- Background of the study:
The scarcity of resources and subsistence-level economic conditions characterize the Bangladesh economy. Bangladesh is predominantly dependent on land, with agriculture as its primary industry; however, increasing population pressure on the land is continually decreasing the land-man ratio from 4 decimals in 151 to 20 decimals in 1991. Although high yielding variety (HYV) technology has expanded since the early 1960s, covering one quarter of cultivable land area the per hectares yield is among the lowest in the world.
Socio-economically, Bangladesh is comparatively disadvantaged interms of such key indicators as per capita income (US$ 750 in 2010), proportion living below the poverty line (40.9% of total population and 40% of rural population), etc. Consequently, the Bangladesh economy is characterized by extremely low in savings and investments. Both the per capita food production index and daily calorie supply as percentages of requirements (83%) are quite low in Bangladesh. The overall literacy rate is only 37% -male 40% and female 23%. Female school attendance is low, and there is an uneven ratio of male/female school enrollment, especially beyond the primary level.
Despite pervasive poverty and underdevelopment, Bangladesh has achieved considerable decline infertility. Bangladesh indeed represents’ an apparent anomaly for a significant decline in fertility, despite the absence of conditions believed to b necessary for such a reproductive change. Bangladesh is the only country among the twenty poorest countries in the world where such a change occurred.
The purpose of this paper is to examine the nature fertility transition in Bangladesh. The paper begins by looking at the tends in contraceptive use and fertility , and then examines the major factors which might have accounted for the fertility transition in Bangladesh ,despite its poor socio-economic conditions Two sets of factors may account for the fertility decline:
- Positive factors which encourage eligible couples to contraceptive for spacing and/ or limiting births; and
- Negative factors which compel women to contraceptive for spacing and/ or limiting births.
1.2 Review of the literature:
The concept of fertility is the beginning of the study of population dynamics. It refers to the number of births that occur in a population or to an individual. Human fertility offers an interesting and challenging area of scientific inquiry. In recent years viewing the reduction of population growth experienced in most of the developing countries and wide variations in the levels of fertility observed within many high fertility countries, identification of the factors contributing to fertility decline received great importance. Because high fertility in the modern world may be seen as a symptom of lack of access: lack of access to health services, which would reduce the need to insure against infant child and child mortality by having many births; lack of access to education, which could also broaden a woman’s outlook and give her some degree of control over her life; lack of access to social security and forms of insurance for old age, including landownership, that might replace children; lack of access to consumer goods and social opportunities that compete with childbearing; lack of access to the media, which promote such goods and often support modern values and the idea of personal control; and lack of access to family planning service3s, which provide the means to limit births.
Since fertility decline and population control cannot be explained by a single factor, research on fertility control invariability looks for a wide range of explanations at the macro and micro levels. However a relatively recent area of interest in explanations of fertility decline is the crucial aspect of women’s empowerment and its impact on reproductive decisions. Most research on the empowerment explanation of fertility behavior assumes that a greater degree of autonomy in important decisions in the family may lead to a higher degree of influence in fertility decisions.
In recent years considerable attention has been focused on the need for raising the status of women. This has been highlighted by the Chinese slogan “break the thousand year old chains, which have bound them tradition and custom to an inferior role in society and reassure them that they too can hold up of the heaven.” According to the United Nations, the status of women in society can be ascertained by the extent of control over her own life derived from access to knowledge, economic resources and the degree of autonomy enjoyed in the process of decision making and choice at crucial points in her life cycle.
Bangladesh has achieved considerable decline in fertility, with the total fertility rate dropping 6.3 in 1971-75 to 2.7 in 2007. The sharp decline in fertility has attracted the attention of population expert’s around the world. Some authors argued that the decline in fertility level in Bangladesh has been achieved due to successful family planning program. During the 1970s and 1980s, researchers documented repeatedly by using the cross sectional data from representative surveys’, consistent empirical association between various commonly used proxies for women’s status such as education and working status their fertility, in wide range of developing countries from different regions. Comprehensive studies on fertility have revealed that improved educational and formal employment opportunities for women world would lead to greater number of women participation in modern-sector employment.
Recent studies have suggested that the status of women may be the single most important element in explaining the fertility transition (Mitra, 1978; Dyson and Moore, 1983). While there are some empirical support, particularly at the macro level, for a relationship between women’s status indicator and both the shift toward controlled fertility and transition from high to low fertility, the mechanism through the status of women effect changes in fertility are not clear(Mason,1948)
Three types fertility behavior directly determine fertility outcomes: marriage timing, breastfeeding duration, and the practice of contraception and abortion. These behaviors may be affected directly through population policies and programs, including family planning programs that change the socio-economic characteristics of households, and therefore the propensities and decisions of their members with regard to each type of behavior.
Khalifa (1986) studied the determinants of fertility in Sudan Fertility Survey data 1979. In his study he found that fertility of Sudanese population was close to natural. Prolonged lactational amenorrhea was found to be the main inhibitor of fertility.
The effect of the intermediate fertility variables on marital fertility in Kenya was examined by Kaula Sabti (1984) and in his findings he suggested that variations in the proportion married among population, level of contraception and post-partum lactational infecundebility could account for much but not all of the observed fertility differentials. From the National Survey in Nepal, 1987 it was found that the most important factor, resulting in reduction of about six children per women. The temporary separation of spouse’s use to emigration was conjecture to be the most important fertility inhibiting factor, not explicitly accounted for in the standard model.
- Objective of the study:
The specific objective is to examine:
1. Trends in the recent fertility.
2. The socio-demographic characteristics of women in Bangladesh and its impact on their fertility preference.
3. Contraceptive behavior among the women and contraceptive prevalence among the adolescent and adult.
4. To identify significant factors influencing fertility using appropriate multivariate analysis.
- Organization of the study
The first chapter contains introduction, background of the study, literature review and objective of the study.
The second chapter describes the data sources and methodology.
The third chapter depicts the recent trends in fertility.
Chapter four discusses the determinant of fertility.
Chapter five is the discussion of status of women in Bangladesh.
Chapter six is designed with the discussion of contraceptive behavior among adolescent and adult married women.
Findings of the study, conclusion & recommendation are discussed in chapter seven.
Besides these list of references used in this study is given at the end of the study.
Data and Methodology
In the study attempt has been made to explore the motive of women’s participation in decision-making activities. To serve the purpose of the study quantitative analysis has been made. To complete the analysis, secondary data source, the 2007 Bangladesh Demographic and Health Survey (BDHS) has been used.
2.2 Sources of data:
The Bangladesh Demographic and Health Survey (BDHS) are intending to serve as a source of population and health data for policymakers and the research community. In general, the aims of the BDHS are to:
(a) Provide information to meet the monitoring and evaluation needs of health and family
Planning programs, and
(b) Provide program managers and policy makers involved in these programs with the
Information they need to plan and implement future interventions.
The 2007 BDHS survey was conducted under the authority of the National Institute for
Population Research and Training (NIPORT) of the Ministry of Health and Family Welfare. The survey was implemented by Mitra and Associates, a Bangladeshi research firm located in Dhaka. Macro International Inc., a private research firm located in Calverton, Maryland, USA, provided technical assistance to the survey as part of its international Demographic and Health Surveys program. The U.S. Agency for International Development (USAID)/Bangladesh provided financial assistance.
2.3 Sample design:
The 2007 BDHS employs a nationally representative sample that covers the entire population residing in private dwelling units in Bangladesh. The survey used the sampling frame provided by the list of census enumeration areas (EAs) with population and household information from the 2001 Population Census. Bangladesh is divided into six administrative divisions. In turn, each division is divided into zilas, and each zila into upazilas. Rural areas in an upazila are divided into union parishads (UPs), and UPs are further divided into mouzas. Urban areas in an upazila are divided into wards, and wards are subdivided into mahallas. These divisions allow the country as a whole to be easily divided into rural and urban areas. EAs from the census were used as the Primary Sampling Units (PSUs) for the survey, because they could be easily located with correct geographical boundaries and sketch maps were available for each one. An EA, which consists of about 100 households, on average, is equivalent to a mauza in rural areas and to a mohallah in urban areas.
The survey is based on a two-stage stratified sample of households. At the first stage of sampling, 361 PSUs were selected. The selection of PSUs was done independently for each stratum and with probability proportional to PSU size, in terms of number of households. The 361 PSUs selected in the first stage of sampling included 227 rural PSUs and 134 urban PSUs. A household listing operation was carried out in all selected PSUs from January to March 2007. The resulting lists of households were used as the sampling frame for the selection of households in the second stage of sampling. On average, 30 households were selected from each PSU, using an equal probability systematic sampling technique. In this way, 10,819 households were selected for the sample. However, some of the PSUs were large and contained more than 300 households. Large PSUs were segmented, and only one segment was selected for the survey, with probability proportional to segment size. Households in the selected segments were then listed prior to their selection. Thus, a 2007 BDHS sample cluster is either an EA or a segment of an EA.
The survey was designed to obtain 11,485 completed interviews with ever-married women age 10-49. According to the sample design, 4,360 interviews were allocated to urban areas and 7,125 to rural areas. All ever-married women age 10-49 in selected households were eligible respondents for the women’s questionnaire.
