Bangladesh 2011 Demographic and Health Survey Shows Continued Fertility Decline and High Use of Family Planning
by Carl Haub, senior demographer
The Bangladesh 2011 Demographic and Health Survey (DHS) is the ninth demographic survey taken in the country since 1975. Except for a few very small countries and city-states, Bangladesh is the world’s most densely populated country with about 1,100 people per sq. kilometer. The country’s area is about the same as the U.S. state of Arkansas and a bit more than Greece but is home to over 150 million people. The preliminary 2011 report has just been released and it shows that fertility has continued its decline to a low level. The total fertility rate (TFR) for the three-year period before the survey was 2.3 — 2.0 in urban areas and 2.5 in rural areas. The survey interviewed 17,842 ever-married women ages 12 to 49 and 3,997 ever-married men ages 15 to 54 from July to December 2011.* Rural women accounted for two-thirds of those interviewed. From 1975 to 1993-1994, the TFR in Bangladesh was in continuous decline. But the next three surveys showed a tendency for TFR decline to “stall” at a medium level (see graph). Desired family size has greatly decreased. In the survey, 76.2 percent of women with two living children said that they did not wish to have any more children and an additional 5.3 percent had been sterilized and 1.3 percent said they were incapable of conceiving.
In the survey, 61.2 percent of currently married women said that they were using some form of family planning, a level comparable to developed countries. The use of modern methods was quite high at 52.1 percent. Unlike neighboring India, where female sterilization predominates, the contraceptive pill is the most widely used modern method at 27.2 percent, followed by injectables (11.2 percent), and the male condom (5.5 percent). Contraceptive use has risen steadily in surveys, up from 7.7 percent in 1975. Family planning use has risen despite the fact that fewer women report a visit from a family planning worker, either government or private. Overall, only 15.5 percent reported contact with a home visitor, which has been an important part of the country’s family planning program. The report notes that this may be due to workers deciding to provide services from community clinics for three days a week.
The decline in infant and child mortality, as reported in earlier surveys, has continued. The infant mortality rate (IMR) in the five years before the 2011 DHS was 43 infant deaths below age 1 per 1,000 live births, down from 87 in 1993-1994 DHS. The decline in the death rate for children ages 1 to 4 was even greater, from 50 deaths per 1,000 five years before the survey in 1993-1994 to 11 in the 2011 DHS. The overall death rate for children ages 0 to 4 was 53, meaning that 1 in 19 newborns dies before their fifth birthday. Bangladesh is on target to achieve the UN Millennium Development Goal of child mortality of 48 by 2015.
Of children under age 5, 41.3 percent were stunted (height-for age) and 15.3 percent severely stunted (included in the 41.3 percent); 36.4 percent were underweight (weight-for-age). Mothers follow the WHO recommendation of supplementing breastfeeding with solid/mushy food at the child’s six months of age. At 6 to 8 months of age, only 7.3 percent continued to breastfeed exclusively with 62.6 percent supplementing with solid food. By 9 to 11 months, 87.2 percent had supplemented. While such proportions are good, many mothers should start supplemental foods earlier. The proportion of young children receiving all required basic vaccinations was quite high at 82.5 percent, including over 90 percent receiving polio drops. Urban and rural vaccination levels were virtually identical. Only 59.6 percent of mothers were able to produce vaccination cards.
Just over two-thirds of women who had had a live birth in the three years before the survey had some form of prenatal care, with 54.6 percent receiving it from a skilled provider (doctor, nurse, or other trained provider). Corresponding proportions in urban and rural areas were 74.3 and 48.7 percent, respectively. The percentage of women who have four or more prenatal visits increased to 26 from 22 in 2007.The proportion of women giving birth in the three years preceding that survey in a health facility was rather low at only 28.8 percent, but it is an improvement from 12 percent in 2004. In urban areas, slightly under half of women gave birth in a health facility.
The 2011 DHS is an important benchmark in the country’s demographic history. Bangladesh has nearly reached replacement level fertility (about 2.2 children per woman in this case) and could expect to see its population growth end about mid-century.
* Very few ever-married women ages 12 to 14 were interviewed in the survey and that age group is not included in report tables.