NATIONAL REPORT ON FOLLOW-UP TO THE WORLD SUMMIT FOR

CHILDREN

Ministry of Women and Children AffairsGovernment of the People’s Republic of

Bangladesh

December 2000

FOREWORD

This “National Report on Follow-up to The World Summit for Children” has been prepared in response to His Excellency, the Secretary General of the United Nations, Mr. Kofi A. Annan’s request and as per the guidelines made available by the Executive Director of UNICEF, Ms. Carol Bellamy. The Government of the People’s Republic of Bangladesh is very pleased to forward this report to the UNICEF Headquarters in New York as the State report that assesses progress made by the country against goals set for the decade of the 1990s in pursuance of the promises made during the World Summit for Children in September, 1990.

Bangladesh has undertaken an impressive range of programmes during the period 1990-2000 to improve the status of children and women. Throughout this decade, the country has experienced significant improvements in most of the indicators that measure success. The progress made not only in this decade but throughout the period since the independence of Bangladesh in 1971, which was achieved under the leadership of Father of the Nation, Bangabandhu Sheikh Mujibur Rahman, have been duly recognised and acclaimed, both nationally and internationally. The Government attaches highest importance to the needs of children through prioritising education, health, nutrition, water supply, sanitation, and other child related programmes.

Bangladesh is one of the first few countries to ratify the Convention on the Rights of the Child (CRC). The Government as a follow up to the CRC had prepared quickly the National Plan of Action for Children (1990-95) and undertook “Progoti (Progress)”, a decade Plan of Action for the girl Child in the same year. The National Children Policy was drawn up in 1994. A comprehensive National Plan of Action was also prepared for the period 1997-2002. The National Health Policy and the National Nutrition Policy were also formulated recently.

Different programmes are being implemented for children by the Government with support from NGOs, development partners, private sector and the community which resulted in marked improvements in selected indicators. These are, increase in immunisation coverage, Vitamin A supplementation, control of diarrhoeal diseases, reduction of fertility rate and improvement of nutritional status of children. Both the infant mortality rate and under-5 mortality rate have been reduced by 39% since 1990. Primary school net enrolment of 80% is a great achievement due to increased budget in the education sector during the last few years.

Despite successes made in the lives of children, we need to sustain the achievements and move forward to reach goals yet to be reached. Although

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State MinisterMinistry of Women and Children Affairs

Government of the People’s Republic of Bangladesh

the target of safe water was reached long ago, the problem of arsenic contamination of ground water has caused a setback. The sanitation coverage is not satisfactory. Health care services require steady improvements. In order to further lower the infant and maternal mortality rates, child marriage and early pregnancy are to be avoided for which social awareness programmes and law enforcement need to be strengthened. My earnest hope is that in the coming decade, faster improvements will be achieved and we will have more intelligent, healthy, educated and balanced generation of children in Bangladesh.

The National Report has been prepared on the basis of reliable data, interviews, available documents, and produced through a participatory process. Bangladesh Institute of Development Studies (BIDS) was involved in writing the report and the authors deserve special thanks for their success in preparing the trend graphs on different indicators and the analysis of data realistically. I would like to thank UNICEF Bangladesh for providing financial and technical support for preparation of this report. I congratulate the Ministry of Women and Children Affairs for presenting us with a comprehensive report on a vitally important subject. This report will remain as a testimony to the progresses made in the lives of children in Bangladesh in the 1990s and the challenges we face in the upcoming decade to realize all aspects of children’s rights.

Prof. Zinatun Nesa Talukdar State Minister

Ministry of Women and Children AffairsGovernment of the People’s Republic of

Bangladesh

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Table of ContentsPage

ForewordTable of ContentsList of GraphsGlossary

Section 1. Introduction and Background11.a Bangladesh and the World Summit for Children1.b Preparation of National Plans of Action1.c Mechanism for Periodic Reviews of Progress1.d Mid-Decade Review on WSC Goals1.e Renewed Commitment to the Convention on Rights of the Child

Section 2. Process Established for the End-Decade Review 3

Section 3. Action at the National and International Levels43.a National Planning, NPAs and the Implementation Processes3.b State-Priorities as reflected in National Budgets3.c Role Played by Families, Communities, Local Governments, NGOs,

Mass Media and others3.d Monitoring Mechanisms through Data Collection3.e Disaster Management by Government and NGOs, Social Mobilization

and Social Service Delivery

Section 4. Specific Actions for Child Survival, Protection & Development 5

4.a Dissemination and Promotion of CRC4.b Child Health, Water and Sanitation4.c Malnutrition4.d Status of Girls and Women4.e Support for Parents and Care-Givers4.f Early Childhood Care and Development, Basic Education

and Vocational Training4.g Children in Need of Special Protection4.h Children in Armed Conflicts4.i Protection of Environment for Children4.j Addressing Poverty and Food Security

Section 5. Lessons Learnt15

Section 6. Future Actions17

References 18

Appendix (Trend-Graphs)

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List of Graphs

Graph No. Title

4.1 Under Five Mortality Rate4.2 Under 5 Morality Rate by Mother’s Education4.3 Infant Mortality Rate – total4.4 Infant Mortality Rate – locality4.5 Infant Mortality Rate – gender comparison4.6 Proportion of Population Drinking Water from Tubewell/ringwell/tap4.7 Use of Safe Means of Excreta Disposal4.8 Number of Clinically Confirmed Polio Cases4.9 Neonatal Tetanus Cases4.10 Measles Cases4.11 DPT3 Immunization – Total4.12 Measles Immunization – Total4.13 Polio Immunization – Total4.14 Tuberculosis Immunization - Total4.15 ORT Use – Total4.16 Home Management of Diarrhoea – Total4.17 Under-Five Death from Diarrhoea – Total4.18 Prevalence of Diarrhoea Last Two Weeks (0-59 months) – Total4.19 Underweight, Moderate and Severe – Total4.20 Stunting, Moderate and Severe – Total4.21 Wasting Prevalence – Total4.22 Nutritional Status by Locality4.23 Maternal Mortality Ratio 4.24 Iodized Salt Consumption4.25 Children Receiving Vitamin A – Total4.26 Children Receiving Vitamin A – Male4.27 Children Receiving Vitamin A – Female4.28 Contraceptive Prevalence Rate – Currently Married Women4.29 Contraceptive Prevalence Rate – Ever-married Women4.30 Fertility Rate for Women 15-19 years4.31 Total Fertility Rate4.32 Antenatal Care Coverage4.33 Exclusively Breastfeeding Rate – Total4.34 Continued Breastfeeding Rate (20-23 months)4.35 Proportion of 5-14 years Children Currently Working 4.36 Children Reaching Grade Five – Total4.37 Children Receiving Grade Five – Male4.38 Children Receiving Grade Five – Female4.39 Primary Net Enrolment Rate – Total4.40 Primary Net Enrolment Rate – Gender Comparison4.41 Primary School Net Enrolment Ratio4.42 Primary School Attendance Rate – Total4.43 Primary School Attendance Rate – Male4.44 Primary School Attendance Rate – Female4.45 Adult Literacy Rate – Total4.46 Adult Literacy Rate – Male4.47 Adult Literacy Rate - Female

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GlossaryARI Acute Respiratory InfectionANC Antenatal CareBBS Bangladesh Bureau of StatisticsBSAF Bangladesh Shishu Adhikar ForumCDD Control of Diarrhoeal DiseasesCEDAW Convention on the Elimination of All Forms of Discrimination Against