The 2007 BDHS used five questionnaires:
(a) A Household Questionnaire
(b) A Women’s Questionnaire
(c) A Men’s Questionnaire
(d) A Community Questionnaire and
(e) A Facility Questionnaire.
Their contents were based on the MEASURE DHS Model Questionnaires. These model questionnaires were adapted for use in Bangladesh during a series of meetings with a Technical Task Force (TTF) that included representatives from NIPORT, Mitra and Associates, ICDDRB: Knowledge for Global Lifesaving Solutions, the Bangladesh Rural Advancement Committee (BRAC), USAID/Dhaka, and Macro International (see Appendix E for a list of members). Draft questionnaires were then circulated to other interested groups and reviewed by the BDHS Technical Review Committee (see Appendix E). The questionnaires were developed in English and then translated and printed in Bangla.
The Household Questionnaire was used to list all the usual members of and visitors to selected households. Some basic information was collected on the characteristics of each person listed, including age, sex, education, and relationship to the head of the household. The main purpose of the Household Questionnaire was to identify women and men who were eligible for individual interviews. In addition, the questionnaire collected information about the dwelling unit, such as the source of water, type of toilet facilities, flooring and roofing materials, and ownership of various consumer goods. The Household Questionnaire was also used to record height and weight measurements of all women age 10-49 and all children below six years of age.
The Women’s Questionnaire was used to collect information from ever-married women age 10- 49. Women were asked questions on the following topics:
1. Background characteristics, including age, residential history, education, religion, and media exposure,
2. Reproductive history,
3. Knowledge and use of family planning methods,
4. Antenatal, delivery, postnatal, and newborn care,
5. Breastfeeding and infant feeding practices,
6. Vaccinations and childhood illnesses,
8. Fertility preferences,
9. Husband’s background and respondent’s work,
10. Awareness of AIDS and other sexually transmitted diseases,
11. Knowledge of tuberculosis, and
12. Domestic violence.
2.5 Data collection period:
Data collection process commenced on April 16 and ended on August 31, 2007.
In this study initially univariate analysis is performed to examine the background characteristics of ever married women and discuss fertility-inhibiting effects of the proximate determinants of fertility. Then bivariate analysis is executed to find the association between socio-economical characteristics or status of women and fertility. A multivariate analysis is also executed by using logistic regression to show the affect of various factors on women’s status and its impact on fertility.
2.7 Multivariate analysis:
Bivariate analysis only provides unadjusted results. An empirical association between two variables doesn’t necessarily imply a causal relationship between them. The relative importance of all the variables has to be examined simultaneously by multivariate statistical techniques. Multivariate analysis is the simultaneous analysis of two or more variables. Multivariate analysis is also used to test the join effects of two or more variables upon a dependent variable. Different multivariate techniques can be used to predict a dependent variable from a set of independent variables. The logistic regression model is one of the multivariate techniques which are used to estimate the probability that an event occurs.
Logistic regression analysis:
There are many multivariate statistical techniques. Two important multivariate techniques are multiple regressions and discriminate analysis. Sometimes it is difficult to apply these techniques when the dependent variables are categorized (dichotomous and polygamous). In such situation it is better to fit linear logistic regression (Cox’s, 1970, Schlesslelman, 11082). Since, it does not require distribution assumption, unlike many other multivariate techniques (for example that the variable\s are normally distributed with equal variances), so it can appropriately handle situation in which the independent variables are qualitative or measured in normal or ordinal scales. It can be used to identify risk factors as well as predict the probability of ‘success’ (Pi), to ‘failure (1-Pi)’ and relating it to the independent variables, the logistic parameter can easily be interpreted in terms of odds and odds ratio, relative odds can be estimated for the categories of each independent categorical variables or combination of such variables.
Logistic regression model:
A brief description of the model is given below. Suppose that there are individual, some of them are called ‘success’ and other are ‘failure’.
Let, Yi denote the dependent variable for the ith observation and let,
Yi = 1, if the ith individual is a success and
Yi = 0, if ith individual is a failure.
Suppose for each of the n individuals, ‘p’ independent variables, Xi1, Xi2… Xip are measured.
In this model, the dependence of the probability of success on independent variables is assumed to be
Where, X10 = 1 and’s unknown coefficients.
Equations (1) and (2) look complicated, however, the logarithm of the ratio of Pi and (1-Pi) which we called logit of Pi turns out to be a simple linear function of Xij.
The logit is the logarithm of the odds of success, that is, the logarithm of the ration of the probability of success to the probability of failure. It is also called the logistic transform of success of Pi and equation 3 is a linear logistic model. Thus the linear logistic model relates to the independent variables to the transform of Pi or the log odds.
In logistic regression, the parameters of the model are estimated using the maximum likelihood estimation procedure. That is the coefficients that make our observed results most ‘likely’ are selected. Since the logistic model is nonlinear, an iterative algorithm is necessary for parameters estimation. To understand the interpretation of the logistic coefficients, consider a re-arrangement of the equation for the logistic model. The logistic model can be re-written in terms of the odds of an event occurring. It has several nice properties. First, as Pi increases, so does logit (Pi). Second, logit (Pi) varies over the whole real line, where as Pi bounded only between o and 1. We see that logistic regression model can be expressed in two equivalent ways. First we can fit a linear model in the logit scale (in terms of the log odds).
From, equation (3) we see that the coefficient can be interpreted as the change in the log odds associated with a one unit change in the independent variable. Since it is easier to think of odds, rather log odds, the logistic equations can terms of odds as
The exponential rose to the power is the factor by which the odds change when jth independent variable increases by one unite. If is positive, the factor will be greater than 1, which means that the odds are decreased. If is 0, the factors equal 1, which leaves the odds unchanged.
Second, it is almost equivalent to modeling the logit of the probability of success a linear function of the independent variables, as given equation (1). The equation (1) express in the model as in the S-shaped curve in the original probability scale. Equation (1) and equation (3) are equivalent. Besides in many ways, equation (3) is the model for normally distributed data.
In the logistic regression, just as in linear regression, the codes for independent variables must be meaningful. We have coded all of our two-categorical independent variable as either 0 or 1. This is called dummy variable or indicator variable coding. For variables more than two categories, we have created new variables to represent the categories. The number of new variables required to represent a categorical variable is one less that of categories. The logistic regression procedure will automatically create new variables for categorical variables.
To fit a best regression model, we have considered a full model with all independent variables at a time. The on the basis of odds ratio and it will be decided which variables are significant or not.
2.7 Software used for analysis:
A well known statistical package SPSS16 & R was used to analyze the data and to prepare the thesis paper. SPSS16 for windows is a comprehensive and flexible statistical analysis and data management system. Besides SPSS, another well known application software such as MS word, MS excel are used to complete the thesis.
Fertility trends in Bangladesh
At the beginning of the 20th century, the total population of Bangladesh was less than 30 million. The annual growth rate of the population was less than 1 percent until 1951, when the population reached about 44 million (Bangladesh bureau of statistics, 1998). From the early 1950’s, mortality started to decline while fertility remained high until the 1970s. owing to the changes in fertility and mortality rates, from the 1950’s the population started to grow at an unprecedented rate, reaching an all time high (about 2.5% per year) in the 1960s and 1970s. The growth rate then started to decline in the 1980s and is currently about 1.2% per year. The Bangladesh population policy indicates that the population should stabilize at 210 million by 2060, if replacement level fertility is reached by 2010. This estimates of future population science is reasonably consistent with the World Bank projection from 1994 (BOS et al., 1994), and the UN projections 1996 revisions (UN 1996), both of which estimated on mid 21st century population of 210 millions. The main source behind the decline in the population growth rate of Bangladesh in the 1980s and 1990s was a remarkable decrease in fertility during the period. In the early 1970s, the TFR was about 7 children per woman, and an estimated 2.7 children per woman obtained by BDHS 2007. The TFR is so surprisingly low that quality of the data is being questioned. The aim of the chapter is to unmark genuine trends from the BDHS 2007 data. Its aim is to reach the firmest possible conclusions about the timing, magnitude, and nature of fertility decline in Bangladesh.
3.2 Lifetime fertility:
Trends in fertility in Bangladesh since early 1970s can be examined by observing a time series of estimates produced from demographic surveys filled over the last 2 and half decades, beginning with the 1975 BFS in 1978, the government of Bangladesh declared population pressure as the leading problem of the country. Since then, the government as well as non-governmental private and international organizations has undertaken several programs to solve population problems. Some success in different areas has been achieved.
Table: 3.2: cumulated number of children ever born to all women, by age group, various sources
Means number of children fluctuate erratically between 3.1 and 3.8 births. The oscillation reflects differential completeness of reporting between surveys as, for instances, have occurred in surveys conducted 1981. The problem is not clearly seen with regard to the differences between the census 1961 and the BFS a year later. A detailed evolution in these years suggests strongly that appreciable omission of children occurred among older age groups (Blacker 1977). The adjusted means are close to those reported in the 1975 BFS.
