Nearly 10 lakh children born annually in Bangladesh are unwanted due to a lack of family planning services and contraceptives, says a new analysis on the Bangladesh Demographic Health Survey (BDHS) 2014.

“Here unwanted birth means either the parents didn't want the child in that time or never,” said Karar Zunaid Ahsan, senior monitoring and evaluation adviser at the programme management and monitoring unit of the health ministry.

According to the BDHS 2014, the fertility rate in Bangladesh is 2.3 children per woman, and it has been stagnant since 2011, becoming a cause of concern.

If the present rate continues, Bangladesh may not achieve the goal of reducing the fertility rate to 1.7 children per woman by 2021 as per the commitment made to the Global Partnership on Family Planning 2020, Zunaid said.

“In that case, our population by 2050 will cross 20 crore,” he told a workshop, organised by the National Institute of Population Research and Training (NIPORT) and Bangladesh Health Reporters Forum (BHRF) with support from USAID at a hotel in the capital yesterday. The countrywide unwanted fertility rate is 0.7 children per woman, with regional variations. Sylhet has the highest unwanted fertility rate of 1.1, while it is 0.7 in Dhaka and Chittagong, 0.6 in Barisal, 0.5 in Rajshahi and 0.4 in Rangpur and Khulna, said Zunaid.

This is happening when the country's contraceptive prevalence rate (percentage of women or their sexual partners using contraceptives) is 62 percent, but the target is to make it 75 percent by 2021.

The Bangladesh Health Facility Survey 2014 found only 25 percent of the facilities offering family planning services are ready to provide quality services. For private hospitals, the proportion is only 5 percent.

“Overall, the main reasons for low readiness are unavailability of guidelines on family planning and a lack of providers with structured, in-service training in family planning,” Zunaid said.

In the public sector, 51 percent of the sanctioned medical officer and 23 percent of the family welfare visitor positions at the Directorate General of Family Planning (DGFP) remain vacant. Moreover, 95 percent of administrative positions of DGFP are vacant.

Karar Zunaid suggested area-specific interventions in Sylhet, Chittagong and Barisal divisions, urban slums and hard-to-reach areas like chars and coastal regions where service coverage is low.

Dr Ishtiaq Mannan, director, health, nutrition and HIV/AIDS at Save the Children in Bangladesh, said improving maternal health was a major challenge in achieving the targets under Sustainable Development Goals by 2030.

The maternal mortality rate now is 176 per one lakh live births, while the SDG target is to reduce it to 59; another target is increasing deliveries by skilled birth attendants to 98 percent from 43 percent now, he said.

Dr Ishtiaq said equity, quality and efficiency were the key principles of Universal Health Coverage, but the progress made so far remained highly inequitable.

For example, between 2004 and 2014, deliveries in the private sector increased from 4 percent to 22 percent, while in the public sector it increased from 7 percent to only 13 percent, he added.

Also, nationwide, only 15 percent of the poorest women give birth in health facilities versus 70 percent of the richest women, the expert said.

“The health ministry has to put more emphasis on regulation and building transparency and accountability across the sector.”