Why is Bangladesh an Exemplar?

Bangladesh, the eighth most populous country on Earth and one of the most densely populated, is a leading exemplar in reducing child mortality.

Key Points 

The reduction in U5M appeared across all income categories and geographic regions. In 1993, the U5M rate among the wealthiest quintile was 97 deaths per 1,000 live births; for the poorest quintile it was almost twice as high, at 184 – a 47 percent difference.² By 2014, both rates had plunged, and the gap between them had narrowed. For the wealthiest quintile, the U5M rate was 37, which was 40 percent lower than the poorest quintile at 62.³ U5M declined across all regions, but the northwest, northeast, and southeast corners of the country still lagged behind the rest of the country.⁴

Modeling from IHME found that the three main causes of death among children under five in Bangladesh between 2000 and 2017 were neonatal disorders, lower respiratory infections, and diarrheal diseases.¹ Reductions in these three causes of death made up 68 percent of the reduction in all-cause mortality between 2000 and 2015.¹

For neonates – newborns in the first 28 days of life – IHME estimated that Bangladesh’s neonatal mortality rate (NMR) was 42 deaths per 1,000 live births in 2000, declining to 23 in 2015, a 45 percent drop.¹

As in the case of U5M generally, the decline in neonatal mortality occurred across income levels, with the wealthiest quintile making the most progress. The NMR rate among the wealthiest quintile declined from 42 deaths per 1,000 live births in 1993 to 20 in 2014, a 52 percent reduction.

For the poorest quintile, NMR declined from 69 to 41 during the same period, for a more modest decline of 41 percent. Geographically, NMR mirrored overall U5M, with reductions across all regions but slower progress in the northwest, northeast, and southeast.^1,3  

Among neonates, the majority of deaths were attributable to three causes: neonatal encephalopathy due to birth asphyxia, neonatal preterm births, and lower respiratory infections.¹

Compared with other U5M exemplar countries, Bangladesh had a persistently high proportion of NMR attributable to birth asphyxia. This may be related to lower coverage of skilled birth attendants at delivery.

Bangladesh’s progress in reducing U5M and NMR outpaced its South Asian neighbors, including those with a roughly comparable gross domestic product (GDP) per capita, such as India, Pakistan, and Myanmar.⁵

Bangladesh’s achievements in reducing U5M and NMR have many causes, but in this report we identify five key themes that run throughout this story of adaptation and progress:

• High levels of collaboration between the national government and nongovernmental organizations (NGOs), including a well-developed NGO sector in-country that played a critical role in research and implementation.
• Emphasis on community-level interventions, carried out by a large, diverse, and highly empowered cadre of community health workers (CHWs).
• Consistent use of data, research, and testing in the implementation of evidence-based interventions, and a willingness to adapt those interventions in response to new findings.
• A focus on equity in the implementation of U5M interventions – as seen in the provision of low-cost treatments and in the decision to begin phased rollouts of certain major programs in the highest-need areas of the country.
• Strong commitment to addressing a range of contextual factors that influence U5M, especially through initiatives to empower women and improve womens' reproductive health. These contributed to meaningful advances in women’s and children’s health in a society where women still face significant limitations and disadvantages.