Fertility rate on rise in urban areas

The number of births per woman or the Total Fertility Rate (TFR) in urban areas has been on the rise, raising concerns that the country may be seeing a backward trend with regard to the "replacement-level fertility".

Replacement-level fertility is the total fertility rate -- the average number of children born per woman -- at which a population exactly replaces itself from one generation to the next, without migration. This rate is roughly 2.1 children per woman for most countries, although it may modestly vary with mortality rates.

According to the Bangladesh Urban Health Survey 2021 (BUHS-2021), the birth rate per woman in urban slums increased from 2.01 in 2013 to 2.14 in 2021, while for women in non-slum areas, the rate increased to 1.91 compared to 1.74 in 2013.

Semi-urban areas also saw an increase in birth rate -- from 1.93 in 2013 to 2.22 in 2021, says the survey by the National Institute of Population Research and Training (NIPORT), released at the Centre on Integrated Rural Development for Asia and the Pacific yesterday.

NIPORT conducted the survey among 35,860 married women aged 12-49, married men aged 15-54 and children under five, in 11 city corporations and the remaining urban populations of district municipalities and large towns with populations over 45,000.

Health and population experts believe that the child marriages and early pregnancies during the Covid-19 pandemic might be the main contributing factor behind the rise in TFR.

According to the survey, the rate of teenage pregnancy and motherhood has increased mostly in non-slum areas -- from 13 percent in 2013 to 20 percent in 2021. In slum areas, the rate increased from 21 percent in 2013 to 22 percent in 2021.

In semi-urban areas, teenage pregnancy has decreased from 19 percent to 11 percent during the same period.

Speaking to The Daily Star yesterday, Mohammad Mainul Islam, professor of the Department of Population Sciences at Dhaka University, "This survey has revealed that the early marriage and teenage pregnancy have risen sharply among the non-slum urban population during the Covid-19 pandemic.

"In contrast, the use of contraception is lower among the teenage groups and the overall use of contraception has not increased significantly, especially in the non-slum areas."

The contraceptive prevalence rate (CPR) was highest in the urban slums -- 72 percent -- and lowest in the rest of the urban areas – 68 percent -- in 2021. Couples in the slum areas were very close to achieving the Health Population and Nutrition Sector Program's goal of reaching CPR of 75 percent by 2022, the survey said.

"C-SECTION UNACCEPTABLY HIGH"

The survey also revealed that the Caesarean section (C-section) delivery was unacceptably high among women in non-slum, slum and the rest of the urban areas.

Some 59 percent of babies in non-slums, 51 percent in remaining urban, and 31 percent births in slums were delivered by C-sections.

Nearly 77 percent of facility deliveries among women in non-slums and 75 percent of the rest of the urban areas, and 58 percent in slums were done through C-sections.

According to the World Health Organization, the international healthcare community has considered the ideal rate for C-sections to be between 10-15 percent since 1985.

"High C-section rate is extremely dangerous for maternal health. There is a need for immediate regulatory intervention to reduce unnecessary C-sections," Prof Mainul said.

LACK OF ANTENATAL CARE

The BUHS 2021 has also revealed another concerning aspect regarding antenatal care, which requires a pregnant woman to have at least four doctor visits before delivery.

The antenatal care coverage is the percentage of women aged 15 to 49 with a live birth in a given time period who received antenatal care (ANC).

The survey revealed that only 40 percent of pregnant mothers in slums received proper ANC, while it was 53 percent in non-slum and 39 percent in semi-urban areas.

Mortality rate in urban areas was 27 percent among the newborns, 36 percent among infants, and 39 percent among children under five.

Exclusive breastfeeding among children under six months both in slums and non-slum areas have decreased in 2021 compared to 2013-- from 59 percent to 54 in slums and 58 percent from 49 in non-slums.

The survey also revealed that a big number children under five suffer from malnutrition related complications.

In the slums, around 34 percent of all under-five children were stunted. In non-slums, it was 27 percent and in rest of the urban areas it was 28.5.

Overall, 16 percent of under-five children in slums were wasted. In non-slums, it was 14 percent and in the remaining urban areas 16 percent. 

In slums, 28 percent of the under-five children were underweight, while in non-slums it was 20 percent and 23 in the rest of the urban areas, the survey said.

Speaking at the unveiling of the BUHS 2021, Professor Dr AKM Nurun Nabi, population expert and former vice-chancellor of Begum Rokeya University, said the survey has revealed how urban health has been neglected.

"The policymakers should focus on this."

Speaking as the chief guest, Health Minister Zahid Maleque said the number of C-sections needs to come down.

"For this, we have to work at the root level. If we can ensure 24/7 delivery services, the number of [unnecessary C-sections] can be brought under control."