A survey of success in population and maternal and child health activities

Bangladesh is the most densely populated country in the world and the fifth largest country in Asia and the eighth largest in the world in terms of population. According to the 2011 census, Bangladesh has a population of 152.5 million, a population density of 1,015 people per square kilometer, and a population growth rate of 1.36. If population growth continues at the current rate, Bangladesh's population will double in the next 50 years or less. 

The impact of this growing population on the country's cultivable agricultural land, education, housing, health, employment has become a major obstacle to the overall development of the country. The present government is continuing its efforts to keep this rate of population growth down by implementing various strategies. Bangladesh Family Planning Program was started in 1953 on a private voluntary basis. 

Realizing the importance of the program, the government adopted the program in 1985 and launched a limited number of clinic-based family planning activities. In the post-independence period, all governments have given utmost importance to population control activities and made every effort to take the program forward. Father of the Nation Bangabandhu Sheikh Mujibur Rahman, realizing the horrors of population growth, said in his Independence Day speech in 1975,

“One thing we should not forget is that every year we have 18 to 20 lakh people. My place is 50,000 square miles. If we increase the number of people by 3 million every year, then in 25/30 years there will be no land in Bengal for plowing. The people of Bengal will eat the flesh of the people of Bengal. For that we have to do population control, family planning ”.

Realizing the importance of this, the then government planned to launch a family planning program to reduce the rate of population growth. In that continuity, the progress of Bangladesh's family planning activities in spite of various socio-economic adversities has been appreciated in the world. Demographic indicators reveal its validity. 

The Bangladesh Demographic Health Survey (BDHS-2011) report published in 2011 shows that the country's total fertility rate, or the average birth rate per woman, has dropped from 6.3 in the 1970s to 2.3 today. The population growth rate has come down from 3.0% to 1.38 now. At the same time, the family planning system has increased from 7.6 to 61.2. 

On the other hand, the under-one mortality rate (per 1,000 live births) has dropped from 150 in the 1970s to 52 now and the maternal mortality rate has dropped from 6.2 in 1982 to 1.94 in 2010.

In the 1980s, the Department of Family Planning conducted maternal and child health services across the country in addition to family planning activities in anticipation of the rapid success of population activities and considering the direct and indirect relationship of population growth rate with maternal and child mortality. However, in the last four and a half years, significant progress has been made in population and maternal and child health activities, despite the slow pace of progress in continuous progress surveys.

The activities undertaken by the Department of Family Planning to achieve the Millennium Development Goals (MDGs) 4 and 5:
The Millennium Development Goals (MDGs) were set in 2000:
 at the United Nations Millennium Conference. The conference, known as the United Nations Millennium Declaration, pledges to achieve six specific goals by 2015, with 189 member states and at least 23 international organizations.

The goals are:
   ** Poverty alleviation;
   ** Ensuring universal primary education;
   ** Gender equality and women's empowerment;
   ** Reducing infant mortality;
   ** Development of maternal health;
   ** Prevention of HIV / AIDS, malaria and tuberculosis infections;
   ** Maintaining the balance of the environment;
   ** Creating opportunities for global partnership for development.

As 04 and 05 of these 6 goals are directly related to maternal and child health development, it is directly related to the activities under implementation of the Ministry of Health and Family Welfare. Needless to say, Bangladesh has made tremendous progress in achieving the above two goals (MDG 4 and 5) and has already been able to attract the attention of the world.

Before discussing that the Department of Family Planning under the Ministry of Health and Family Welfare has played a direct and important role in achieving the Millennium Development Goals 4 and 5, ie reducing infant mortality and improving maternal health, MDG 4 and 5 related indicators and their current status are presented.

MDG Target-4, Reducing Infant Mortality Rate:

Indicator

Base year

Current status

Target 2015

4.1: Infant mortality rate below 05 years
(For every thousand living born)

65
(BDHS-2006)

53
(BDHS-2011)

48

4.2: Infant mortality rate
(For every thousand living born)

52
(BDHS-2006)

43
(BDHS-2011)

4.3: Neonatal mortality rate
(For every thousand living born)

36
(BDHS-2006)

32
(BDHS-2011)

MDG Target-5, Improving Maternal Health:

Base year

Current status

Target 2015

MDG Target - 5A: Reducing Maternal Mortality by Three-Quarters Between 1990-2015

Maternal mortality rate
(For every million living born)

320

194
(BMSS-2010)

143

The ratio of delivery assistants to skilled health professionals

26.6
(BDHS-2011)

MDG Target 5B: Achieve universal access to reproductive health services by 2015

Family Planning Method User Rate (CPR)%

57
(BDHS-2006)

61.2
(BDHS-2011)

