Debapriya Bhattacharya, Towfiqul Islam Khan, Fabiha Bushra Khan and Faria Tahmeen Momo |
Jan. 10, 2022, 9:03 p.m.
Bangladesh has made tremendous progress in food security and nutrition, maternal and child mortality rates, and other socio-economic indicators over the past decades. However, the Covid-19 pandemic has not only ravaged the economy in Bangladesh, but has also resulted in indirect and long-term health problems manifested in starvation, malnutrition, risks to maternal and child health. . These threaten to alter the progress of the associated socio-economic indicators.
The “left behind” and “pushed back” populations (LNOB and PNOB) were particularly vulnerable to recent realities. Given pre-existing economic and health inequalities as well as the unpleasant coping mechanisms of vulnerable groups to the multidimensional challenges of the pandemic, the scale and intensity of these societal repercussions have multiplied by several. A February 2021 survey of around 1,600 households from nine marginalized groups (LNOB and PNOB) illustrates the issues involved.
COVID-19 VACCINATION AND FALLS: The government of Bangladesh launched the nationwide immunization program on January 27, 2021, with the intention of immunizing 80% of the total adult population. The vaccines were to be distributed mainly through tertiary health centers in metropolitan cities, district hospitals and upazila health complexes. Nevertheless, various publications and various sources indicate generalized disparities linked to the vaccination against Covid-19.
Due to low levels of digital literacy, marginalized communities have had difficulty registering for immunization. A dearth of information on immunization was widespread in the communities. In addition, vaccine distribution and administration was insufficient to ensure uniform coverage at the local level. The minimum age of eligibility for vaccinations could not be reduced to 18 years in the initial stages due to the limited availability of vaccines and various pre-existing institutional challenges. In addition, during the first phase of vaccine deployment, potential migrant workers faced significant obstacles in obtaining the necessary vaccines. A number of marginalized communities were not fully immunized with the required vaccine doses. The transgender community has not been included in mass vaccination programs and has been subjected to harassment in the centers.
CHANGES IN NUTRITIONAL SUPPLY: Income losses resulting from the adverse economic shocks induced by the pandemic have manifested themselves in a drop in food consumption and a decrease in the quality of the diet. Larger marginalized households responded by limiting food intake. Almost 90 percent of households who lost their jobs reported a decline in their food consumption. The corresponding figure for families who have not suffered a job loss is also relatively high at almost 78 percent.
Marginalized households have adjusted their eating habits by reducing their consumption of high protein food sources. A significant reduction has taken place in non-food and food expenditure as well as in loan repayments. Savings withdrawals and asset liquidations were widespread. The higher cost of maintaining urban living in the face of loss of income has increased the risk of unsafe adjustment of nutritional intake.
Among the LNOBs, people living in char areas, people with disabilities (PWD) and slum dwellers had the highest number of households that had lost their jobs and reduced their food consumption. Micro, small and medium-sized enterprises (MSMEs) households, on the other hand, accounted for the lion’s share of the “new poor”.
BARRIERS TO MATERNAL AND CHILD CARE: Non-institutional deliveries have increased during the pandemic. About half of all pregnant women in disadvantaged communities opted for a home birth, which was above the national average of 47% in 2019. About 61% of rural women and 43% of urban women gave birth at home. During the pre-pandemic period, rural home births accounted for 51% of births nationwide, while urban home births accounted for 32%.
In general, a greater proportion of LNOB women than PNOBs were forced to give birth at home during the pandemic. In rural (65 percent) and urban (48 percent) areas, LNOB households had a higher rate of home births. About 64 percent of Indigenous women gave birth at home, which was the highest among LNOB groups. However, a reverse trend was observed for migrant households where around 67 percent of rural women and 75 percent of urban women opted for institutional delivery.
The pandemic has also created a marked disparity in access to prenatal and postnatal maternal care. Half of rural slum households did not attend all of their antenatal care appointments. The frequency was also high among households headed by people with disabilities (34 percent) and migrants (34 percent). In addition, the skip rate for all postnatal care visits was extremely high among rural Dalit households (67%), followed by rural slum households (33%).
Data from the survey on the vaccination rate of children during Covid-19 shows a similar pattern of inequity. LNOB households missed childhood immunizations at a higher rate than PNOB households in both rural and urban areas. The proportions were higher among households headed by Dalits and people with disabilities, with missed vaccination rates of 20 percent and 19 percent, respectively. It should be noted that with the exception of Dalit and indigenous households, none of the communities in the metropolitan areas missed the required child immunization.
LESSONS AND THE WAY FORWARD: Immunization rates of the vulnerable population, especially those living in remote locations, are well below the national average. Pursuing a targeted approach to identify, sensitize and immunize marginalized communities can help alleviate immunization deficits. Social campaigns at the local level can help provide the general population with the necessary information about vaccination against Covid-19. Simultaneously providing appropriate digital assistance to people without digital literacy and streamlining registration processes can also help increase participation rates among vulnerable groups. The establishment of dedicated Covid-19 vaccine distribution centers or camps in hard-to-reach communities should be considered. Involving nongovernmental organizations (NGOs) in the immunization process can help expand immunization coverage in marginalized communities.
Nutritional intake has declined dramatically for a disproportionately large portion of marginalized households, regardless of job loss status during the pandemic. Direct financial transfers and food aid to the most marginalized demographic groups, namely chars, people with disabilities, slums and MSME households, can help improve the situation.
Increased funding for public maternal health centers can make institutional deliveries available free of charge to low-income populations. Involving NGOs and community workers in educating target groups about the availability of free deliveries will further promote institutional deliveries.
Since LNOB communities, especially Dalit and disabled households, are more likely to miss childhood immunizations, authorities need to devote more effort to include all segments of diverse LNOB communities. Updating the existing database and strengthening the partnership between government and non-government organizations can identify a way to reduce gaps in immunization programs and other measures addressing health-related impacts.
Debapriya Bhattacharya, Distinguished Fellow, Center for Policy Dialogue (CPD); Towfiqul Islam Khan, Principal Investigator, CPD;
Fabiha Bushra Khan, Research Associate (Project), DPC; Faria Tahmeen Momo, Former Research Associate, CPD. [email protected]