In a society where access to basic menstrual health products is still a contentious issue, the recent controversy surrounding the shutdown of booths selling sanitary napkins at Amar Ekushey Boi Mela—following "complaints from religious groups"—highlights a deep-rooted stigma around menstruation in Bangladesh. Despite progress in gender rights, menstrual hygiene remains a hushed topic in the country, often confined to whispers within households. It would be quite rational to say that the recent incident is not isolated, but is part of a larger pattern perpetuating human rights concerns for women and girls across the country.

This stigma extends beyond cultural taboos, intertwining with economic disparities and gender-based discrimination. The silence around menstruation reinforces an uneven scale of reproductive responsibility, where women are expected to manage their periods discreetly while bearing the responsibility of family planning, along with the weight of societal judgement.

When Aasha (not real name) told her husband she was considering his sterilisation, his response crystallised a reality faced by millions of women across Bangladesh. "I don't want to end the option of having a child again, it could have adverse health effects too," he said, effectively placing the entire burden of contraception on his wife's shoulders.

Aasha was devastated. The couple had decided beforehand that they didn't want any more children and had been using modern methods to avoid pregnancy. But it was not a foolproof method; condoms for example, have a relatively high failure rate—about 14-15 percent. And when she conceived—twice—she took over-the-counter abortion pills the first time. The second time, she had to undergo a clinical procedure for abortion performed in legally dubious circumstances.

"I had heavy bleeding, my head would spin, I had blackouts, and I was listless and tired all the time. So, I told him that sterilisation would be better than taking these blighted pills or using condoms," the 27-year-old, a mother of two, told this writer over the phone from her home on the outskirts of Pirojpur district, in the southwestern region of Bangladesh.

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Aasha's story is not unique. It reflects a broader pattern in the country where, despite six decades of scientific advancement in contraception, women continue to bear disproportionate responsibility for family planning.

A recent review of 10 years of Bangladesh Sample Vital Statistics from 2014 to 2023, conducted by the Bangladesh Bureau of Statistics (BBS), reveals that the use of birth control methods decreased in 2023, the lowest since 2015, and stands at 62.1 percent. The 2023 report only provides the results; it does not clarify why and where the use of contraception has fallen. Moreover, it also reveals a troubling scenario: while modern contraceptive use among women has fallen to what it was eight years ago, the gender disparity in contraceptive responsibility remains stark.

The numbers tell a clear story. In 2023, oral contraceptive pills remained the most common choice, used by 35.5 percent of women, followed by injectable methods at 14 percent. Meanwhile, male participation in contraception was minimal: condom use accounted for just 6.9 percent of all contraception methods, and male sterilisation represented a mere 0.2 percent. This imbalance reflects not just a medical choice, but a deeper societal issue rooted in gender inequality.

What's particularly concerning is the privatisation of contraceptive access. According to the Bangladesh Demographic and Health Survey 2022, 60 percent of modern contraceptive users now rely on the private sector—a significant increase from 42 percent in 2011. This shift has created a two-tier system where access to family planning increasingly depends on economic status. The commercialisation of contraception has made it a privilege rather than a right, disproportionately affecting women in rural and economically disadvantaged communities.

The recent decline in the use of contraception signals a systemic failure that extends beyond individual choice. There remains a critical lack of government attention to population control programmes. Despite adequate funding, shortages of contraceptives have become commonplace. The consequences are severe: death rates from abortion complications have more than doubled, from six percent in 2016 to 14 percent in 2024.

The urban-rural divide further compounds these issues as the disparity in modern contraceptive use reflects broader inequalities in healthcare access and highlights the failure of current distribution systems to reach remote areas effectively. The government's inability to deliver contraceptives to char areas, haors, and other remote locations has created geographical barriers to reproductive healthcare.

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The global context adds another layer to this discussion. While women have access to a wide array of contraceptive options—from daily pills to long-term implants and IUDs—men's options have remained unchanged since the 1960s: condoms or vasectomy. These limited choices indicate not just a technological gap, but a persistent societal assumption that family planning is primarily a woman's responsibility. As US biologist Gregory Pincus predicted in 1964, the development of male contraceptives would have to overcome "the attitude of men"—a prophecy that remains relevant even now.

The knowledge gap between genders is equally troubling. A 2020 survey by BBS found that only 29 percent of men had knowledge about family planning methods, compared to 61 percent of women in Bangladesh. More concerning still, only 12 percent of men believed they should be responsible for family planning, while 69 percent of women recognised it as a shared responsibility. This disparity in awareness and accountability perpetuates a cycle where women's reproductive autonomy is compromised by men's disengagement.

Recent developments in male contraception, including the clinical trial of YCT-529 in the UK and the promising NES/T hormonal gel in the US, suggest that new options for men might finally become available within the next decade. However, these advancements will mean little without corresponding shifts in cultural attitudes and healthcare policies in least-developed countries like Bangladesh.

The solution requires a comprehensive overhaul of current approaches. First, there must be increased education and awareness campaigns specifically targeting men about their role in family planning. Second, healthcare policies need to ensure consistent availability and affordability of contraception options. The recent shortages of pills and injectable methods at the field level demonstrate the devastating impact of supply chain failures. Third, there needs to be a reversal of the privatisation trend in contraception access, ensuring that family planning remains a public health priority rather than a commercial opportunity. Finally, there must be a fundamental shift in societal attitude about reproductive responsibility.

The burden of birth control shouldn't rest solely on women's shoulders. Until our male counterparts recognise family planning as a shared responsibility, and until healthcare systems and societies support this view, women will continue to bear both the physical and emotional costs of contraception.

Mahiya Tabassum is a member of the editorial team at The Daily Star.

Views expressed in this article are the author's own.

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