Antenatal care (at least 1 time)%

26.5 (1993)

47.6
(BDHS-2011)

Antenatal care (at least 4 times)%

5.5 (1993)

26
(BDHS-2011)

Motherhood in adolescence
(For every thousand living born)

121
(BDHS-2006)

116
(BDHS-2011)

Incomplete family planning demand rate (%)

16.6
(BDHS-2006)

13.5
(BDHS-2011)

Activities of the Department of Family Planning on the achievements achieved in the last 5 years (2009-2013):
The Department of Family Planning has been providing maternal and child health services in addition to family planning since 1985. Pregnancy Services, Normal Delivery Services, Emergency Delivery Services, Postpartum Services, 

Health and nutrition education is provided to children under the age of 5, including health care, adolescent health care, reproductive health care, sexually transmitted diseases, and post-abortion services.

The Department of Family Planning has been providing services through the following service organizations-

01. Mohammadpur Fertility Services and Training Center(MFSTC)

02. Azimpur Maternity and Child Health Training Center (MCHTI)

  ** National level Azimpur Maternity and Child Health Training Center, Mohammadpur Fertility Services and Training Center,   two model clinics adjacent to two medical colleges;
  ** District Level - Maternal and Child Welfare Centers (80 out of 98 centers provide emergency maternity services);
  ** Upazila level Upazila Health Complex MCH-FP Unit (427) 12 Maternal and Child Welfare Centers;
  ** Union level Union Health and Family Welfare Center 360, Maternal and Child Welfare Center - 24;
  ** 30,000 satellite clinics across the country every month at the community level.

The following activities implemented by the Department of Family Planning have played a direct role in reducing infant mortality and improving maternal health.

  ** So far, 323 physicians and 548 Family Welfare Inspectors (FWVs) have been trained in emergency obstetric care.
  ** So far, 1557 Family Welfare Inspectors (FWVs) have completed midwifery training and are providing safe and normal delivery services at the union level.
  ** To date, 690 Family Welfare Assistants (FWAs) and Health Assistants (HAs) have completed community-based Skilled Birth Attendant (CSBA) training and provided community-level antenatal care, including normal delivery services and postpartum services.

** In the last 5 years, 639 Family Welfare Inspectors have been providing maternal and child health services in their respective workplaces after 18 months of basic training.

  ** In the last 5 years, a national level 100-bed specialized hospital MFSTC, Mohammadpur, Dhaka has been launched.

** Emergency maternity services are being provided round the clock in 60 Maternal and Child Welfare Centers.

 ** Safe delivery services are being provided round the clock in 1108 Union Health and Family Welfare Centers.

 ** Closed community clinics have been reopened. New community clinics are being set up from where mother and child services are easily available.

  ** Uninterrupted logistics supply service has been ensured. No shortage of supply has been noticed in the last 5 years.

  ** Inspired by the digital activities of the government, broadband internet connection including LAN has been provided in all the units of the department, internet connection has been provided in all the departments, districts and upazilas through modems.

  ** Departments, districts, upazilas as well as selected union health and family welfare centers are in the process of supplying 1300 laptops. At the union level, 440 employees have been provided with computers and internet.

In spite of all the arrangements for the provision of services in the implementation of any program, in the absence of proper activities to create demand, those activities cannot go far. Since its inception, the IEM Unit of the Department of Family Planning has been playing an important role in generating demand for population activities, child mortality reduction and maternal health development activities.

Role of Information, Education and Motivation (IEM) Unit in Awareness Activities:
Despite the low literacy rate and low status of other socio-economic indicators, the family planning program in Bangladesh is a successful one. Increasing use of birth control pills is inextricably linked with a decline in overall fertility rates. This has been possible due to consistent political commitment, creative activities, coordination of public and private activities, strong information, education and communication activities and strong commitment of the field administration. Accurate information, education and motivation activities on health, family planning and nutrition have proven to be very successful in this country over the past four decades. Adopted communication activities have increased the rate of contraceptive use and the tendency of people towards small family formation.Total fertility rates, infant and maternal mortality rates, respiratory illnesses and violence against women have decreased. In addition, significant progress has been made on safe motherhood, breastfeeding, neonatal care, adolescent care, gender equality, universal immunization, and more.Since its inception, the IEM Unit under the Department of Family Planning has been playing a leading role in the formulation and implementation of information, education and communication activities. These activities are being conducted across the country in coordination with various ministries, development partners and non-governmental organizations.In addition to the interpersonal communication activities conducted through Family Welfare Assistants, Family Planning Inspectors and Family Welfare Inspectors, electronic and print media have been used with equal importance.Separate population cells were opened on Bangladesh Betar in the mid-seventies and on Bangladesh Television in the early eighties. Since then, with the funding of IEM unit, Bangladesh Betar and Bangladesh Television have been conducting various activities to increase the awareness of the target population.Bangladesh Betar (Dhaka and 11 other sub-stations) broadcasts 360 minutes daily on family planning, maternal and child health, adolescent reproductive health, gender equality and HIV / AIDS. On the same subject, Bangladesh Television conducts 25 minutes of programs every day except Friday.Bangladesh Betar's Population Cell conducts discussions on family planning and maternal and child health, including discussion programs, interviews, live phone calls, inspirational songs, documentary events, short stories and jingles. Among the programs that Bangladesh Television broadcasts are movie slides, TV-spots, magazine shows, talk-shows, dramas, serials, short films and music videos.

