Growing Out of Control
Bangladesh faces no greater challenge than overpopulation. During the time it takes to read this page, another 20-odd people will have been added to the country’s population. At the current official growth rate of 1.4% the number of people in Bangladesh increases by more than 2 million each year. Experts say the population will cross the 28 crore mark by 2050, putting a tremendous strain on already fragile infrastructure and the environment. Food, water and sanitation will be in short supply. It is feared that spiraling unemployment will lead to social upheaval. Although significant progress was made in Bangladesh in the 80s and 90s in the area of family planning, many of the programmes have lost their edge. Yet, some policymakers do not seem fully convinced of the urgency of creating an ever-increasing awareness among the population and of the need for more focused family planning strategies. Inadequate manpower and lack of resources continue to hamper efforts to curb the population boom in the near future.
Syed Zain Al-mahmood and Kajalie Shehreen Islam
Hajera Begum, in her early 40s, has four children. The eldest, a girl, is 20, while the youngest, a boy, is nine. Hajera’s husband is unemployed, so she works as a housemaid to support the family. The couple don’t use contraceptive methods. Hajera’s husband refuses to use protection. She tried pills but found they didn’t suit her. Last year she was forced to get an abortion after she got pregnant. It happened again last month. “I had a miscarriage,” says Hajera. “My eldest daughter got pregnant recently. How embarrassing for me to be pregnant at the same time as my daughter!”
Rafiqul Islam, a farmer, has eight children. He only has a few decimals of land – inherited from his father. “There isn’t enough for all of my six sons,” says Rafiqul, “My sons will be even poorer than I, but what can I do?”
Bangladesh is already one of the most densely populated countries in the world, with a total area of 55,598 square miles (143,999 kilometres). Around 140 million people live on this land mass, making it the seventh most populous nation in the world. According to official statistics, the density of population is round about 1,100 per square Km. At the time of independence, 750 million people lived here. The population has doubled in the last 36 years, and it is expected to double again in the next 40. The remarkable population density can be put into perspective when one considers the fact that Russia’s population is slightly smaller than Bangladesh’s even though Russia has a land area of 17.5 million square kilometers, at least 120 times bigger than Bangladesh.
Experts say overpopulation must be understood not just in terms of population density but by the numbers of people in an area relative to its resources and the capacity of the environment to sustain human activities. Scientists call this the area’s “carrying capacity”. An area is overpopulated when its population can't be maintained without rapidly depleting nonrenewable resources and without degrading the capacity of the environment to support the population. In short, if the long-term carrying capacity of an area is clearly being degraded by its current human occupants, that area is overpopulated.
The ripple effects of the burgeoning population can be seen everywhere in Bangladesh. Phenomena such as deforestation, desertification and water and air pollution are stark indicators of a country creaking under the weight of its population. According to experts, if the population increases at the current rates, Bangladesh will soon face more and more problems with food, water and waste disposal.
The area available for producing food grain for each person alive today has fallen by half since 1950, according to UN estimates. So farmers are turning to increasingly marginal land on hillsides and in forests. The immediate result is deforestation which can make flooding more frequent and more severe. The longer-term consequence is the impoverishment of the soil itself. And the soil in Bangladesh is already being degraded by rising sea levels and salinity, leaving even less productive land. The exploding population means cultivable land is being divided up at a faster rate resulting in ever-smaller plots of land for succeeding generations, till there is too little left for survival. Despite the gains of the green revolution, the nutrients in the soil are being used up at an unsustainable rate. With 2 million more mouths to feed each year, Bangladesh will struggle to cope.
Water supplies are also affected by rising populations. By 2050, the amount of fresh water available per person will be about 25% of the 1950 figure, according to the World Food Programme. Many of Bangladesh’s main rivers are running dry for part of each year. With ground water levels already dangerously low, Bangladesh is struggling to provide fresh water to meet the needs of its current population.
Urban life in Dhaka and other major cities is already polluted and unhealthy, and ultimately unsustainable, sucking in resources and spewing out wastes for disposal elsewhere. From transportation to healthcare, the ever-increasing headcount threatens to undo progress and retard development.
“Overpopulation has a knock-on effect everywhere,” says epidemiologist Dr. Abul Kalam Ajad. “Healthcare is often worst hit. Children are not cared for, they are not healthy, women die in childbirth, the economy of the family is much worse because the mother and the father cannot support the children. They don’t have proper housing, they don’t have proper education and so the economy suffers.”
Climate change is already a fact of life. The Intergovernmental Panel on Climate Change predicts that as sea levels rise due to global warming, about 35 million people from Bangladesh will become environmental refugees by 2050 needing rehabilitation in other parts of the country. The impact of climate change is putting extra pressure on the limited natural resources of the country.
