Geographical variations in total fertility rate

A M M Anisul Awwal Bangladesh Demographic and Health Survey (BDHS) 2007 shows that the country has undergone a considerable decline in fertility from 6.3 births per woman in 1971-75 to approximately 2.7 births per woman in 2007. Bangladesh Maternal Mortality Survey 2010 shows that the total fertility rate (TFR) of the country has come down to 2.5. There are, however, substantial variations in the level of TFR among the seven divisions, with higher fertility in the East side (Chittagong and Sylhet) than in the West (Khulna, Rajshahi and Rangpur). Barisal division shows declining trends, while with a TFR of 2.0, Khulna has achieved replacement level of fertility in 2007. Women in Sylhet have 1.7 more children than women in Khulna and women in Chittagong have 1.2 children more than that of Khulna. Bangladesh has been passing through a critical phase of fertility transition. Fertility level had started to decline since the mid-seventies. However, since 1993-94 to 2000, the level of TFR appeared to have remained unchanged at the level of 3.3 as evident from three consecutive BDHSs - 1993-94, 1996-97 and 1999-2000. From 1999-2000, TFR again began to decline, resulting in 3.0 births per woman in 2004 and 2.7 births per woman in 2007. It has been observed that delayed marriage can play an important role in reducing the level of fertility through reduction of child bearing span. However, the level of fertility appears to be a function of not only age at marriage, and hence age at first birth, but of interval between subsequent births as well. Since the 2004 BDHS, TFR has been declining, but the decline has not been uniform throughout the country. Socio-economic and demographic characteristics of the country show that the average age at marriage in the East and the West is almost same. However, it is interesting to note that, on an average, women of the East have 0.6 child more as opposed to the West. The average education is almost same in both areas. With regard to the religious categorisation of the respondents, about 13 per cent respondents in the East were Hindu and Christians compared to about 9.0 per cent in the West. In the East, socio-economic characteristics such as education, religion, present work status, NGO membership and wealth index of the recently married women- all have significant association with current use of contraception. But association is weak in case of education and wealth index in the West, indicating that poverty is not important for current use of contraception in the area. Availability of family planning services at outreach areas have significant association with current contraceptive use in the West, but not in the East. Visit by family planning workers is strongly associated with current use of contraception in both the East and the West. Access to electricity is also associated with the current use of contraception in both the areas. Total Fertility Rate: Adolescent fertility is higher in the West than that of the East which possibly can be attributed to low age at marriage in the West. The figure indicates that TFR is maintaining downward trends constantly over the years 1999-2007 between the East and the West. This also shows that the West had already achieved replacement fertility (i.e. 2.2). Age at marriage: Early age at marriage is more prevalent in the West than in the East. For example, by age 15, over 44 per cent girls from the West of the respondents were currently married as against about 30 per cent in the East. Similarly, by age 18 which is the legal age of marriage, over 65 per cent girls were married in the East and it was 73 per cent in the West. The median age at marriage of adolescents in the East is one year higher than that of the West. Current use of contraception: There is a large variation in the use of contraception in the East and the West. In the West, the current use of contraception is higher than that of the West. Intention to future use indicates that about 35 per cent recently married women in the East were users of modern methods of contraception compared to about 56 per cent in the West. However, traditional method users were considerably lower in the East than the West (5.9 per cent in the East vs 9.3 per cent in the West). One in five women in the East does not intend to use contraception methods in the future. The comparable figure in the West is one in ten women. 40 per cent women from the East expressed their intention to use contraception in future as against 26 per cent in the West. In the East, use of contraception by newly married women is about 41 per cent compared to 65 per cent in the West. Unmet need for contraception: There is a distinct difference in the unmet need for contraception in the East and the West. The unmet need for contraception had been declining since 1993-94 to 2000 and then increased again to 17 per cent in 2007, with a significant variation in the prevalence of unmet needs across the East and the West. Policy options and recommendations: Age at marriage is still low in both the regions. This should be increased to legal age at marriage which is 18 years. In addition, women should be motivated to increase birth intervals, particularly first birth interval. Teen age marriage and teen age fertility need to be socially discouraged due to high risks involved with both health and fertility. The method mix of contraception can be made more effective through encouraging long acting methods to couples who have two living children. In order to reduce the unmet need, family planning program and access to good quality services be maximised with focus on men. Religion, son-preference and death of previous child are important barriers of current contraceptive use in the East side of the country. Proper communications are needed to overcome the barriers. An Information Dissemination Cell (IEC) material focusing 'religion is not against the birth control' require more dissemination in the community. This could be done through mass media and using advocacy program among the religious leaders of the East. The article is a PID-UNICEF feature. The writer, a PhD is Director, NIPORT. Contact may be made to Press Information Department PID email: piddhaka@gmail.com