When attention is confined to the more reliable sources, a pattern emerges. Starting in 1983, the CPS has been conducted by Mitra and associates under contract to USAID, employing high standards of fieldwork supervision. A comparison of three most recent Contraceptive Prevalence Surveys reveals a decline in fertility among all age groups except the oldest. Similarly, comparison of the two Bangladesh fertility surveys both of which laid particular stress on accuracy of measurements shows an appreciable decline. The overall standardized mean changes from 3.79 births in 1975 to 3.14 in 1989, a fall of 17 percent. While deterioration in completeness of birth reporting or discrepancies in sample design could account for both the CPS and BFS comparisons, a genuine decline in fertility is a more likely explanation.
A comparison of the mean of number of children ever born reported in the 2004 BDHS and various other surveys does not highlights recent changes in fertility, but rather is an indication of the cumulative changes in fertility over the decades preceding the 2004 BDHS. Despite the fluctuations between surveys, the data generally show only modest declines until the late 1980s. Between 1985 and 1989, the decline in the mean number of children gain declined considerably between 1991 and 1993-1994 and 1999-2000 at all ages except 15-19. The most recent data showed a decline in the mean number of children between 1999-2000 and 2007 among women age 30and above.
3.3 Fertility levels and trends:
Bangladesh has been cited a remarkable decline in fertility that has begun in 1980s this is the main force behind the decline in the population growth rate of Bangladesh during this period. In the early 1970s the TFR was about seven children and women in the first demographic and Health Survey 94. TFR remained almost unchanged at 3.3 children per woman in the next two DHSs conducted in 1996-97 and 1999-2000. (Mitra and others, 1997, BDHS 2000). According to the BDHS 2007, the estimated TFR is 2.7. This shows a very small change in TFR in recent years. The following table also represents the trends in current fertility.
Table: 3.3.1: Trend in current fertility according to national survey:
|Year||1975 (BFS)||1989 (BFS)||1991 (BDHS)||1993-94 (BDHS)||1996-97 (BDHS)||1999-00 (BDHS)||2004 (BDHS)||2007
Other predictors of fertility are the age at first birth. The onset of childbearing has a direct effect on fertility. Early initiation into childbearing lengthens the reproductive period and subsequently increases fertility. In many countries, postponement of first births reflects an increase in the age at first marriage has an important role to decline fertility. Early childbearing involves substantial risks to the health of both the mother and child and restrict educational and economic opportunities for women. The following table gives the relevant evidence from the 1989 BFS and 2007 BDHS in terms of median age at 1st birth:
Table: 3.3.2: Age t 1st birth according to the 1989 BFS and 2007 BDHS:
|Age at 1st birth||Survey||20-24||25-29||30-34||35-39||40-44||45-49|
The prevalence of reported pregnancy is slightly lower in 1975 than in the subsequent 3 surveys; probably because of an effect on fertility of the severe 1974 famine (The Matlab data series shows a marked fertility response to the famine). Percentage of currently married women who reported that they were pregnant, 1975 and 2007 BDHS.
Table 3.3.3: Percent of pregnant in 1989 and 2004
The above discussion revealed the factors behind the fertility decline in Bangladesh. There is another important factor which has important role in this decline the contraception prevalence which is discussed in later.
Direct determinants of fertility
In the previous chapter, fertility trends and patterns were reviewed. In this section, attention turns to the direct or physiological determinants of fertility. The factors that determine fertility can be placed into major categories – biological and social. The biological component refers to the capacity to reproduce, usually called fecundity.
Cultural and economic factors do not affect fertility directly; they influence another set of variables that determine the rate and the level of childbearing. One of the major demographic advances of the last 15 years has been the development of a crude but simple method to express the fertility reducing impact of the major direct determinants of fertility. (See, e.g. Bongaarts 1982). These are:
- Exposure to sexual intercourse
- Postpartum infecundity
- Brest feeding]
- Induced abortion
The legal union of two persons of opposite sex dually solemnized by certain religious norms for the purpose of leading conjugal life, production of offspring and establishment of family is defined as marriage. Marriage is essentially a reproductive union and in most societies, reproduction is normatively restricted to married couples only. From the demographic point of view marriage is the event that marks the beginning of the potential period of childbearing. The age at which women enter into stable sexual unions (through marriage) determines the lengths of reproductive life span and hence number of children women potentially can bear.
In most populations, actual fertility of women is substantially lower than the potential fertility. Marriage contributes significantly to this reduction in potential fertility. A study using data from World Fertility Survey (WFS) showed that martial exposure is one means through which substantial reductions in potential fertility are achieved in all groups of countries covered in most cases, 35-40 percent of the total reduction is due to this source (UN 1987). Nuptiality has received relatively less attention in terms of its effect on fertility than contraception. This arises partially from the fact that on most Thirds World countries family planning programs were directed towards married couples with the aim of reducing marital fertility (Freeman, 1979). In Bangladesh, as in most Asian countries, childbearing outside of marriage is very rear, thus the age at which men and women marry, the proportions who remain single and the frequently of divorce widowhood are all potentially powerful influences on fertility level.
East Bengal has a long tradition of very early and universal marriage for female, together with a large age difference between husband and wife. The precocity of marriage has been a subject of concern for successive governments, which have legislated against young marriages with little success. For instances, the Child Marriage Act of 1929 banned unions below age 14. Thirty years later, the mean age of marriage was still below this legal minimum. As we shall see, changing ideas and economic forces have largely succeeded where legislation failed. The main sources of information on age at marriage are censuses. Censes data on marital status by age group can be converted into indicators of mean marriage age using the method proposed by Hajnal (1953). The results, given in the table 4.2 reveals a longstanding upward drift in age at marriage for both men and women, with a slight attenuation of the large age differences between bride and groom. The mean age at marriage for women has increased from bout 14 year in the 1950s and 1960s to about 18 years in 1989 and 20 years in 2006
This table shows a very large decrease in the proportions reporting consummation of first marriage before the age of 15: from 68 percent among women age 45to 49 in 1989 to 37 percent among those ages 20-24. There is a parallel decrease in the proportion of marriage that starts before menarche, a particularly welcome change.
Table 4.2 Simulate mean age at marriage, census and survey data:
This imbalance represents an unfavorable marriage market for women. Parents face problems in finding suitable husbands for their daughters. Marriages are thus delayed. Another consequence is a shift in marriage transactions whereby the bridegroom’s family demands a large dowry. Both anecdotal and empirical evidence indicates that this is happening (Lindenbaum 1981)
The modern methods of contraception are in fact technologies, which apparently gave women the ‘right’ to control her reproductive behavior. Women in the early twentieth century launched births control. This demand was certainly radical from the feminist point of view and perhaps genuine in those times. Nevertheless, it is also true that women have demanded reproductive rights before they could gain recognition in the society as human being or as a person. They did not fight enough to establish themselves in the society and against the patriarchal oppression. The society responded to their demands by offering various methods of birth control to be used by women were happy to get it and thought that they have gained “reproductive rights”. In the context of western society, perhaps this, a reproductive right bears some meaning, but it has no meaning at all to the majority of women in Bangladesh. The processes of poverty and underdeveloped have reduced their life to margin thinly above death by chronic starvation. For the minority of middle and upper class women, the acceptance of modern methods of contraception was somewhat an imitation of the west without having the reproductive rights.
Breast-feeding is the focus of rapidly growing interest in the developing countries because of its important implications not only for health of children, who are breastfeed, but also on fertility levels. Recent research has documented the benefits of breastfeeding as an inexpensive and appropriate source of nutrients and to stimulate strong emotional relationship between mother and child, breast milk provides immunological protection against common childhood illness and it has a significant impact on reducing infant and child mortality (Hacht, Da Vanzo and Butz, 1989, Cunningham. 1988).
Aside from these major roles, breastfeeding is equally important in controlling fertility in developing countries. It is well known by both researchers and mothers that the process of breast-feeding can affect the probability to conceive Demographic analysis have demonstrated that in populations without access to modern form of contraception, birth intervals are determined principally by the duration of breast-feeding. (Bongaarts and Potter, 1983). In Asia and Africa, breast-feeding has been shown to inhibit an average of four potential births (representing 25percent of the total fecundity) per women (Thapa, Short and Potts; 1988).
Following a pregnancy a women remains infecundable (i.e., unable to conceive until the normal pattern of ovulation and menstruation is restored. The duration of the period of infecundability is a function of the duration and intensity of lactation. A number of recent investigators have clarified the physiological mechanism through whish breast-feeding influence ovulation. The period in which normal pattern of ovulation and menstruation is absent due to child’s birth is known to as postpartum amenorrhea. Without breastfeeding, the average amenorrhea period duration of amenorrhea increases to some extent, but not at a constant rate. Additional month of breastfeeding may therefore extend the period of no exposure to the risk of conception and thereby declines fertility.
Breast-feeding is almost universal in Bangladesh. Evidence suggests that the pattern has changed very little in the recent years (Islam et al., 1997). In Bangladesh, the average duration of breast-feeding is over two years, one of the longest in the world (Kabir and Rab, 1990). This long duration of breast-feeding has substantial impact on fertility through postpartum amenorrhea.
