everyone. Earlier, we could provide 150-200 with contraceptives each month. But now it is 100-110 at best. Our door-to-door outreach campaigns have also been winded down.”
Bilkis Akhter, a paramedic, said: “People whose profession involve extensive manual labour are too preoccupied with work to listen to us. The TV ads to raise awareness do very little as they are confined only to BTV, the state-run channel.”
Dr AKM Nurunnabi, professor of Population Sciences at Dhaka University remarked that the city corporations had a major role to play, but lack of coordination has complicated the matter.
He remarked: “Given our socio-economic situation, the contraceptive acceptance rate is actually satisfactory. But there are issues with reaching people in remote areas and slums.”
The latest dataset on population and fertility is from the Bangladesh Demographic and Health Survey 2014. While the data is certainly dated, it remains referred to by all concerned government agencies and NGOs.
According to the 2014 survey, the population growth rate in the country was 1.37% and the net fertility rate was stable at 2.3% between 2007 and 2014.
Directorate General of Family Planning
80,199,796 contraceptive methods used by 102,510,413 couples between January-April 2019
86,032,001 contraceptive methods used by 108,827,370 couples in 2018
82,693,167 contraceptive methods used by 106,592,517 couples in 2016