Bangladesh makes dramatic advances in child survival.

In 1990, the infant mortality rate in Bangladesh, 97 deaths per 1,000 live births, was 16% higher than India’s 81. By 2004, the situation was reversed, with Bangladesh’s infant mortality rate (38) 21% lower than India’s (48). 

Three main factors seem to explain the dramatic improvements. 

First, economic empowerment of women through employment in the garment industry and access to microcredit transformed their situation. The vast majority of women in the garment industry are migrants from rural areas. This unprecedented employment opportunity for young women has narrowed gender gaps in employment and income. The spread of microcredit has also aided women’s empowerment. Grameen Bank alone has disbursed $8.74 billion to 8 million borrowers, 95% of them women. According to recent estimates, these small loans have enabled more than half of borrowers’ households to cross the poverty line, and new economic opportunities have opened up as a result of easier access to microcredit. Postponed marriage and motherhood are direct consequences of women’s empowerment, as are the effects on child survival. 

Second, social and political empowerment of women has occurred through regular meetings of women’s groups organized by nongovernmental organizations. For example, the Grameen system has familiarized borrowers with election processes, since members participate in annual elections for chairperson and secretaries, centre-chiefs and deputy centre-chiefs, as well as board member elections every three years. This experience has prepared many women to run for public office. Women have also been socially empowered through participation in the banks. A recent analysis suggests much better knowledge about health among participants in credit forums than among nonparticipants. 

Third, the higher participation of girls in formal education has been enhanced by nongovernmental organizations. Informal schools run by the nongovernmental organization BRAC offer four years of accelerated primary schooling to adolescents who have never attended school, and the schools have retention rates over 94%. After graduation, students can join the formal schooling system, which most do. Monthly reproductive health sessions are integrated into the regular school curriculum and include such topics as adolescence, reproduction and menstruation, marriage and pregnancy, family planning and contraception, smoking and substance abuse, and gender issues. Today, girls’ enrolment in schools exceeds that of boys (15 years ago, only 40% of school attendees were girls). Women’s empowerment has gone hand-in-hand with substantial improvements in health services and promotion. With injectable contraceptives, contraceptive use has surged. Nearly 53% of women ages 15–40 now use contraceptives, often through services provided by community outreach workers. BRAC also provided community-based instruction to more than 13 million women about rehydration for children suffering from diarrhoea. 

Today Bangladesh has the world’s highest rate of oral rehydration use, and diarrhoea no longer figures as a major killer of children. Almost 95% of children in Bangladesh are fully immunized against tuberculosis, compared with only 73% in India. Even adult tuberculosis cases fare better in Bangladesh, with BRAC-sponsored community volunteers treating more than 90% of cases, while India struggles to reach 70% through the formal health system.

Article taken from UN HDI Report by Ms Anita Rego.