1. Course No: MDS 5303
P1.2 The Millennium Development Goals (MDGs) Bangladesh Progress Report (Ch. 4-6)
Presented by:
MDS
MDS

2. Introduction
The MDGs are the world’s first shared set of integrated, quantitative and time-bound goals for poverty reduction.
A set of 8 major goals accompanied by 18 targets and 48 indicators for measuring progress towards the goals.
Adopted by the nations at the Millennium Summit in September 2000, committing to achieve some targeted progress in poverty, education, health, gender equality, sustainable environment and strengthening inter country co-ordination for development.
The MDGs were not meant to be national goals. Yet they are universally treated as such: 86% countries have taken one or more of these goals for their own either by changing the targets or adding additional goals; or localizing the goals even further to sub-national level plans.
Primary schooling, health, income poverty and hunger to be widely adopted; however women’s political representation and natural resource conservation are among the least popular.

3. MDG 3: Promoting Gender Equality and Empowering Women
Achieved gender parity in primary and secondary education at the national level.
Interventions focusing on girl students, such as stipends and exemption of tuition fees.
Steady improvement in the social and political empowerment scenario of women.
The government has adopted the National Policy for Women’s Advancement 2011 and a series of programs.
A sharp increase in the number of women parliamentarians elected (20 percent of total seats) in 2012.
However, only one out of every five women is engaged in wage employment in the non-agricultural sector.

5. Indicator 3.1a: Ratio of girls to boys in primary education
Indicator 3.1: Ratios of girls to boys in primary, secondary and tertiary education
Indicator 3.1a: Ratio of girls to boys in primary education
Gender parity was achieved in 2005 and sustained till 2011.
However, Significant regional disparities: Female literacy rate: Sylhet (42.80%)-Chittagong (54.60%); Urban–rural gap: Barisal (19.1 %); and Male-female gap: Khulna (7.5 %).

6. Target 3.A: Eliminate gender disparity in primary and secondary education preferably by 2005, and in all levels of education no later than 2015

7. Indicator 3.1b: Ratio of girls to boys in secondary education
Gender parity since 2000.
Encouraged through providing, financial support to purchase books and payment of fees.
However, dropout still exists due to poverty and other hidden costs, violence against girls, restricted mobility, lack of separate toilet facilities, lack of female teachers, and lack of girls’ hostel facilities

8. Indicator 3.2: Share of women in wage employment in the non-agricultural sector (%)
Steadily increased over the last two decades even during fluctuation in significantly higher male share.
The creation of opportunities for women labor force remains the major bottleneck for in the non-agricultural sector (except garments industry).

9. Indicator 3.3: Proportion of seats held by women in national parliament
During the last four governments of parliamentary democracy, women’s participation in the Parliament was 12.7, 13, 12.4, 18.6 and 20.0% respectively.
The present government has the highest no. of members (6) in the cabinet including the PM and Speaker.
Reserved seats has also been increased from 45 to 50.

11. Other Challenges to Achieving the Targets
Narrowing the gap through intensive public and private initiatives.
Bridging between formal and non-formal education and opportunities for technical and vocational education.
Involve women more in productive income generating work.
Increasing female labor migration from Bangladesh.
Encouraging direct involvement of women in mainstream politics.
Addressing underlying socio-cultural factors that make women vulnerable.
Effective implementation of relevant laws and policies.
Change the deep rooted gender norms and attitudes among individuals and in society.
Generating and reporting data disaggregated by gender.

12. Way Forward
Strengthen capacity in formulation-adoption-implementation of laws/policies, advocacy and monitoring.
Make gender sensitive policies and legal frameworks effective.
Address the barriers for girls to access tertiary education.
Increase economic participation.
Provide immediate relief, rehabilitation, and protection of the survivors of discrimination, violence, and trafficking.
Make social protection and safety net programs more gender sensitive.
Enhance the capacity of Ministry of Women and Children Affairs (MOWCA).
Capacity building for system strengthening, conducting quality studies and surveys and promoting effective use of information.

13. MDG 4: Reduce Child Mortality
Considerable progress in child survival rate as the mortality has declined rapidly over the last years.
The successful programs for immunization, control of diarrheal diseases and Vitamin A supplementation are considered to be the most significant contributors.
But while the mortality rates have declined substantially, inequalities in terms of access and utilization of health services among the populations still need to be addressed.

