Context

Demographic characteristics

The predominant religion of Bangladesh is Islam, with 90% of the population identifying as Muslim and approximately 8% as Hindu. The vast majority of Bangladeshis are ethnically Bengali, although increasing numbers of Rohingya refugees from Myanmar are settled in the southeast. The official language of Bangladesh is Bengali, which is spoken nearly universally in the country and is used for all government affairs.

The population of Bangladesh has aged in recent decades, with children under 15 constituting 26.8% of the population in 2020, compared with 37.0% in 2000.¹ This is largely driven by increases in life expectancy (58.2 in 1990 and 72.6 in 2019) and decreases in total fertility rate (4.5 in 1990 and 2.0 in 2019).

Subnational Variation

Bangladesh is divided into eight administrative divisions, each of which is described below.

• Barisal. The least populous of the divisions, Barisal occupies the middle of Bangladesh’s lengthy Bay of Bengal coastline. It is known historically as “the granary of Bengal” due to its rice production. It has the second-highest literacy level of any division, behind neighboring Dhaka.
• Chittagong. Geographically the largest of the divisions, Chittagong comprises the entire southeast area of the nation. It includes the port city of Chittagong (officially now Chattogram)—the nation’s second-largest metro area and the tourist center of Cox’s Bazar.
• Dhaka. With a metropolitan population of over 21 million in 2020, Dhaka is one of the largest urban centers in the world and the political, economic, and cultural capital of Bangladesh.² The division in which the city is located dominates the geographic center of the country, bordering all other divisions except Rangpur.
• Khulna. Khulna is home to the nation’s third-largest city, from which the division takes its name. In addition, this division is a center of substantial industrial and naval activity. It also includes the world’s largest mangrove forest.
• Mymensingh. This division was created in 2015 as a carve-out from Dhaka. The city of Mymensingh, only 120 kilometers (75 miles) north of the national capital, is a considerable economic and educational center in its own right.
• Rajshahi. The city of Rajshahi and its environs have a combined population of about 1 million. Otherwise, the division’s economy is marked by its reliance on agriculture, particularly fruit production.
• Rangpur. This division, the northernmost in Bangladesh, was formed in 2010 from districts/zilas formerly belonging to Rajshahi. The city of Rangpur is at the center of a medium-sized metropolitan area; the rest of the division includes some economically important agricultural areas.
• Sylhet. The nation’s northeastern division, Sylhet is heavily reliant upon agriculture (particularly tea and fruit) and tourism. A high proportion of Great Britain’s sizable Bangladeshi immigrant community comes from this division.

Household infrastructure

Economic progress and urbanization have translated to improved infrastructure at the household level. Interview respondents echoed these findings, as described:

The percentage of households with access to an improved water source has been high for decades, and access to improved sanitation facilities rose substantially from 25.0% in 1993 to 65.3% by 2018.³ Household access to digital infrastructure also improved, with a steady increase in electricity access from 17.8% in 1994 to 81.5% in 2018.³ Similarly, the percentage of homes that owned mobile phones rapidly grew, from 31.7% in 2007 to 94.4% by 2018.³

Women’s empowerment

In recent decades, women have become more educated, tended to marry later, and have become more active in the country’s workforce. This has dramatic implications for health, as described by one interviewee:

The percentage of women with secondary education or higher increased from 15.0% in 1993 to 52.2% by 2018.³ The literacy rate among women similarly improved from 54.5% in 2007 to 73.3% in 2018.³ As they increasingly attended school, the percentage of girls who married before age 15 decreased from 64.1% in 1993 to 34.4% by 2018.³ Women also make up a growing portion of the workforce in Bangladesh, with 47.7% of women employed in 2018 compared with 22.5% in 2004.³

Other public health challenges

Bangladesh has not experienced particularly severe malaria or HIV epidemics in comparison with peer countries, as malaria incidence fell to 0.4 cases per 1,000 people at risk in 2020 and HIV prevalence among adults has remained near 0.1% for several years.^4,5 Nutrition is one key area in which Bangladesh has higher prevalence rates than many peer countries—as 37% of women of reproductive age were estimated to have anemia and 29% of children under five were estimated to experience stunting in 2019.^6,7 Nutritional trends could be exacerbated by flooding related to climate change in vulnerable lowland areas.

Development assistance for health

Bangladesh has been successful in attracting funds specifically directed at child health, maternal and newborn health, and reproductive health. Development funding in each of these three areas doubled from 2002 to 2017. Bangladesh’s health care system has proven highly capable at channeling funding from multiple sources into a variety of service delivery platforms, through the world’s oldest and largest sector-wide approach for health. As of 2012, maternal and newborn health programming constituted 7.5% of total health expenditures, with 69% of maternal and newborn health funds directed toward general hospitals.⁸ A high proportion of these funds have been allocated for preventive and primary care as opposed to more expensive curative care—leading to a conclusion in a 2019 World Bank report that although “the government has spent comparatively little, it has spent it comparatively well.”⁸