In 1989, the Governing Council of the United Nations Development Programme recommended that July 11 be observed by the international community as World Population Day, a day to focus attention on the urgency and importance of population issues. This year, on World Population Day, the United Nations Population Fund, UNFPA, will celebrate the theme “Family Planning is a Human Right”. This year marks the 50th anniversary of the 1968 International Conference on Human Rights, where family planning was, for the first time, globally affirmed to be a human right.
Family planning as a human right views people not as passive beneficiaries, but as active agents in planning their families and shaping their lives. Family planning is widely considered as a foundation for a range of rights, built upon the explicit identification of individuals as rights-holders and governments and other entities as duty-bearers that are responsible for delivering these rights.
Family planning is, quite simply, central to women's empowerment, reducing poverty and achieving sustainable development. When a girl or woman has access to family planning information and services she can shape her life, she can avail of more education, seek better jobs and contribute to her family, society and nation as a whole.
Bangladesh has made commendable progress in many reproductive health outcomes including family planning. The Contraceptive Prevalence Rate (CPR), a widely used indicator to understand usage of contraceptive methods among married women of reproductive age, increased from 7.7 in 1975 to 62.4 percent in 2014 and Total Fertility Rate (TFR) has reduced from 6.3 to 2.3 per women in similar period. However, 3.8 million women of reproductive age are not using any contraceptives even though they want to avoid pregnancy for at least two years.
Adolescents who comprise 22 percent of Bangladesh's population—some 35 million—are crucial to the country's future. Such a large cohort of young people represent an opportunity for growth, development and innovation. But more than half of all girls still get married before the legal age of 18—a huge concern on many fronts. These girls enter into married life without the necessary information and knowledge about sexual and reproductive health, jeopardising their rights, health and wellbeing. The adolescent fertility rate of 113 live births per 1,000 girls and women aged 15-19 remains the highest in South Asia. The Bangladesh Demographic Health Survey (BDHS) 2014 shows that 31 percent of adolescents aged 15-19 have begun childbearing; about 25 percent had given birth, and another 6 percent were currently pregnant with their first child.
In Bangladesh, the use of contraception among married adolescent girls remains low at 51 percent, lower than the national average of 62 percent. Furthermore, the unmet need for family planning is highest among married adolescent girls, at 17 percent compared with 12 percent among women aged 15-49. Moreover, women during the first two years after a birth have a high unmet need for contraceptives at 44 percent. UNFPA will continue to support the Government of Bangladesh in addressing the unmet need for family planning, especially for vulnerable and marginalised communities all over Bangladesh.
Despite the achievements made in reducing TFR and increasing CPR, it is clear that formidable challenges remain. These include the following: young married females, especially adolescents, are underserved; geographic inequalities in contraceptive use prevail probably due to shrinking outreach activities; low use of effective methods of contraception such as long acting methods and insufficient post-partum and post abortion contraception; absence of a structured urban family planning service delivery system and limited contribution of the NGO sector to CPR. In addition, the shortage of a skilled workforce and its management is a continuous challenge especially in the remote rural hard-to-reach areas.
Bangladesh currently stands at a population of 160 million. Half of its population are women. At the midpoint of Global Family Planning 2020 (FP2020) commitment, a global partnership that supports the rights of women and girls to decide, freely, and for themselves, whether, when, and how many children they want to have, at a summit held in July 2017 in London, Bangladesh committed to achieving its family planning objectives by implementing the postpartum action plan, regional family planning package for the lagging behind Sylhet and Chittagong divisions, and the national adolescent health strategy, in a time-bound efficient and effective manner.
The movement towards Sustainable Development Goals (SDGs), long-term political engagement and cost-effective interventions are essential to ensure Universal Health Coverage for all. The SDGs, otherwise known as the Global Goals, are a universal call to action to end poverty, protect the planet and ensure that all people enjoy peace and prosperity. These 17 Goals build on the successes of the Millennium Development Goals, while including new areas such as climate change, economic inequality, innovation, sustainable consumption, peace and justice, among other priorities. The goals are interconnected—often the key to success on one will involve tackling issues more commonly associated with another. The SDGs work in the spirit of partnership and pragmatism to make the right choices now to improve life, in a sustainable way, for future generations.
Henceforth, to minimise inequalities in different variables and respond to the SDG call to leave no one behind, additional efforts are needed to move FP programme towards more effective, longer lasting and lower-cost clinical and permanent methods. FP services should be widely available, accessible and affordable for all. Bangladesh's current health policies set a clear agenda for ensuring availability and accessibility to effective and safe family planning services for all citizens. In order to ensure zero unmet need for family planning the government should strengthen effective partnerships with all stakeholders across civil society to create an enabling environment for women and girls in accessing wider contraceptive choices.
UNFPA would like to commend the Government of Bangladesh, in particular the Ministry of Health and Family Welfare, for its hard work in promoting family planning in the country.
In celebrating World Population Day, UNFPA would like to further advocate for increased national investment in family planning services, reproductive health commodity security and efforts to expand the choice of methods and improve the quality of services. UNFPA reaffirms its commitment to working with the Government of Bangladesh and other development partners to increase contraceptive access.
Let us not forget that the right to family planning, permits the enjoyment of other rights, including the rights to health, education, and the achievement of a life with dignity. An informed rights-based approach to family planning is the most cost-effective intervention for tackling maternal death in Bangladesh. Ensuring universal access to reproductive health services, including family planning, can ultimately speed up Bangladesh's progress towards reducing poverty and achieving the SDGs.
Dr Asa Torkelsson is UNFPA Bangladesh Representative and Dr Sathya Doraiswamy is Chief of Health, UNFPA Bangladesh.