4.5 Induced abortion:
Any practice that deliberately interrupts the normal course of gestation is considered as indeed abortion. Induced abortion is one of the oldest methods of fertility regulations and one of the most widely used methods of fertility control in many countries. It is well established fact that induced abortion is play an important role in fertility decline in many countries. Induced abortion is practices in remote rural societies and in large modern urban centers. Although detailed statistical information on induced abortion is scarce and trends to be incomplete, it is evident that induced abortions are performed in both developed and developing countries.
Abortion is illegal in most of the countries, except some cases where it is permitted to save women’s life. In countries, where abortion illegal and widely available, abortion poses a minimum threats to women’s health. Where abortion is legal, however and widely available, abortion poses a minimum threat to women’s health. Where abortion as legal, however abortions are usually performed in substandard and unsanitary conditions, leading to a high incidence of complications and resulting chronic morbidity and often death.
Very little information is available on the prevalence of abortion in Bangladesh. Except in very few circumstances’, such an s pregnancy from rape or threat to the mother’s life, abortion is illegal in Bangladesh. Due to these legal complications, hospitals do not keep correct or complete records on abortion related services of treatment.
Anecdotal evidence suggests that abortion is common in rural areas of Bangladesh. However, lack of data makes it impossible to estimate the true rate. In rural areas, indigenous practitioners who refuse to identify themselves to investigators due to legal and social constraints, thus making the data gathering process even more difficult, perform abortion. In cases where these practitioners have been interviewed, the information provided is incomplete because none keeps ant records of the number of abortions each has performed.
Hospital records also suggest that abortions are common in rural Bangladesh. (Obaidullah 1981) estimated that approximately 17 percent of total pregnancies were terminated by induced abortion during the year 1978-80. According to the authors, they provide the estimated abortion is low since the information they were able collect was incomplete awing to abortions illegally, ethical unacceptability and cultural reasons.
In a recent study, Ahmed et.al. (1996) observed that during the period 1982-1991, there were 1183 induced abortion among 22500 women of reproductive age over a nine years period in Matlab comparison area. Using this information about induced abortion, Islam teal (1996) estimated the total induces abortion rate as 0.18, which they argued that due to likely under reporting, this estimate should be taken as a lower bound of the total abortion rate in Bangladesh.
In Bangladesh, the ministry of health and family planning promotes Menstrual Regulation (MR) services as a method of menstrual regulation. In recent years, several government and nongovernment clinics have been providing MR services. Some private clinic perform abortion in cover MR and despite the restrictive laws every years a considerable number of women in Bangladesh. Tale reason to pregnancy termination (Khan Et. al.1986). Records of clinics suggest a rising trend of MR in Bangladesh.
Therefore, induced abortion is not negligible in Bangladesh. The incidence of induced abortion play substantial role in fertility decline and for this reason it attracts the attentions of researchers.
Status of women in Bangladesh
Women’s status is often described in terms of their legal rights, education, economic independency, and empowerment, age at marriage, health, and fertility, as well as the roles she plays in her family and society. The status of women implies a comparison with the status of men, and is therefore a significant reflection of the level of social justice in the society.
Over the last decade, much concern has been shows about the need to empower women so that they can make their own decisions about childbearing and about other areas of their lives. Lack of power over their own decision-making has long been recognized as a barrier to improve women’s sexual and reproductive health. Many NGOs have been demonstrating the link between women’s development and successful family planning program and were responsible for introducing innovative women’s programs in the 1980s. The 1980s saw a number of schemes that trued to combine income generation or literacy or some other aspects of improving women’s status with family planning in order to give women more control over their lives. The role of women in development and as agents of changes as mothers, producers, and as environment managers- also came to be much more widely recognized during this period.
Women’s status as reflected in their legal rights, age at marriage, education, employment is low in Bangladesh. The women here do not have equal access to resources within the household and that their direct role in the process of reproduction gives them some influences over its outcome.
In the following section an overview of the status of women in Bangladesh about their education, employment, mobility etc. are discussed and the relationships between different factors that affect their status are assessed by logistic regression.
5.2 Status of Women in Bangladesh:
In the male dominant society women’s are in a disadvantageous position. Women, in custom and practice, remained subordinate to male in almost all aspect of their lives; greater autonomy was the privilege of the rich or the necessity of the very poor. Most women’s lives remained centered on their traditional roles and they had limited access to markets, productive services, education, health care, and local government. At the household level, the girl child often has unequal access to nutrition, health care and education compare to boy child. Many discriminatory practices arise out of some deep-rooted socio-cultural factors. Women still earn less than men earn and are mostly occupied in low paid jobs. They often do not have easy access to credit and other income generation opportunities, and are still under represented at management and policy levels.
The lack of opportunities contributed to high fertility patterns, which diminished family well-being contributed to the malnourishment and generally poor health of children and frustrated educational and other national development goals. In fact, acute poverty at the margin appeared to be hitting hardest at women. As long as women’s access to health care, education and training remained, limited and prospect for improved productivity among the female population remained poor in our country.
In the 1980’s women’s status in Bangladesh remained inferior to that of men. About 80 percent of women lived in rural areas in the late 1980’s. The majority of rural women, most probably seventy percent, were in small cultivator; tenant and landless households, many of them worked as laborers part time or seasonally, usually during the post harvest and received payment in kind or in meager cash wages. Another twenty percent, mostly in poor landless households, dependent on the casual labor, gleaning, begging and other irregular sources of income, typically their income was essential to household survival. The remaining ten percent of women were in household mainly in the professional, trading, or large-scale landowning categories, and they usually did not work outside the home.
The economic contribution of women was substantial, but largely unacknowledged. Their contribution in agricultural sector and manufacturing jobs, especially in the ready-made garment industry is remarkable. Despite the fact that women constitute half of our citizenry, they continue to face persistent disadvantages and exclusion, evident in gender differentials for various indicators of health. One of the most telling indicators of the disparity between male and female can be found in child mortality. Though following global norms in Bangladesh infant mortality is higher for males than females, soon after birth the mortality rates start to reverse. For example, post neonatal mortality among males is twenty-seven per thousand births versus thirty-one among females and child mortality among male is twenty-eight per thousand births versus thirty-eight among females. These disparities clearly indicate the neglect of girl children in terms of nutrition and access to health care.
The factors that determine the status as well as the fertility of women in Bangladesh are education, and empowerment, occupation of husband, residence and possession of items and religious beliefs and norms.
Educational attainment of women is generally considered a useful index of socioeconomic status as well as of the level of overall social sophistication, and therefore, it is inversely related to the desire for additional children and women’s mean age at marriage. Education is a key determinant of the life style and status an individual enjoys in a society. It affects many aspects of life, including demographic and health behavior. Education through literacy provides access to wider source of information and a broader perspective. Education through socialization process spread out social values. A modern and rational grows out of education.
Table 5.3.1 Level of education of household population (male vs. female) according to age and place of residence.
|Background characteristics||No education||Primary
Both in urban and rural areas the percentage of illiteracy is higher among women than males. Through the gap in “primary incomplete” level between male and female is narrow, a significant wider gap exists in the “secondary and higher” levels. Similar trend is also seen from the different age group between male and female.
In most developing countries, there is a tendency for female to be largely concentrated in liberal arts while the male students are largely enrolled in the pure and applied science. Female literacy remains a major problem in all developing countries. Table 5.3.2 shows the distribution of currently married women by education level according to some selected characteristics using the BDHS 2007 Data.
This is apparent from the differences in the level of educational attainment by age group. Education is inversely related to age, that is older women are less educated than younger women are. From this table, it is seen that in case of urban women 25.4 percent of women have no education compared to 36.2 percent of the rural women.
Table 5.3.2 Levels of education of currently married women according to selected background characteristics.
|Background characteristics||Highest level of education|
Many factors have an influence on women’s educational opportunities. Most studies point to poverty as the main hinder behind the fact that families fail to either enroll their girls in school or withdraw them before finishing the primary level. It is not just the direct and indirect costs of school attendance are beyond their means, but also that the children are needed at home to perform duties that fall preponderantly on the girls.
Prevailing cultural values and norms appear to have far more significance in the low state of female education, however. Many parents in rural areas lack interest or are openly hostile to the formal education of their daughters for reasons related to social and religious norms in general and to marriage prospects in particular. Most often people of superstitious mentality both in urban and rural areas belief that education spoils a girls’ character and undermines her willingness to fulfill her traditional role. Early marriage and the importance of preserving a girls’ good reputation lead to widespread withdrawal of girls from school.
Among other factors contributing to gender differentials to enrolment are location and physical facilities of school, the shortage of female teachers and a lack of basic amenities (such as sanitation facilities). Female education is further hampered by inadequate incentives to induce the poor to send girls to school. However, education is considered, as the key factor for achieving a sophisticated socioeconomic position for women in cannot always directly affect fertility. It is only possible when a woman get marry at higher age or uses contraceptives.
Women’s participation in labor force is a widely accepted factor for their sound socioeconomic status. Because a woman who employed is more likely to have direct access and control over financial resources be able to function in the non-domestic sphere be able to translate the autonomy required for and embodied in being to autonomy and control inside the home.
The participation of women in labor force is still at the rudimentary level for most of the developing countries. Women still tend to be concentrated in the “unpaid” family labor category and employed mostly in agricultural and related occupation and other family based enterprises. Though women’s participation is professional and technical, occupation is increasing in recent years the majority of women in the category are employed in low-paid low status jobs.
