“I joined family planning when no doctor would ...”

* What were your initial impressions following the Award’s announcement?

Dr. Akhter: “I felt very excited, happy and realized that I have done work of internationally recognized quality. I have been working hard to pursue with passion what my judgement dictated to be good and right for a developing country. The award comes as an honour and recognition, not only for me but also for all those who worked hard to facilitate development. It confirms my belief that recognition comes ultimately when one serves people who need help and perhaps even more so when it is in one’s native country. We sometimes forget that motherlands have so much to offer no matter how poor the country might be…”

* What do you think is your major contribution to the field of population in Bangladesh?

I have dedicated my career to advance services and research and introduce new methods of contraception in clinics and programmes thanks to the support of senior government officials and executives. I joined the Family Planning Department in 1969 when no graduate doctor would have as medical officer... It required a lot of self selectivity and courage to work in a department which actually only had a single method programme. Although I did not know the definition of reproductive health at first I clearly understood women’s needs in terms of preventing unwanted pregnancy, or spacing births and realized I could help them… I was fortunate to be involved in the introduction, training and implementation of various advanced methods of contraception. I was a proponent of the capacity and capability of female paramedics not only to provide family planning services but also maternal heath care, referrals, menstrual regulation services and simple post abortion care to rural women, in areas where access to physician is scarce”.

* How would you describe the contribution of FPAB to the field of population in your country?

Within a span of 53 years, FPAB has made a significant contribution to creating awareness among couples about family planning and smaller family norm. In the mid-1990s, FPAB contributed to at least 7 per cent of the total family planning performance.
During the last decade, through its multi-dimensional reproductive health services, the association has imparted reproductive health and population education to nearly 2,000 youth leaders including out-of-school adolescents in rural communities. Over 1,200 journalists working in electronic and print media have also been involved in the sexual and reproductive health and rights advocacy programmes. FPAB involved about 25,000 rural marginalized women in empowerment activities including provision of small loans, skill trainings, reproductive health education and treatment of minor ailments. FPAB has also been instrumental in changing the attitude of religious leaders on family planning issues”.

* What has been the role of the NGO-Government collaboration in this particular contribution?

Bangladesh is characterized by an excellent collaboration between NGOs and the Government that complement one another working towards the goal of successful family planning and extending reproductive health-care packages to rural communities. This creates a very positive and stimulating environment”.

* During the past ten years, the total fertility rate of Bangladesh has remained almost constant (at slightly over 3). In your opinion, what are the causes and what should be done to address it?

During a 30-year span, the total fertility rate has been reduced by half, from 6 to 3 children per woman. Factors having contributed to this success include the involvement of countless female fieldworkers offering services at door step and the adoption of a cafeteria approach” to family planning, with a wider choice of long- and short-term methods of contraception.

By contrast, several reasons could explain the plateauing of fertility rates at 3 children per woman since the last ten years, including set backs owing to the Government’s acceptance of a cluster approach, making about 23,000 female fieldworkers temporarily inactive and contributing to loosing the momentum in the field. Another set back the programme suffered was when the Health and Population Sectoral Programme went through a major reform… Besides, although contraceptive knowledge level is very high among women, there remain large proportions of unmet need. There is also room for increasing programme efficiency by enhancing quality and comprehensiveness of care. Also, more attention must be paid to clients’ needs and to providing a constellation of services to couples and adolescents. But one of the most important factors is to improve the status of women and empower them in decision making”.

* Are there programmes trying to address the still large proportion of births to very young/teenage women, which have serious implications for reproductive and child health?

Owing to social, cultural and religious norms, early marriage is almost universal especially in rural areas of Bangladesh. Yet there are some government scholarship programmes aimed at encouraging girls to remain in schools which have helped raise the age at marriage for female adolescents. Employments in the garments sector also contribute to delaying marriage and pregnancy. However, because they are insufficient in number, they are not able to have a sufficient impact on the fertility of this age group. Various NGOs including FPAB are working with adolescents trying to address their information needs and develop adolescent friendly services on sexual and reproductive health”.

* What other population issues are of serious concern for Bangladesh nowadays?

“There is a need for a clearer understanding by all actors of the right-based needs of individuals, irrespective of age and sex. Amongst other, one also has to address gender-based violence and ensure greater male participation in family planning and safe motherhood…”