WomenCPR Contraceptive Prevalence RateCRC Convention on the Rights of the ChildDANIDA Danish International Development AgencyDGHS Director General Health ServicesDHS Demographic and Health SurveyDPHE Department of Public Health and EngineeringECCD Early Childhood Care and DevelopmentEDR End Decade ReviewEOC Emergency Obstetric CareEPI Expanded Programme on ImmunizationFWA Family Welfare AssistantFWV Family Welfare VisitorGOB Government of BangladeshIMR Infant Mortality RateJGUAG Joint Government-UNICEF Advisory GroupLBW Low Birth WeightMCH Maternal and Child HealthMICS Multiple Indicator Cluster SurveyMMR Maternal Mortality RatioMOWCA Ministry of Women and Children AffairsNCC National Children CouncilNFPE Non-Formal Primary EducationNPA National Plan of ActionORT Oral Rehydration TherapyPMED Primary and Mass Education DivisionTBA Traditional Birth AttendantTFR Total Fertility RateTLM Total Literacy MovementU-5MR Under Five Mortality RateUN United NationsUNICEF United Nations Children’s FundUP Union ParishadWCEFA World Conference on Education for AllWHO World Health OrganisationWSC World Summit for Children

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Section 1Introduction and Background

1.a. Bangladesh and the World Summit for Children

The Convention on the Rights of the Child (CRC) established a very important instrument for promoting and protecting the rights of children. Bangladesh is amongst the first few countries to have ratified the CRC and participated actively at the World Summit for Children in September 1990 to launch the CRC. The Summit was participated by a total of 159 countries of which 71 were represented by the Heads of State or Government. Bangladesh delegation to the Summit was headed by the President of the country, signifying the importance the Government attached to this Summit and to the issue of children.

1.b. Preparation of National Plan of Action

The Government of the People’s Republic of Bangladesh undertook the preparation of National Plan of Action (NPA) (1990-95), in pursuance of the World Summit for Children goals and completed it by the end of 1992. The NPA was formally launched through a ceremony attended by the Prime Minister. The Joint Government-UNICEF Advisory Group (JGUAG) provided the leadership in formulating the first NPA (UNICEF 2000). JGUAG is a permanently established coordinating body chaired by a Member of the Planning Commission and includes several Government Ministries and agencies and UNICEF. Four separate working groups in the areas of (i) health and nutrition, (ii) water and environmental sanitation, (iii) education, and (iv) social welfare and disaster management, combined their efforts to draft the first NPA. The second National Plan of Action for Children (1997-2002) was prepared in a more organized manner with the coordinating role played by the Ministry of Women and Children Affairs (MOWCA). A 10-member inter-ministerial core group was formed with the Chairperson of Bangladesh Shishu Academy as its head. Several national–level NGOs and UNICEF country office were represented in the core group. Six sectoral technical committees were formed. These were (i) primary and secondary education, (ii) health and nutrition, (iii) water and environmental sanitation and (iv) children in need of special protection, (v) social integration, participation and cultural affairs, (vi) communication and information. Individual consultants with specialized knowledge were made part of the sectoral committees to help design the programs. The draft NPA was widely discussed with different stakeholder groups including children before finalization. The Parliamentary Standing Committee on the Ministry of Women and Children Affairs approved the NPA in May, 1998 and the cabinet approved it in January, 1999. The NPA was available as a public document in September, 1999.

In order to implement the first NPA, the total resource requirement was estimated to be US$ 1,305 million. Out of this amount, US$ 1,125 million was projected to be drawn from the pool of Government’s own resources (UNICEF 2000). The additional US$ 180 million was expected to be mobilised by the Government from external sources. The second NPA has a separate estimate of the resource requirements. It assumed that the projected sectoral allocations in the Fifth Five-Year Plan (1997-2002) are required to implement the programmes. Experience shows that in terms of actual implementation, there is always a gap in availability of resources projected in the Five-Year Plans.

1.c. Mechanism for Periodic Reviews of Progress

In 1995, the Ministry of Social Welfare prepared and submitted the Initial State Party Report of Bangladesh on the Convention on the Rights of the Child (CRC) to the CRC Committee in Geneva. Later on, the Ministry of Women and Children Affairs (MOWCA) undertook monitoring and reporting of the progress of implementation of CRC and achievement of World Summit for Children (WSC) goals, and submitted a supplementary

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report to the initial report to the CRC Committee in December 1996. This year, the country’s first periodic report on CRC is being prepared by MOWCA.

With an objective of directly collecting child-related data to assess progress, Multiple Indicator Cluster Survey (MICS) was designed in the first NPA period. The first MICS survey was conducted in 1994. The survey since then has been annually carried out by Bangladesh Bureau of Statistics (BBS) and the results published in Progotir Pathey (“On the Road to Progress”), a joint publication of BBS and UNICEF. In 2000, MICS collected 27 different indicators related to health, water, sanitation, and education from over 63,000 households located in 1264 clusters throughout the country. The data allows analysis by each of the country’s 64 districts and disaggregated by gender, urban/rural as well as slum/non-slum. This report used data from MICS and other relevant surveys and studies.

1.d. Mid Decade Review on WSC Goals

The mid decade review on WSC goals reported a number of major findings. Both infant and under-5 mortality rates decreased between 1990 and 1995. These were estimated to be 71 and 125 deaths per 1000 live births respectively in 1995 (Graph 4.3 and 4.1). But the rates were still far from the goals of 50 per 1000 live births in case of infant mortality rate (IMR) and of 70 per 1000 live birth in case of under-five mortality rate (U5MR). The positive result was achieved through an expanded programme on immunization (EPI). The proportion of children aged 12 to 23 months with immunization against six common childhood diseases had increased from 2% in 1985 to about 70% in 1995 (Graph 4.11). Use of oral rehydration therapy (ORT) had gone up during this period.

The nutritional status of children had marginally improved by the mid-decade. The moderate and severe underweight rate had come down from 65% in 1990 to 56% in 1996 (Graph 4.19). Malnutrition in children has been related to a number of factors, such as low household income, low level of mother's education, poor health of mothers, low weight at birth, lack of breast feeding and large size of the family. A large number of children suffered from micro-nutrient deficiencies, such as Vitamin A, iodine, and iron deficiencies. In Bangladesh, the situation of women is generally poor. An estimated 14,000 women die annually due to pregnancy and birth-related complications. The maternal mortality rate had declined from 650 deaths out of 100,000 live births in 1986 to 447 in 1995.

The education policy of the state had facilitated compulsory free primary education in early 1990s to ensure regular attendance at the primary schools. There was an estimated 30% increase in primary school enrolment between 1990 and 1995. Due to a significant improvement in female enrolment, satisfactory gender-balance was also achieved. Improvement had been made in terms of school completion rate, which had increased by over 40% between 1990 to 1995.

1.e. Renewed Commitment to the Convention on the Rights of the Child

In accordance with Article 44 of CRC, Bangladesh is expected to report to the CRC on measures taken to implement the rights of the children as enshrined in CRC. Similarly, the specific article of CRC also enjoins on the State to report on the progress in the relevant intervention–areas related to CRC. The commitment of the State to realize objectives of the CRC and WSC-goals is reflected in the Fifth Five Year Plan (1997-2002). The Plan gives a clear articulation of the future policy directions for the survival, protection and development of children through implementation of sectoral and multi-sectoral programmes under the National Plan of Action (1997-2002) and Decade Action Plan for Girl Child. The Plan’s strategy is to implement programmes for children with the collaborative efforts of the Government, NGOs and private sector. A two-fold approach has been adopted. The first one will include monitoring of plan targets, support and

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maintenance of the data-base, and undertaking of demonstration and pilot projects. The Ministry of Women and Children Affairs (MOWCA) is the lead agency in this regard. The second will be the adoption of direct measures to assist children achieving the various development goals as conceived by the State. The various child related ministries and divisions, such as the Ministry of Health and Family Welfare, Ministry of Education, Ministry of Planning, Local Government Engineering Department, Department of Public Health Engineering, and Primary and Mass Education Division, have been made responsible for implementation of various programs. The CRC Implementation Committee headed by MOWCA includes ten relevant ministries and monitors situation of children in the country. The National Children’s Council (NCC) is the highest authority for overall policy-guidance on child development.

