Population  The total population size of Bangladesh was 111.4 million in 1991 and it stood at 129.25 million in 2001. The population density of the country in the two reference years was 720 and 832 per square kilometer. Bangladesh is one of the most densely populated countries in the world and it is estimated that the population of the country will nearly double by 2050. The number of households in 2001 was 25.36 million, of which 19.44 million were in rural areas and 5.92 million in urban areas. The average size of a household was 4.8. The male-female ratio was 103.8. In 1991, the child-women ratio was 742 and the dependency ratio 102.

Table 1 Population, 1801-2001 (in million)

The population of Bangladesh remained almost stationary until the end of the eighteenth century despite the very high birth rate because of the equally high mortality rate. Since the beginning of the nineteenth century, the population started to grow at a slow pace. This was attributable mainly to frequent occurrence of calamities, including economic disasters and famines, as well as to very high prevalence of deadly diseases. Since 1921, the population had experienced a rapid decline in mortality and increase in fertility rate, which began to decline in the mid-1970s, although continued to remain at a high level. The increase in population at a rate that will double the total size in the next fifty years even after replacement level fertility is achieved during the next five to ten years is an echo effect of the high level of fertility observed until now and the overwhelming young age population.

Tribal population The tribal population in 1991 was 1.2 million, which was about 1.13% of the total population. The major tribes are chakma (252,258 persons), marma (157,301), tripura (79,772), manipuri (24,882), santal (202,162), garo (64,280), murong (22,178), tanchangya (21,639) and rakhain (16,932). The tribal population has a high concentration in the khagrachhari (13.9% of the total tribal population) and bandarban (9.15%) districts of the chittagong hill tracts. Major tribes living in these two districts are Chakma, Marma, Tripura, Murong, Tanchanghya and Rakhain. Most Manipuris live in sylhet, while Garos and hajongs live mainly in the mymensingh area and Santals in dinajpur and rajshahi districts.

Table 2 Distribution of Tribal population by religion, 1991

Religious composition Muslims constitute 88.3% of the total population of Bangladesh. Slightly more than one-tenth (10.5%) of the population in 1991 were Hindus. Buddhists, Christians, and the people of other religions constituted 1.2% of the total population. There had been a steady increase in the proportion of Muslims since 1901-91. The proportion of Muslims increased from about two-thirds in 1901 to 88% in 1991. In 1947-1951 and in 1961-1971, the proportion of the Muslim population grew in default because of a decrease in the Hindu people, who felt it more secured to migrate to India, especially because of the repressive actions of the Pakistan government and the brutal atrocity of the Pakistan Army in 1971.

Growth of population The economic prosperity of Bengal attracted people from all other parts of India as well as from other countries during the rule of the Mughals. Attracted by the prospects of abundant agricultural productions started to migrate to and settle in the active delta regions in the 16th century. Muslims from various parts of India came to settle in the region during the period between the 13th and 18th centuries. Their number in the area was about 9 million in 1600. The total population of the area was 11.8 million in 1770 and 14.5 million in 1801. Both the birth and death rates were very high and the increase in population was attributed mainly to migration from other parts of India.

The population of Bangladesh was around 14.5 million in 1801. It doubled to 28.9 million after 100 years in 1901. The growth rate, however, was almost constant at a level of 0.67%. The slow growth of population continued till 1931 when the size of the population reached 35.3 million. After 1931, the doubling of population took place every 40 years. 24 years after the independence of Bangladesh in 1971, the population of the country increased by nearly the size of its population in 1961 (50 millions). The alarming demographic pressure crippled all other efforts at sustained economic growth and development. The rate of growth of population is still very high (about 1.6%). Even if the population reaches replacement level fertility in the year 2005, the impact of demographic pressure will continue to be a major problem for Bangladesh for at least the next 50 years.

The growth rate of the population was much lower than 1% during the period between 1801 and 1931. Records showed a relatively high growth rate in 1941. This could be the result of a gross overenumeration of population pushed politically by both Hindu and Muslim religious groups. Also, there was a negative growth of population during 1941-1951, caused by large-scale migration after the independence of Pakistan. The population growth rate was considerably higher after 1951. The rate was 1.93% during 1951-1961, 2.61% during 1961-1974, 2.35% during 1974 -1981, and 1.48% during 1991-2001.

