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.
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