Contraception  prevention of pregnancy. The term is associated with birth control, fertility control, population control, family planning, child spacing, and planned parenthood. Under some circumstances pregnancy or child bearing has been considered undesirable, and even prohibited. Although considered unlawful, abortion had been in practice in Bengal since very old days. bedey women (gypsy women) sell herbal medicines for abortion or permanent prevention from conception. Regarding spacing of sexual intercourse, the elderly people would say: 'once a month, twelve times a year, even less the better'. Another popular saying ran thus: 'one who commits sin becomes the father of eighteen kids'. This signifies the awful disadvantage of producing too many children. That unlimited child-birth was not appreciated even a thousand years ago is revealed in verses from charyapada, an anthology of poems written by Buddhist saints of the 8th-10th centuries AD: 'domni (a dom woman) is giving birth to innumerable children like tadpoles. So she is facing the problem of feeding them'.

The practice of contraception or fertility control on a scale sufficient to influence the birth rate began in France toward the end of the 18th century and in other countries during the 19th century. Margaret Sanger of USA started a movement for planned parenthood in 1914. In the Medical Colleges of Bangladesh surgeons favoured or prescribed abortion or hysterectomy to avoid illegal or unexpected pregnancies due to health or social reasons. The idea of contraception has of late found its place in the modern system of medical or surgical treatment. The well-to-do and educated classes have not only backed the idea of contraception but have also adopted the method of sterilisation. In 1953, Purba Banga Paribar Parikalpana Samity, an organisation modeled on International Planned Parenthood Federation, was formed and activities were started to promote contraception. In the general election of 1954, however, Nezame Islam, a religio-political party vehemently opposed the idea in public meetings and religious gatherings. In 1956, the government supplied conventional contraception devices to hospitals and clinics for providing them to clients and for publicity among patients. This was the first governmental attempt to promote contraception among the people.

In 1965, as part of the five-year plan of the government, the provincial government of East Pakistan established the Family Planning Board. Educated persons were employed full time and thousands of dais (traditional birth attendants) were involved in the publicity of the contraceptive programme, especially in the countryside. During the mass upsurge of 1969, a segment of petty-feudal and religious fanatics damaged some establishments promoting the contraception programme. In 1973, the government of Bangladesh declared contraception as a recognised method of population control. In 1976, thousands of whole-time female workers were appointed in villages to contact eligible couples to make them aware of the value of contraception. After more than two decades, the policy of 'contraception to the couples' has been changed to 'contraception from the centre'. Contraception, like the family planning programme, entered a new phase when the government of Bangladesh launched the Health and Population Sector Programme (HPSP) in July 1998. Planners now expect couples to come to union and village-based community health clinics to choose the contraception method of their choice. At present, contraception is considered a component of reproductive health. Stress is being laid more on its reproductive aspect than on its demographic aspect.

In Bangladesh, contraception was formerly used for prostitutes, maid-servants, widows, spinsters and for the uterine-diseased and breast-diseased women. Herbal medicine was applied for them. Ayurved physicians known as kabiraj or ayurvedacharya knew about contraception. According to them, (1) a woman who bathes on the fourth day of the menstrual period, takes or eats the akanda (sunplant) or its leaves by pounding them will conceive; (2) a woman who takes milk diluting it with the mixture of pipul, bidongo and the same quantity of powder of fried grain of shohaga during menstrual period will not conceive; and (3) a woman will not conceive if she eats cakes made of the mixture of pounded chalta leaves and powdered rice grain. Village quacks still depend on the knowledge of herbs developed by ayurvedics and spread them to remote villages. Due to the miss-application of medicinal herbs for abortion or for permanent sterility many women die or face serious uterine complications. When indigenous contraception failed, indiscriminate acceptance of imported contraceptives gained ground in the country. No attempt has been made to research, develop, and produce contraceptives scientifically from medicinal plants and herbals containing anti-fertility ingredients.

Two methods are widely practiced: one is time-biased or rhythmic, and the other is herbal and medicinal. A common belief is that semen should be thrown out beyond the vaginal boundary if someone does not want a child. Maulanas or those who are conversant in Islamic theology cite the example of Azl. Yoga is also applied in procrastinating the ejaculation so that the semen may be thrown outside the female organ. buddhism, hinduism and islam greatly influence the daily lifestyle including sex-behaviour of the people of Bangladesh. Solar season and moon periods also regulate their sex-behaviour/copulation to a great extent. For example, rainy season is the best time for copulation, but pre-winter (Kartik-Agrahayana) is not. This may be due to the scarcity of food or off-season of agriculture. Copulation was strictly prohibited during amabashya (darkmoon) according to mothers-in-law or other elders who generally control the internal life-style (including sex behaviour) in rural society. They maintain that every couple should lead their sex lives according to certain rules and regulations. Such views definitely refer to the selective period of copulation. According to the views of 'eighty-ups', children come in large numbers, because new couples do not abide by the rules prescribed by the elders. Herbal medicinal method is still in use in Bangladesh. Kabiraj, gunin, dais and folk quacks use totka chikitsha or quack remedy for treatment among illiterate people and womenfolk of our countryside. In most cases, the quacks get their knowledge either from ancestral or acquired sources. Their contraception methods are kept secret.

