World Population Day: Total fertility rate rises in Bangladesh

Previously, every 10 mothers in Bangladesh gave birth to a total of 23 children. That number has now risen to 24. While an increase of just one child may seem negligible, it has emerged as a major indicator of heightened pressure and impending risk. Population experts view this shifting scenario with deep concern.

A recent survey reveals that, for the first time in decades, the country’s Total Fertility Rate (TFR)—the average number of children born per woman—has experienced a slight increase.

Compounding this issue, birth control and family planning initiatives have been stagnating for more than a decade. The Directorate General of Family Planning (DGFP) is grappling with severe human resource shortages from its central headquarters down to field-level operations. Furthermore, the official supply of contraceptives has collapsed, leaving many couples unable to access reproductive health supplies when needed.

This supply and staffing crisis became particularly acute during the final months of the ousted Awami League administration and has persisted through the tenure of the interim government. To date, these systemic crises remain unresolved. Relevant officials and experts strongly believe that this infrastructure breakdown is the primary driver behind the sudden rise in TFR.

The Total Fertility Rate represents the average number of children a woman gives birth to during her reproductive years (ages 15 to 49).

According to the Multiple Indicator Cluster Survey (MICS)—a joint study by UNICEF and the Bangladesh Bureau of Statistics (BBS) published last December—the country's TFR now stands at 2.4. This means an average of 2.4 children are born per mother, up from the previous baseline of 2.3.

Ashrafi Ahmad, the Director General of the Directorate General of Family Planning, views this marginal increase as highly alarming.

Speaking to Prothom Alo, she emphasised that this upward trend warrants deep analysis and rigorous, long-term research. Several faculty members from the Department of Population Sciences at Dhaka University have echoed this anxiety in recent articles and statements provided to Prothom Alo.

Demographic and research officials from the United Nations Population Fund (UNFPA), the United Nations Children's Fund (UNICEF), and the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) have similarly agreed that a rising TFR is an ominous sign for the nation.

The anxieties stem from multiple critical factors:

Compounding Population Volume: An increase in births per mother across a demographic of roughly 45 million women of reproductive age will exponentially amplify overall population pressure.

Systemic failure: This upward trend serves as a direct indictment of the country's weakening family planning infrastructure.

Currently, 27 per cent of all positions within the DGFP—spanning from central administration to grassroots field offices—lie vacant, and new recruitment has ground to a halt. The shortage of government-subsidised birth control commodities is severe at the field level, while commercial alternatives in retail markets remain prohibitively expensive. Coupled with a near-total absence of public awareness campaigns, experts warn that the TFR risks climbing even higher if immediate interventions are not staged.

Following independence, successive governments treated population growth as a primary barrier to national development. The country’s First Five-Year Plan (1973–1978) characterised population growth as the most complex obstacle to economic progress. It explicitly noted that politicians, academics, social workers, and intellectuals must collectively voice concern over high growth rates and actively motivate the public to adopt birth control measures.

Professor Mohammad Bellal Hossain of the Department of Population Sciences at Dhaka University pointed out that, excluding small city-states, Bangladesh remains the most densely populated country in the world. Even during the extended period when the TFR had plateaued and stopped declining, the sheer momentum of the population continued to exert tremendous pressure on national resources.

"The latest data indicates that the TFR is no longer stable; it is shifting upward," Professor Hossain told Prothom Alo. "We anticipate this upward trend will persist into the near future. This carries incredibly negative implications for Bangladesh."

Bangladesh had previously earned international acclaim in public health and demographics for its dramatic success in lowering its Total Fertility Rate. This decline had been consistent since the post-independence era.

Halida Hanum Akhter, a senior faculty member in the Department of International Health at Johns Hopkins University in the United States, began her career in 1969 with the family planning board of the pre-independence era. The women's health specialist noted that no comprehensive demographic surveys or major initiatives were executed prior to independence, making it difficult to state exact fertility figures for the Pakistani era.

However, historical records from the Bangladesh Fertility Survey show that in 1975, the TFR stood at a staggering 6.3, meaning a woman gave birth to more than six children on average. Driven by rigorous national population programmes, that figure dropped to 5.1 fourteen years later, in 1989.

