Health specialists fear that the ongoing supply crunch of birth control products at government family-planning centres can fuel unwanted pregnancy and subsequent maternal mortality due to abortion.
The government usually provides contraceptives, including condoms, pills, injectables to people, particularly those on low incomes in rural areas
But contraceptive supplies have witnessed a disruption since December 2023 mainly due to lack of pre-assessment and procurement.
The Directorate General of Family Planning assured that it would start resuming the supply of contraceptives in April, but the supplies are yet to reach district and upazila offices.
This supply-side delay has made health experts worried as maternal deaths due to abortion have become a matter of serious concern.
According to the Bangladesh Bureau of Statistics (BBS), wanted abortion was 2.31 per cent and unwanted abortion 7.66 (women aged 10-49) in 2023.
The most leading reason for maternal mortality is complex delivery, according to the Bangladesh Sample Vital Statistics 2022 published this year by the BBS.
Complex delivery results in a maternal mortality rate of 44 per cent of total deaths, while complex abortion/miscarriage contributes significantly to the overall maternal mortality of 14 per cent.
Public health expert Prof Dr Abu Jamil Faisal told the FE that contraceptive use fell sharply, certainly in rural areas, due to supply crunch at family planning centres.
This would augment the rate of unwanted babies, he said.
Supply crunch has caused the use of contraceptives to see a gradual fall in the last three years since 2021.
Contraceptive use fell to 62.1 per cent in 2023 from 65.6 per cent in 2021, according to the latest data.
"An increase in the rate of unwanted babies has a link to maternal deaths as major cases of unwanted pregnancy ended in abortion. Again, abortion causes serious health complications for mothers, including maternal death," explained Dr Faisal.
Meanwhile, less use of contraceptives will increase the rate of having more births. The total fertility rate (TFR) was 2.17 per cent in 2023 from 2.04 per cent in 2020.
"I think the TFR has already increased further than that of the BBS data," he projected, adding: "Such a rise in the TFR could change the total family planning scenario we achieved."
Furthermore, a higher TFR is linked to less mother capabilities of taking care of her babies as mothers in such conditions have to foster more children in less pregnancy gaps.
Those are indirectly linked to higher child mortality rates.
The country is also seeing an increased child mortality rate, according to the specialist. "This less use of contraceptives will have an indirect connection to a hiked maternal and child mortality."
According to the latest BBS survey, the child mortality of one-year old children also sees a gradual rise to 27 per thousand in 2023 from 21 in 2021.
Health specialists warn that the achievement in reducing maternal mortality can reverse unless proper care is not taken.
FAMILY PLANNING DIRECTORATE FAILS
Health specialists alleged that the family planning directorate has failed to meet people's needs and its director has hardly played a role in improving the situation.
They do not have any plan to ensure supplies before reaching this poor situation with its stock.
"Usually, we see the office (Directorate General of Family Planning) assesses supplies a year before and keeps the supplies ready beforehand. But the ground reality is there has been a serious supply crunch since last December."
"This is a serious preparation laps and leadership weakness of the government agency," alleged Dr Faisal.
Prof Syed Abdul Hamid of the Institute of Health Economics at Dhaka University echoed Dr Faisal's view on the same, saying that the government had a serious lack of preparation.
He also said that unexpected pregnancy would rise further due to the supply crunch with a sharp price hike on the open market.
Unwanted pregnancy leads to abortion. Of the total unborn babies in unexpected pregnancy, 66 per cent ends in abortion here, according to Prof Hamid.
Abortion not just a medical procedure, it has certain health complications which can lead maternal deaths to rise, he observes.
SUPPLY ON THE CARDS
ATM Nazmul Huda, line director (logistics and supply unit) of the directorate, said condoms have been sent to their local offices, while other contraceptives, including injectables, would be available soon.
"Necessary formalities, including tender for other types of contraceptives, have been done. We'd send supplies to local offices soon," he told the FE.
The official, however, claimed his office was working duly to send necessary supplies to local offices.
Prasenjit Prannoy Mishra, Gaibandha deputy director (family planning), said condoms have reached their regional warehouse but they do not have any update on other contraceptive items.
"We started releasing condom supplies to upazilas and rural offices as per their demand paper. We can distribute condoms this month," he told the FE.
