Bangladesh is unusual in that the traditional pattern of very early marriage and high fertility has been transformed with virtually no evidence of marriage being delayed.
One important indicator of early marriage is the proportion of teenage women aged years currently married. Bangladesh has, until recently, maintained one of the highest proportions—close to half—of teenage marriage in the world, matched only with a few West African countries. What is surprising about this unchanging early-marriage trend is that substantial investments have been made in the past decade to increase access by girls to primary and secondary education. There is a draft policy proposing to extend this scheme to girls from poor families in urban areas.
Thus far, there is little evidence of these educational inputs translating into delayed marriage, as the historical experience from other countries would predict.
It is probably safe to predict that continued investments in female education will result in delays in early marriage in the near future—at least among some groups.
This, in turn, will contribute to further fertility decline. What is less certain about mass education schemes, such as the FSSSS, is whether girls from poor families, who now achieve high levels of education through such schemes, will behave similarly to girls who historically had high education and tended to come from economically well-off families with different knowledge, experience, and values.
There easily could be a delay in observing later marriage among poor families. Typical of most developing countries, the elderly of Bangladesh currently constitute only about one in 20 of the population. It is partly this ageing trend that is triggering the shift from infectious to non-infectious diseases as the major causes of death. The remainder is due to injuries, which will increase a little, mainly as a result of more road accidents. It can safely be assumed that, during this century, a health service system, probably incorporating some form of health insurance, will evolve in response to these new demands.
Is this a safe assumption? Who is going to pay for these services, which will inevitably be much more expensive than existing services for most infectious diseases? While the elderly population grows at a rapid rate 2.
The effect of this will be that the present dependency ratio will fall precipitously from 11 workers per one elderly person to three workers by and to two workers by —similar to current Western ratios.
Even assuming an effective taxation system in place, the burden on workers to pay for health services will be greatly increased. In the next section, the implications of ageing for health services will be briefly discussed. There will be two ways in which population growth impacts patterns of disease and the need for health services.
The other is the impact of the changing age structure. A simple exercise will illustrate these two effects. Applying the WHO GBD age-specific prevalence rates for diabetes for South Asia to the growing Bangladesh population, then applying costs per case of treatment at current retail prices and assuming all cases receive complete treatment , suggest that the number of cases will rise from 2. The impact of ageing is not limited to non-communicable diseases, but infectious diseases that afflict adults, such as tuberculosis TB , are also important.
The impact of ageing is much greater with diabetes than TB because the age-specific rates rise much more steeply with diabetes, and it is not presently a curable disease, so the duration needed for management is much longer.
While the rapidly-rising number of cases of both non-communicable and communicable diseases of adults has major cost implications for the health system, it also suggests that issues relating to skill balances and medical school curriculum need to take account of the changing demands.
Not only are the total population figures important, their distribution between urban and rural areas is also critical. The urban population, however, will absorb the additional 70 million national population growth, so the current urban population of 34 million will blow out to over million, possibly during this century.
This frightening growth will be driven predominantly by rural-urban migration, with a small component of natural increase. How can urban populations grow at this rate, tripling in size within this century? The current rate of growth of the urban areas within the six metropolitan areas is around 3. The BBS quotes a rate of natural increase for urban Bangladesh of about 1. If this estimate is correct, the difference 2.
This gives a doubling time of 20 years [The doubling time is estimated by dividing the annual growth rate in percentage into Populations grow exponentially, and the natural log of 2 is 0. So, a doubling is probable by mid-century at the current growth rate.
For example, in Dhaka, more than one-third Nationwide, that proportion is similar, at The growth rate for urban Dhaka indicates that, in absolute terms, it is growing at around , persons per annum in the metropolitan area, of which three-quarters are added to the slum population. This proportion is likely to be similar elsewhere, although the total numbers will, of course, be smaller than in Dhaka.