As public awareness expanded and the use of contraceptives grew, the TFR dropped to 3.3 by 1999–2000, and further receded to 3.0 by 2004. By 2011, it reached 2.3. Following 2011, however, the decline ceased entirely. Data from successive Bangladesh Demographic and Health Surveys (BDHS) confirm that the TFR remained completely stagnant at 2.3 from 2011 through 2022.

Commenting on this stagnation, Professor Mohammad Bellal Hossain noted, "For a prolonged period, the TFR failed to drop. This put immense strain on the country. Authorities should have taken warning measures back then, but they failed to act. As a result, instead of remaining stable or declining further, the rate has actually increased. The long-term ramifications of this will be profound."

According to the joint UNICEF-BBS MICS data, the TFR held steady at 2.3 during the 2012–13 and 2019 survey cycles. The MICS report published in December 2025, however, documented an increase of 0.1. Historical data shows that Bangladesh has no modern precedent for an increasing fertility rate.

Public health and demography experts emphasise that women who undergo frequent pregnancies face significantly higher health risks than those with fewer children. Frequent gestations and births lead to severe maternal anaemia and malnutrition, significantly elevating the risk of mortality from delivery complications. It also increases the long-term risk of uterine prolapse, obstetric fistulas, and chronic lower back pain.

Furthermore, children born under these conditions face a heightened risk of low birth weight and chronic malnutrition. From a socioeconomic perspective, managing a large family frequently strips women of opportunities for education, gainful employment, and personal advancement.

Since the 1990s, successive administrations have maintained that the TFR must be brought down to 2.1—known as the replacement-level fertility rate. This target was explicitly codified in the 2012 National Population Policy, which mandated that the replacement rate be achieved by 2015. That milestone was missed. A replacement rate of 2.1 implies an average of two children per couple, a threshold at which a population eventually stabilises.

In contrast, the most recent 2025 National Population Policy contains no such target.

Professor Mohammad Bellal Hossain, who was directly involved in drafting the policy, explained that a primary policy document is not necessarily the place to lock in specific numerical TFR targets; instead, such goals belong in strategic action plans. Worryingly, however, the Bangladesh National Family Planning Strategic Plan (2025–2030) is completely devoid of any specific TFR targets.

The 2024 projections from the United Nations Department of Economic and Social Affairs (UN DESA) Population Division indicated that if the TFR had remained at 2.3, Bangladesh’s population would reach 188 million by 2031, and climb to 196.7 million by 2036.

However, a specialised expert panel comprising representatives from the BBS, the University of Dhaka's Department of Population Sciences, and the UNFPA is currently re-evaluating these models to analyse the impact of the newly elevated fertility rate. Sources within this panel reveal that when factoring in the current TFR of 2.4, the revised projections indicate: the population will surge to 193.8 million by 2031; and, the population will balloon to 206.3 million by 2036.

Consequently, this seemingly minor 0.1 increase in the TFR means that Bangladesh will have to absorb an additional 5.8 million people within five years, and a staggering 9.6 million additional citizens within the decade.

On 9 March, the Director General of the DGFP, Ashrafi Ahmad, along with three senior colleagues, discussed the operational bottlenecks with this correspondent.

Ahmad conceded, "At this moment, we are facing acute shortages of personnel at the field level, alongside severe deficits of contraceptive supplies and essential medicines."

According to official DGFP data, the department has a total of 54,225 sanctioned posts from headquarters down to the field level. Of these, 14,550 positions are currently vacant—meaning 27 per cent of the total workforce is missing.

In certain districts, the administrative paralysis is even worse. On 10 March, Mohammad Fakhrule Alam, the DGFP Deputy Director for the Munshiganj district, told Prothom Alo, "How can you expect us to deliver adequate services to the public when more than half of our positions are entirely vacant?"

Data provided by the Deputy Director revealed that Munshiganj has 781 sanctioned posts within its family planning department, but 413 of those positions are vacant, meaning the district is running on a 53 per cent deficit in manpower.

Rokeya Begum serves as a Family Welfare Assistant (FWA) in the Sreenagar Union of Munshiganj district. She told Prothom Alo that while the union has five sanctioned FWA positions, she is currently the sole active worker. She is forced to shoulder the workload meant for five people.