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Section 2

Process Established for the End Decade ReviewThe Preparation of the National Report through review of end decade progress began in August 2000. The process included a review of all reports, documents and statistics by three researchers of the Bangladesh Institute of Development Studies (BIDS), the foremost research organization of the country. The researchers worked under the guidance of the Ministry of Women and Children Affairs and CRC Implementation Committee. The researchers met officials in government agencies, NGOs and others. The authors also met with relevant UNICEF program persons. UNICEF assisted in preparing a set of time-trend graphs, for the period 1990 to 2000 based on data gathered from different sources. Discussions were held with the local-level administrators in October 2000. Three sub-national consultation meetings were held in Chittagong, Bogra and Mymensingh. A two-day discussion with about 60 children and facilitated by professional facilitators provided important indications on their felt needs. A national consultation meeting to review the draft report was held in Dhaka in November. All the consultation meetings were participated by senior Government officials, NGO executives, private sector representatives, lawyers, journalists, teachers and UNICEF officers. After reviewing the comments, a second draft report was prepared. The final draft report was submitted to MOWCA on December 5, 2000.

Chart – 2.1Flow-chart showing National Report Preparation Process

Program Reports/ Documents Reviews

National Report Preparation

Inputs Provided byrelevant Ministries/UNICEF

Trend Graphs Prepared

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National

Consultation

Meeting

First Draft Report

Draft Report

Final Report

Children and

Adolescent

Meeting

Meetings with

Ministries,

UNICEF

Divisional Consultation Meetings

Section 3

Action at the National and International Levels

3.a. National Planning, NPAs and the Implementation Processes

The State has drawn up five-yearly development plans on a more or less regular basis. After the World Summit for Children, two five-year plans i.e., the Fourth Five-Year Plan (1990-95) and the Fifth Five-Year Plan (1997-2002), have been formulated. The Fifth Plan currently under implementation has clearly articulated the goals and objectives of WSC. The plan is being implemented through shorter and time-bound annual programmes. Moreover, there are sectoral Plans and policies such as National Food and Nutrition Policy, 1997, National Plan of Action for Nutrition, National Policy for Safe Water Supply and Sanitation, 1998, Compulsory Primary Education Act, 1990, National Education Policy, 2000, and National Health Policy 2000.

3.b. State-Priorities as Reflected in National Budgets The national budget is composed of revenue budget and development budget. In Bangladesh, social sectors which include primary education, health and family planning and social welfare, comprise 33% of the Government's revenue budget expenditure. The allocation from development budget in social sectors increased from 13.8% in 1990 to 25.5% in 1996. Over the last five years, the government has allocated higher budgetary allocation for education and health of children. The total budgetary allocation for education reached US$ 1,036 million in fiscal 2000-2001 which is eight percent higher than that of 1999-2000. During last five years, the level of actual funding for education has gone up by 59%. The achievements in health and family planning sectors are also noteworthy. The third largest government budgetary allocation is made to the health sector.

3.c. Role Played by Families, Communities, Local Governments, NGOs, Mass Media and Others

There is limited efforts by different stakeholders e.g., family, community and local government bodies for implementing the WSC-goals. It is mainly the government agencies and NGOs, especially those that work in the realm of children, play an important role in realizing the WSC goals. Family has been the bedrock of Bangladesh society and underlies the value-system. The family and the community play important roles in shaping the attitudes and values of the people but these institutions have not played their due roles in improving the lives of children. Mass media has popularized the concepts of health, nutrition and education.

3.d. Monitoring Mechanisms through Data CollectionBangladesh Bureau of Statistics (BBS), the national statistical agency, collects yearly data since 1994 through a well-planned representative survey, called Multiple Indicator Cluster Survey (MICS) on the major WSC-related indicators. UNICEF, Bangladesh collaborates in this effort. The MICS data are published in Progotir Pathey (“On the Road to Progress”), an annual report jointly published by BBS and UNICEF.

3.e. Disaster Management by Government and NGOs, Social Mobilization and Social Service Delivery

Bangladesh is a disaster-prone country. The common occurrences are flood, cyclone and river erosion. From the early 1970s, the Government and NGOs have developed a commendable capacity to handle disaster-related situations. The local government

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organizations such as Union Parishads and Municipalities play a very important role in distributing relief and food grain during the disasters.

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Section 4

Specific Actions for Child Survival, Protection and Development

4.a. Dissemination and Promotion of CRC

This section gives a brief assessment of changes taking place in Bangladesh in each of the ten subject-areas of actions, in the decade (1990-2000), as was specified in the Plan of Action for the WSC. The subject-areas or interventions are generally related to the three major concerns of WSC i.e., survival, protection and development of the children. An attempt is made to present the WSC-goal-related changes in the 1990s, on the basis of best possible data available on relevant indicators. No new survey or primary data has been collected for the present review. This section tries to relate progress in the action-areas with some proximate determinants i.e., positive and/or constraining factors.

Indicator (a): Proportion of children 0-59 months of age whose births are reported registered.

Births of children are not regularly registered, despite there being a law mandating it. The Union Parishad in the rural areas and Pourashavas and City Corporations in the urban areas are supposed to conduct birth registration. But due to funds constraints and lack of human resources, these organizations do not undertake complete birth registration. An initiative has however been taken recently through a UNICEF project to register births in 20 districts.

4.b. Child Health, Water and Sanitation

Goals b.1: Reduction of infant and under-five mortality rate by one-third or to 50 and 70 per 1000 live births respectively, whichever is less.

b.2: Reduction by 50% in the deaths due to diarrhoea in children under the age of 5 years and 25% reduction in the diarrhoea incidence rate.

b.3: Reduction by one third in the death due to ARI in children under 5 years.b.4: Maintenance of a high level of immunization coverage.b.5: Global eradication of polio by the year 2000.b.6: Reduction by 95% in measles death and reduction by 90% of measles

cases.b.7: Elimination of neonatal tetanus by 1995.b.8: Special attention to the health and nutrition of the female child and to

pregnant and lactating women.b.9: Access by all couples to information and services to prevent pregnancies.b.10: Access by all pregnant women to pre-natal care, trained attendants during

childbirth and referral facilities for high-risk pregnancies and obstetric emergencies.

b.11: Universal access to safe drinking water.b.12: Universal access to sanitary means of excreta disposal.

Child HealthThere has been significant reduction in infant and under-5 mortality during the last decade. Under-5 mortality rate declined from 151 deaths per one thousand live births in 1990 to 92 deaths in 1998 with a goal of 70 per 1000 live births (Graph 4.1). Though the trend shows a gradual fall in the rate at the beginning of the decade, the rates significantly dropped since 1994. Infant mortality rate declined from 94 per 1000 live births in 1990 to 57 in 1998 (Graph 4.3). With the targeted goal of 50 per thousand live-births, the trend shows a gradual fall in the IMR in the country. The mortality rates of male child dropped from 116 in 1990 to 58 in 1998 and female from 105 to 56.

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In Bangladesh, like many other developing countries, communicable diseases are the main causes of child mortality. Some of the major communicable diseases are diarrhoea and acute respiratory infections (ARI). The three broad types of diarrhoeal diseases, are acute watery diarrhoea, persistent diarrhoea and dysentery. Acute watery diarrhoea by rotavirus is the single biggest threat to children. The percentage of children (0-59 months) having severe diarrhoea during the preceding 14 days was 12.6% in 1993 which dropped to 6.1% in 1999 (NIPORT, 1994 and 1997) (Graph 4.18). Specially targeted campaigns have reduced deaths due to diarrhoeal diseases and ARI in 1997.

