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About Bangladesh

Today, Bangladesh has a population estimated at close to 150 million, averaging nearly 1000 people per square kilometer throughout the country.  It ranks at 129 out of 169 countries according to the Human Development Index.  Planning and policy are currently focused on Bangladesh outgrowing its ‘low-income status’, and becoming a middle-income country by 2021. The difficulties Bangladesh faces are also compounded by the acute risk of natural disasters; leaving the country vulnerable to adversity and crises.  
Poverty and Economic Development
Although official poverty rates have declined substantially over the past decade to 31.5 percent in 2010, close to 50 million people continue to live below the poverty line; and as many as 30 million people may live in extreme poverty. 
At the same time, Bangladesh has made progress in the improvement of education, poverty reduction, and gender equality—by targeting population growth; more inclusive educational planning and programming; and social support programs spurred by the adoption of the Millennium Development Goals (MDGs).
Demographic Challenges
The demographic structure, particularly concerning young people, who in the range of 15-24 years make up nearly 20% of the population—will cause the population to reach 220 million by 2050, even if replacement level fertility is met today. 
Bangladesh has high rates of fertility and low levels of secondary and post-secondary education enrolment.  Adolescent girls face high incidences of child marriage, and women in general commonly experience violence and abuse. 
In anticipation of the approachingdemographic window (which will temporary balloon the working-age population), there is a profound need to debate how the event will be shaped by policy, and how future programs can generate sustainable social and economic growth which can benefit more of the country’s people.
Fertility and Population Growth
By diminishing population growth through strong family planning programs, the GoB and its development partners have been able to reduce the total fertility rate (TFR) from an average of 5 lifetime births to less than 3 per woman between the mid 1980’s and 2007.  TFR plateaued between 1994 and 2004, and has declined to 2.3 as of 2010.  The total population growth rate has decreased from 2.3 percent in 1981, to 1.6 percent in 2001, and stands at 1.34 percent at the conclusion of the 2011 census. 
The use of modern methods of contraception (Contraceptive Prevalence Rate, CPR), has increased only slightly between 2004 and 2007 (from 47.3 percent to 47.5; with 52.5 percent of married women not currently using any form of contraception).  Unmet need for family planning has increased from 11 per cent in 2004, to 17 percent in 2007.  Underpinning the need for better FP services are overall educational levels, infant mortality, gender inequality, inequality on women’s empowerment and the inability to have basic (reproductive) rights acknowledged by society. 
Maternal Health
High maternal mortality and morbidity remains a serious concern in Bangladesh. To achieve the MDG-5 target, the country needs to reduce its maternal mortality ratio (MMR) to 143 per 100,000 live births (LB) by 2015. The most recent figure for MMR is 194/100,000LB (2010); a marked decline from 322/100,000LB in 2001, indicating that the country is on tract to reach its MDG target.
While Bangladesh has made gains in maternal health provisions, there are still marked gaps and unmet need for services.  In 2010, 76% of deliveries in Bangladesh still took place in the home (23% in a private, public or NGO-run health facility; doubling the figure between 2001 and 2010).  Medically trained birth attendants (qualified doctors, nurses, midwives, paramedics, or other Skilled Birth Attendants) are present at 27% of births as of 2010, up from 12.2 percent in 2001. 
An estimated 73 percent of births in Bangladesh are attended by non-medically trained persons with close to 7,000 mothers dying each year due to pregnancy-related causes; nearly two-thirds of all maternal deaths are the direct result of obstetric complications (e.g. hemorrhaging, eclampsia, obstructed delivery, abortion, et al).
Early Marriage
Early marriage and childbirth limit young women’s and girls’ educational opportunities, most often suspending them indefinitely; further inhibiting responsible family planning measures and ultimately impacting the sexual and reproductive health and rights of women over their entire lives.  Early marriage also inhibits socio-economic advancement, and directly impacts household security and wellbeing.  In the past two decades, the percentage of woman between the ages of 20 and 24 who were married by age 18 has only diminished slightly from 73% in the early-mid 90’s to 65% in 2000.  This figure has remained more or less static over the past decade.
The median age of marriage for girls is approximately 15.5 years reported by married women ages 20-49 in 2007—men by contrast average approximately 26 years of age as of their first marriage—figures which have remained stagnant for decades despite improvements in girls’ education. 
The most recent statistics from 2007 show that approximately 66 percent of women in Bangladesh were married before the age of 18; and 33 percent of girls begin childbearing before the age of 20.   Consequently, adolescent fertility in Bangladesh is still one of the highest in the world, with 126 births per 1,000 women between the ages of 15-19.  The figure is approximately 50.26 births per 1000 women ages 15-19 on a global average.
Women constitute the majority of the poor and experience greater deprivation and vulnerability to poverty and socioeconomic adversity due to their low status in society.  Despite some progress in Bangladesh’s overall ranking within the Human Development Index (HDI), the status of women still remains low (0.49 GDI and 0.21 gender empowerment measurement - GEM).  Women's participation at the policymaking level and politics also remains low, however, Bangladesh has been committed to increasing the number of women parliamentarians to 33% by 2021.
Violence against women, in the form of rape, assault (domestic as well as workplace violence), trafficking, or acid throwing, is also prevalent—between 50 and 60 percent of women in Bangladesh are estimated to have experienced some form of violence in their lives.  Although several legal and protective policy measures have been adopted that effectively outlaw gender-based violence and discrimination—implementation through enforcement remains difficult, greatly impeding the advancement of women's rights in society.
Bangladesh still has a low prevalence of HIV/AIDS (less than 1% among general population), but the disease is at an epidemic stage among Injecting Drug Users (IDUs) in Dhaka city (prevalence at 7%).  Surveillance has also shown that there is high level of needle and syringe sharing among IDUs. Such a concentrated epidemic together with low rates of condom use and low level of awareness about HIV/AIDS have far-reaching implications on HIV transmission in vulnerable segments of the society. 
Young boys are particularly vulnerable to Sexually Transmitted Infections (STI), HIV/AIDS and drug abuse. Because of their curiosity, inadequate knowledge and peer pressure many boys get involved in unprotected sex/commercial sex and drug use. Access to appropriate SRH information and services for this group is inadequate, and raising awareness on HIV prevention among general population and promotion of condom use among youth and high-risk groups is paramount.
Population growth and rapid urbanization will continue to pose major challenges to Bangladesh’s development.  These conditions will be compounded further by the effects of unmet family planning needs, lacking availability of reproductive health services for the general population, as well as the prevalence of gender inequality and social exclusion.  
The Government of Bangladesh drafted the Sixth Five-Year Plan 2011-2015 (6FYP) which focuses on socioeconomic and human development—with due consideration to ICPD, Beijing Platform for Action and MDGs in meeting these challenges.  In order to strengthen health and family planning programmes, there has been a policy shift towards bifurcation of reproductive health and family planning services which were previously integrated into a similar focal area of intervention.
1. Bangladesh Bureau of Statistics (BBS), Population and Housing Census, 2011 Preliminary Results
2. BBS, Household Income and Expenditure Survey, 2010 Preliminary Report
3. National Institute of Population Research and Training (NIPORT), Bangladesh Maternal Mortality Survey, 2010 Preliminary Report
4. NIPORT, Bangladesh Demographic and Health Survey, 2007
5. United Nations Development Programme (UNDP), Human Development Reports, 2011 http://hdr.undp.org/en/
6. World Bank Indicators, http://data.worldbank.org/indicator

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