From ancient times, however, some herbs have been used either for abortion or for contraception, eg, pan or tambuli (Piper Betel, Latin Fam - Piperaceae). Juice of the root of pan is reported to promote permanent sterility in women. In some cases chewing of pan leaves lingers the time of conception. Joba (Latin Hibiscus rosa sinensis Fam-Malvaceae) flowers fried in ghee is generally given in manorrhagia; and is applied for diseases of the genito-urinary tract. Its juice is used in abortion. It possesses anti-fertility ingredients. Ulatchandal, Bishlanguli, Bilambuli and Agnishikha (Gloriosa superba, Fam-Liliaceae) are very effective in contraception. Juice of its rhyzomes (root mass) is also used. Juice of leaves and barks of Ulatkambal (Abroma augusta, Fam-Sterculiaceae) is taken to make the irregular menstruation regular and to prevent unwanted pregnancy. Juice of Sthalpadma (Hibiscus mutabilis, Fam-Malvaceae) flowers and leaves is also used for the same purposes. Fresh juice of the leaves of the unripe Anaras (Ananas Sativus) is regarded as an abortifacient. Juice of the leaves and the roots of Bishkatali (Persicatia hydropiper) is good to stop hemorrhage and sometimes to cause abortion.

Modern contraceptive methods can be divided into two forms: clinical and non-clinical. Almost all clinical medicines, surgical appliances, and contraceptives are imported from abroad. Clinical methods are as follows:

Tubectomy is for permanent sterility of women. Vasectomy is for permanent sterility of men with their vas bisected. Intra Uterine Devices (IUD) are inserted into and placed in the uterus of women, usually by lady para-medics. Plastic coil, Plastic loop and Copper-T are some of the varieties. Norplant, the newest contraceptive, provides protection for five years. Periodical hormonal injections are widely taken by women.

Oral hormonal pills are the most popular contraceptive. Several brands are known among woman folk in rural Bangladesh. Condom is a conventional contraceptive.

Both traditional and modern (clinical, non-clinical and hormonal) contraceptives have side effects. In traditional methods, complications like permanent termination of menstrual period or too-early menopause happen. Sometimes, they cause extremely irregular menstruation. Very often abortion leads to excessive bleeding that may cause even death. On-the-spot treatment is not always available. Mainly for this reason these methods are not popular. But modern methods have fewer complications.

Contraceptive prevalence rate (CPR) in Bangladesh was very low during the introductory period in the 1960s. The rate increased six-fold by 1975, from 8 to 49 percent. The use of modern methods has grown faster. Between 1993-94 and 1996-97, CPR increased from 45 to 49 percent. Use of modern methods rose from 36 to 42 percent. There has been a steady growth in the CPR, with an average increase of almost two percentage points a year. Use of pills quadrupled in eleven years, from 5 percent in 1985 to 21 percent in 1996-97. The pill accounts for 42 percent of contraceptive use. Use of female and male sterilisation declined. Use of IUD declined slightly.

From the very beginning, the government was responsible for wide-ranging contraceptives distribution system. Before that, a lone non-government organisation, the Family Planning Association of Bangladesh, started distribution of condom, jelly and foam tablets in a very limited scale, especially among the educated community. Later, NGOs became involved in this process in the 1980s. But the distribution system revolutionised when Family Welfare Assistants were engaged in villages to deliver pills and condoms directly to clients in their houses and to refer willing clients to clinics to receive IUDs, injections and sterilisation methods. Due to this system, the contraceptive prevalence rate jumped five times from 7.7 to 39.9. A switch-over has been caused from clinical contraception to conventional contraceptives like oral pills and injections. The government supplies contraceptives free of charge through field workers and clinics. NGO service providers charge a nominal price.

The most remarkable name in the marketing of contraceptives is the Social Marketing Company which distributes and sells oral pills and condoms through pharmacies and small shops all over the country. Organon Bangladesh also sells oral pills through its network. Pharmacies are important outlets of contraceptives to thousands of general, and to some extent, 'disguised clients'. Despite the participation of these private commercial agencies, the government still handles 90% of imports and distribution of contraceptives. [Mustafa Hossain]