14. Interventions to achieve MDG-4
Syphilis Control
Folate Supplementation
Birth spacing
Maternal Nutrition
Malaria Control
Kangaroo Care
Warming Resuscitation
Tetanus Toxoid
Safe and Clean Delivery
Prophylactic Eye Care
Early and Exclusive Breastfeeding
Management of infections
Immunization
Case management in community and facility (IMCI/Community IMCI)
ORS
Zinc

17. Target 4.A: Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate (U5MR) Indicator 4.1: Under-five mortality rate (per 1,000 live births)
Bangladesh Demographic and Health Survey (BDHS) 2011 shows a remarkable decline (53 per 1,000 live births) in the U5MR since 1990 and that Bangladesh is on track to achieve MDG 4 target.
Sample Vital Registration System (SVRS) 2011 shows that U5MR was 44 per 1,000 live births in 2011 compared to 146 in 1991, suggesting that Bangladesh has already achieved MDG target.

18. Table: U5MR between 1991 to 2011 Year Sex National Rural Urban 2011
Both Sexes 44 47 39
Male - 50 37
Female 43 41
2005 52 55 57 58 51 30
2003 53 40 42
1991 92 94 69 95 98 72 90 65
Source: BBS, Report on SVRS, 2011

19. Indicator 4.2: Infant mortality rate (per 1,000 live births)
Substantial reduction in Infant Mortality Rate (IMR) showed in BDHS 2011 report (from 87 per 1,000 live births in to 43 in 2011).
On the other hand, recent data available from the SVRS 2011 show that the IMR is 35 per 1,000 live births in 2011 as compared with 94 in 1990 (98 to 36 for males and 98 to 33 for females).

20. Indicator 4.3: Proportion of 1 year-old children immunized against measles (PO1YOCIAM)
The BDHS 2011 shows a remarkable increase in the PO1YOCIAM which rose from 54 percent in 1991 to 87.5 percent in 2011 (Male: 88.3 percent, Female: 86.8 percent).
The EPI Coverage Evaluation Survey (CES 2011) reports steady increase of the PO1YOCIAM at 85.5 percent in 2011 especially after adoption of the Reach Every District (RED) strategy.
Efforts needed to ensure full coverage and remove regional disparities, supplemented by better access and utilization of health services.

21. Other Challenges to Achieving the Targets
Efforts to test and scale up effective interventions for preventing drowning related deaths.
Quality services is the major bottleneck in facility-based child and newborn healthcare.
Reducing the neonatal mortality.
Adequate availability of essential.
Effective strategies for universal health coverage, the removal of rural-urban, rich-poor and other form of equities and the provision of essential services for the vast majority.
Poverty related infectious diseases, mothers suffering from nutritional deficiency, children suffering from malnutrition, pregnant women not receiving delivery assistance by trained providers, poor maternal and child health, unmet need for family planning and the rise in STD infections.

22. MDG-4:Regional Disparity
Division
U5MR per 1000 live births
IMR per 1000 live births
% of children of one year age vaccinated against measles
Barisal 46 44
90.4
Chittagong 52 33
86.6
Dhaka 45 34
85.5
Khulna 41 39
92.8
Rajshahi 49 36
90.8
Sylhet 50 43
79.9
Underlying Reasons:
Various socioeconomic including behavioral and health related factors.
Mother’s level of education and nutritional status.

23. Way Forward
Establish an enabling policy environment and advocate for adequate resource allocation.
Increase valid immunization coverage of all vaccine preventable diseases.
Ensure the provision of quality home and facility based newborn and child care services.
Promote demands for services, particularly by the poor and the excluded.
Develop and update technical guidelines and support operational research.
Put emphasis on the human dimension of poverty.
Continue to progressively increase allocations to the health sector.

24. MDG 5: Improve Maternal Health
According to the Bangladesh Maternal Mortality Survey 2010 (NIPORT 2011), maternal mortality declined from 322 in 2001 to 194 in 2010, showing a 40 percent decline which gives an average rate of decline of about 3.3 percent per year.
The overall proportion of births attended by skilled health personnel increased by more than six-folds in the last two decades, from 5.0 percent in 1991 to 31.7 percent in 2011.

25. Interventions to achieve MDG-5
Iron supplements,
Intermittent
Treatment of Malaria
Antiretrovirals for HIV
Active Management of the Third Stage of Labor
Management of postpartum Hemorrhage
Tetanus Toxoid
Clean delivery
Treatment of
postpartum infection
Family Planning and Postabortion Care
Magnesium
Sulfate
Calcium supplementation
Partogram

27. Target 5.A: Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio (MMR) Indicator 5.1: Maternal mortality ratio (per 100,000 live births)
According to Bangladesh Maternal Mortality Survey (BMMS) 2010 (NIPORT 2011), the average rate of decline was about 3.3 % per year, compared with the average annual rate of reduction of 3.0 % required for achieving the MDG in 2015.
Sample Vital Registration System (SVRS) of BBS found relatively higher MMR during 1990 to 2011 period.