Bangladesh’s real problem is not only unemployment but also under employment. Taking as underemployed those working less than 35 hours per week the rate of underemployment is 35 percent. Some of these people mat not wish to full-time because they have responsibilities at home.
To understand the link between employment and women’s status, ideally employment of women should be examined in combination with concepts of cultural acceptance different types of work for women, women’s total workload and control over training in all branches of technology. Women’s employment does prevail in the no paid or worst paid branches of the national economy. Occupational promotion of women is much more difficult than that of man even in “feminize” occupation as, for example teaching. Even the college and university education for the girl’s is not a guarantee to get jobs. Unemployment and underemployment problem is in such an acute condition. Women are concentrated, as usual in the lower levels of the occupational pyramid and so continue to be a source of cheap labor.
A remarkable increase in the number of female labor force in 1980 and afterwards is compared to 1985-86. No tremendous development over this period has occurred. It is simply because of the definitional change, we have witnessed a handsome amount in female labor force after 1989. The new definition of the economic activities include activities like caring domestic animals and poultry, threshing, boiling, dying and husking crops, processing and preserving food etc. Female usually performs these activities and hence, the number of female labor has increased. We have at least and at least, recognized these works as economic activities. In this society, the men credit for whatever little is produced. The women live in pitiable state of dependency and low status (Daily Star, March, 1999).
Table 5.4.1 Working status of women according to some selected variables
|Background characteristics||Working status|
5.5 Mobility and Autonomy
Women’s mobility that is freedom to movement and participation in domestic decision-making is an indicator of their status. Freedom of movement outside the homestead area is of special interest in many Muslim societies where strong traditions of “purdah” may act to seclude women within their homes. Travel away from home, whether to visit friend or to shopping or take a sick child to a health care center, may be considered shameful, unless an adult family member accompanies the woman. This relative seclusion of Muslim women has direct and obvious consequences in terms of access to static services. It may also have a more profound influence on mentality and outlook by circumscribing interactions with the outside world and exposure to new ideas and models of behavior.
It is time that the seclusion of women is less stringently practiced nowadays than was the case in the period prior to liberation. At the same time, it would be misleading to claim that the position of women in Bangladesh has been transformed. Their lives are still restricted and this restriction varies from urban to rural. The following table 4, obtained by using the BDHS 2007 data, gives an illustration of current situation. The results are shown below.
Table 5.5.1 Women’s mobility according to affirmative response:
|Activity||Percentage affirmative responses|
|Go to outside alone||47.8|
|Go to health center alone||48.3|
Now a logistic regression analysis is performed to assess influence of different background characteristics that affect women’s mobility. The results of the logistic regression analysis are given table 5.5.2. Out of the nine variables, three variables are statistically significant. Table 5.5.2 shows the logistic regression estimates of odds ratios of Bangladesh for the effect of women’s mobility. An odds ratio above 1.00 means a positive effective while an odds ratio below 1.00 represents a negative effect.
Women’s mobility is directly influenced by their education, partner’s education From the table it can be observed that women with higher education are more than 2.6 times likely to have good outdoor mobility than women with no education. Exposures to radio and TV are considered because these have indirect effects on the outlook of women and they are found statistically significant. The higher is the mobility of women the higher is their exposure and awareness regarding their rights and privileges in the society. Working status of women is also an indicator of their mobility. A Woman who is mason/agricultural worker and sophisticated profession (doctor/lawyer/teacher) has 1.6 times more chance of having the freedom of movement than women who are unemployed. This is quite expected because these occupations require outdoor mobility. The wealth index is also influence women’s mobility where the signs of them β-coefficients as well as the odds ratios reflect of more mobilization of the middle class women from other economic class including the rich.
Table 5.5.2 Logistic Regression Analysis (Dependent Variable – Women’s Mobility):
|Independent variables||Coefficient (β)||Odds ratio||Standard
|Ever listened to radio|
|At least once in a week||0.053||1.054||0.051||1.0315||.302|
|Ever watched TV|
|At least once in a week||0.526||1.693||0.048||10.826||.000|
|Current use of contraceptive|
|*Use no method|
|Use any method||0.239||1.270||0.042||5.744||.000|
|Sophisticated profession(doctor/ lawyer/ teacher)||0.465||1.592||0.240||1.937||.052|
|Below status occupation(mason/ agricultural worker)||0.465||1.592||0.047||9.823||.000|
The objective was also to assess to show that the higher the mobility of a woman the higher will be the likelihood that she will use contraceptive. This is confirmed by the positive relationship between the mobility and current use of contraceptive with the coefficient β = 0.239. The odd ratio suggests that the women who use contraceptive their mobility score will be 1.27 times higher than those who do not use contraceptive.
This is likely because good outdoor mobility will ensure the exposure of the woman to the world which will make her more conscious of the family planning issues.
Another important dimension of the status of women is their autonomy. It concerns the execution of women’s decision within the sphere of domestic activities. The following table represents participation of making decision in domestic activities.
Women’s mobility will give her the opportunity to have the exposure that is necessary for self development. This mobility can be caused by her education program or occupation. In the long run, this mobility has an impact in reducing the fertility rate. Table 5.5.3 also shows that the decision of the respondent alone or her and her husband’s jointly taken decision is ultimately held for domestic purposes. Therefore, given that her decision is valued; her mobility plays a significantly positive role in reducing fertility, in other words, improving the fertility rate of Bangladesh.
Table 5.5.3 women’s participation in domestic decision-making:
|Type of decision||Husband||Respondent||Joint||Total|
|Child health care||20.6||26.4||53.0||100|
|Final say on own health care||32.8||20.8||46.4||100|
|Decision on large household purchase||29.4||17.1||53.5||100|
|Decision on household purchases for daily needs||26.1||38.2||35.8||100|
|Who decide how to spend money||17.9||28.7||53.4||100|
The power of decision-making has always been regarded as a key component of women’s status and once again, if possible consequences for reproductive decision are rather obvious. It is often claimed that men are less concerned about the spacing and limitation of births perhaps because they do not experience the burden of pregnancy and childcare. Moreover, contraception may be regarded, as a woman is subject and therefore embarrassing or inappropriate for men to discuss and decide upon. Women design the majority of contraceptive methods for use and in many countries; this gender bias is reinforced by family planning services that are focused almost exclusively on women. It follows, therefore, that women who are not prepared, or not allowed to participate in domestic decision may be at a severe disadvantage in terms of reproductive decisions.
5.6 Self-declared Demand for Children
Conceptualization and measurement of desire or demand for children is one of the most controversial aspects of fertility analysis. There are many particularly economists who equate actual fertility with demand for children.
The demographic literature abounds with explanation of fertility levels and differentials, which assume that childbearing behavior, must be an expression of conscious desire or need (Lee and Bulatao, 1983). An equal large body of opinion and research aspects that the reproductive wishes or needs may diverge from reproductive performance because of perceived lack of choice or a host of other barriers that prevent the translation of attitudes into behavior. From this perspective has arisen a huge literature on unmet need for family planning that has been influential in persuading governments and donors to support contraceptive services as the centerpiece of population control policies.
Now to assess whether enhancement of a woman’s access to income generation program would influence her desire family size through her exposures and knowledge. It is argued that the most effective route to smaller families is to provide women with the means of social and economic self-determination. For this purposes a logistic regression analysis is performed where desire for more children is considered as the dependent variable and independent variables are:
- Age of the respondent
- Age of the partner
- Place of residence
- Number of living children
- Current pregnancy wanted
- Current pregnancy terminated
- Partner’s education level
- Discussion of family planning with partner
- Respondent’s involvement in income generation
- Wealth status
Table5. 5.4 Logistics regression analysis to identify socio economic factors to identify the desire for more children
|Age of respondent||-0.213||0.808||0.120||-1.771||.076|
|Place of residence|
|Current pregnancy wanted|
|Current pregnancy terminated(before calendar beginning)|
|Partner’s Education level|
|Discussion of family planning with partner|
|Employment status of respondent|
|Number of living child|
|At least one||-4.648||0.009||1.058||-4.390||.000|
Women’s education is an important index of socioeconomic status as well as of the level of overall social sophistication and therefore it is inversely related to the desire for additional children and women’s. The odds ratio suggests that the higher the education level the lower the desire for additional children. Age of respondent and partner is also inversely related to the desire for more children. With the increase of age, couple’s attitude towards the desired family size will change. If the current pregnancy terminated is 1.2 times more likely to prefer to have additional children. When the number of living children increases, the desire for more children decreases significantly.
Discussion of family planning with partner can have a fruitful impact in the decrease of fertility rate, as it is shown; a discussion decreases the desire of children for the couple.
The respondent’s involvement in income generation increases the desire for more children by 1.2 times as it might give her the ability to provide her children with basic necessities.
Women from poor economic status have less desire for more children (odds ratio 1.199, 0.363). Whereas women from middle class have 2.2 times higher chance to have a desire for more children. The rich mostly desire fewer children (odds ratio 0.764) compared the poor because of their spontaneous involvement in their own profession.