In ideal conditions, oral rehydration therapy (ORT) can successfully treat 90% of cases of acute watery diarrhoea. Data show that proportion of under-5 children who had diarrhoea in the previous two weeks and were treated with oral rehydration salts or an appropriate household solution (ORT) ranged from 41.5% in 1996 to 46.4% in 1999 (Graph 4.15). The percentage of diarrhoea episodes in under-five children who were given increased fluids and continued feeding (home management) ranged from 61.3% in 1991 that fell to 37.3% in 1997 but rose to 49.2% in 2000.

Acute Respiratory Infections (ARI) is the number one killer disease of children in Bangladesh. An estimated number of under-five deaths due to ARI was 145,000 in 1990 which decreased to only about 100,000 in 1997, whereas the goal to be achieved by the year 2000 was 48,000 cases per year. Poverty, low birth weight, malnutrition, and environment degradation are the principle factors behind vulnerability of the children.

Malaria exists mainly in the southeastern part of Bangladesh e.g. Chittagong Hill Tracts. In addition to its direct effect on children, it can be a cause for low birth weight contributing to increased vulnerability. According to a WHO report, the number of malaria cases was 115,660 in 1992 which increased to 167,000 in 1994 and decreased to 101,000 in 1996.

The impact of immunization on children’s health has been dramatic. The Expanded Programme of Immunization (EPI) has administered immunizations against six killer diseases: measles, diphtheria, pertussis, tuberculosis, tetanus and poliomyelitis. The immunization coverage has reached about 80% against the WSC goal of 90%. A large number of children still die from diseases that can be prevented by more effective implementation of EPI.

Figure 4.1: Bangladesh: The Percentage of Vaccination Coverage of Children

12-23 months of DPT3, Polio and Measles by Three Major Areas

Source: BBS/UNICEF, 1999, Progotir Pathey.

The percentage of children aged 12-23 months immunized against poliomyelitis increased from 62% in 1990 to 75% in 1999 (BBS/UNICEF, 1999). Immunization rate reached upto 88% in 1993. The percentage of male children covered increased from

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68.9% in 1993 to 76.8% in 1999 and female children from 64.6% to 68.3% during the same period. Despite concerted efforts the goal of the Global Eradication of Poliomyelitis by 2000, could not be reached. The number of clinically confirmed polio cases was found to be 298 in 1998 and 322 in 1999 (Graph 4.8).

The immunization of pregnant women with tetanus toxoid vaccine is a highly effective means of protecting newborns from neonatal tetanus. The percentage of newborns protected at birth against tetanus was 66% in 1997 and 61% in 1998 (EPI, 1998). Data show some gains in immunization of DPT3 from 68.4% in 1993 to 75.9% in 1999 in case of male children. It rose from 63.5% to 67.8% in case of female children (Graph 4.11).

Contraceptive prevalence rate increased from 40% in 1990 to 53.8% in 1999 (Graph 4.28). Total fertility rate dropped from 4.3 in 1990 to 3.3 in 1998 (Graph 4.31). The year-2000 goal was 2.1. The percentage of women attended at least once by trained health personnel during pregnancy remains at around 25% (Graph 4.32), against the goal of 80%. The percentage of births attended by appropriately trained health personnel increased from 9.5% in 1993 to 24.4% in 2000, though the goal is 80% (NIPORT 1993-94, 1999-2000). The number of facilities having basic emergency obstetric care (EOC) was 0.41 per 500,000 population in 1994 which increased to 0.60 in 1999. The number of facilities providing comprehensive essential obstetric care was 30 in 1994 and 68 in 1999 (UNICEF 1999).

HIV/AIDS has not yet emerged as a serious problem. There is no confirmed number of individuals affected by HIV/AIDS. However, there is concern about the potential threat, especially in the context of favourable environment, inadequate surveillance and reporting as well as inadequate control measures which put the country in a state of denial of the existence of the problem. Massive awareness about the disease and an effective surveillance system does not exist.

Safe Drinking Water

The indicator used to measure the goal related to safe drinking water is the proportion of population using improved drinking water sources for drinking. In terms of this indicator, the goal, i.e. 80%, had been achieved before 1990 and was maintained throughout the decade. In 1994, 97.3% of households were collecting drinking water from either tubewell or ring well (Graph 4.6). However, recent years have experienced a significant level of arsenic-contamination problem in tubewell-served areas of south-western and south eastern districts. The Department of Public Health Engineering (DPHE) estimates that the coverage of “safe water” has gone down to about 80%. Moreover, low water table in the northern districts, and salinity in the coastal areas make safe drinking water availability per tubewell lower than the desired level.

Environmental Sanitation

The use of sanitary means of excreta disposal has increased from 21% in 1990 to 43.7% in 2000 (Graph 4.7). The goal is far from the present situation. The average annual growth rate is 4.76%.

Proximate Determinants

The factors responsible for changes in the above-mentioned broad intervention-areas are:

(i) Maternal and child health interventions by the Ministry of Health and Family Welfare have undoubtedly played an important role in reducing the under-five mortality rates. The media, both electronic and print, folk-culture-based publicity campaigns and audio-visual campaigns played their roles in popularizing the benefits of MCH-care, safe drinking water and environmental sanitation. It is likely however, that social and economic changes have also contributed to this

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decline in mortality rate. The reasons for not however attaining under-5 mortality goal are: failures especially in urban slums, to identify those most likely to be infected and least likely to be immunised, lack of community participation, improper maintenance of cold-chain, and dropout cases. In case of IMR, attaining the goal of 50 by the year 2000 could be attained if faster improvements in neonatal care could be achieved since as high as 64% of the infant deaths occur in the first month of the birth.

(ii) Highly motivated DPHE and NGOs, inspired by the multilateral/bilateral donor-funding (mostly UNICEF and DANIDA) utilized the relatively abundant ground-water acquifer of the country. Mainly, a low-cost technology (No. 6 hand tubewell pump-set) brought home this miraculous development in the late 1980s. The arsenic-related problem has however caused a setback.

(iii) The low adoption rate of scientific excreta disposal methods is due to behavioral,

economic and natural reasons. In a riverine, seasonally flooded country, people in general find it difficult to keep latrines operational round the year. Even low-cost slab-latrine, indigenously improvised by DPHE and NGOs is slowly becoming popular due to this reasons. The local UP-based social mobilization mechanism has not been strong enough to popularize and motivate the rural people, especially the poor to use sanitary latrines.

4.c. Malnutrition

Goal: c.1: Reduction of severe and moderate malnutrition among under five children by half.

c.2: Reduction of low birth weight to less than 10%.c.3: Empowerment of all women to breast-feed their children exclusively and

to confirm breastfeeding.c.4: Virtual elimination of vitamin A deficiency and its consequences, including

blindness.c.5: Virtual elimination of iodine deficiency disorder c.6: Reduction of iron deficiency in women by one third of 1990.

Malnutrition is a general problem in Bangladesh and is the underlying cause of many childhood illnesses. Bangladesh exceeds the WHO criteria of "very high" prevalence rates.

The anthropometric indicators used in this report are stunting, wasting, and underweight.

While a steady decline can be observed in the proportion of severe underweight among under 5-year old children, there has not been much change in the proportion of moderate underweight children over the decade. The rate of severe underweight (below -3SD) which was 25.9% in 1990 became 17.9% in 1996 (BBS, 1990 and 1996), and indicated a further decline to 13.1% in 1990 (NIPORT, 1999-2000), whereas the proportion of moderate underweight children (-2SD>=z>-3SD) showed only a slight decline from 40.6% in 1990 (BBS, 1990) to 34.8% in 1999 (NIPORT, 2000).