Fieldworkers like Rokeya Begum are responsible for conducting home visits, organising courtyard community meetings, and providing services at satellite and community clinics. During home visits, they register eligible couples, track births and deaths, and provide counseling to newlyweds on family planning, contraceptive methods, prenatal and infant health, nutrition, adolescent reproductive health, and the prevention of child marriage. They are also tasked with distributing temporary contraceptive methods, such as oral pills and condoms.

"There are more than 4,100 households in this union," Rokeya Begum noted. "If I visit a family today, it is physically impossible for me to return to that same household in less than nine months."

The structural vacancy crisis similarly affects Family Planning Inspectors, Family Welfare Visitors, and Sub-Assistant Community Medical Officers (SACMOs). With so many positions left unfilled, vital community health metrics are suffering heavy deficits.

Fieldworkers traditionally distribute birth control pills or condoms directly during household visits. Apart from this, they escort individuals to union sub-centres or sub-district health complexes for long-term methods (injectables, IUDs, implants) or permanent procedures (vasectomies, tubal ligations). Nearly all of these services are mandated to be entirely free of charge.

However, DGFP Director General Ashrafi Ahmad and Director of Logistics, Moammad Abdur Razzaq, confirmed to Prothom Alo that the procurement and distribution pipeline has been disrupted since early 2024. Bureaucratic hesitation and procurement delays during the final months of the Awami League administration, which persisted entirely through the interim government's tenure, have left the country facing a severe contraceptive drought.

The central warehouse distributes these commodities to 23 regional warehouses, which in turn supply sub-district repositories before fieldworkers receive them. A review of the official tracking website (scmpbd.org) on 24 March revealed an alarming reality: not a single regional warehouse in the country held any stock of oral contraceptive pills, IUDs, or hormonal implants.

The website showed that the entire national supply of condoms at the regional level consisted of just 18,000 units, held exclusively in the Rangamati regional warehouse. Injectable contraceptives were entirely depleted across the country, save for a small stock in Bandarban (12,300 units) and Rangamati (2,700 units).

Prothom Alo had previously published a comprehensive report detailing this supply crisis back in February 2024 during the Awami League regime. Despite the subsequent interim government holding office for 18 months, the crisis remained entirely unaddressed.

DGFP officials now admit that there is virtually no prospect of normalising the government's family planning supply chain for at least another six months.

In the absence of free government supplies, commercial sales have spiked dramatically. The Social Marketing Company (SMC) stated that they are straining to meet the shifting public demand.

SMC’s Managing Director and Chief Executive Officer, Toslim Uddin Khan, told Prothom Alo, "A large segment of the population relies on our oral pills, condoms, injectables, IUDs, and implants. Over the past year, our sales for pills, condoms, and injectables have registered a highly significant increase."

While the government programmes provide oral pills, injectables, IUDs, and implants entirely free of charge—and even offers monetary incentives to clinical implant and permanent method recipients—commercial options are costly. Government-distributed condoms cost a nominal fee of Tk 2 per dozen.

Conversely, commercial brands sold in pharmacies and grocery stores are priced anywhere from Tk 25 to 120 for a pack of three, with premium variants costing up to Tk 450. For low-income and impoverished couples, purchasing these items regularly from the retail market is financially unsustainable.

The latest national data indicates that the unmet need for family planning now stands at 10 per cent—meaning one in 10 couples cannot access contraceptives despite wanting them. Consequently, the Contraceptive Prevalence Rate (CPR) among capable couples is on the decline. According to MICS data, the CPR dropped from 62.7 per cent in 2019 to 58.2 per cent in 2025.

Demographers and a section of government officials have openly accused recent administrations of systematically sidelining the population issue for several years. They point to specific policy directives under the ousted Awami League government as the turning point.

On 2 June 2010, the then-Prime Minister Sheikh Hasina stated in Parliament, "I consider the vast population of Bangladesh to be an asset, not a burden. Therefore, we must reconsider how far we want to go with population control measures."

Urging the nation to capitalise on global demographic trends where youth populations were declining, she added, "Personally, I do not view the population of Bangladesh as a problem."

Experts note that this high-level rhetoric severely undermined the urgency of national population control programmes. Abu Jamil Faisel, a public health expert who has spent over two decades working in demographics and formerly served as the Country Director for EngenderHealth, told Prothom Alo, "We saw Prime Minister Sheikh Hasina attend countless state functions, but between 2009 and 2024, she did not attend a single official event marking World Population Day on 11 July."

