Child deaths higher among the poor, little care for mothers

Inequality is delivering a dual blow to Bangladesh's poorest families: children are nearly twice as likely to die before age five, while their mothers are three times less likely to receive adequate healthcare compared to the wealthy.

These disparities are laid bare in the Multiple Indicator Cluster Survey (MICS) 2025, which surveyed 63,000 households. The findings reveal that economic and educational gaps are actively driving life-and-death outcomes for the country's most vulnerable.

According to the data, under-five mortality stands at 39 per 1,000 live births among the poorest population, compared to just 22 per 1,000 in the richest group.

The child mortality rate climbs to 48 per 1,000 live births among mothers with no education or only pre-primary schooling, dropping to 22 per 1,000 among those with higher education.

The survival of the child is inextricably linked to the care of the mother. The survey, conducted by the Bangladesh Bureau of Statistics (BBS) with UNICEF support, highlights a massive gap in antenatal care (ANC).

While 99 percent of pregnant women in wealthy households received ANC at least once, the rate drops to 84 percent among the poorest women. The gap widens for quality care: 68 percent of women in the richest group received the recommended four or more visits, compared to only 23 percent in the poorest group.

"It is alarming that women and children from the less educated and poorer groups lag behind in almost all indicators," said Shafiun Nahin Shimul, a professor at the Institute of Health Economics at Dhaka University. "But the trend is not unusual."

The development Bangladesh has seen in recent decades has not been inclusive, leaving poorer segments of society behind.

Shafiun Nahin Shimul, a professor at the Institute of Health Economics at Dhaka University

Explaining the reasons, he said the development Bangladesh has seen in recent decades has not been inclusive, leaving poorer segments of society behind.

The government's contribution to health and nutrition services remains small, forcing people to rely heavily on private healthcare. Poorer communities have limited access to private healthcare, he added.

Following the Covid-19 pandemic, the economy still faces multiple challenges, including high inflation and soaring food prices -- which have hit low-income households the hardest, particularly in terms of nutrition, he said.

"All these factors likely contributed to the disparities," he told The Daily Star on November 26.

Apart from efforts to improve the macroeconomy, the government must take more initiatives targeting the poorer and less educated sections, he noted.

The survey released on November 16 shows that child stunting is 32 percent among the poorest population, compared to 16 percent in the richest group.

The rate of wasting -- an indicator of severe short-term undernutrition -- stands at 15 percent in the poorest households against 10 percent in the richest group.

The disparity is also evident in education, as only 21 percent of children from poor families complete upper secondary schooling, compared to 66 percent in well-off households. The picture is almost the same for primary education.

OTHER KEY INDICATORS

One of the major findings of the study is the rise in the total fertility rate (TFR) to 2.4 after decades of decline.

The TFR is 2.8 among the poorest population, compared to 2.2 among the richest group, the study shows.

The rate is 2.7 among women with only primary education, dropping to 2.1 among those with higher education.

Mymensingh has the highest TFR at 2.8. In 2022, the division also recorded the lowest literacy rate -- 67.09 percent, according to the Population and Housing Census.

The adolescent birth rate is 120 per 1,000 women among the poorest households, compared to 61 per 1,000 in the richest group.

The rate is 155 per 1,000 among adolescents with lower secondary education, falling to 20 per 1,000 among women with higher education.

"… it suggests that increased access to education could be a decisive factor in reducing adolescent fertility and thus ensuring the well-being of adolescents," reads the survey's preliminary report.

Poverty and education are key drivers of disparities in terms of child marriage, which has declined slightly but remains widespread, with 47 percent of women married before the age of 18.

The rate is as high as 69 percent among women with no schooling or only pre-primary education, compared to just 13 percent among those in the richest group.

Similarly, 65 percent of womenin the poorest households were married before 18, against 42 percent in the richest ones.

2 DIFFERENT INDICATORS

According to the study, 68 percent of women in wealthier households give birth through caesarean section, compared to 34 percent among poorer women.

Similarly, the C-section rate is 75 percent among women with higher education, falling to 20 percent among those with no schooling.

The rate of early initiation of breastfeeding is 38 percent among the poorest women against 24 percent among those in the richest households.

Similarly, the rate is 35 percent among women with primary education, compared to 26 percent among those with higher education.