Human Capital: How Bangladesh effectively invested in its people by focusing on women’s health
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Seeing is believing. In May 2016, a delegation from 5 Sahelian countries - Burkina Faso, Chad, Mali, Mauritania, and Niger – traveled to Bangladesh to learn how the country was able to bring about a rapid demographic transition, with sustained support focused on reproductive and women’s’ health. The South-South knowledge exchange brought together Ministers and policy makers for an intensive one-week agenda, filled with discussion, multiple site visits, shared good humor, and complicated language interpretation (French/Bengali/English)!
The success story in Bangladesh is indeed remarkable.This achievement is even more impressive given that it was largely achieved while the country was in the midst of tackling serious economic and social challenges.
Moreover,, and a more than doubling of its per-capita GDP this past decade.
Smaller families often mean that parents are able to invest more resources in the health and education of their children. This human capital accumulation, when combined with policies that generate good jobs for large numbers of the working age population, can drive economic growth and makes countries wealthier.
One major factor in Bangladesh’s success is attributed to the government’s prioritization of demographics in the national policy agenda, adopting a whole-of-government approach.
1. Embed demographic issues across Ministries and policy agendas
The government prioritized demographics in the country’s first Five-Year Plan in 1971, recognizing that high fertility not only jeopardized the health of both the woman and her children but also represented a major constraint to the country’s economic development.
The widely respected National Planning Commission provided leadership, coordination, and oversight over the development of the Five-Year Plan. Numerous ministries including health, education and religious affairs, then integrated these issues into their planning, resulting in a multi-sectoral coalition.
2. Invest in research that translates into policy actions
Early on in its efforts, Bangladesh invested in rigorous research and evaluation, which was essential to enable evidence-based program design and implementation. Academic institutions, NGOs, development partners, and the government collaborated on the research and in scaling-up innovative solutions.
A key such effort was in 1977, when the International Centre for Diarrhoeal Disease Research, Bangladesh initiated an experimental Family Planning and Maternal and Child Health (FPMCH) program in the religiously conservative area of Matlab. Under the program, community health workers made regular home visits to married women in the villages and offered them a choice of family planning methods.
Evaluations showed that families living in the program intervention area became healthier and wealthier compared to those in a comparison area.
The use of evidence-based approaches went further. In the mid-1990s the Ministry of Education started the Female Secondary School Stipend Program, which provided free tuition and stipends universally to eligible girls from grade 6 to 10, conditional on school attendance, maintaining exam scores, and remaining unmarried until age 18 or completing secondary school. Evaluations showed the program resulted in a tripling of the number of girls enrolled in secondary school and a decline in early marriage.
By effectively and actively engaging with community and local influencers, Bangladesh was able to garner broader support.
3. Sustain policy commitments across administrations
The high-level leadership of the National Planning Commission over population policy continued over the decades with steady focus and priority on the issue – with changes largely limited to implementation framework rather than to the priority given to the issue. This has resulted in Five-Year Plans for close to 50 years to date maintaining a concerted national commitment to population issues and sustaining it across successive administrations, regardless of political party.
4. Mobilize “local influencers” including religious leaders…and Women
including family planning and reproductive health. This empowered religious leaders to use religious texts to explain to their local communities that Islam does not prohibit family planning – helping to legitimize the program from a religious perspective.
, who were recruited from the communities that they served.
By effectively and actively engaging with community and local influencers, Bangladesh was able to garner broader support for more rapid change in social norms, preferences, and behaviors.
to empower and enable women and families to achieve their desired family size. Other countries that are struggling to achieve this transition and set the stage for the economic gains that can follow, can learn much from Bangladesh’s approach and success.
This blog is based on several sources, including a case study of the Bangladesh experience conducted by the World Bank’s Human Capital Project. Read the complete Bangladesh Case Study here (PDF)
Excellent blog, one of the best I have seen in a long time. Shows how a comprehensive program and religiously sticking to it can drive results. Very important lessons for sure for Africa, but also closer to BD home - Pakistan!
It is a good analysis. But the role of social media in inculcating the lower fertility norm has not been explored in the study. As someone who was a teenager in Bangladesh in the 70s, I know social medial campaign played an important role in reducing fertility. You could not go anywhere without bombarded with the message, "whether it is a boy or a girl, two is enough." It was on huge billboards on the major street intersections, on the back of rickshaws, trucks, and buses. It was on stamps and postcards. The message was broadcast daily on the radio and tv. This is worth exploring now that other countries are encouraged to emulate Bangladesh's strategy