There is a slightly encouraging sign that urban growth appears to be slowing in recent years. While there is little evidence, this is possibly linked to the rapidly-expanding microcredit facilities in rural areas, and consequent employment and income-generation taking some pressure off the poor to move to the cities in search of work.
The health of the urban poor or slum dwellers is primarily due to crowding and lack of access to basic services, such as water and sanitation. Consequences of these living conditions include stress due to crowding, insecurity due to lack of housing and land tenure, various types of illegal or criminal activities, including violence, drug-use, prostitution, etc. If conditions are so bad, why do people move to these areas?
Presumably because there are better perceived chances to find cash from employment. Rural Bangladesh has a relatively high population density of per sq km This is sparse compared to the urban population densities from the latest slum-mapping 5 , which are 30 times higher, averaging 23, nationwide 7, in Barisal City Corporation to 29, in Dhaka metropolitan.
The slums, however, at , persons per sq km, are almost times more densely populated than the rural averages. Figure Fig. Chittagong is the highest at , persons per sq km. With modal most common values of persons per room and the average house-size of sq ft, there can be little doubt that crowding is a genuine issue.
Since slums tend to be in low-lying areas, where the better-off do not want to live, they are subject to flooding More than half What are the prospects for this situation with future rapid urban growth?
Water is likely to be a limiting factor. At present, the people of Dhaka city need 2. Dhaka WASA provides 1. Many additional deep tubewells are serving the mushrooming numbers of high-rise buildings, and the overall impact of extraction of this underground water at a rate exceeding the capacity to recharge the aquifer is a drawdown of the Dhaka water table at an unsustainable rate.
The water table is presently over 60 metres below the surface [One positive aspect of this low water table is that it is below the level of arsenic contamination of the shallow aquifer, down to 30 metres], some 20 metres lower than eight years ago, and 35 metres lower than in the mids. Surface water should be a viable alternative [There is a proposal to import relatively clean surface water from areas to the south-west of Dhaka city, as the Shitalakshya river has reached its extraction limit due to pollution and siltation].
However, surface water is contaminated by industrial wastes mostly toxic chemical dyes, heavy metals, etc. Only Chittagong and Dhaka are the two cities with any piped, water-based sewerage system, but it is very old and poorly maintained. With the Dhaka population increasing by over , persons each year, theoretically needing six million additional litre per day, the numbers limited to this inadequate amount or less, will undoubtedly increase, unless something drastic is done.
The health implications must be clear, where populations are growing, water is becoming increasingly scarce, and sanitation is poor and not improving, waterborne diseases are very likely to become a serious problem again.
In addition, air-borne diseases, such as influenza, pneumonia, and TB, which tend to be exacerbated by crowding, are obviously also likely to increase under these pressured conditions.
There can be no doubt that the continued growth of the large population of Bangladesh has major implications in the future development of the country. Questions that are not often asked are what population can Bangladesh support; what strategies might be used for minimizing the negative impact of future population growth; and what changes to population distribution and the economy will be needed.
There are several issues that throw light on this. What is the capacity of agriculture to generate employment and absorb the expanding population into gainful employment? What is the capacity of agriculture to feed the growing population? Bangladesh has 8. Has Bangladesh reached the limits of agriculture?
This may depend in the short term more than anything else on the availability of water [In the longer-term, the shift to genetically-engineered or modified crops might play a role in Bangladesh, just as the introduction of high-yielding rice varieties did in the s and s].
Bangladesh resides in a water paradox in that it receives massive volumes of water both from transboundary rivers and from monsoon rains average 2. Among the 57 transboundary rivers are the Ganges [The Ganges carries so much water into Bangladesh that the Paksey bridge near the Indian border needs the deepest pylons in the world—91 metres below the riverbed], the Brahmaputra, and the Megna, with peak discharges among the highest in the world according to the Food and Agriculture Organization 6.
Between these and other minor rivers, some 1, km 3 of water enters Bangladesh annually, mostly during the monsoon June-October. To put this in perspective, it is equivalent to covering the entire country in water to a depth of 7. How can there be water shortages? There are two reasons. The remaining area uses minor irrigation systems, with pumps for groundwater, shallow and deep wells of various kinds.