## Main activities of IEM unit:

  ** Motivation, awareness raising and awakening of mindfulness;
  ** Skills development and logistics support;
  ** Create, distribute and display information, education and communication materials;
  ** Conduct inspection, evaluation, monitoring and survey activities on information, education and communication activities;
  ** Preparation and dissemination of communication materials for mass media.

In addition to government activities under the IEC Operational Plan of the Health, Population and Nutrition Sector Program, the IEM Unit also conducts various activities jointly with UNFPA, BKMI / USAID and Save the Children USA.

Activities to address family planning, maternal and child health challenges:

  ** Nationwide campaign on sustainable and long-term procedures, late marriage, newborn care, breastfeeding, etc.
  ** Newlyweds and couples with fewer children at the upazila level on family planning, maternal and child health, reproductive health, safe motherhood and birth control meeting program.
  ** Orientation meetings with marriage registrars, religious leaders, school and madrasa teachers on family planning, maternal and child health, reproductive health, adolescent health care, safe motherhood and late marriage.
  ** Organize interpersonal communication and skills enhancement workshops for service providers.
  ** Production and distribution of posters, leaflets, booklets, brochures and flipcharts.
  ** Display billboards and hoardings.
  ** With the aim of creating public awareness through film screenings across the country, film screening activities at grassroots level, slums and remote areas are continuing through audio-visual vans divided into 26 zones.
  ** Making, broadcasting and screening of short films, documentaries, TV dramas, TV spots, TV magazines and path dramas.
  ** Conducting mass communication activities on population, health and nutrition through Bangladesh Television and Radio, various private TV channels and FM radio.
  ** Conducts motivational activities on family planning, maternal and child health, reproductive health through folk songs, jarigan, jatra, football and cricket.
  ** Organizing musical shows on family planning, maternal and child health, reproductive health and gender equality in seven divisional cities in local languages ​​through local artisans.

Nationwide World Population Day, Service and Promotion Week, mass mobilization meetings in various departments, family planning, maternal and child health and gender awareness activities have been instrumental in transforming people's psychological awareness by highlighting the horrors of maternal and child mortality.

Success in Family Planning, Maternal and Child Health Activities:

The above activities taken by the Department of Family Planning are playing a catalytic role in reducing infant mortality rate and improving maternal health. At present, the under-five mortality rate is 53 per thousand live births. It is hoped that it will be possible to surpass the Millennium Development Goals (MDGs) of 2015 ahead of schedule. The infant mortality rate is currently 43 per thousand live births. It has set a target of 31 by 2015. Which will be very easy to overcome.

Achievements in improving maternal health are also eye-catching. At present, 194 mothers die for every lakh live births. The target is to reduce this number to 143 in 2015. It is hoped that this goal will be achieved by 2015 as a result of practical steps taken for the development of maternal health. Over the past decade, the maternal mortality rate has dropped by almost 40% which has been hailed as a landmark achievement in the world.

It needs to be mentioned that by 2015, Bangladesh is on track in almost every indicator of universal access to reproductive health services. It is expected that it will be possible to reach the target of increasing the user rate of family planning system to 72 percent by 2015.

Because this rate has already exceeded 72 percent in Bangladesh. The target is to increase the rate of antenatal care recipients (at least 1 time) to 100 by 2015, which has already exceeded 60.The target has been set to reduce the demand rate to 9 percent by 2015. At present, the incomplete demand rate has come down to below 14 percent. Thus, visible improvement in each index has been made possible through various activities undertaken by the Department of Family Planning in accordance with the high level directives of the government.

International success:

The groundbreaking achievements in the Millennium Development Goals (MDGs) 4 and 5 have caught the attention of the world. The Prime Minister received the award on 19 September 2010 in New York on behalf of the country for its historic achievement in reducing infant mortality.Bangladesh was awarded the prestigious South-South Award on September 20, 2011 for its groundbreaking achievement in reducing maternal and child mortality. The Hon'ble Prime Minister also accepted the award on behalf of Bangladesh.