The fertility rate can be decreased successfully by discussion with partners on family planning. Higher education, more involvement in income generation and better wealth status will help the fertility rate to decrease significantly.
The number of living children is an important determinant of desire family size. Because, the higher the number of living children the lower will be the desired family size.
Fertility preferences as measured by desire for more children show that many factors are effective behind the desire of smaller family size among the women of Bangladesh. Knowledge, attitude, availability and use of health care services are important determinants of reproductive health of women and children. A woman’s status in society and her reproductive behavior are intricately intertwined in a two-way relationship. Overall, reproductive behavior, but in particular the ability to regulate and control fertility has an impact on the status of woman. The reversed is also true that is the status of a woman has an impact on her number of children she has, her ability to regulate and control her fertility will be limited. The present study suggest that women’s participation in economic activities is linked to improved status of women and improved status of women is strongly linked to low desired family size and improved child survival.
5.6 Policy Implication
From the above discussion, it is clear that welfare of women is particularly likely to contribute to fertility decline. Where education reduces fertility, female education has a much larger effect than male education. Women’s low status also induces a preference for sons over daughters, which sometimes contribute higher fertility. Son preferences have been shown to induce women to want additional children in several countries (Bulatao and Faweett, 1983). Other improvement in women’s status are their increasing economic independency, working status and self declared desire for children also contribute to reduce fertility.
It emerges from the analysis that the most important outcomes for the participants of income generation project were their education, skill that increases their confidence and the new respect for which they can be treated by their husbands and communities. The multivariate analysis supports the contention that women’s status has had an impact on family planning as intended.
It is also found that empowerment of women is associated with mobility, independence in decision-making and husband-wife interaction. The study further supports the view that the women who participate in development programs, their exposure to economic, social and physical situation change such women find themselves is simply not conductive to desiring more children. The effects of generation program outlined in a setting that is affected by modern exposure. While these changes do not amount to a major socio-economic transformation, they helped facilitate the status effect. However it would be a mistake to conclude that these broad social influences are solely responsible for the changes that occurred.
Clearly the income generation opportunities introduced by the different NGOs were essential.
Contraception among Adolescents in Bangladesh
Contraception has been practiced within the family unit for thousands of years throughout history, various civilizations and cultures have used a variety of plant extracts, herbs and mechanical devices to control fertility. However most of these were ineffective by today’s standards. Even the spermicidal agents, mechanical barriers and the rhythm method used in modern society are not very reliable. As the world experienced a ‘Population explosion’ during the second half of the present century the need for fertility control extended beyond the family to society levels as a means of limiting the population growth to a level within their socio-economic capabilities. With the willingness of various governments to support birth control programs and the advocacy of feminist leaders and increased financial support for biological research, the development of oral contraceptives began in 1950. However it was not until the early 1960’s that contraception became reliable and accepted effectively. The oral contraceptives remain among things the most effective reversible methods of birth control available today, providing almost 100 percent effectiveness with an impressively high margin of safety and other important health benefits.
A lack of knowledge of contraceptive methods or a source of supple, cost and poor accessibility are the barriers that exist in these countries. The health concerns of these individuals also stop a lot of women and men from using modern contraceptive methods. Side effects perceived or real are a major factor for the abandoning of the modern methods, unintended pregnancies leading to induced abortions are the major drawback in the vaginal methods, periodic abstinence and withdrawal. These methods have the least health concerns but have frequent contraceptive failures. Bongaart and Bruce (1995) estimate that the health concerns reduce prevalence on an average of 71 percent for the oral pills, 86 percent for IUCDs and 52 percent for sterilization. The users for contraceptive methods in the subcontinent come from different socio-economic groups and demographic subgroups within a country are highly segmented.
In reproductive health there is an awareness of women’s and men’s views on contraception. Bruce emphasized no product can be fully acceptable if its intrinsic properties or service delivery procedures are ominous t the user’s personal and cultural needs (Bruce 1987). These research articles are very informative about the views of the people on contraceptive methods and this knowledge can help us in “developing and modifying technology and family planning programs to fit people rather than modifying the people to fit the programs” (Marshall 1977). Women’s perspectives on technologies and services are much appreciated now, “since women bear the brunt of the responsibility for fertility regulation, it is vital to include their perspectives in research on fertility regulation (Van Look P and Perez-Placois 1994). Who also aims to “expand its technical support for family planning services with broader reproductive health perspectives, placing particular emphasis on the needs young people (WHO EB 95/98). The objective of this chapter is to compare contraceptive prevalence among the adolescent and adult women married women in Bangladesh. A regression analysis is performed to assess the factors that affect the use of contraceptive among the married women.
6.2 Contraceptive Behavior among the Women of Bangladesh:
Women’s lives are in transition. There is a definitive fertility decline in Bangladesh that begun in 1980. Women’s statements reveal their awareness of socio economic transition and their interest in family size limitation which was bolstered by a strong family planning program. Although shifts in the social and economic circumstances are not large, in conjunction with strong family planning programs they constitute a powerful force for a change in attitudes, ideas and behavior in these women (Simmons R. 1996).
Some studies have been carried out in Bangladesh have been carried out in Bangladesh many of them in the Matlab area were family planning workers have offering various methods of contraception for at least 20 years. In a study conducted here in 1987-1988 a women remembered the arrival of ac community based family planning worker in her village 10 years early before she was married. The discussions showed that many young unmarried women learn about family at an early age from these community based family planning worker, female relative, and the media (Mitra R 1995).
Although contraceptive prevalence among currently married women of reproductive age is increasing rapidly in many developing countries, the rates have not yet reached those of developed countries. The level of contraceptive use in most developing countries is higher among women in their thirties and, typically, lowest among teenage women and women in their forties (United Nations, 1987). Studies in developed and developing countries demonstrate that behavioral patterns of contraceptive and developing countries demonstrate that the behavioral patterns of contraceptive acceptance and use differ significantly between adolescents (females) approximately 10-19 years of age) and adults (women 20-49 years) (United Nations 1980). This difference may attribute to the maturity, greater knowledge and experience of adults compared with adolescents.
Such considerations as desired family size and child-spacing influence contraceptive prevalence among married women at the individual level, while at macro level, laws and regulations and cultural mores are important factors that determine access to contraception. Some laws relate specifically to female teenagers. Both married and unmarried adolescents face the added obstacles of legal or cultural restrictions which limit their access to family planning services. However, unwanted pregnancies resulting from lack of contraceptive use have led to an increasing number of abortions among young women. In many parts of the world, despite the fact that young women are often denied access to legal abortion service, both the number and the proportion of abortions performed for young women have been increasing over time.
Aside from external influences at the socio cultural and policy levels that affect an adolescents’ contraceptive behavior, factors which vary at the individual level are also important, such as whether or not contraception occurs with a stable relationship, and whether or not either partner has previous experience with contraception.
Although contraceptive use rate is gradually increasing in Bangladesh, it is still very low compared with any developed country and many developing countries. Since the average age at marriage (15.02) years in Bangladesh remains one of the lowest in the world, a large proportion of the potential acceptors of contraception are married adolescents. The adolescent phase of human life is often termed as a very “demographically dense” phase because more demographic actins occur during these years than at any other stage of life.
Unfortunately, no exclusive and comprehensive study on the contraceptive behavior of married adolescents in Bangladesh has been undertaken; therefore, in view of the importance of this matter, an attempt has been made in this study to investigate their contraceptive behavior. For comparison, consider the contraceptive behavior of married adults along with that of adolescents.
There has long been strong social pressure for the preservation of virginity until marriage, which is cultural characteristic of the great majority of people in Bangladesh irrespective of their religion (Maloney and others, 1981). Religion has a strong influence on early child marriage. The majority of Bangladeshis who are Muslim (about 85 percent of the total population) think that girls should be married immediately after menarche. In Bangladeshi society sex outside marriage occurs only seldom since premarital six is looked down upon harshly.
Marriage is almost universal in Bangladesh. By age 35, almost 100 per cent of females have been married. Bangladesh Fertility Survey (BFS, 1989) data suggest that 96 percent of ever married women were married when they were teenagers (Islam Nand Islam, 1993, Mahmud, 1994). This gives rise to a very low average age at first marriage in Bangladesh, i.e. only 14.8 years. Several studies conducted in the 1960s and 1970s also reported very low age at marriage (Obaidullah, 1966, sadiq, 1965, Khuda, 1978). The mean age at marriage among all ever-married women in Bangladesh was reported to be 12.3 years (BFS, 1975).
Adolescent fertility contributes substantially to overall fertility in Bangladesh, accounting for about 18 per cent of the total number of births (Huq and Cleland, 1990). The adolescent fertility rate, measured as the number of births per thousand women aged 15-19 years, was observed to be 239 per thousand in Bangladesh, whereas it is only 7 per thousand in the Republic of Korea, 35 per thousand in Sweden, and 44 per thousand in the United Kingdom of Great Britain and Northern Ireland (UN, 1988). This variation in the levels of adolescent fertility may be attributed largely to differences in the age at which women marry and the extent to which young married couples use contraception.
