Rights and choices are the key concerns in reproductive health and rights

Since 11 July, 1990, the United Nations and other organisations and institutions commemorate World Population Day (WPD) in partnership with governments and civil society to enhance population issues, including their relations to the environment and development. 

But like last year, the observance of the WPD 2021 is also different from previous years due to the Covid-19 pandemic. In the year 2021, the theme of the WPD is "Rights and Choices are the answer: Whether baby boom or bust, the solution lies in prioritising the reproductive health and rights of all people." 

This year's message is to look for the answers to find solutions regarding fertility to ensure the rights and choices of women and girls' sexual and reproductive health and rights. 

During this Covid-19 pandemic, many people have concerns regarding increasing or decreasing fertility rates across the countries and regions. The ongoing pandemic has exposed weaknesses in health care systems that have caused severe gaps and challenges in providing sexual and reproductive health information and services. 

As we know, during this crisis, not everyone is affected equally in the world. The supply chains are being interrupted due to lockdown, impacting the availability of contraceptives and worsening the risk of unintended pregnancy. 

Earlier examples, mainly from high-income countries and historical precedents, show that Covid-19 may be accelerating fertility decline in some countries (like some European countries, the United States), as couples react to the crisis by delaying pregnancy or changing fertility plans.  

There are pieces of evidence in the past; much crisis-related infertility, like the Great Depression in the 1930s and the Great Recession in the late 2000s, was followed by post-crisis fertility recoveries. 

For countries experiencing declining fertility during the pandemic, similar rebound infertility could occur in the coming months or years. At the same time, data and projections (UNFPA 2021) indicate that, in some low- and middle-income countries like Kenya and Malawi, the pandemic has interrupted access to family planning services, even increasing unintended pregnancies among vulnerable groups. 

Whatever these observations are being reflected, it will be enormously harmful if they undermine individual health, rights, and choices. There are also examples that narrowly focused interventions on fertility often do not work. 

For example, financially incentivising increased fertility does not lead to sustained higher birth rates in low-fertility countries. Instead, demographic changes can offer opportunities and must be addressed holistically, for example, through well-designed family support and child-care systems accompanied by efforts to ensure higher levels of gender equality (UNFPA 2021). 

Furthermore, demographic changes within the country may seem steep, but overall global demographic changes are more subtle. Here population 'momentum' affects population upsurges even when fertility rates fall due to an increasing share of younger women entering the reproductive age- that will result in world population growth for further decades to come. Bangladesh can be an example in this regard. 

However, in some regions and countries, populations are projected to decline (UNFPA 2021). Thus, state level policy supports fertility and demographic shifts by prioritising the reproductive health and rights of all people, including through their access to sexual and reproductive health information and services are needed- where Bangladesh is no exception.

TBS Illustration

As a sovereign state, Bangladesh- the eighth largest populated territory in the world, is celebrating its 50 years of independence in 2021. The country has got substantial socio-economic advancement and remarkable changes in reproductive health and rights. 

Despite impressive success in family planning over the years since 2011, the Total Fertility Rate (TFR) and Contraceptive Prevalence Rate (CPR) evidenced in 'Bangladesh Demographic and Health Survey 2017-2018, and The Multiple Cluster Indicator Survey 2019' refer the rates almost stagnant- TFR (2.3) and CPR (62%), respectively. 

However, SVRS (Sample Vital Registration System) of the Bangladesh Bureau of Statistics (BBS) refers to the rate as 2.1 in 2016 and 2.04 in 2019. The high unmet need for family planning of currently married women (aged 15-49) was evidenced in BDHS 2014 and BDHS 2017-2018, but the rate was higher (15.5%) among the young adolescent married women (aged 15-19). 

Women who want to avoid pregnancy are not using safe and effective family planning methods for reasons ranging from lack of access to information or services to lack of support from their partners or communities. Although a substantial decrease in the total fertility rate in Bangladesh, the adolescent birth rate is one of the highest (83 per 1000) in South Asia (Human Development Report 2019, UNDP). 

The BDHS 2017-2018 reports adolescent fertility (aged 15-19) is 27.7% which was 30% in BDHS 2011. The reduction of the maternal mortality ratio (MMR) has become a big challenge. 

The 'Bangladesh Maternal Mortality and Health Care Survey (BMMS) 2016' shows stagnant or slightly increased Maternal Mortality Ratio (MMR) per 100,000 live births (196) despite the increased number of women seeking maternal care at health facilities. 

However, SVRS referred to the MMR (per 1000 live births)-1.78 in 2016. Moreover, the number of women aged 20–24 who marry before age 18 in Bangladesh remains high and the highest (58.9%) in South Asia (BDHS 2017-2018). 

Between 2011 and 2018, only 6% had been reduced. Like ending child marriage ending Gender-Based Violence (GBV) is also critical here. At least once, women who experienced partner violence or faced any other type of violence (physical or sexual or economic or emotional violence or controlling behavior) were 80.2% in 2015 and 87.1% in 2011 (BBS, VAW Survey 2011 & 2015). 

Currently, Bangladesh faces challenges like gender-based violence, child marriage, and making contraceptive services more available and accessible to the grassroots. Unintended pregnancies, including those among adolescents in the pandemic, create further barriers to pregnant women who need antenatal care or safe-delivery services. 

Thus, we need to explore how to maintain the momentum towards achieving the Sustainable Development Goals (SDGs) and to fulfill the 'Three Zeros'- commitments given at the 'The Nairobi Summit on ICPD25'- to transform Bangladesh by ending all maternal deaths, unmet need for family planning, and gender-based violence and harmful practices against women and girls by 2030. 

The current facts and figures show that women and girls are more vulnerable. Still, in the pandemic situation, they are more susceptible where their specific needs must not be overlooked. 

The pandemic has also interrupted school and community-based services for adolescents and youth with current straining health systems and medical supply chains. 

Women primarily work in the informal economy, at greater risk of falling into poverty due to Covid-19. News media also reports the increasing incidence of child marriage and gender-based violence during the pandemic where the country is on lockdown and health systems struggle to cope, sexual and reproductive health services are being sidelined.  

Before the pandemic, only 55% of women in countries with data (UNFPA 2021) reported making their own decisions about accessing health care, using contraception, or engaging in sex with their partners. The optimistic scenario we may not experience as the pandemic is going on. 

Thus we need to examine the impact of Covid-19 on fertility rates in Bangladesh. For that, timely and accurate information about births and deaths is required to understand the demographic shifts. 

Furthermore, as the pandemic is not ending, we need to assess and publicise how access to family planning, maternal health, or the ability to achieve desired family size has changed due to the pandemic. 

Also, we need to hear the views from women and girls asking what they think needs to be done to empower them to have their ideal family size. No doubt, they must be empowered educationally, economically, and politically to exercise their rights and choices. 

Dr Mohammad Mainul Islam is a professor at the department of population sciences, University of Dhaka

Disclaimer: The views and opinions expressed in this article are those of the authors and do not necessarily reflect the opinions and views of The Business Standard.