The severe stunting rate, according to Child Nutrition Survey, has declined gradually from 35.2% at the onset of the decade to 24.5% in 1996 (BBS, 1991 and 1997). In more recent years, DHS showed the rate at 28% in 1996 and 18.4% in 1999. Not much change has been observed in the prevalence of moderate stunting during this period, i.e. 30.3% in 1990 (BBS, 1990) to 26.4% in 1999 (NIPORT, 2000).

Severe wasting is a sign of acute malnutrition, closely linked to an increased risk of death (WHO, 1995). In Bangladesh, the proportion of severely wasted children is relatively low, i.e. 1.05% in 1999 (DHS, 2000). The preliminary report of the latest Demographic Health Survey also showed a significant decrease in the rate of moderate

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and severe wasting in the last few years, i.e. from 16.6% in 1996 to 10% in 1999 (NIPORT, 2000) (Graph 4.20).

Geographical comparison reveals that a much higher rate of children in rural areas are stunted, wasted, and underweight than in urban areas (Graph 4.22). However, when the urban data is disaggregated to slum and non-slum populations, it becomes clear that the nutritional status of children that live in urban slum areas is worse than rural areas (Figure 4.2).

Figure 4.2 - Geographical Comparison of Nutritional Status

According to one survey done in 1998, the proportion of live births that weigh below 2500 grams in two control upazilas was 29.9%, and in 6 BINP project upazilas was 25.6% (BINP/UNICEF, 1998). Low birth weight contributes as a major factor of neonatal mortality and a cause for susceptibility of the under-five children to infections and other illnesses.

The percentage of children 4-6 months of age who are exclusively breastfed is low. It was 25.1% in 1999 with a goal of 75% in 2000 (NIPORT, 2000). The percentage of children aged 20-23 months who were breastfed continuously with or without supplementary feeding was found to be 73.9% in 1993 and approximately 90% in 1999 (Graph 4.34).

Vitamin A supplementation programme has proved to be a success over the past decade. The proportion of children 9-59 months of age who have received two or more doses of Vitamin A supplement in the last 1 year shows a significant rise from 42% in 1993 to 76.5% in 2000 (BBS/UNICEF, 2000) (Graph 4.25). The prevalence of night blindness in rural areas has come down to 0.66% in 1997 (HKI/UNICEF/USAID, 1997) from 1.77% in 1989 (IPHN/UNICEF, 1989). This is below a cutoff point of 1.0%, a WHO criteria for measuring public health status.

Figure 4.3 - Night blindness in Children

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Source: The data for 1989 is from IPHN/UNICEF, 1989 and for 1997 is from HKI/USAID/UNICEF, 1997

Prevalence of iodine deficiency disorders has been significantly reduced over the decade through universal salt iodization. According to MICS, the proportion of households consuming iodized salt was 19% in 1993, and became 70.3% in 2000 (note: iodine content assessed by using iodine testing solution). Similarly, the USI survey showed an increase from 56.2% in 1996 to 66.9% in 1999 (note: salt samples collected from households and assessed for the levels iodine content in laboratory. 10.1 ppm or higher for 1996, 10 ppm or higher in 1999) (Graph 4.24). Consequently, the low urinary iodine prevalence rates (below 10 micrograms / 100 ml) among 5-11 age children and 15-44 age population are also decreasing from 70.7% and 67.4% respectively in 1996 to 42.5% and 43.6% in 1999 (Dhaka University, IDDIDD, UNICEF, 1993 and 2000).

Anaemia during pregnancy is associated with low birth weight. Data shows that the proportion of women of reproductive age in rural areas (15-49 years) with anaemia is 49.2% in pregnant women (<11gm/100ml blood) and 45% in non-pregnant women (haemoglobin level <12gm/100 ml of blood). The high percentage of anaemia in women of Bangladesh is mainly due to malnutrition, poverty, and lack of education.

Proximate Determinants

Proximate factors related to such widespread malnutrition are:

(i) Income-poverty, lack of awareness about food intake, and discriminations are the main reasons for widespread and persistent malnutrition among the children and mothers of the country; roughly 46% of the total population live below the absolute poverty-line. There may be cases, not insignificant, where family-level incomes are not constraints to consume a balanced, well-nourished diet. It may be lacking due to a lack of knowledge (i.e., illiteracy) and/or sheer behavioral/cultural practices.

(ii) Significant gender-gap in food-intake in favor of the boys and male members of family lead positively to differences in malnutrition. There is son-preference in parental care, feeding patterns and treatment during illness. The differential feeding practices are culturally prescribed and occur even when it is women who mostly serve food during meals.

(iii) The situation of children and women of marginalized groups, vulnerable and disadvantaged groups, including urban slum dwellers, refugees, tribal groups and those living in remote and inaccessible areas are the worst. Disabled children also experience discrimination in many cases, due largely to ignorance among parents and the community, and the lack of suitable arrangements. Children in institutions like orphanages suffer from many problems due to poor management of such institutions, and lack of resources. There are approximately 33,000 children in orphanages.

4.d. Status of Girls and Women

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Goal: d.1.: Reduction of maternal mortality ratio (MMR) by half.

The trend in maternal mortality ratio shows a gradual decline from 478/100,000 live births in 1990 to 440 in 1997, according to BBS. The risk factors for high maternal mortality in Bangladesh are early marriage and early child bearing. Though the mean age at first marriage has increased throughout the decade, a significant proportion of rural population remains vulnerable to early pregnancy.

Childbearing begins early in Bangladesh. Over one-fifth of all births (22%) during 1999 were to be found in the age group 15-19 years. The fertility rate among women belonging to 15-19 years has slightly gone up between 1993 and 1996 (140 to 147 per 1000 births), however declined between 1996 and 1999 (147 to 144) (Graph 4.30). During 1991 and 1998, total fertility rate (TFR) has declined from 4.3 to 3.3 but remain static now (Graph 4.31). The decline in TFR is mainly due to increased rate of contraceptive use. The contraceptive prevalence rate has gone up from 40% in 1991 to 53.8% in 1999 (BBS, 1991 and NIPORT, 2000) (Graph 4.28). The available evidence from micro studies suggests that son-preference does affect family size as couples are not limiting births until they have at least one male-child. Reducing male-preference by enhancing the value of girl-children could result- in further decline in TFR. The Government is encouraging to limit the number of children to two, whether they are boys or girls.

Positive developments have taken place for girls and women in the last two decades. The State ratified CEDAW in 1984. A female secondary school stipends program (FSSP), which was started on a pilot-basis in the mid-1980s, now covers the whole of rural Bangladesh. The tuition fee-waiver for all rural girls studying between grade six to ten has gone a long way to reduce the gender-gap in enrollment and also the rural-urban disparity in female education. The Parliament has passed a number of laws in 1997 and 1998 ensuring more equitable representation of women in Union Parishad (the lowest tier of the local government), municipal bodies, districts, and sub-district levels.

The exploitation of children and adolescents, especially girls, is a problem in the country. They are often victims of violence like sexual harassment and rape. Acid violence is also a growing concern. Female child labour has been a big problem for the country. There are over 6.3 million working children (under 14 years). Prevalence of child labour is more common in the rural areas (37%) and in the informal sector. In Dhaka city, there are an estimated 300,000 child domestic workers. Non-formal education offers a flexible model for working children and others outside the formal system, but they still need greater access to further learning opportunities. Graph 4.35 gives the prevalence of child labour by gender. This shows that the gender gap is narrowing down rapidly over the last decade.

Factors Related to Changes

Factors related to developments in the status of female population are as follows:

(i) Favorable developments in terms of primary and secondary educational enrollment, literacy rate (though significantly below the south Asian neighbors such as Sri Lanka and India) and economic, political and social empowerment which have taken place in the last two decades are combined and mutually reinforcing affirmative actions taken by the state, NGOs and the supportive role played by the development partners, both multilateral and bilateral. Grameen Bank and BRAC have earned world-wide reputation for their female micro-financing and non-formal primary education (NFPE) program respectively.

