Keynote Presentation PHAB-NH Roundtable on Family Planning

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Sustainable Development Goals: Universal Access to Quality Reproductive Health Services in Bangladesh Dr. A. J. Faisel Public Health Association of Bangladesh (PHAB)


Relevant Sustainable Development Goals (SDG) and Targets • SDG # 3: “Ensure healthy lives and promote well-being for all at all ages”. Target # 3.7: By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programs”. • SDG # 5: “Achieve gender equality and empower all women and girls”. Target # 5.6 “Ensure universal access to sexual and reproductive health and reproductive rights as agreed in accordance with the Programme of Action of the International Conference on Population and Development and the Beijing Platform for Action and the outcome documents of their review conferences”.


Population Development & Family Planning in Bangladesh Population density is the driving factor. FP decreases maternal and neonatal mortality FP decreases certain maternal morbidities and thus improves women dignity and productivity FP leads to lowered fertility leading to social development


Population Density


FP 2020 Bangladesh Goals by 2021 Reduce TFR from 2.3 to 2.0 Increase CPR from 62% to 75% Increase use of LARC and PM from 8.1% to 20% Reduce Unmet need from 12% to 10% Reduce discontinuation of FP methods from 30% to 20% Base figures are of BDHS 2014


Trends in Total Fertility Rates, 1975-2014 Births per woman 6.3

5.1 4.3 3.4

3.3

3.3 3.0 2.7 2.3

1975 BFS

1989 BFS

1991 CPS

1993-1994 1996-1997 1999-2000 BDHS BDHS BDHS

2004 BDHS

2007 BDHS

2011 BDHS

2.3

2014 BDHS


Trends in Urban TFR (BUHS 2013) Total Fertility Rate (TFR), UHS 2006 and UHS 2013 3

Births per woman

2.5

2

1.5

2.5 1

2.0

1.9

1.7

0.5

0

UHS 2006

UHS 2013

City Corporation slum

UHS 2006

UHS 2013

City Corporation non-slum


Trend in Contraceptive use Among Currently Married Women, 1975-2014 61 58

Percent

56

54 49 45

8

11

9

62 8

8

10

40 8 31 25 19

8

7

42

5 8 3 5

14

9

31 18

43

47

48

2004 BDHS

2007 BDHS

52

54

2011 BDHS

2014 BDHS

36

23

1975 BFS 1983 CPS 1985 CPS 1989 BFS 1991 CPS 1993-1994 1996-1997 1999-2000 BDHS BDHS BDHS

Any modern method

Any traditional method


CPR has historically grown 1.8% per year, but significant slow down to 0.6% per year 2011-2014; meeting the GOB goal of 75% will require an annual growth rate of 2.7% Unmet Need mCPR

CPR

Bangladesh contraceptive prevalence rates (modern and overall), unmet need and total fertility rate over time 2.7% p.a. 0.6% p.a.

1.8% p.a.

45

22

Total Fertility Rate

20

18

17

15

54

52

48

14

Increasing CPR from 62% to 75% in 2021 requires an additional ~6.75 million women using contraception

62

61

56

48

44

42

37

59

54

50

75

12

10

1994

97

00

04

07

2011

2014

20211

3.4

3.3

3.3

3

2.7

2.3

2.3

2.0

1 Updated Government targets SOURCE: BDHS 2014,


Source of Supply of Specific Modern Methods Source

Pill

Injectables

Condom

Female sterilization

Male sterilization

IUD

Implants

Total

Public sector

42.3

61.0

14.9

68.7

84.5

92.1

93.1

48.7

NGO sector

3.1

9.6

2.0

2.0

3.0

1.3

4.8

4.4

Private medical sector

49.1

28.8

76.0

28.8

7.5

6.6

2.2

43.0

Other private source

5.4

0.3

6.6

0.0

0.0

0.0

0.0

3.5

Source: BDHS 2014


Opportunities to Accelerate Scale Up of Postpartum Family Planning TOTAL ANNUAL BIRTHS: Across participating countries 2014 Births (in Millions) 8 7 6 5 4 3 2 1 0

7.4 4.6 3.1 1.0

3.0

2.3 0.7

5.0

4.6

3.2 1.6

2.4 0.8

2.0

1.7

0.4

0.7

62,568,534** Total Annual Births * SPECTRUM Estimates **Total includes all of India Source: UNPD, World Population Projections, 2012


Trend of facility based deliveries ď ą Demographic health surveys show rapid increase in facility delivery ď ą These create opportunities where we can provide PPFP even after the delivery of the first child.


Trends in births delivered by C-section, 2004-2014 23 Percent

17

9

4

2004 BDHS

2007 BDHS

2011 BDHS

2014 BDHS


Challenges: Factors for Moving Forward • There is almost no attempt in undertaking a comprehensive Population Development Plan. Population issues end up with only FP activities • Private Health sector is fast growing with minimal contribution from FP and public sector providers grossly dominating the private sector. • An Action Plan regarding the implementation of the National Population Policy 2012 has been developed with the involvement of 18 Ministries endorsed by MOHFW but yet to see the light of implementation. • Population Development requires comprehensive and coordinated SBCC activities • Current Health Sector Program & the future one (HPNS SIP) could be the only opportunity to instill the dynamics of Population Development.


Thank you


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