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Though the number of children who die before age 5 has declined significantly in the last two decades, the path to ending child mortality is long and hard to navigate. Nearly 7 million young children still die yearly, largely from preventable causes. What works and what doesn’t in the fight against child mortality? What will it take to go the last mile, and end preventable child deaths?  

Defying the odds: Bangladesh makes strides in child health

Counter to the common perception of Bangladesh as hopelessly impoverished, the country has dramatically reduced overall child mortality in recent decades.

There is no single, simple answer to how Bangladesh has managed to come so far. Rather, a multifaceted set of factors has improved child health, and the country is trying to close in on the remaining weaknesses.

The Bigger Picture

Bangladesh is infamous for stories of bleak factories and industrial disasters, including the collapse of a garment factory near Dhaka that killed more than 1,100 people in April.

Less in the spotlight are workplaces that provide decent jobs with steady salaries to lift people out of extreme poverty. The $19 billion garment industry accounts for 80 percent of Bangladesh’s exports and has fueled economic growth of more than 6 percent in recent years.

The country’s garment industry is the world’s second largest, behind China, and employs three million people, 80 percent of whom are women. Remittances from Bangladeshis working overseas also boost the economy.

Although grim poverty and appalling working conditions still exist in Bangladesh, overall macroeconomic conditions have improved. In turn, rising incomes have contributed to more education and better health. Poverty fell 19 percentage points in the last decade and a half, though overall poverty is still significant, with 53 million people below the poverty line.

“It’s hard to disentangle health and development,” said Laura Reichenbach, director of the center for reproductive health at the International Center for Diarrheal Diseases Research (icddr,b), in Dhaka. “There has been broader social and development improvement. All these pieces together facilitate improvements.”

The adult literacy rate is still only at 56 percent, but that is a big improvement over the 21 percent it was in 1970. UNICEF statistics show that school enrollment has increased, and now there are more girls than boys in primary and secondary school. Those girls grow up to be women who can give better care to children, said Lianne Kuppens, UNICEF’s chief of health in Dhaka.

“Educated mothers have an impact on practices and behavior,” Kuppens said.

One benefit of being one of the world’s most densely populated countries — 152 million Bangladeshis live in a space about the size of Iowa — is that clinics and hospitals are within six miles of most homes, according to a report from icddr,b. Roads are in surprisingly good condition, and the terrain is mostly flat, allowing people to reach health facilities.

Programs with Big Impact

In addition to better macroeconomic conditions, important health programs seeded decades ago are now bearing fruit.

Family planning, spearheaded by the government with additional support from nongovernmental organizations (NGOs) has slashed birth rates. In 1975, women in Bangladesh had an average of 6.3 children. Now the fertility rate is 2.3, compared with 2.6 in India, according to the 2011 Bangladesh Demographic and Health Survey.

Wide availability of contraceptives through government workers and NGOs, combined with economic empowerment of women and greater health awareness, contributes to controlling population. Outside a village clinic run by the Naifa Maruf Foundation an hour from the southern city of Khulna, 22-year-old Mukta Begum spoke about her 3-year-old son, who was being treated for intestinal worms. Even with a group of men listening, Mukta said she used an IUD for birth control. Across the country, women mentioned contraceptives — from pills to injectables — without batting an eyelash.

Another program with far-reaching impact is the government’s child immunization program, which started in the late 1970s and intensified in 1985. Vaccination coverage has steadily risen since then.

Only trained medical personnel can administer vaccines, but both educated and uneducated workers spread the word among the poor about the importance of the vaccinations. Lower-rung government and NGO community health workers and volunteers reach the poor through home visits in villages and slums, encouraging mothers to visit vaccination camps and clinics.

Dr. S.A.J. Musa, director of primary care in Bangladesh’s ministry of health, said accessibility, strong local monitoring, and community involvement have all contributed to the program’s success.

“Now in the community, mothers ask, ‘When will you conduct vaccinations?’” he said.