(ii) Child labour has been a persistent problem for the country. Cross-country evidence indicates that high rates of child labour are linked to poverty and underdevelopment and to poor quality of education. In Bangladesh, child labour is going to be an issue for quite some time.

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Some positive developments with regards to child labor in the garments sector have taken place with the technical and financial support of ILO. Child labor has been phased out and they have been enrolled in school. Bangladesh Garments Manufacturers and Exporters’ Association (BGMEA), GOB and UNICEF played laudable roles in phasing out the child labor in this particular industry.

4.e. Support for Parents and Care-Givers

No broad-based formal institutional arrangements are there for supporting parents who are in need of child-care. In large urban centers e.g., Dhaka, Chittagong, crèche for working mothers and skilled garment-workers are more an exception than a rule. In this respect, generally the tradition of peasant-based practice still persists in rural Bangladesh. When a parent fails to give adequate care to the child, somebody within the extended family tries to make it up by providing care. It may be the aunt, grand-parent(s), elder sister/brother or similar other relatives in the same household. This peasant-family tradition relating to supplementary child-care becomes less viable in big urban-centers for a number of reasons: (a) the family is basically nucleated, (b) the family-size is small, with 2 to 3 off springs, a slender possibility of elder off-spring (with a big age-difference) taking care of the younger ones.

Due to widespread and persistent poverty, which becomes acute during prolonged periods of natural disaster such as flood and drought, children get separated from their families. Large metropolitan cities, especially the capital city Dhaka have become converging centers for fully or semi-abandoned rootless street-children. A few S-O-S villages, maintained by foreign and local funding throughout the country for these vast and ever growing number of abandoned children, are inadequate.

4.f. Early Childhood Care and Development, Basic Education and Vocational Training

Goal f.1 : Universal access to basic education and achievement of primary education by at least 80% of primary school-age children.

f.2 : Reduction of the adult illiteracy to at least half in 1990 level, with emphasis on female literacy.

f.3 : Expansion of early childhood development activities, including appropriate low-cost family and community based intervention.

f.4: Increased acquisition by individuals and families of the knowledge , skills and values required for better living, made available through all educational channels, including mass media, other forms of modern and traditional communication and social actions.

The concept of early childhood care and development (ECCD) is new in Bangladesh. There is enormous opportunities to develop the full potential of the child through ECCD. Exiting support to the 3-5 year age group is inequitably limited to a small number of institutionalized activities. In rural Bangladesh, there exists Maktabs (Pre-school) for Muslim children; similar institutions exist for Hindu and Buddhist children.

The concept of basic education as propounded at the World Conference on Education for All (Jomtien, Thailand) in 1990 is equivalent to primary level education in Bangladesh. It is estimated that the gross enrolment rate has gone up from 85% in 1990 to roughly 106% in 1999. Net enrolment, although increased in the early 1990s, it has stuck at around 80% since 1994 (Graph 4.39). The trend-rate of net enrollment depicts an unexpected pattern - a decrease from 82.45% in 1994 to 80.9% in 2000. The net enrollment-rates, for both male and female, have declined between 1994 and 2000. Children reaching grade five has been increasing over the years. The children reaching grade five has increased from 42.5% in 1990 to 70.3% in 1998 (Graph 4.36). The estimates for male-children for the period 1990-98 has been 43% to 69.1% (Graph 4.37). Equivalent estimates for the female-children have been 42% in 1990 and 66.7% in 1998

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(Graph 4.38). Another positive indicator in educational development is pupil-attendance rate in the school (Graph 4.42). Primary school attendance for both sexes has gone up from 64.4% in 1994 to 72.8% in 1997; in case of male pupils it was around 63% in 1994 and 71% in 1997 (Graph 4.43). In case of female pupils, the attendance increased from 66% in 1994 to 74.7% in 1997 (Graph 4.44).

Adult literacy (15 years and above) has gone up from 36.9% in 1990 to 55.9% in 1998 - a simple rate of growth of 1.8% per annum (Graph 4.45). The male-literacy is higher, 63.1% in 1998 and the female literacy rate lower, 48.1% in the same year (Graph 4.46).

The main institutions offering vocational training at secondary level are 51 Vocational Training Institutes (VTI) and 12 Technical Training Centres (TTCs). At present, there are about 11,000 students attending these institutions, just over 10% of whom are female. Both VTIs and TTCs offer training in basic trades. Most students have completed Grade 8 before entering into these schools but out-of-school applicants with lower qualifications are accepted for basic trades training.

At higher secondary level, Government Polytechnic Institutes (20), Commercial Institutes (16), single-purpose institutions and affiliated non-government institutions offer a variety of courses which lead to diplomas in technical and other vocational subjects. A tenth grade education is required for entry. Places are very limited and girls’ participation is low, except in nurses’ and teachers’ training courses. A recent initiative has been taken to introduce a Higher Secondary Certificate in business management in 200 schools, intermediate and degree colleges and other independent institutions in order to expand the vocational training opportunities for this age group.

Proximate determinants

(i) For free primary education, Parliamentary act titled “Compulsory Primary Education, 1990” made a significant impact. The CPE Program implementation throughout the country beginning in 1992 and the creation of Primary and Mass Education Division under the direct guidance of the Prime Minister’s Office, made important positive impact.

(ii) There has been a sustained budgetary allocation for the primary education sub-sector (around 14% of the total non-development budget). A good number of development projects financed by World Bank, ADB, Saudi grant, NORAD and SIDA have been undertaken in the sub-sector. Food for Education Program (FFEP) for socio-economically disadvantaged rural children started in 1993, covering about 17% of the total primary school-going children, has a positive impact on enrollment and retention rates.

(iii) Liberal state-policy towards NGOs working in NFPE-related activities e.g., BRAC (operating around 42,000 NFPE-centers and enrolling about 1.5 million children), Proshika, Dhaka Ahsania Mission, Center for Mass Education in Science and other smaller NGOs have been working from the second half of 1980s, have done a lot of R&D with material development, delivery mechanisms and programmatic improvements. Their innovative approaches have enhanced accessibility to basic education of female, especially adolescents in both rural and urban areas.

(iv) The female secondary school stipend programs (FSSP) played an important role in attracting female children to the primary school. After graduating from the primary level these children are entitled to secondary school stipends/opportunities.

(v) Despite early achievements in net enrolment (from 60% in 1990 to 76% in 1994 reaching 81% in 1998), there is a significant number of children who are not attending school. Out of a total primary school age population of 19 million, 3.5 million are not enrolled. The challenge is to enroll this big segment of children into the school.

(vi) The quality of primary education has been a matter of concern. Reasons for low level of educational quality at the primary level are: (a) low contact hour; (b) lack of effective academic supervision; (c) high pupil-teacher ratio of 59:1 in 1999 and significant regional variations (74:1 in Chittagong Division compared to 44:1 in

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Barisal Division); (d) lack of community participation in resource-mobilization and in school-management; and (e) lack of physical facilities and adequate number of teachers in many school.

4.g. Children in Need of Special Protection

It is suspected that in a slow-growing and populous country, children from mainly socio-economically disadvantaged families are finding themselves in difficult circumstances, e.g., drug, tobacco and alcoholic abuse. From the print and electronic media reports, it is apparent that child-trafficking to India, Pakistan and Gulf-countries have been taking place. Rape of children, torture of maid-servants and other forms of exploitation are going on. It is a stupendous task for both the state and the society to protect children from exploitation. However, the Government is giving maintenance of law and order top priority and has in 2000 passed “Supervision of Violence Against Women and Children Act” repealing the 1995 “Control of Opposition of Women and Children (Special Provision) Act.