29. Indicator 5.2: Proportion of births attended by skilled health personnel
The proportion of deliveries by medically trained providers has doubled from about 16 percent in 2004 to about 32 percent in 2011, mostly due to improvement in institutional delivery mechanism.
More than half of births (53 per cent) in Bangladesh are assisted by dais or untrained birth attendants, and 4 percent of deliveries are assisted by relatives and friends.

30. Target 5. B: Achieve, by 2015, universal access to reproductive health
Target 5.B: Achieve, by 2015, universal access to reproductive health Indicator 5.3: Contraceptive prevalence rate (% of CPR)
Use of contraception among married women in Bangladesh has increased from 8 percent in 1975 to 61.2 percent in Contraceptive use varies by place of residence.
While contraceptive use continues to be higher in urban areas (64 percent) than in rural areas (60 percent), the gap is narrowing.
Contraceptive use ranges from 69 percent in Rangpur division to 45 percent in Sylhet division.

31. Indicator 5.4: Adolescent birth rate (per 1,000 women)
according to SVRS 2010, the adolescent birth rate has declined, from 79 per 1,000 women in 1990 to 59 in 2010.
As expected, early childbearing is more common in rural areas, among the poor and the less educated.

32. Indicator 5.5: Antenatal care coverage (at least one visit and at least four visits)
According to BDHS 2011, 67.7 percent of women with a birth in the three years preceding the survey received antenatal care at least once from any provider.
The urban-rural differential in antenatal care coverage continues to be large: 74.3 compared to only 48.7 %.
Also, regional variation persists (65% in Khulna to 47% in Sylhet).
The likelihood of receiving antenatal care from medically trained provider increases with the mother’s education level and wealth status.

33. Indicator 5.6: Unmet need for family planning
Unmet need increased from 15 % of currently married women in 2004 to 17 % in 2007 and then decreased to 14 % in 2011 (5.4 % for spacing of births and 8.1 % for limiting births). (BDHS 2011)
It decreases with increasing age, ranging from 17 % among women aged to 8 % among women aged
Women in rural areas have a higher unmet need (14 %) than women in urban areas (11 %).
Unmet need is highest in Chittagong (21 %) and lowest in Khulna and Rangpur (both 10 %).

35. Other Challenges to Achieving the Targets
Inadequate coordination between health, family planning and nutrition services.
Human resource capacities.
Further progress with CPR will require consistent and reliable access to contraceptives.
Overall, public spending on health and allocation of public resources based on accurate indicators of individual and household health needs, incidence of poverty, disease prevalence and population.
Increase use of public health facilities by the poor.
Underlying socio-cultural factors like social marginalization, low socio-economic status of women and lack of control over their personal lives, early marriage and child bearing, poor male involvement in reproductive health issues and poor community participation.
Disparities in terms of the services women receive according to rural/urban residence, mother's education level, household wealth status and geographic location.
Enforcement of the Child Marriage Restraint Act 1984.

36. MDG-5:Regional Disparity
Division
Maternal mortality ratio per live births
Proportion of births attended by skilled health personnel
% of Mothers received ante-natal care more than once during pregnancy
Barisal
250
15.0
53.3
Chittagong
247
20.8
57.2
Dhaka
207
28.2
55.3
Khulna
222
30.4
58.8
Rajshahi
182
24.4
58.6
Sylhet
285
14.4
50.1

37. Way Forward
The life-cycle approach should be used to address the general and reproductive health needs of women and essential health services should be provided in an integrated manner.
Strong government commitment through national policies and program implementation needs to be continued.
A holistic population planning program should be contemplated.
The promotion of contraceptives along with FP services should continue and be expanded to poor and marginalized.
A mainstreamed nutrition with required life-skills education and access to accurate information program should target adolescents, particularly girls.
Comprehensive emergency obstetrical care (EmOC) facilities should be expanded and more community skilled birth attendants (SBA) should be trained.
Demand creation for service.

38. Findings on Country Progress
Data discrepancy between BBS data and that of MDG website due to definitional variation.
Progress is non-linear
Periods of acceleration and slow-down
Increasing marginal costs as targets approached
Progress is heterogeneous
Different regions within a country progress at different rates
Not just a matter of increasing public services in social sectors (i.e. more social expenditures)
Demand factors matter
Efficiency and quality of supply matters
Economy-wide effects

39. THANK YOU