Faisel further observed, "The National Population Council is the supreme policy-making body for population issues in the country, and it is mandated to meet at least once a year under the chairmanship of the prime minister. Yet, during the 15-year tenure of the Awami League government, this council met exactly once. This lack of engagement sent a clear message down the chain of command."

This shift in political priorities also led to a reversal of the state's messaging. The iconic slogan of the 1980s, "Boy or girl, two children are enough," had been updated in 2004 to "No more than two children, one is even better," a phrase reinforced in the 2012 policy to encourage single-child families. However, on 30 October 2018, the Awami League administration officially revoked this stance, reverting to the older slogan: "Boy or girl, two children are enough."

Abu Jamil Faisel maintains that these shifting goalposts directly demotivated fieldworkers and administrators. "The government completely ignored the vacancy crisis and failed to prioritise the procurement pipeline for contraceptives. The rise in TFR is the inevitable cul-de-mission of this prolonged neglect," he stated.

DGFP officials note that administrative decisions taken during the late interim government's tenure only exacerbated the institutional damage. In an effort to restructure the Ministry of Health and Family Welfare, authorities attempted to abolish the distinction between the Health Services Division and the Health Education Division, seeking to consolidate all directorates under a single umbrella.

Currently, family planning operations and the DGFP fall under the jurisdiction of the Health Education Division. Many officials within the DGFP possess decades of specialised demographic and field management experience that requires distinct administrative handling. The interim government's unilateral move to merge these structures triggered widespread frustration and demoralisation within the department.

The newly formed government, led by the Bangladesh Nationalist Party (BNP), appears to be continuing with this consolidation plan. High-level ministerial meetings have already taken place to discuss how to integrate field-level health workers with family planning staff.

Md Abul Kashem, General Secretary of the BCS (Family Planning) Association, strongly urged the new administration to reconsider: "The new government must abandon the idea of merging these departments. If the Directorate General of Family Planning loses its administrative independence, population control will lose its visibility and priority. It will be pushed out of focus, and the entire nation will suffer the consequences."

While the Health Sector Reform Commission report, compiled during the interim government's tenure, contains extensive statistics regarding population growth, fertility rates, urban density, and migration, it offers no policy directives or actionable solutions for population control. Out of the 32 short- and medium-term recommendations presented in the reform report, not a single one addresses the demographic crisis.

Faced with this policy vacuum, DGFP officials are pinning their hopes on the newly formed BNP government, hoping the administration will restore priority to the sector, resolve the logistical gridlocks, and halt the institutional merger with the Directorate General of Health Services (DGHS).

However, a review of the BNP’s official election manifesto reveals no explicit pledges or structured positions regarding population control. The topic is only mentioned tangentially across disparate sections, touching briefly on strengthening women's reproductive rights, leveraging the demographic dividend, and expanding social safety nets.

SM Zia Uddin Haider, who was directly involved in drafting the BNP's election manifesto and currently serves as the Special Assistant on Health to the Prime Minister, strongly defended the party’s stance.

Speaking to Prothom Alo, he stated, "We are prioritising the population issue more than any previous administration. The primary healthcare package promised by the BNP explicitly includes comprehensive family planning services. We are currently in the process of recruiting 100,000 healthcare workers, and a core component of their mandate will be delivering family planning services and contraceptive supplies directly to citizens' doorsteps."

The Bangladesh National Family Planning Strategic Plan (2025–2030), finalised during the transitional period of the interim government’s tenure, outlines several essential objectives: streamlining the availability of commodities, enhancing service quality, removing regional disparities, scaling up urban family planning networks, generating public demand for reproductive services, and strengthening empirical research and monitoring.

According to Professor Mohammad Mainul Islam of the Department of Population Sciences at Dhaka University, the immediate execution of this strategic plan is of paramount importance.

"We must aggressively increase the Contraceptive Prevalence Rate and deploy every available resource to drive down the TFR," Professor Islam told Prothom Alo. "It is absolutely vital for the future of Bangladesh that we bring the Total Fertility Rate down to the replacement level of 2.1 in the shortest possible timeframe."