Bangladesh needs to focus on promoting long-term and permanent contraceptive methods to control further growth of population, experts say at an international conference in Bali.

Although Bangladesh's progress in family planning had been impressive over the last two decades, it has been almost stagnant for the last four years, which is a matter of concern, they said at the International Conference on Family Planning (ICFP) that began on January 25 at the Bali Nusa Dua Convention Centre in Indonesia.

The total fertility rate (TFR) has been stagnant at 2.3, meaning each adult woman having 2.3 children, for the last four years. The TFR declined to 2.3 in 2011 from 6.3 in 1975, according to the Bangladesh Demographic Health Survey 2011.

Also, contraceptive prevalence rate is 62 per cent among the married couples, and only 54 per cent of them use modern contraceptives, and the rest eight per cent use traditional ones.

Of the 54 per cent, only eight per cent use long-term methods -- injections, intrauterine devices (IUDs), and permanent methods -- vasectomy and tubectomy, while the rest use temporary methods, including oral pills and condoms.

“The problem with the temporary methods is drop-out, which is almost 30 per cent in Bangladesh,” said Reena Yasmin, senior director [services] of Marie Stopes Bangladesh, who is attending the five-day ICFP.

Due to drop-outs in temporary contraceptive methods, around 1.3 million women face unintended pregnancies in Bangladesh, while abortion among them is 18 in each 1,000 pregnancies, she told The Daily Star, referring to a 2010 study by the Bangladesh Association of Preventive and Septic Abortion.

To avoid such unintended pregnancies and abortions that have psychological, physical and economic consequences, experts suggest that Bangladesh focus on long-term and permanent methods.

“When you take pills, you need to take those every day, and when you use condoms, you need to use them every time you have sex. It is also costly. But, if you take IUDs like implants or injections, you are safe for three, five, or 10 years,” said Loshan Moonesinghe, family planning specialist at the UNFPA Bangladesh.

“And, permanent methods help permanently,” he told The Daily Star at the convention centre.

As there are risks of drop-outs in the use of temporary methods like pills and condoms, long-term and permanent methods are encouraged in countries like Bangladesh with a huge population.

For this to happen, Loshan suggested that the family planning personnel counsel and follow up, and the authorities create awareness among couples about long-term and permanent methods.

Reena Yasmin said the absence of doctors and trained health workers at the remote and rural Bangladesh is a real hurdle in the promotion of long-term and permanent methods.

Besides, private sector is also not vigorously pushing for such methods, she said.

Moin Uddin, director of the Directorate General of Family Planning (DGFP), said almost 50 per cent posts of 1,200 family planning and welfare officers of the DGFP at the upazila levels remained vacant for over a decade.

“Also, the health personnel are not doing so well in counselling and client screening [for couples for long-term and permanent methods],” Moin Uddin, who is attending the ICFP, told The Daily Star yesterday.

The government is working on ways to accelerate family planning, especially long-term and permanent methods, he added.