CASE 13: Reducing fertility in Bangladesh

Map showing Bangladesh

How do we know

A Contraceptive Prevalence Survey was conducted in 1991 to provide information about Bangladeshi women?s knowledge of modern contraception. Multiple regression analysis was used to separate out different influences on the health outcomes provide the grounds for claims of success.


Health Condition: In the mid-1970s, a Bangladeshi woman had more than six children on average. In combination with poor nutrition and lack of access to quality health services, this high fertility rate jeopardized the health of both the woman and her chil­dren. Beyond the health impact, high fertility and rapid population growth represented a major constraint to the country’s economic development and social progress. More than 150 million women in the developing world who would like to limit or space their pregnancies do not currently use a contraceptive method. So, for example, about 16 percent of mar­ried women in India have this “unmet need.” In sub-Saharan Africa, where services are in rela­tively short supply, the unmet need is the greatest.

Intervention or Program: The Bangladesh family planning program has depended on a large cadre of female outreach workers going door-to-door to provide information, motivate clients, and provide commodities; the program has used mass media to stimulate a change in attitudes about family size. The program both contributed to and benefited from improve­ments in women’s status in Bangladesh during the past 30 years.

Impact: As a result of the program, virtually all women in Bangladesh are aware of modern family planning methods. The current use of contraception among married women increased from 8 percent in the mid-1970s to about 60 percent in 2004, and fertility decreased from an average of more than six children per woman in 1975 to slightly more than three. Although social and economic improvements have played a major role in increasing demand for contraception, the provision of services and information has been shown to have had an independent effect on attitudes and behavior.

Cost and Cost-Effectiveness: The program is estimated to cost between $100 million to $150 million per year, with about one-half to two-thirds of the funding coming from external donors. Cost-effectiveness has been estimated at about $13 to $18 per birth averted, a standard measure for family planning programs.