The spiraling population is taking a toll on the country's limited resources and services.
Solving the population problem was a big thing in the 80s and 90s and for a while Bangladesh was held up as a success story. The dramatic increase in the prevalence of contraceptive use (from 3% to 45% among married women since independence in 1971) and the declining Total Fertility Rate (TFR, from about 6 in 1990 to around 2.7 in 2007) have been attributed in large part to the efforts made to expand access to family planning methods and services and to motivate people to use them. The success is particularly remarkable when seen against the backdrop of persistent poverty, high mortality and low literacy.
However, many experts believe the early success may have led to complacency and the hard-won gains may have been squandered. “If you consider that the TFR hit 2.7 at the turn of the century, then you realise that not much progress has been made since then,” says Prof Dr AKM Nurun Nabi, of the Department of Population Sciences, University of Dhaka. “We have a huge population already so even a TFR of 2.7 is dangerous for us.”
In general terms, TFR is the average number of children that would be born to a woman over her reproductive lifetime. In order to stabilise the population a country would need to have a TFR of around 2.2, say experts. In such a scenario a couple would leave two children on average at the end of their reproductive life. Experts call this Replacement Level Fertility. Bangladesh is a long way from achieving this benchmark.
Some experts like Prof Nurun Nabi believe the current family planning programmes have become stagnant and the Directorate of Family Planning under the Ministry of Health and Family Welfare is unable to deliver the results needed to stabilise the exploding population.
“I think the Directorate is unable to do its job properly because of a variety of reasons: lack of vision, lack of trained staff, and bureaucratic infighting between the medical doctors and the non-medical staff of the Family Planning Directorate.”
The strengths of the National Family Planning Programme could also be its weakness. Behind the early success of the family planning programme was its central strategy: delivery of family planning information and methods to women in their homes. The main part of the programme was launched between 1976 and 1980, when thousands of female family welfare assistants (FWA) were hired and trained. The majority had some secondary schooling. Their primary functions were to inform women about various methods of contraception; to motivate women to use contraceptives; to supply condoms, pills and in some cases injectable contraceptives; and to refer women who wanted clinical methods to appropriate sources such as government clinics.
Although the strategy was initially very successful in reaching Bangladeshi women and persuading them to use contraceptives, critics say it often fails to support contraceptive users and to meet women’s other reproductive needs. There is also criticism that instead of attempting to engage men, the programme places the responsibility for family planning disproportionately on women, who lack the resources to deal with its costs and risks.
Raisun Bibi, 38, of Ghatail, Manikgonj, has five children, the youngest is four years old. She says she became very ill during her last childbirth and doesn’t want any more children. She says she tried talking to her husband who is a rickshaw-puller about using contraception. But he wouldn’t hear of it. “How could I disobey my husband?” says Raisun Bibi.
The burden of family planning most often lies with women.
With the family planning programme hit by diminishing returns, experts like Dr. Nurun Nabi think the Directorate should be dismantled and totally restructured. “Population is not just about family planning and contraception. There are other crucial issues such as preventing early marriage -- the Directorate has no role in that. There should be a separate ministry for population.”
Other experts disagree. “I wouldn’t say the family planning programme has failed,” asserts Dr. Noor Mohammad of the UN Population Fund (UNFPA). “Bangladesh is still held up internationally as a success story. But I agree that the focus of the programme might have to change over time. For example, family planning is now exclusively directed towards ‘eligible couples’. But I think we should start the awareness building process with adolescents.”
Dr. Ubaidur Rob, Country Director of the Population Council, an international development organisation active in the field of population and public health research, has a different angle. “In my view, the main problem right now is not lack of awareness or shortage of contraceptives, it is a logistical weakness. People need and want service, but there is a lacking when it comes to service delivery. There is an acute shortage of manpower in the Family Welfare Centres from where people should get the services. In Sylhet and Chittagong divisions up to 60% of posts are vacant, whereas in Rajshahi and Khulna it is around 20%. Ensure service, and you will get your population control.”
In support of his view, Dr. Rob points out that in Rajshahi and Khulna the TFR is close to the magic figure 2.2 -- replacement level fertility. The population in these two divisions is close to stabilisation, according to the Population Centre Country Director. “The rate of contraceptive use is around 75% in Khulna while it is roughly 40% in Sylhet division. When you consider that in Rajshahi and Khulna almost all the unions have Family Welfare Centres, and in Sylhet only 60% do, the picture becomes clear.”
