Council Commentary

Shaping family planning programs and policy in Bangladesh

When women have access to contraception everyone benefits. Women and children are healthier. Families and communities can invest more in education and health care. And poverty is reduced. Family planning should be a high policy priority and should be seen primarily in terms of its benefits to people’s health and rights, but also as an important investment in economic development and higher living standards.

A case in point is Bangladesh. In the 1970s, Bangladesh had some of the highest rates of fertility and mortality in South and East Asia. Purdah—the social seclusion of women—prevented many women in the country from accessing health care services, including effective contraception. Use of clinic-based health services was low because of women’s restricted movement outside the home.

In 1977, the Population Council began a long-term collaboration with the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) and funded in part by USAID to document the benefits of family planning in the Matlab sub-district of Bangladesh.

Matlab’s population of 173,000 people was divided into two areas: an experimental area, where access to high-quality family planning services was greatly expanded to include home visits, a wide array of contraceptive choices, and follow-up care; and a control area that received a standard set of less-intensive services that were already available country-wide.

The Council’s research showed that the impact in the experimental area was large and immediate: contraceptive use increased markedly, fertility declined rapidly, and women’s health, household earnings, and use of preventive health care improved for the families. Children living in households that received family planning outreach were more likely to survive to the age of five and to attend school than were children from households that did not participate.

The groundbreaking research at Matlab showed us the way to bring effective family planning to a poor, rural, conservative population. The program was so successful that it was expanded across the country—with extensive technical assistance and support from the Population Council—and has shaped the country’s national family planning program since the mid-1980s. Findings from Matlab have also been used to design village-based family planning programs in Pakistan.

I was lucky enough to begin my career in public health at icddr,b while the Matlab project was in progress. During the 1980s, I worked there as a demographer and statistician and became acquainted with the project when it was under the leadership of James Phillips, who was “on loan” from the Population Council. Jim was my mentor, and his involvement with Matlab and icddr,b exemplifies one of the Population Council’s great strengths: providing technical assistance to local organizations and then supporting local ownership of successful projects. Jim went on to use lessons learned from Matlab to design projects in several African countries, most notably a community-based health service delivery program in Ghana.

Today, I am the proud director of the Population Council’s office in Bangladesh. And my country is widely recognized as a world leader in family planning. We have learned that robust, high-quality voluntary family planning programs are among the most important policy responses for improving the lives of people in developing countries. As in Bangladesh, other countries that have adopted voluntary family planning programs—such as Ethiopia, Indonesia and Kenya—are seeing improved economies, public health, and standards of living.

Dr. Ubaidur Rob is a Population Council senior associate and director of the Council’s Bangladesh office.