Two major components of population growth are fertility and mortality. Estimated crude birth rates were very high at a level of around 50/1000 for a long period until mid 1970s. It eventually reduced to 27.8 per thousand in 1994. The decline in the level of crude death rate was initiated long ago. The estimated crude death rates were higher than 40 per thousand and it came down to a level of less than 40 for the first time during 1931-1941. The highest crude death rate of 47.3 per thousand was during the period between 1911 and 1921. The influenza epidemic alone caused 400,000 deaths in 1918.

The factors that caused the high death rates in the period before 1921 were: (i) frequent recurrence of epidemics, (ii) mismanagement by the east india company administration, (iii) frequent occurrence of famines, and (iv) scarcity of food supplies. The most fatal epidemic diseases were cholera, malaria, smallpox and tropical fever (kalajar). Diseases like tuberculosis and plague were not prevalent in India prior to the invasion of the British. A slight increase in the crude death rate during 1941-1951 could be attributed to various factors associated with the partition of India and Pakistan in 1947. There was a sharp decline in the crude death rate during the subsequent time periods of 1951-1961 and 1961-1974. The estimated crude death rate was 8.6 per thousand in 1994.

Age-sex composition 16.5% of males and 17.0% of females in Bangladesh were less than 5 years old in 1991. A little less than half of the males and females were under 15 years of age. This is indicative of the very young age structure of the population of the country, reflecting a high level of fertility in the recent past. Another salient feature of the country's population is a very high proportion of women in the reproductive age (42.3%). Although the proportion of elderly population of age 60 years and higher is still relatively small (5.4%), it is likely that the proportion will increase rapidly with the process of population momentum in the near future.

Marital status The distribution of population by marital status in 1991 shows that out of all males aged 10 years and above, the never-married, currently married, and the widowed, divorced or separated were 42.1%, 57.2% and 0.7% respectively, compared to 25.2%, 64.8% and 10.0% respectively for females. marriage is almost universal among males of age 30 years and above as compared to females of age 25 years and above. About 5% of the males in the age group 15-19 appeared to be currently married in 1991. 31% were married among males aged 20-24.

However, the proportion of currently married was much higher in the age groups below 20 years among females. Three per cent of the females of age 10-14 and almost 50% of age 15-19 were currently married according to the 1991 census. This is an indication of the high prevalence of early marriage among females in Bangladesh. The proportion of widowed, divorced, or separated females steadily increases with age among female population from 0.2% in the age group 10-14 to 56.3% in the age group 60 years and above. The mean age at marriage of males was 19 years in 1931 as compared to that of 12.6 years for females. The difference in the mean ages for males and females was 6.4 years. The mean age increased to 25.2 years for males and to 18.1 years for females in 1991. The difference in the mean age at marriage for males and females increased slightly (7.1 years) during the period 1931-1991. In 1998, the mean age at marriage increased for both males (27.8 years) and females (20.2 years).

Rural-urban population The process of urbanisation in Bangladesh has been very rapid since 1961. The census enumeration in 1901 recorded only 0.7 million people living in urban areas but the number increased slowly to 2.6 million in 1961. The urban population increased from 2.4% in 1901 to 5.2% in 1961. However, the percentage of urban population started to increase sharply since 1961. In 1991, the urban population (22.5 million) was one-fifth of the total population of Bangladesh. According to the 1991 census enumeration, the four most populated cities in the country were dhaka (6.95 million), chittagong (2.08 million), khulna (1.02 million) and Rajshahi (0.55 million). The urban population of Bangladesh increased at a rate much faster than that of the national population. The urban population grew at more than twice the rate of growth of the national population between 1941 and 1991. A projection indicates that the share of the urban population will increase from 20% in 1991 to 37% in 2015.

Literacy Based on the definition of a literate person as one capable of writing a letter, the literacy rate among population aged 7 years and above in 1991 was only 32.4%. The rate for males was 38.9% and for females 25.5%. The literacy rate was 26.0% in 1981, 33.8% for males and 17.5% for females. Annual growth in the rate of literacy during the 1981-91 was higher for females (3.84%) than for males (1.42%).

