Stalled procurement deepens birth control crisis, raising unintended pregnancy risks

Infographic: TBS

Highlights:

• Procurement has been stalled since July 2024
• Interim govt withdrew from sector programme, disrupting supply chains 
• Condom distribution plunges from 459,000 to 50,000
• Oral pill distribution drops from 251,000 to 140,000
• Fertility rate rises to 2.4 after decade-long stability at 2.3

A severe shortage of contraceptives across Bangladesh raises the risk of unintended pregnancies, putting the country's family planning gains under strain.

Officials at the Directorate General of Family Planning (DGFP) said procurement has been stalled since July 2024, after the 5th Health, Population and Nutrition Sector Program (HPNSP) was not approved and the interim government withdrew from the sector programme, disrupting supply chains.

DGFP data as of 19 April show condoms – the most widely used method – are fully out of stock in 394 upazilas. Implants are unavailable nationwide, while oral pills have run out in 335 upazilas and IUDs in 395.

DGFP field workers distribute condoms, pills, IUDs, injectables and implants free of cost. But with procurement frozen for over two years, the system is under severe strain, with many areas meeting less than 10% of demand.

Data further show 51 upazilas are at stockout risk. Only 14 have adequate stock, nine are understocked, and 26 have excess stock. Distribution has plunged from 459,000 in April last year to 50,000 in March.

Oral pills show a similar pattern: out of stock in 335 upazilas, with 93 at stockout risk. Only 19 have an adequate supply, 26 are understocked, and 21 have excess stock. Injectables and implants are critically low, with less than three months' supply remaining, while IUDs are stable at three to six months.

Impact at the grassroots

Field officials say the shortage is already translating into rising unintended pregnancies. Women discontinuing implants or other long-term methods often have no alternatives, while low-income households cannot afford market purchases, leaving many unprotected.

Kamal Hossain, family planning officer of Tala upazila in Satkhira, told The Business Standard that procurement has been stalled for nearly one and a half to two years.

"With the sector programme halted, no new supplies have come in. Early on, limited stocks at the Central Medical Stores Depot were rationed, but the situation is now critical," he said.

"For six to seven months, supplies have been almost non-existent. We received less than 10% of demand, lasting at most two months."

He said unintended pregnancies are rising and the total fertility rate (TFR) is climbing again after years of stability. "Long-term methods have stalled. When implants expire, we can remove them but cannot offer alternatives, leaving women unprotected," he said.

Frontline services, he added, are also weakening. "Our workers go door to door, but without supplies, their credibility drops. Many cannot afford contraceptives, leaving them at risk."

DGFP Director General Dr Ashrafi Ahmad told TBS that emergency measures are underway, with supplies expected to reach districts and upazilas by mid-May.

She said pending bills from the previous fiscal year have been cleared, and procurement is ongoing. Some items, including condoms, are expected to reach the field partially this month, alongside medicines and delivery kits.

She acknowledged that the suspension of the sector programme has significantly disrupted the system, and full normalisation will take time. "Procurement is ongoing, and the new government is prioritising the issue. We are working to restore momentum in family planning services." 

Are we moving backwards?

Bangladesh has long been a success story in population control. At independence, women had over six children on average; this has fallen to around two, driven largely by contraceptive use.

But after remaining at 2.3 for over a decade, the TFR is rising. The Multiple Indicator Cluster Survey 2025, released on 16 November, reports a TFR of 2.4, up from 2.3 since 2012. Contraceptive prevalence has fallen from 62.7% to 58.2%, while demand satisfied for modern methods has also declined.

Experts warn that shortages may further increase unintended pregnancies and reproductive health risks, particularly among poor and vulnerable groups.

Prof Mohammad Mainul Islam of the University of Dhaka told TBS that access is the foundation of family planning. "If contraceptives are not freely available, low-income groups cannot afford them, increasing unintended and adolescent pregnancies," he said.

He added that the impact extends beyond fertility, affecting maternal and child health and overall reproductive health, while potentially increasing sexually transmitted infections due to riskier behaviour.

He noted "unmet need" has risen despite a target to eliminate it by 2030. "We now see unmet need increasing, contraceptive use declining, and fertility rising – an alarming trend. The question is whether we are moving backwards."

He stressed that resolving the crisis requires more than restoring supply, calling for full implementation of the family planning strategy with targeted planning, awareness and improved access.