MATLAB, Bangladesh — The positive effects of long-term investment in family planning programs are endless, as proven by the experimental program that began in Matlab, Bangladesh in 1977. This program is “one of the longest running and most detailed health and population data sets in the developing world.”
This program has proven to be so successful that the total fertility rate of Bangladesh, which was 6.9 before the program began in 1970, was decreased to 4.6 in 1990 and was further reduced to just 2.2 in 2012.
The Matlab hospital originally opened in 1963 as a cholera research station by the International Centre for Diarrhoeal Disease Research. In 1977 they began their experimental program for family planning and maternal and child health.
The study was conducted using 149 villages with a population of about 180,000 people. The villages were divided into two groups with half given access to the program, and the other half continuing to receive the Ministry of Health services.
The villages were identical in the sense that they were both poor fishing and farming communities with little or no electricity, running water or sanitation. Both groups were 88 percent Muslim, and in this particular area contraception was denounced by Islamic clerics.
The program was introduced specifically in this area to determine if the poor, under-educated women living in such a religiously conservative community would adopt family planning methods.
Part of the program’s success is attributed to its doorstep service in which female health workers “help mothers pick a method of contraception that was best for them, treat side-effects and provide basic maternal and child health care.”
The Benefits of Family Planning
“This relationship between smaller families and greater wealth highlights the benefit of sustained investments in family planning and MCH (maternal child health) programs as a poverty reduction strategy,” states the policy brief entitled “Family Planning and Economic Well-being: New Evidence From Bangladesh” from the Population Reference Bureau.
Over time, women in the program area were found to have an average of 1.5 fewer children than the women in the counterpart area. Through reducing the amount of children per mother and increasing spacing between second and third births, maternal and child death rates decreased and resulted in overall better health for children.
By 1996, program areas were found to experience unexpected positive results including higher incomes, higher valued homes, greater savings and assets, higher educational achievement, greater access to water and better health.
Family planning and maternal-child health (FPMCH) services started by providing family planning but later included other services such as maternal tetanus inoculations, antenatal care, measles immunizations, and oral rehydration therapy.
Women in program areas were found to weigh an average of one kilogram more. Women also had a higher body mass index which reduced their risk of dying by as much as 20 percent.
The reduction in family size resulted in other benefits. Both groups of boys ages 9-14 and 15-30 had higher levels of education in program areas. This trend similarly existed for girls, as they were more likely to be enrolled in school than the comparison area and were overall better educated. As there were less children per family, education levels were higher and children stayed in school longer.
Higher levels of education for mean higher level skills, and therefore better paying jobs. Economic security increased as families had fewer children to raise, higher levels of education and higher wages.
When wealth was increased, families were able to build more valuable homes and even gain access to running water. Program areas that invested in more accessible water meant women spent less time traveling and transporting water and more time on activities to improve their family’s well-being.
Expansion of Matlab Model
The government noticed how positive the effects had been in the Matlab program and began training government employees of their “door-to-door approach.” Tens of thousands of female health workers were trained with the effective Matlab model.
As the government began implementing the Matlab model in more areas they found a similar increase in contraceptive use in the areas of trained health workers as soon as the early 80s.
“Over the next five years, it was phased in across the whole country,” noted Mohammed Yunus who ran the health center for almost 40 years. “Bangladesh became a success story for family planning and reducing infant mortality.”
Bangladesh is one of the first impoverished nations to achieve the Millennium Developmental Goal 4 to reduce child mortally rates by two thirds.
An estimate by the UN in 2000 found that the population of 160 million in Bangladesh would increase to 265 million by 2050. A more recent report showed that this estimate has decreased to about 200 million by 2050 and then a predicted stabilization of the population growth.
Family planning is a relatively modest investment considering how many positive outcomes it produces. Bangladesh is a shining example of how long term investment in family planning is a cost effective way to lift citizens out of poverty, improving health, wealth and overall quality of life.
Sources: The Guardian, Population Reference Bureau, UNICEF
Photo: SAJIDA Foundation