Fertility and contraception The three major factors that influence the decline in the level of fertility are the use of fertility reducing measures of contraception, age at marriage, or the proportion of never married for females in the age groups below 20 years, and the pace of urbanisation. The reduction in fertility in Bangladesh was not preceded by any remarkable change in the socio-economic status. The government had traditionally given high priority to family planning programmes, and as a result various activities were performed to motivate potential clients. For example, services were provided both at door-steps as well as at static centres known as Family Welfare Centres and Thana Health Complexes.

Initially, family planning workers promoted longer acting methods such as sterilisation and IUD, but since the beginning of 1990s, there was a shift in the choice of methods. Ar present, most contraceptive users prefer modern reversible methods of shorter duration, such as oral contraceptives and injectables, rather than longer acting methods. In addition to family planning programmes, other factors that contributed to the decline in the level of fertility include an increase in the proportion of never married females in the younger ages, increase in the literacy rate and years of schooling, and rapid urbanisation. The estimated total fertility rate (TFR) in Bangladesh in 1975 was 6.3. This declined to 3.3 in 1999-2000. The steady decline in TFR indicates that, on an average, three births were averted per woman of reproductive age during the last 25 years. The decline in TFR is largely attributed to the increase in the level of contraceptive prevalence from 7.7% in 1975 to 54% in 1999-2000. The increase in the level of contraceptive prevalence rate (CPR) took place in Bangladesh without any remarkable change in the human development status. In fact, the demand for contraceptives was generated through a strong programme to motivate people towards fertility regulation.

Proportion never married The mean age at marriage is not a very good measure to register changes in the age at marriage of the males and females of different age groups. Delay in age at marriage in the younger ages can be offset by an acceleration in the marriage at relatively older ages. Hence, changes in the proportion of never married instead of mean age at marriage is a better analytical tool. The proportion of never married women of age group 15-19 increased from 28.7% in 1981 to 45.3% in 1991 in rural areas and from 45.1% in 1981 to 61% in 1991 in urban areas. Similarly, the proportion of never married women of the age group 20-24 increased substantially in both rural (4% in 1981 and 8.4% in 1991) and urban areas (11% in 1981 and 18% in 1991).

Mortality reduction Despite a significant reduction in the crude death rate, the level of infant mortality rate (IMR) in Bangladesh is still very high compared to that of many other developing countries. The declining trend in mortality was initiated more than 50 years ago and the crude death rate reduced from about 41 to 8 per thousand during this period. The level of IMR is around 70 per thousand live births. The neonatal and post-neonatal mortality rates show that there are still some formidable challenges to be met to reduce the level of mortality for infants. However, there was a substantial decline in the level of IMR for both sexes from 116 per thousand live births in 1988 to 67 per 1000 live births in 1996. This might be attributed to the increasingly successful role of the EPI programme of the government of Bangladesh. The IMR remained consistently lower for females than for males during the same period and substantially higher in rural areas than in urban areas. A comparison between neonatal and post-neonatal mortality shows that although there is lower level of neonatal mortality for females, the post-neonatal mortality remains almost similar for both sexes.

The decline in the level of neonatal mortality rate for males was very sharp (from 71 per thousand live births in 1990 to 50 per thousand live births in 1995), but for females, it declined from 62 in 1990 to 47 in 1995. According to DHS 1993-94, two-thirds of the women took at least one dose of vaccine and 50% took two or more vaccines during pregnancy. A further decline in the level of IMR would require a major shift in the socio-economic status of the population of Bangladesh.

The life expectancy at birth increased from 56.1 years for both sexes in 1991 to 60.8 years in 1998. The life expectancy at birth indicates longer survival for those who live in the urban areas than those who live in the rural areas. There is, however, no substantial difference between life expectancies of males and females in Bangladesh.