When irrigation is most needed, farmers suffer water shortages due to erratic power supply, which limits their capacity to operate electric pumps to access the shallow and deep aquifers. A further consequence of these embankment projects has been a gradual reduction in the fertility of the soil due to preventing the natural siltation associated with flooding.
Farmers living within embankments may be able to multiple crops—rice and other cereals, but they report needing increasing amounts of artificial fertilizers each season. Unless major changes are made in access to water sources for irrigation in the dry season, agricultural production will not increase significantly. The optimistic view is that food production will keep pace with the growing population at least until , when requirements of food-grains will be 31 million metric tonnes mt , and production will be about 30 million mt.
These national averages may conceal household-level variations. For example, assuming a daily per-capita requirement of g of food-grains, an average family of five would need kg annually. With average agricultural land-holding at 0. However, this leaves no excess for sale and for supporting the population in non-agricultural households in the country. The National Water Management Plan may contribute to changes in patterns of water extraction that may alleviate some of this problem, but if agricultural production does not increase, what will be the trend for agricultural employment?
The latest figures suggest that, compared to the mids, the numbers working in agriculture are about Figures on small or zero land-holdings by farming households are elusive. The agricultural census indicates that This range is not useful as it covers impossibly small areas to reasonably large areas, but includes most farm households. What is clear is that farms in all size categories have declined between the — and the agricultural census, and the overall average farm size has fallen by one-quarter from 2.
These trends suggest that agriculture will not absorb the continuing growth of population into the economically-productive labour force. Thus, the continuing short-term growth in the rural areas of around two million annually will have to find other sources of employment, of which there are a few, or they will be driven into the cities looking for work.
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World Bank. October 28, Population density of Bangladesh from to in people per square kilometer [Graph]. In Statista. Accessed November 12, Population density of Bangladesh from to in people per square kilometer.
Statista Inc.. Accessed: November 12, Even in more recently developed countries, such as China and Korea, the flight towards cities has largely been in line with income growth. In other words, urbanisation has outpaced development, resulting in the creation of teeming but dysfunctional megacities such as Lagos , Karachi , Kinshasa and Dhaka.
Dense urban populations, Glaeser writes, bring benefits such as social and creative movements as well as scourges like disease and congestion. In ancient Rome, Julius Caesar successfully fought traffic by introducing a daytime ban on the driving of carts in the city. Baghdad and Kaifeng, China, meanwhile, were renowned for their waterworks.
In Dhaka, management of the city falls to a chaotic mix of competing bodies. Seven different government departments — including two separate mayors — are working to combat waterlogging, an arrangement that has led to a farcical game of buck-passing.
Wasa subsequently blamed Khokon. In , the city signed a deal to dredge some of the canals — following the example of Sylhet, another Bangladeshi city suffering from waterlogging — but there has been little sign of progress.
But dysfunctional administrations have not always been an obstacle to getting things done in Bangladesh. The country has won praise for its adaptation-focused response to climate change. And some urbanists are rethinking the prevailing negative view of slums , while urbanisation — which tends to bring declining birth rates — can be a partial solution to overpopulation. Glaeser points out that social movements formed in the confines of urban areas can have the power to change and discipline governments.
In the meantime, however, the unchanged misery of the sewer cleaners serves as a reminder that, as cities grow, they tend to get more unequal. Sujon says his community is shunned by both Muslims and Hindus. His daughters conceal their origins even from their friends. This week, the Overstretched Cities series examines the impact of the rush to urbanisation, which has seen cities around the world explode in size. Follow Guardian Cities on Twitter , Facebook and Instagram to join the discussion, and explore our archive here.
The dysfunctional megacity: why Dhaka is bursting at the sewers. The sewerage system is so poor in Dhaka that it often overflows during monsoon season. What are cities doing so right — and so wrong?
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