Fear of sterilisation holds back population control

The best way to keep Bangladesh’s population under control, experts believe is by sterilisation. Bangladesh currently has a population approaching 160 million, a figure that was just 129 million according to a 2001 census. The fertility rate (TFR) has stagnated at 2.3 in the last seven years as family planning initiatives have been unable to convince people of having a smaller family and to share the responsibilities of birth control equally between partners. High rates of population growth is exacerbating almost all of the problems facing Bangladesh by overburdening systems designed to meet the needs of much smaller populations, according to family planning data. Technical Officer- Family Planning at UNFPA Bangladesh Syed Abu Hasan told Dhaka Tribune that Bangladesh needs to increase Contraceptive Prevalence Rate, (CPR). Experts also believe that Bangladesh needs to stablilise its population through a change in marriage patterns and a shift to long-term contraception in order to ease the burden on infrastructure, health systems and agriculture. Family planning experts observed that Bangladesh’s progress in family planning had been impressive over the last two decades, but it has been almost stagnant for the last seven years since 2011, which is a matter of concern. “Absence of doctors and trained health workers in remote and rural Bangladesh is a real obstacle in the promotion of long-term and permanent methods of birth control,” said Syed Abu Hasan. “The country has no lack of funds available to tackle this problem but we need trained family planning workers who can work door-to-door, like the twentieth century, to build awareness. “Follow up initiatives and creating awareness among couples on long-term and permanent methods are necessary,” he added. The total fertility rate (TFR) has been stagnant at 2.3 - each adult woman having 2.3 children -- for the last four years. The TFR declined to 2.3 in 2011 from 6.3 in 1975, according to the Bangladesh Demographic Health Survey 2011. The contraceptive prevalence rate is 62% among married couples, out of which only 54% use modern contraceptives, while the remaining 8% use the rhythm method and the withdrawal method. Some use long-term methods of birth control like the injection, intrauterine devices (IUDs) and permanent methods such as vasectomy and tubectomy. Although sterilisation is simple procedure, for both men and women, women tend to bear a disproportionate amount of burden when it comes to getting sterilised. Most men the Dhaka Tribune spoke to said they were scared of going under the knife and that health workers were unable to convince them that it was a good idea. Abdul Kazi, 32 a rickshaw puller has four children. His family lives in Rajshahi, said: “I have never used contraception. They came to my village about sterilisation once but I was so scared about what they were saying that I did not want to hear about it again. I think that a vasectomy is risky.” Mohammad Rafiq Miah, 37, a banker from Chittagong said that awareness is enough. As long as people are aware of birth control then there is no need for permanent solutions like sterilisation. Forty-year-old teacher, Kamal Miah, got a vasectomy in 2007 and says that there is nothing to be scared of. It is the best way to avoid unwanted pregnancies and it is a minor surgery. "The problem with the temporary methods of birth control is the drop-out rate is at almost 30% in Bangladesh,” said Dr Reena Yasmin, senior director (services) of Marie Stopes Bangladesh. “Due to drop-outs in temporary contraceptive methods, around 13 hundred thousand women face unwanted pregnancies in Bangladesh. The abortion rate among them is 18 in a 1000 pregnancies,” she said referring to a 2010 study by the Bangladesh Association of Preventive and Septic Abortion. To avoid such unwanted pregnancy and abortions that have psychological, physical and economic consequences, experts suggest that Bangladesh focus on long-term and permanent methods of birth control. Because there are high risks of dropping out of temporary methods of birth control like the pill and condoms, long-term and permanent methods are encouraged in the countries like Bangladesh that have a large population. Dr Md Moinuddin Ahmed, ‎line director, Clinical Contraception Services Delivery Program (CCSDP) at Directorate General of Family Planning (DGFP), said: “The government is working on ways to increase family planning acceptance, especially long-term and permanent methods. However, we do have problems in implementing these plans because 5,000-6,000 family planning posts are currently vacant nationwide.” “Our success nationwide is good except in Dhaka City, as the TFR has increased by 0.1. For the last six months, we appointed 339 doctors in this field, we trained them well and hope they will be able to succeed out in the field.”