Lifetime migration Rough estimates from census data suggest that the number of lifetime migrants increased in Barisal, Khulna and Rajshahi divisions and decreased in Chittagong and Dhaka divisions in 1951. Since 1961, Barisal Division started to lose population through out-migration. Similarly, Chittagong experienced that lifetime out-migrants outnumbered lifetime in-migrants. Although Dhaka had more out-migrants than in-migrants during 1951-1961 censuses, it gained in net number of migrants since 1972. On the other hand, although Khulna division gained substantially by net migrants during 1951-74 period, there was a loss of population due to higher number of out-migrants than in-migrants in that division. Only Rajshahi division gained by net migrants in all census counts since 1951. The extent of gain in population by net migrants was 0.64 million in Dhaka division and by 0.42 million in Rajshahi division. However, these net migrants originated from Barisal division (0.48 million), followed by Khulna division (0.30 million) and Chittagong division (0.29 million).

Population policies and priorities A population programme was initiated in Bangladesh by the Family Planning Association of Bangladesh in 1953. Their efforts to provide clinical family planning methods were assisted by the government and external donor agencies. Government efforts began during 1960-65 through integrated health and family planning services, but with very limited success. An intensified family planning programme was initiated during the 1965-70 period to provide clinical services through communication programmes and outreach services. However, the turning point for implementing population programmes began on the basis of policies formulated during the First Five-Year Plan (1973-78). Population was given a high priority since the independence of Bangladesh. To provide services as well as to motivate potential clients at the grassroots levels, Family Welfare Assistants were employed. In subsequent five-year plans, government continued to support population sector programmes, which were expanded with inclusion of new components and activities such as construction of FWCs, satellite clinics, local initiative programmes, maternal and child health care, reproductive health etc. NGOs also played an important role in expansion of population sector programmes.

The Health and Population Sector Programme (HPSP) was developed as a continuation of the Fourth Population and Health Project (FPHP) sponsored by IDA and some co-financiers for the period 1998-2003. Some of the major concerns identified during implementation of the FPHP were poor utilisation of government services and issues related to cost-effectiveness, sustainability, and quality of services. The specific recommendations that emerged from FPHP were: reorganising the service delivery system; improving management through capacity development and human resource development; organising effective management information system; implementing lessons from innovative and pilot projects; integrating family planning and reproductive health services; and enhancing cost-effectiveness, sustainability and quality of services.

The major objective of the Health and Population Sector Strategies is to reform the health and population sector to provide an essential services package (ESP) to the population of Bangladesh. The main sectoral objectives of HPSS are maintenance of the momentum of efforts in Bangladesh to lower fertility and mortality, reduction of maternal mortality and morbidity, and reduction in the burden of communicable diseases. The components of ESP are basic reproductive and child health services, control of selected communicable diseases, limited curative care, and behaviour change communication. It is expected that ESP will be delivered through the primary health care system at community, union, thana and district levels. HPSP introduced a shift from door-steps service to a one-stop client-oriented service.

Population momentum and its impact The population of Bangladesh will achieve replacement level fertility if the TFR reaches 2.2-2.3. However, due to the young age structure of the population, the population will continue to grow in the next 40-50 years after the time of attaining replacement level fertility until stabilisation of the population size and structure is achieved. This is known as the population momentum. According to one projection based on prevailing the contraceptive prevalence and age specific fertility rates, it is assumed that the population will be 185.2 million in 2021 and 243.9 million in 2051. Another scenario based on an increased level of CPR, decrease in age specific fertility rates, and decline in infant mortality rate suggests that the population size in these two reference years will be 157.9 million and 188.1 million respectively.

The increase in the number of females in the reproductive ages will pose the most formidable challenge to the new population policy. Estimates according to BDHS 1996-97 show that the projected number of women in reproductive ages will increase from 35.6 million in 2001 to 48.5 million and 56.3 million in 2021 and 2051 respectively. According to the second scenario, the corresponding figures for population estimates will be 35.6 million, 45.2 million and 41.8 million respectively. Another problem that will play an increasingly important role during the next decades is the process of ageing of population. According some estimates, the projected number of elderly population (60 years or older) in 2001, 2021 and 2051 will be 7.22 million, 15.09 million and 44.95 million respectively. During the period 1991-2021, the number of elderly people will increase 2.5 times while the size of the elderly population will increase 7.4 times during the period 1991-2051. Social, economic and health problems will increase and even go beyond control of conventional makeshift solutions if this issue is not addressed properly and if an adequate planning process is not initiated soon. [M Ataharul Islam]