The Government of Bangladesh is fully committed to the Convention of the Rights of the Child. In the recently held Millennium Summit in New York, the Prime Minister has signed two optional protocols to the Convention on the Rights of the Child. These are; (a) Sale of Children, Child Prostitution, and Child Pornography; and (b) Involvement of Children in Armed Conflicts.

4.h. Children in Armed Conflicts

This particular aspect does not fully apply in the case of Bangladesh. The long-running political problem in the districts of Chittagong Hill Tracts has been resolved to a great extent through the signing of a peace accord in 1997 between the Government and the ethnic minorities. The displaced ethnic minorities and their children have been rehabilitated. But the Rohinga refugees and their children in Cox’s Bazar District still suffer due to their eviction from the bordering Myanmar. Bangladesh as a State has stood for tolerance, mutual understanding and peace-making. The State has taken up a number of pioneering steps to built regional cooperation such as the SAARC, the South Asian regional forum, to enhance socio-political and economic co-operation among the member-States. Therefore, the desire to avoid armed conflicts is very much ingrained in the State Policy.

4.i. Protection of Environment for Children

Due to high population-pressure, low natural resource-base, low level of education and technology, the bountiful nature of the country has not been utilized in a balanced way, keeping the future in view. In many cases, significant degradation of environment is taking place due to ignorance and for short-term economic gains. Education and skills training to children relating to natural environment will help restore and sustain the bounties of our nature.

4.j. Addressing Poverty and Food Security

In the last decade, Bangladesh has made significant progress in food production. Through this, food security has been ensured to a large extent. Increase in domestic production aided by adequate imports of foodgrains has contributed significantly to bumping up stocks of foodgrains. Poor households do not have food security because they cannot make sufficient stocks from their own produce, nor do they have cash incomes or resources to acquire food. Direct transfers of foodgrains through targeted food aid has been a means of alleviating the needs of poor households in Bangladesh. The Government has food for work and vulnerable group development programmes from which several hundred thousand women receive foodgrains and different types of training every year.

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Section 5

Lessons Learnt

5.a. Liberal Values and Open-Mindedness of the State

In general, Bangladesh has taken a positive attitude toward different UN sponsored conventions and treaties. The fact that the State is one of the early countries ratifying CRC (in 1990), reflects the receptive posture of the State of universally accepted humanistic values and norms. This liberal attitude and open-mindedness of the Bangladesh State is the major factor behind the country's achievement in socio-political spheres, notwithstanding the country’s generally poor performance in economic terms e.g. low per capita income of US $ 360 and high incidence of poverty.

5.b. More Active Local Government Authorities for Promotion of CRC

It is generally believed that the country could do significantly better in terms of dissemination and promotion of CRC if the sub-district level local governments e.g., the newly enacted Upazila government and the existing Union Parishads could be more organized. The local government elections to Zila (district) and Upazila (sub-district) could not take place on time last year. The situation of children could be better if mobilization of resources by local government bodies and supervision of local service organization by local bodies could be ensured.

5.c. More Motivated and Accountable Primary Health-Care, Speedy Arsenic-related Problem-Solving, Economic and Behavior-Related Interventions for Excreta Disposal

Vigorous efforts are needed by the State-agencies (especially the Directorate of Health) and the local government authorities (i.e., Union Parishad, Municipalities and Upazila Parishads) to make EPI, Control of Diarrhoeal Diseases (CDD), control of other communicable diseases, and Vitamin A programmes more effective. Without more participatory and accountable delivery-mechanism, the child-health-related indicators e.g., under-5 mortality and IMR, may not significantly improve further.

More intensive interventions are headed to provide arsenic free drinking water in the southwestern and southeastern districts. DPHE and UNICEF need to quickly translate the research findings (based on Jadavpur University, West Bengal, India and other national research-initiatives) into actions.

Around 44% of the total population use sanitary means of excreta disposal. Though some cost-effective means of excreta-disposal e.g. materials for slab-latrines, are widely available in the country due to economic and behavioral reasons, the adoption rate has been much below the desired level.

5.d. Income-Poverty and Lack of Proper Knowledge Related to Balanced Food

To break out from the vicious cycle of malnourished mothers (both pregnant and lactating), low birth weight babies, high IMR/under-5 mortality and morbidity, the most promising way for the country is to raise the rate of growth of GDP from 5.0% per annum at present to around 8.0%. If manufacturing and agriculture grow at higher rates, then the other activities e.g., trade, transport and communication and construction will generate more employment for the poor and socio-economically disadvantaged population.

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5.e. Positive Developments Through Socio-Political Participation

The maternal mortality rate in the country is still very high. It is mainly because of the country’s economic backwardness and high rate of income-poverty. Positive development have taken place in terms of women's participation at the grass-roots level organizations e.g., local governments, Grameen Bank, BRAC, non-formal basic education and credit programmes. Motivation among the people belonging to the political and administrative leadership, is required to reduce the prevailing level of violence against women and girls. There is a high incidence of child labour in the country. In a poor and slow-growing economy, this problem cannot be alleviated in the short term. Following ILO’s recommendation, children may be kept out of the hazardous jobs. Social campaigns by the local government bodies, NGOs and media can play an important role in this regard.

5.f. Parental Care for the Abandoned Children

The number of abandoned children is increasing in the bigger cities such as Dhaka and Chittagong. Some formal interventions (may be by the philanthropic organizations, partly subsidized by the State) can be made to give them parental care. Other well-off families in need of alternative parental care (the broken-up families, working parents/mothers) may seek private cost-effective solutions.

5.g. ECCD and Primary Education

It seems that the concept of Early Childhood Care and Development (ECCD) does not sound very clear to the policy-makers, not to speak of the general people. The country has done well in terms of quantitative development (e.g., gross enrollment ratio, gender-parity) in primary education in the 1990s. In spite of liberal NGO-participation in the NFPE-sub-sector, the hard-core poor households are not satisfactorily covered by this enrollment drive. Much more pedagogical and academic supervision are needed to improve retention of the pupil and improve the teaching-learning process.

5.h. Children in Need of Special Protection

The society faces a difficult situation with regard to the children in need of special protection. The overall law and order situation is improving but not upto one’s satisfaction. Due to widening income inequality, the socio-economically disadvantaged families are driven to desperate and difficult circumstances. Trafficking of women to the neighboring countries is a phenomenon of social and economic deprivation. In many cases, the well-off families are also finding themselves affected by the social malaise.

5.i. Children in Armed Conflict

Bangladesh has kept good relationships with its neighbours, i.e., with the bordering States of India and Myanmar. No significant number of children suffer due to any armed conflict. The military-political problems, involving the Rohinga refugees and the ethnic minorities in Chittagong Hill Tracts, have been mostly resolved by peaceful negotiations, and returnees are being rehabilitated.

5.j. Environmental Degradation

The bountiful nature of the country has been degrading at a rapid rate due to mindless and unbalanced use of the country’s resources. Highly unfavourable land-man ratio, lack of proper education among the people, and lack of adequately equipped administrative machinery in enforcing the existing laws in protecting the nature are some of the major reasons for environmental degradation.

5.k. Addressing Poverty and Food-Security

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Over the last two decades, the domestic production of foodgrains has increased significantly to bring food self-sufficiency in the country. During bad harvests due to some natural disasters, the State has gone out to help the vulnerable, socio-economically disadvantaged households by test-relief, vulnerable group development programme and other similar programs. These relief activities are to a great extent underwritten by the multilateral and bilateral grants. The best way to ensure food-security to the poor households is to ensure reasonable year-round gainful employment opportunities.

Section 6

Future Actions

6.a In the short and medium terms, the State can take up a number of steps to achieve the WSC goals. The most important step will be to devolve political, economic and social powers to the sub-district level local government bodies i.e., the newly enacted Upazila Parishads (Council). Given the existing socio-political milieu, the proposed Parishad, numbering around 464, should be the optimal and most appropriate local government units to propagate CRC-related provisions, plans and implementation. The present top-down approach to implement the WSC-goals in Bangladesh need to complimented by a bottom-up approach.