Dr. Rob believes the Directorate of Family Planning should be strengthened rather than dismantled in order to ensure delivery of family planning services. “Many countries have separate ministries for Population. But that is something for the future. I believe we should strengthen what we have. Hundreds of workers recruited in 1975 are now close to retirement. The government must take up urgent plans to replace these family planning workers.”
According to Mohammad Abdul Qayyum, Director General, Directorate of Family Planning, the main problem is the geographical location of some places which are hard to reach and the unavailability of health service providers there. In areas like some parts of Sylhet and Barisal, coastal belts and the Chittagong Hill Tracts, it is difficult to recruit women involved in the family planning programme. Also, whereas previously one FWA was responsible for visiting the homes of 600 eligible couples a month, now they are having to serve between 1200 and 1800 couples, thereby naturally reducing the frequency of visits to the homes.
Too many people in too little space.
"Our main challenge is to provide service at people's doorsteps," says Qayyum. In the meantime, the directorate has adopted a new strategy of 'satisfied clients' -- people who have benefited from family planning measures -- passing on the message. "It is more convincing when family and friends who have benefited from the programme motivate others to adopt them, rather than health workers whose job it is to promote it."
According to Qayyum, the religious taboo of family planning is not a major obstacle to its adoption. Rather, the (often baseless) promise of more children meaning more income and wealth is what causes many couples to want more children.
According to Dr. Rob, there is significant awareness regarding the need for family planning, but not enough about actual practices. “These days even religious leaders are calling for family planning. But few people know exactly what to do. A decade ago, BTV was the only channel available, and we could reach millions through that medium. Nowadays there are many private channels, but they are not really doing enough to get out the message.”
The developed countries of the world are experiencing a decline in population. Has this resulted in population control falling off the development agenda? Dr. Noor Mohammad of UNFPA does not think so. “I think it is a priority for a country like Bangladesh. But we cannot look at population control in isolation. We have to look at migration patterns, resource limitations and training people so that population turns into manpower. If the population grows unchecked all our efforts to reach development goals will be in vain.”
When Thomas Malthus wrote his pioneering Essay on the Principle of Population, published in 1798, he advanced a subtle argument and an alarming conclusion. Malthus argued that improvements in food production would lead to population growth; growing populations would also lead to increases in food production; but of these two lines of growth, the population line would be much steeper than the other. And once they were far apart, only famine, disease and war would bring them back together. While one of the challenges of the 20th century has been to combat mortality by improving public health, the challenge of the 21st century will be to find a way to curb fertility. Nothing short of an all-out effort from all stakeholders will defuse the population bomb.
Photographs: Zahedul I Khan
A Global Concern
"We are burdensome to the world, the resources are scarcely adequate for us... already nature does not sustain us." So wrote Tertullian, an early Christian, back in the 3rd century. At that time, the world population stood at some 200 million. Eighteen centuries on and with 34 times as many people on the planet, the debate continues. (New Scientist, 25 September 2009)'
Yes, the debate has to be kept alive and it must go on for the sake of our posterity on consideration that planet Earth cannot grow in size to accommodate the ever increasing humans and offer all of them food, water and shelter, and at the same time swallow millions of tonnes of waste humans world-wide are producing every day, 365 days a year.
More and more researchers, demographers, scientists and policy makers now consider population as the number one reason for most of world's woes, such as poverty, illiteracy, water pollution, denuding of forests, extinction of animals and insects, global warming, melting of ice caps, sea level rise, shrinkage of agriculture land and the rising spectre of crime.
Let us look at some of the concerns expressed by population researchers of various countries. These views have been collaged from some international magazines, journals and UN, government websites.
On 25 September 2009, Alison George of New Scientist wrote the following in the cover story titled The Population Delusion: “ Think of the biggest crowd you've ever been in - perhaps 50,000 in a sports stadium. Just 6 hours from now there will be that many more people in the world, and another 50,000 in the following 6 hours, and on and on... No wonder that the burgeoning human population is often seen as 'the single biggest problem facing our world.'
According to this internationally acclaimed magazine there are nearly 7 billion humans alive today, twice as many as there were in 1965, with 75 million more being added each year. UN sources predict there could be an extra 2 to 4 billion of humans by 2050. It has been mentioned recently by the UK government's chief scientific adviser John Beddington that there would be a population-led global crisis by 2030. At the same time, influential billionaires including Bill Gates and George Soros identified overpopulation as the greatest threat facing humanity.
Elsewhere it is written (Paul Ehrlich and Anne Ehrlich in New Scientist) that by 2050 there may be about 35 per cent more people on Earth than there are today. They wrote: "We are already seeing increasing shortages of food, water and other resources and growing numbers of hungry people."
