Bangladesh makes progress, slowly, on population problem. Birth control gains acceptance, despite tradition
``Population,'' says Lt. Gen. Hussain Muhammad Ershad, ``is our worst enemy.'' General Ershad is the President of Bangladesh - a country whose 110 million people live in an area slightly smaller than Iowa and whose numbers are increasing at a rate of 7,700 per day.
From inside Ershad's elegant palace, it is hard to remember that in this crowded, fast-growing capital many children drink from open sewers, and women who are privileged to work often sit all day with their babies in clouds of dust, breaking up stones and bricks with hammers.
Most experts agree that overpopulation in the developing world is central to such problems as urban congestion, poor sanitation, and underemployment. But President Ershad goes even further. When asked to evaluate the importance of population control to his country, his reply is quick and blunt: ``It's a question of the survival of Bangladesh,'' he says.
Bangladesh is among the world's poorest countries. Its per capita income of $120 ranks with that of its neighbor, Bhutan, as the second-lowest, surpassed only by that of Chad. Infant mortality is higher than Asia's average of 87 per 1,000.
In many developing nations, including Bangladesh, overpopulation threatens survival by limiting access to food, shelter, health care, sanitation, education, and employment. It often has devastating effects on the environment as well.
But perhaps more alarming to third-world leaders, overpopulation can be a political time bomb. Recent unrest among university students and graduates in Dacca over the lack of job opportunities has resulted in strikes and demonstrations. Government officials watch such developments with foreboding.
Bangladesh's population problems have also caused friction with its powerful neighbor, India. In the past 30 years, more than 2 million Bangladeshis have crossed the border into northeast India. Many fled during the 1971 war of independence, and a steady stream has continued to pour in since. Bangladeshis complain of the murder of many of their countrymen who entered Assam in search of work. Indian authorities in Assam State have vowed to erect a fence along the border to keep immigrants out.
The average number of children per woman, the fertility rate, stands at 4.6 in Bangladesh. The goal of the Ministry of Health and Family Planning is to bring this down to 2.7 by 1990. Ministry officials are optimistic because, as a result of a national campaign to promote family planning, the proportion of couples of child-bearing age who practice contraception has risen from 7.7 percent in 1975 to 29.7 percent.
But according to the UN Fund for Population Activities, demographics are against them. Forty-seven percent of Bangladeshis are under age 15, and the population will continue to swell as this group reaches child-bearing age. It is estimated that by the time Bangladesh manages to stabilize growth, the present population will have more than doubled.
Despite total commitment at the government level, formidable obstacles stand in the way of widespread family planning in Bangladesh. One is the people's expectation, born of hard experience, that natural disasters may decimate their families and that having many children provides insurance against such calamities.
With its wide rivers and low-lying plains, Bangladesh is hit most summers by torrential monsoon rains, as well as occasional cyclones and tidal waves that cause untold damage to life and property.
Ironically in Bangladesh, as elsewhere in the developing world, poverty prompts couples to have many children. With no equivalent of social security, people expect their offspring to care for them in old age. And with infant mortality high, they want many children to ensure that at least a few will survive.
Hence, infant and maternal health care and family planning go hand in hand in Bangladesh. A woman whose children are healthy and likely to survive will be content to have fewer babies. And a woman not exhausted by closely spaced births is able to care for her children better, thus increasing their survival chances.
Another hindrance to more widespread family planning in Bangladesh is the low - indeed, sometimes invisible - status of women. Bangladesh is 90 percent Muslim, and polygamy, though practiced by less than half the population, is widespread. The lives of most women are tied to their homes. A women seldom goes out unaccompanied; if she wishes to use family planning, she must have her husband's consent.
Throughout the developing world, it has become axiomatic that when female literacy and women's participation in the work force rise, fertility rates fall. In Bangladesh, female literacy is 18.8 percent, compared with 39.7 percent for male literacy. The proportion of women employed outside the home is even lower.
Family planning is promoted throughout the country by making contraceptives widely available at minimal cost. Even in rural areas, contraceptives are sold by vendors who travel from village to village selling tea, kerosene, and other household items. Advocates of family planning do not promote permanent methods of birth control over temporary methods.
Bangladesh has one health clinic for every 100,000 people, and doctors are paid approximately 60 cents to perform sterilizations. A woman who travels to a clinic for sterilization is compensated for the cost of her journey, but officials insist that the women always come voluntarily. If a woman has fewer than two children, or is under 20 years of age, sterilization is not performed. Although twice as many people (men and women) choose permanent means of birth control as choose temporary means, President Ershad expects that this preference will change, as ``the use of other methods'' increases.
Abortion is illegal in Bangladesh, but local observers say it is quite common, often endangering women's health. It is expected that when other methods of birth control are more widely used, abortions will diminish.
Afazuddin Akhand is a landless farmer from northern Bangladesh. A thin, wiry man with a gentle face, he is seeking work in Dacca in the fallow season. A father of four, he says he cannot support a larger family. Some of his friends recommended vasectomies, and he now awaits his turn outside a family planning clinic.
``We never used any birth control before,'' he says. ``Some family planning workers had approached me, but I didn't understand what it was all about. My wife doesn't know I'm doing this, but she will be very happy.''