The objective of this chapter is to find and assess the practicing behavior and knowledge among the eve married
6.3 Knowledge of Family Planning:
Usually knowledge of contraceptive method refers to whether the respondent had heard of or knows of a family planning method. In the 1989 BFS, data on knowledge of family planning methods were collected through a series of questions by following what is popularly known as the “recall and prompting” procedure (WHS, 1980). The main purpose of the questions on knowledge was to define for the respondent exactly what is meant by contraception or family planning.
Table 6.3 presents the percentage of adolescent and adult women who were aware of any modern contraceptive method. It shows that knowledge of contraceptive is almost universal among both adolescents and adults in Bangladesh. Almost all the adolescents and adults interviewed were aware of certain family planning methods. However, it is obvious that knowledge of various modern methods of contraception does not imply that the respondents actually knew how to use these methods effectively.
Table 6.3: percentage of adolescent and adult ever married women who are aware of contraceptive method:
|Aware of contraceptive method||Age category||Total|
|Knowledge of any method||Knows no method||3||21||24|
|Knows modern method||1345||9621||10966|
6.4 Ever Use:
The term “ever use” refers to the use of a contraceptive method at any time before the date of interview without making any distinction between past use and current use. Any respondent reporting that she or her spouse had ever used some form of contraception was counted as an ever user regardless of the time of use. Also, and ever user might have used more than one method. The following table 6.4.1 represents the percentage use of contraceptive methods among the adolescent and adult ever married women. It is evident from the table that folkloric method is used by 4.17 percent of the adolescents and 95.83 percent of the adults. However the most surprising aspect of the ever use of contraceptive methods is that, modern method comprised a significant proportion of ever use of contraceptive among the adults (89.77%) but among the modern method users only 10.23 percent is adolescents. Traditional method is more popular among the adults than the adolescents. Among the users of folkloric method proportion of adolescent comprises only 4.17percent whereas proportion of adults is 95.83 percent.
Table 6.4.1: Percentage of adolescent and adult women who have ever used contraceptive methods:
|Ever use of any method||Never used||455
|Used only folkloric||1||23||24|
|Used only trad. method||43||375||418|
|Used modern method||849||7447||8296|
Table 6.4.2: Percentage of current use of contraceptive among adolescent and adult women:
|Current contraceptive method||Not using||819||4549||5368|
6.5 Factors affecting Current Use of Contraception:
In this section, multiple regressions are used to identify the factors affecting contraceptive use among the married women. Current use of contraceptive is considered as the dependent variable and the explanatory variables are:
- Duration of marriage
- Respondent involved in income generation
- Desire for additional children
- Number of living children
- Discussion of family planning with partner
- Respondent’s education
- Husband’s education
Table 6.5: Regression analysis of current contraceptive use among women on some socio-demographic characteristics
|Independent variables||Coefficient (β)||Odds ratio||Standard
|Respondent’s working status|
|Desire for more children|
|Number of living children|
|At least one||1.651||5.214||0.096||17.183||.000|
|Discuss family planning with partner|
|Independent variables||Coefficient (β)||Odds ratio||Standard||Independent variables||Coefficient (β)|
|Place of residence|
Here, ‘*’ indicates reference category.
From the above tables it is clear that the current use of contraceptive is positively associated with respondent’s involvement in income generation, discussion of family planning with husband, economic independency whereas, it is inversely related with the desire for additional children . This indicates that desire for additional children preference is still a major constraint in the adoption of contraception. The higher the desire for more children the lower is the likelihood that a woman adopt contraception.
Similarly, women who are involved in income generation program can take financial decision independently are likely to be contraceptive users. Husband and wife’s interaction is important whether or not a couple should use contraception. Education of respondent and her husband is another important factor that influences the current contraception use. Maternal education is a strong predictor in the multiple regression of current use of contraception.
Marital duration has no impact on the usage of contraceptive method.
Working and educated respondents have the exposure to know about the current contraception methods and are aware of family planning issues. Their contraceptive usage plays an important role in the reduction of fertility.
6.6 Conclusion and policy Implication:
The study contains a number of implications for policy purposes that could be useful in devising ways to increase the contraceptive prevalence rate among adolescents and thus bring about a further reduction in fertility in Bangladesh. These are as follows:
- Provide education to and create more employment opportunities for young women to increase their status in society.
- Create awareness among adolescents about the negative health, social and economic consequences of early marriage, early pregnancy and large family size. This could be done through special information, education and communication (IEC) campaigns, regular home visits by family welfare visitors (FWVs) and family welfare assistants (FWAs).
- Proved adolescents with information on the availability of family planning methods and their use-effectiveness.
- Improve the quality of care of reproductive health services and make them available at the door-step; and
- Devise programs designed to overcome the resistance of husbands and in-laws
The discussion on the status of women in Bangladesh and its impact on fertility begin with the factors affecting fertility. This paper reviews the factors that determine the socio-economic position of women as well as in some aspect it attempts to find the discrimination between male and female. Education is an important factor that gives women the ability to control various aspects of personal life. Theoretically, education is a resource for skills and knowledge. Thus a woman having education compared to her husband may little voice in household decision.
Women’s right to self determination is rapidly becoming recognized as one of the key factors of developments. Over the last decade considerable efforts were made to improve the women’s economic and social status. They have the greatest potentials to play the major role in development if they were so empowered, and they must be provided with tangible support. Keeping this rationale in mind, this report is designed to understand the women’s status in a traditional poor society like Bangladesh and its consequent impact on fertility. For this purpose, this report is designed by the discussion of women’s status and emphasis is also given on the contraceptive behavior among the adolescent and adult women.
A women’s status in society and her reproductive behavior are intricately intertwined in a two way relationship. Overall, reproductive behavior, but in particular the ability to regulate and control fertility has an impact on the status of women. The reversed is also true that is the status of women has an impact on her reproductive behavior. In societies where a woman’s value is based on the number of children she has, women’s participation in socio-economic activities is linked to improved status of women and improved status of women is naturally linked to low desired family size and improved child survival. In the light of above discussion, socio-economic and demographic characteristics of the two groups of women are reviewed in order to draw conclusions.
With increasing age, Bengali married woman may participate more in household decision-making matters. However, such recognition and gain in status comes generally, first by becoming a mother Chaudhury, 1982; Chen, 1986). Thus age, in Bangladesh, is a life cycle factor that affects a women’s status in the family. Although in recent years the literacy level of women has gone up, this is still considered to be low compared to men.
Marriage is a near universal phenomenon in Bangladesh. By age of the range 15-19 years, nearly half of the females in Bangladesh are married indicating a low age for females. Though the mean age at marriage is now decreased in comparison to the previous experience the age distance between bride and groom is still large. This indicates that traditional custom in marriage remain unchanged. The prevailing marriage custom adversely affects women’s status. Although some legal steps were introduced for legal age at marriage, their lack of knowledge about such changes, their lower socio-economic condition and cultural backwardness keep them in disadvantageous position.
Women’s development involves changes in many interrelated aspect of their life. These aspects will be examined for their effect on fertility: income and wealth, education, health and mortality, urban vs. rural residence, and the status of women. The specific package of development measures with the greatest potential for reducing fertility will vary from place to place. Nevertheless, some general observations can be made about the potential fertility effects of improvements in each these broad areas. Income effects fertility in many ways, both direct and indirect, and previous studies that compare countries households within countries and obtain significance results find that fertility rises as income rises (Mueller and Shotr, 1983: 608-614).
Theoretical analyses suggest that the pure income effect is likely to be positive. Children draw on household resources and provide various rewards, many of which are difficult to obtain in many other ways: those with more money, therefore, can better afford the satisfactions children provide (turchi, 1975, the possibility the children are inferior goods). This pure effect is more likely to be observed in household studies, where more variables can be controlled and samples are more homogenous. In cross sectional studies, the fewer controls possible make it difficult to exclude indirect effect, whether negative or positive. Indirect effects also take longer appear and should therefore be more visible across countries (Simon, 1975).
Among indirect income effects are the following:
- Higher income may lead to more spending on children’s education, and therefore fewer children. It may also lead to mare spending for children’s consumption, and for other things that produce child “quality”, with the same effect. It has been demonstrated that fertility effect of income gains in developed countries, leading to lower fertility (Becker and Lewis, 1973: Wills, 1974; Detray, 1972). For developing countries, however, the evidence is ambiguous. Increase in amount spent on childbearing appears to be roughly offset by increases in ability to pay (Mueller, 1972; Arnold and others, 1975).
- Higher income makes available substitutes for children’s economic contributions. It means an increased surplus to invest in land or some other asset, declining information cost regarding alternative investments, and increased access to social security and welfare mechanisms to guard against destitution. The reduced economic contributions from children at higher income levels (Mueller, 1972; Caldwell, 1978; Bulatao, 1979) should mean a demand for children.
- In many settings, a woman does not work outside the home if her husband’s income permits it. Higher income would therefore increase the likelihood of the wives staying at home, reducing possible conflict with and possibly increasing the motivation to care for many children.
- Rising income should increase exposure to consumer goods, reducing the propensity of couples to spend disposable income on children (Freedman, 1970; Bulatao, 1982). The acquisition of watches, bicycles, TV sets, better medical care. And better schooling by higher income urban families includes a felt for these goods among other families, promotion reduction in fertility.
