A crisis has emerged in the government supply of contraceptive products at a field level. The supply of contraceptives at an upazila and grassroots level is almost exhausted. There is no Implanon (a birth control contraceptive) in any upazila of the country and no contraceptive injections at the upazilas either.
The stock of even prophylactics (condoms) is diminishing fast in the field. The supply of birth control pills will last for another five months or so. This information was availed from the family planning directorate under the ministry of health.
On one hand the government is talking about increasing family planning services, yet on the other there is a crisis of contraceptives at the field level
According to government records, 37 per cent of the eligible couples (of reproductive age) receive contraceptives from the government sector and 3 per cent from NGOs. The remaining 60 per cent avail this from the private sector.
The supply of contraceptives didn't suddenly exhaust overnight. The family planning directorate's website has a record of the contraceptives in stock. This is updated regularly. Despite observing the dwindling stock, the family planning directorate and the health ministry did nothing to replenish it.
Experts say that this situation has emerged due to the lack of accountability. If this state of affairs in public service continues for long, there is risk that this will have an adverse impact on the country's population. However, despite attempts to contact concerned government officials, they were not available for comment on the matter.
Bangladesh has significant success in population control. During the time of the country's independence, a reproductively capable woman would give birth to over 6 children on average. Now a mother, on average, gives birth to two children. This has been possible due to the increased use of contraception. In 1975, around 8 per cent of the eligible couple would use family planning methods. In 2022 that went up to 64 per cent. On one hand the government is talking about increasing family planning services, yet on the other there is a crisis of contraceptives at the field level.
Situation on ground
Field workers of the family planning directorate deliver birth control contraceptives to eligible couples free of cost. These contraceptives can be collected from government centres too. These contraceptives include Implanon, condoms, oral birth control pills, emergency contraceptive pills (ECP), IUD, injections and implants.
Five colours are used on the website to indicate the stock of contraceptives in different areas. Red indicates that the stock is exhausted, copper colour indicates stock is near exhausted, yellow indicates stock lower than requirement, green indicates adequate stock and blue indicates surplus stock.
A look at the government website (supply chain management portal) to check on the supply of Implanon, reveals that the entire map of Bangladesh is 'red'. In other words, there is no Implanon in any of the 494 upazilas of the country. Implanon is a long-acting contraception in the form of a soft rod implanted under the skin of a woman. There are no two-rod implants in 49 upazilas.
On condition of anonymity, a deputy director of a family planning office in a district of Chattogram division, told Prothom Alo there was not a single injection in his district. The last injection was used on 31 January. Officials of the family planning directorate said that injections finished on 31 January all over the country. According to the website, there are no injections in 298 upazilas and the stock of injections is nearing an end on 155 upazilas. This information was of December 2023.
Condoms are the common contraceptive for men. According to December 2023 records, there was not a single condom in 348 upazilas.
Pills for 5 months
The website indicates that the stock of oral birth control pills has not exhausted as yet. Yet this commodity is not available in 38 upazilas. The oral pill 'Apon' (used only for 6 months after giving birth) is not available in 67 upazilas. However, officials say that the polls in stock will last for another 5 months. After that the oral pills will no longer be available with any government institution or field worker.
A senior official of the directorate said that the process for purchasing pills has not started as yet. Experience of the past three decades indicates that it takes almost a year before the directorate receives the goods once the process for purchasing contraceptives is initiated. Unless special initiative or measures are taken, the stock of polls will finish too.
Unwilling to comment
Information of the contraceptive stock up till December 2023 was available on the website. After that, there is no information about the past month, that is, January. However, the deputy directors of several district family planning offices and upazila family planning officer, said that they have not received any contraceptives in January. An official of a district in Chattogram division said he brought in products from Cox's Bazar district to tackle the situation.
Attempts were made to contact the director general of the family planning directorate, Shahan Ara Banu, for an update on the supply of contraceptives and the possible impact if the stock exhausted. This correspondent waited for almost an hour at the directorate yesterday, Thursday, but could not meet her or talk to her.
While waiting in the office, it was advised from the director general's office to speak to the director of the field service unit. But when this correspondent went to his office, it was said that he was not available. This correspondent then tried to contact the secretary of the health ministry's medical education and family welfare division, but he did not reply to the phone calls either.
Fallout of zero stock
Many people collect contraceptives from the private sector instead of government centres or field workers. These contraceptives are available at the pharmacies and at the private chambers of physicians. Condoms are commonly sold in general store too.
It is normally the people of the poorer strata of society who collect contraceptives from government centres, according to population experts. Now they will not be able to get these items easily. There is no guarantee that they will go to the shops to buy these when needed. This will increase the risk of unwanted pregnancies among the poor.
Another problem may crop up. When collecting birth control contraceptives from government centres, the people also receive other health services and advice. They will be deprived of this if they do not go to collet contraceptives.
Professor of the department of population sciences at Dhaka University, Mohammad Mainul Islam, told Prothom Alo, "If there is a shortage in supply of contraceptives, people of the poorer class may go to the private sector. This may lead to a decrease in use of contraceptives. This will push up the rate of latent demand or unmet need. This is 10 per cent at present. There is commitment to bring this down to zero by 2030. If latent demand increases, so does unwanted pregnancies, abortion and maternal mortality. It is urgent to increase the stock of contraceptives immediately."