Let us now a have a look at the population scenario of two most populous countries of the world.
An Internet report says that China's population stands at 1,321,851,888 (as of mid-2007), hence making it the world's most populous country, a home to 20 percent of the world's population. It is said that one in every five people on the planet is a resident of China. Experts are of the opinion that China's population growth has been somewhat slowed by the one child policy that came into force in the '70s. They emphasise that because of the one child policy China's population is less by 40 million today. In the 1950s, China's population was around 563 million and the country reached the 1 billion mark in the early 1980s.
India's population today stands approximately at 1.13 billion people (estimate for March 10, 2008), which comprises approximately one-sixth of the world's population. India was the first country in the world to launch a mass media campaign in 1952 to spread the concept of family planning in response to its ever-growing population. Most developing nations copied the model and had some success. The current National Population Policy of India came into effect in 2000 with the objective of achieving a stable population by 2045. The immediate objective of the policy is to address the unmet needs for contraception, health care infrastructure, and health personnel, and to provide integrated service delivery for basic reproductive and child health care. The medium-term objective is to bring the TFR (Total Fertility Rate) to replacement levels by 2010. TFR is the average number of children each woman would have in her lifetime.
India is expected to overtake China by 2030 and will then be the most populated country in the world. Another research finding says that by 2040, India's population will reach the 1.52 billion mark, when China's will be 1.45 billion.
From all studies done by experts it is now almost clear that India will possibly be the first country to have a population of 2 billion. In a recent study conducted by The Population Reference Bureau of India it was shown that India's population would near the 1.8 billion mark by mid-century and may even exceed 2 billion by 2100, unless fertility rates decline more rapidly in India's largest and poorest states.
Tale of success from Iran
Many of us possibly are not aware of family planning policies and activities going on in Iran. It has been gathered from various sources that the government there is implementing a comprehensive family planning policy to keep the country's population growth within limit. Documents reveal that while Iran's population continued to grow at a rate of more than 3 percent per year up to early 80s, the growth rate began to fall since the late 80s and early 1990s thanks to wide acceptance of the family planning programme. According to one report, 76 percent of Iranian women are using some kind of contraception of whom 56 percent are using modern methods such as oral pills, condoms, IUCD, sterilization etc.
It is encouraging to note that since 2007, the growth rate has been on the decline at a rate of 0.7 percent per year. The projected target for 2005 to 2010 birth rate is fewer than two, which is replacement level fertility. Janet Larsen of “Earth Policy Institute” wrote that Iran's birth rate has been going down at a record pace and this success story could provide a model for other developing countries. By reducing its population growth to 1.2 percent, a rate only slightly higher than that of the United States, Iran has no doubt set an example for other countries, especially those Muslim countries, where population growth and abject poverty are deterring all developmental efforts.
Historical records show that because of political change over and pursuing of a different policy, Iran's population had doubled from 27 million in 1968 to 55 million in 1988. But it did not take long for the religious leaders to realise population as an obstacle to development and they engaged in dialogues on the subject of birth control. By 1989, the National Family Planning Policy was revived by setting the goals to encourage women to allow three to four years birth spacing, discourage childbearing for women younger than 18 or older than 35, and to limit family size to three children.
What is interesting is that the policy called for the Ministries of Education, Culture and Higher Education, and of Health and Medical Education to include/provide information on population, family planning, and mother and child health care in curriculum materials. Side by side, the Ministry of Islamic Culture and Guidance was requested to allow the media play its role in creating mass awareness on population issues and family planning programmes.
Washed out. A tired mother sleeps in the street as her four children are left to fend for themselves.
As a result, by 2001, Iran's total fertility went down drastically from seven children per woman to less than three. There is a government-sanctioned condom factory in Iran. Since family planning has been integrated with primary health care, there is no social resistance in using family planning methods, including permanent male and female sterilization, considered a first among Muslim countries. Birth control, including the provision of condoms, pills, and sterilization, is free. And it is mandatory for men and women to attend a counselling session on family planning before marriage.
The most important and encouraging fact is that in Iran, the religious leaders have joined in the movement for smaller families and they talk about it in their weekly sermons. They also have issued fatwas, religious edicts with the strength of court orders that permit and encourage the use of all types of contraception.
Thus the prevailing attitudes toward large families everywhere has to be changed through making universal education mandatory. It should be considered immoral and irresponsible to have too many children. One cannot just keep having children and then leave the burden of providing all basic rights on the shoulders of society and the government. Population study should be a curriculum component in the higher classes in schools.
Shahnoor Wahid is Senior Assistant Editor, The Daily Star.
(R) thedailystar.net 2009