6.b. The whole country is covered by a network of Upazila level Health Complexes (numbering about 464) and Union-level Health and Family Welfare-Centers (UHFWCs) (numbering about 13,000). The Upazila Health Complexes and UHFWCs, with well-built physical structures should be provided with adequate current budgetary allocations and doctors and other staff. More accountable staff inspired by an improved set of material and non-material incentives, are needed to make health-facilities attractive. If the health-facilities can be managed properly, it will be possible to improve child health to a great extent.

6.c. For alleviating the situation of malnutrition of mothers both pregnant and lactating mothers and their children, the only way is to develop economically, at a much higher rate of growth of GDP of 8 percent per annum. Income-poverty is the single-most important determinant malnutrition. Alongside, the social awareness programs with regard to nutritional knowledge, information and relief-programs for socio-economically vulnerable groups during natural calamities should continue.

6.d. For dealing with arsenic-contamination of tube well water, the Department of Public Health Engineering with its many local-level offices, will have to take the lead, in collaboration with other bilateral and multilateral agencies e.g., UNICEF and World Bank. Motivational drive and sale-campaign of slab-latrines at the Union Parishad and Upazila levels should improve the sanitation situation.

6.e. Adequate legal support for victims of the suppression of violence of women and children has been provided in the law. However, cooperation of the politicians and the law-enforcing authorities will be required to implement the existing laws and rules. Social awareness and systematic work with employers to phase out child labour from hazardous activities are needed.

6.f. In bigger cities such as Dhaka and Chittagong, more organized efforts are needed to give street children some alternative parental care. It is difficult to bring them under an organized system. The elected City Corporations can try out innovative projects involving these children; multilateral and bilateral donors can help with technical and financial assistance.

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6.g. The primary education sector will do well by gradually giving planning and administrative powers to the locally elected governments. The sector should ensure community-participation in the operation and maintenance of primary schools. Such a devolutionary process will lead to local-level resource-mobilization, supervision and improvement in quantitative and qualitative aspects of primary education.

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References

Alam, Mahmudul, 'Primary Educational Development in Bangladesh - ways to Move Forward', BIDS, forthcoming, December, 2000.

Alam, Mahmudul, “Basic Education in Rural Bangladesh: Level; Pattern and Socio-economic Determinants”, Research Report No. 146, BIDS, Dhaka, 1997.

Bangladesh Bureau of Statistics (BBS), Child Nutrition Survey of Bangladesh, 1995-96 and 1997-98.

BBS, “Sample Vital Registration Survey”, 1996-98.

BBS/UNICEF, Progotir Pathey: Achieving the Goals for Children in Bangladesh, 1994 to 1999.

BBS/UNICEF, Progotir Pathey: Achieving the Goals for Children in Bangladesh (Preliminary Results) 2000.

CDD-DGHS/UNICEF, Report on Evaluation of ORT Communication Campaign, 2000.

Dhaka University, ICCIDD, UNICEF, Iodine Deficiency Disorders Survey in Bangladesh, 1993 and 1999.

Government of Bangladesh, Planning Commission, The Fifth Five-Year Plan, 1997-2002, March 1998, Dhaka.

HKI/USAID/UNICEF, National Vitamin A Survey Bangladesh, 1997.

IPHN/BSCIC/UNICEF/ICCIDD, Evaluation of Universal Salt Iodization (USI) in Bangladesh, 1996.

IPHN/UNICEF, National Blindness Prevention Programme Evaluation, 1989.

Ministry of Health and Family Welfare and Institute of Nutrition and Food Science, Mid-term Evaluation of Bangladesh Integrated Nutrition Project (BINP), 1999.

National Institute of Population Research and Training (NIPORT), Demographic and Health Survey (DHS) 1993-1994 and 1995-1996, 1995 and 1997.

National Institute of Population Research and Training (NIPORT), Demographic and Health Survey (DHS) 1999-2000 (Preliminary Report), 2000.

PMED, Education For All: The Year 2000 Assessment, Bangladesh Country Report, 1999.

Shahabuddin, Qazi, “Policy Options to Enhance Food Security in Bangladesh” in Bangladesh Economy 2000’ Selected Issues, BIDS, Unpublished, June, 2000.

UNICEF, First call for Children, New York, December, 1990.

UNICEF, “Review of Availability and Use of Emergency Obstetric Care (EOC) Services in Bangladesh” 1999.

UNICEF Regional Office for South Asia, Bangladesh National Plan of Action for Children – An Assessment (Draft), September 2000, Kathmandu.

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World Health Organisation, World Health Report.

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Appendix Page 1

APPEND

IX

- Trend Graphs -

NOTE: See Page (ii) for list of graphs.

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Appendix Page 3

NOTE: Infant mortality rates from two different sources are considered to be reliable i.e. Sample Vital Registration Survey by Bangladesh Bureau of Statistics, and Demographic and Health Survey by NIPORT. Data from both surveys show overall consistency in trend indicating steady improvement in infant survival over the last decade.

Appendix Page 4

NOTE: Though the gap seems to be becoming smaller in the recent years, the locality comparison shows that the infant mortality rates are higher in rural areas.

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Appendix Page 6

Source: Sample Vital Registration Survey, BBS

NOTE: The data do not imply that the quality of water is safe. No discounting was made for arsenic contamination in the country’s ground water. Figures from Progotir Pathey do not always round up to 100% due to multiple responses.

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NOTE: MICS figures allow for immunization done on both the routine immunization and the National Immunization Days (NIDs). The fact that MICS 2000 was conducted right after NID is reflected in the high figure (better memory by respondents) of Polio coverage.

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NOTE: Diarrhoeal prevalence in MICS is much higher than in DHS. DHS used the term ‘diarrhoea’ which refers to cases of ‘severe diarrhoea/cholera’ in Bangla terminology, while MICS followed the WHO/UNICEF guidelines, i.e. three or more episodes of loose or watery stools per day or blood in stool.

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[NOTE] National data for children’s nutritional status are available from Demographic and Health Survey conducted by the National Institute of Population Research and Training (1996/97, 1999/2000) and Child Nutrition Survey by the Bangladesh Bureau of Statistics (1990, 1992, 1996). Despite the disparity that exists between the two sources due to difference in surveyed age groups (i.e. 0-59 months for DHS, 6-71 months for CNS), data from both surveys have been kept to examine the overall trend. The graphs 4.19 through 4.21 suggest an improvement in the children’s nutritional status during the past decade. However, the graph 4.22 indicates a higher percentage of malnourished children in rural areas than in urban areas. DHS survey report further analyses that prevalence of stunting varies little by sex of the child, but it rises with birth order of the child and the length of the preceding birth interval (i.e. children born less than 24 months after a prior birth are considerably more likely to be stunted than those born after an interval of 48 months or more) (Bangladesh Demographic and Health Survey 1996/1997, NIPORT).

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NOTE: There is a cultural tradition in Bangladesh of giving honey or sugar water to a newborn baby as the first food in life. DHS survey allowed this in its definition of exclusive breastfeeding.

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NOTE: Available data on primary school net enrolment rate show little or no gap between boys and girls. However a great disparity exist between that of slum boys and national male average. The MICS data suggest a widening gap in the recent years.

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NOTE: Adult literacy data is available from a large number of sources, the most regularly collected and reliable source being the Sample Vital Registration Survey conducted by the Bangladesh Bureau of Statistics. Though the primary school net enrolment rate is relatively high, low literacy rates, especially among the female population, is an outcome of the long-term issue of the unequal access to and the low completion rates of basic education.

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