- Rising incomes should improve nutrition and health care and contribution to lower infant and child mortality, which may in turn affect fertility. Rising incomes are also often associated with decreased breast-feeding. With possibly substantial positive effects on fertility.
- Higher income should mean better ability to afford contraception and abortion income is commonly associated with greater use of both it negative effect on fertility.
- Where the need for a dowry or bride-price, or cost of setting up a new household, are obstacle that tend to delay marriage, rising incomes should permit earlier marriage and earlier childbearing, and therefore higher fertility.
To rely on rising incomes to lead to fertility control is clearly a deficient strategy, since in particular circumstances rising income could instead increase fertility. In the long run, as societal comparisons suggest higher income and the associated societal changes should eventually mean lower fertility. In the short run, for individual households, extra income might instead be spent to support additional children. In some threshold income level, before its effect turns negative (Encarnacion, 1974; Canlas, 1978; Rpetto, 1979; Chernichovsky and Meesook, 1981).
Much depends, of course, on how income redistribution is achieved, whether through land redistribution, tax schemes, welfare programs, or other measures. Any attempts to raise living standards among the poor will have many other effects- probably more important on fertility.
Education: Lags in Antenatal Impact
Like income, education affects fertility through a variety of channels. Unlike income, education is more consistent in its effects, being more likely to reduce fertility in most circumstances.
Education can be seen as providing the individual with four things: literacy and the access to information and the broader perspective it makes possible; socialization or enculturation into different attitudes and behavior patterns; specific kills that often provide occupational advantages; and, often a useful certification of status (Cochrane, 1979:29).Each of these things has some effect on fertility. Literacy leads to practical knowledge. Contraception becomes more really available, the survival of children more likely. Socialization leads to greater commitment to educate one’s children. Occupational skills facilitate employment (and raise income), particularly in urban settings where jobs may interfere with childbearing. Certification may also facilitate employment and in addition raise aspirations regarding a marriage partner. These effects on fertility largely, though not exclusively, negative.
Educating women has a more negative effect on fertility than educating men (Cochrane, 1979; Strout, 1983). In comparisons of couples in 20 developing countries, lower fertility (with marital duration controlled) is almost always exhibited when the wife has secondary education than when the husband has secondary education (Rodriguez and Cleland, 1982). Summaries of household multivariate studies show that the effect of wife’s education is negative more often, and more likely to be statistically significant, than the effect of husband’s education (Cochrane, 1983). Explanations for this are not difficult to find, from the greater marriage delay due to female than male education to the stronger link between male education and household income, which may allow higher fertility.
An argument might be made that one other effect of education implies a shorter lag. Educating children reduces the economic contributions they make and increases their cost to parents. Not only does schooling prevent children from working on the farm or elsewhere, it also makes them less willing to do manual work and loosens their ties to their parents (Caldwell band others, 1981). For these reasons the argument goes, children are a poor investment where education is important, and parents therefore should prefer smaller families.
Employment: Uncertain effects
Many dimensions of employment are potentially of interest in regard to fertility, none of them is easy to study. Employment depends on education, is bound up with place of residence, and results in a greater or smaller increase in income. Each of these factors has its own complex effects on fertility, and the specific effects of employment are consequently difficult to untangle.
Comparisons between countries have focused on the proportion of the labor force in agriculture, with the argument that traditional links between family and work are disrupted and the economic returns from children diminish as the labor force contributes to fertility decline ( Birdshall, 1977: 80-81),but the time series evidence is not strong (Richards, 1983: 731-722).
At the household level, the fertility differential between agricultural and non agricultural workers varies greatly, depending on a number of factors like stage of development. Farmer fertility is often high, though not necessarily highest among all occupation groups. As fertility declines, farmer fertility sometimes falls faster than fertility in other groups (United Nations, 1973:100-101; see also Mc Greevey and Birdshall. 1974:18-19). In some developed countries, a U-shaped relation between occupational status and fertility has emerged, with the highest fertility not only among low status group like farmers and workers but also among high status group (Anodorka, 1978:251-258).
The employment of a woman has attracted special attention, because of the possibility that work could interfere with childbearing and provide reasons for a smaller family. This is not easy to test; it is quite possible that female employment initially requires having a smaller family rather than eventually leading to fertility control. Numerous studies have attempted to verify the hypothesis that working women in developing countries have lower fertility, with notable lack of success (standing, 1983; Brezzell, 1983). To women in developed countries, it may appear that employment leaves little time for childcare, but this is seldom true for peasant women in developing countries (Standing, 1983). Family agriculture and cottage industries keep women close to the home and permit considerable flexibility in working conditions, and are therefore often compatible with childcare. Such jobs do little to modernize a woman’s outlook or to develop a commitment to continued employment that may interfere with fertility. In addition, peasant settings often provide parental surrogates from within the extended family or other cheap sources of domestic care. Childcare requirements are typically low and personal tutelage by the parents seldom emphasized. Finally, in low income areas, any remaining incompatibility between childcare and work is often resolved by a woman’s reducing her leisure time rather than her work time (ref: studies cited in standing, 1983: 525).
These mean of resolving the conflict between childcare and tend to be less available in urban areas. Though there are many exceptions, research in these areas more often finds that women working full-time tend to have fewer children (Brazzell, 1983: 65). Women employed in the modern sector, especially, tend to have lower fertility, despite the prenatal implications of the higher incomes and maternity benefits they receive. However, it has difficult to confirm that employment itself has been responsible for reducing fertility.
Where an inverse relation does not exist between urban, modern sector female and fertility, contraceptive use apparently accounts for only a part of it (Brazzell, 1983: 56-59). Of equal significance is delay in marriage that results from female employment (Duza and Baaldwin, 1977). Even if late marrying women eventually end up with the same number of children as other women (which is generally not the case), the delay in the start of childbearing reduces fertility rates immediately.
Attempts to duce fertility solely by changing employment patterns, therefore, are likely to have limited success. Increasing female employment in agriculture or cottage industries has uncertain effects on fertility, though placing women in modern sector jobs- a considerably more expensive proposition- does lead to the desired fertility reduction. Reducing child employment is potentially an important step, and is a key factor in the fertility transition. This is difficult to accomplish, however, other than through the normal development process.
Urban-rural residence: pervasive influence
Among the development factors considered here, residence has an unusual position. Governments almost never favor increase3d urban growth, because of the dealing with burg coming urban populations. Nevertheless, residence summarizes many fertility relevant differences in opportunities available to households: urbanites generally have access to better education, a wider spectrum of work opportunities, a more sanguine public health environment, and generally more avenues for self-improvement5 and social mobility. They also face higher costs in raising children. With all these differences taken into account, urban fertility tends to be substantially lower than rural fertility, by 0.5 to 1.5 births on average across countries (Stolnitz, 1983).
This discussion of the tangled web connecting specific development indicators to fertility decline should not obscure the central fact that socio-economic development does, in the long run, contributing greatly to lower fertility.
Gubhaju Bhakta and Durand Yoshie, Moriki. “Fertility Transition in Asia: Past Experiences and Future directions”. Asia Pacific Population Journal, September 2003.
Bulatao Rodolto A. “Reducing Fertility in Developing Countries.”
Kabir M, K Rokeya, and A Israt. “Impact of Women in Development Projects on Women’s Status and Fertility in Bangladesh.”
Kabir A, Jahan R, Alam SM. “The Effect of Education on Fertility in Bangladesh.”
International Quarterly of Community Health Education, 2004; 22(3): 199-214.
Caldwell JC; Barkat-e-Khuda; Caldwell B; Pieris I; Caldwell P. “Population and Development Review”. 1999 Mar; 25(1): 67-84.
Bongaarts, J., Cotts- Watkins, S. (1996). “Social Interaction in Contemporary Fertility Transition”, Population and Development Review, 22, Dec., 4, pp.: 639-62
Lesthaeghe, Ron. (1980). “On Social Control of Human Reproduction,” Population and Development Review 6, no.: 525-549.
Population of Bangladesh. Countru of Monograph Series no. 8
ESCAP (1994). 1994 ESCAP population Data sheet, (Bangkok: Economic and Social Commission for Asia sand the Pacific).
Islam, M.N. And M.N. Islam (1993). “Biological and determinants of fertility in Bangladesh: 1975-1989”, Asia-Pacific Population Journal, 8(1): 3-18.
Cain, M. (1982). “Perspectives on family and fertility in developing countries”, Population studies, 36(2): 159-175.
United Nations (1987). Fertility Behavior in the Context of Development: Evidence from the World Fertility Survey, (New York, Department of International Economic and Social Affairs).
V’an de Walle, E and J. Kondel (1980). “Europe’s fertility transition: new evidence and lessons for today’s developing world”, Population Bulletin, 34(6):3-44.
World Fertility Survey (1979). The Bangladesh Fertility Survey, 1975: A Summary of Findings.
“Impact of Women in Development Projects on Women’s Status and Fertility in Bangladesh” By M Kabir, Rokeya khatun, Israt Ahmed.
Kabir M, Robert B. Hill, Ahmed U Ashraf “Reproductive Change in Bangladesh Evidence from Recent Data”, Asia-Pacific Journal, Vol. 8 No.4 (1993, pp.39-58)