Simeen Mahmud

Harnessing pluralism for better health in Bangladesh.

How do we explain the paradox that Bangladesh has made remarkable progress in health and human development, yet its achievements have taken place within a health system that is frequently characterised as weak, in terms of inadequate physical and human infrastructure and logistics, and low performing? We argue that the development of a highly pluralistic health system environment, defined by the participation of a multiplicity of different stakeholders and agents and by ad hoc, diffused forms of management has contributed to these outcomes by creating conditions for rapid change. We use a combination of data from official sources, research studies, case studies of specific innovations, and in-depth knowledge from our own long-term engagement with health sector issues in Bangladesh to lay out a conceptual framework for understanding pluralism and its outcomes. Although we argue that pluralism has had positive effects in terms of stimulating change and innovation, we also note its association with poor health systems governance and regulation, resulting in endemic problems such as overuse and misuse of drugs. Pluralism therefore requires active management that acknowledges and works with its polycentric nature. We identify four key areas where this management is needed: participatory governance, accountability and regulation, information systems, and capacity development. This approach challenges some mainstream frameworks for managing health systems, such as the building blocks approach of the WHO Health Systems Framework. However, as pluralism increasingly defines the nature and the challenge of 21st century health systems, the experience of Bangladesh is relevant to many countries across the world.

Diverging Stories of “Missing Women” in South Asia: Is Son Preference Weakening in Bangladesh?

ABSTRACT South Asia is a region characterized by a culture of son preference, severe discrimination against daughters, and excess levels of female mortality, leading to what Amartya Sen called the phenomenon of “missing women.” However, the onset of fertility decline across the region has been accompanied by considerable divergence in this phenomenon. In India, improvements in overall life expectancy have closed the gender gap in mortality rates among adults, but persisting gender discrimination among children and increasing resort to female-selective abortion has led to growing imbalance in child sex ratios and sex ratios at birth. In Bangladesh, by contrast, fertility decline has been accompanied by a closing of the gender gap in mortality in all age groups. Using quantitative and qualitative data, this study explores changing attitudes toward sons and daughters in Bangladesh to explain why the phenomenon of “missing women” has played out so differently in these two neighboring countries.

Development, welfare and governance: Explaining Bangladesh’s ‘development surprise’

This book chapter was published in Development and Welfare Policy in South Asia [ ©2014 Taylor and Francis ] and the definite version is available at: http://doi.org/10.4324/9780203386255 The book website is at: http://www.tandfebooks.com/isbn/9780203386255

The contested relationship between paid work and women’s empowerment: empirical analysis from Bangladesh

The debate about the empowerment potential of women’s access to labour market opportunities is a long-standing one but it has taken on fresh lease of life with the increased feminization of paid work in the context of economic liberalization. Contradictory viewpoints reflect differences in how empowerment itself is understood as well as variations in the cultural meanings and social acceptability of different kinds of paid work. Research on this issue in the Bangladesh context has not been able to address these questions because it tends to use very restricted definitions of work and narrow conceptualizations of empowerment. This paper uses a combination of quantitative and qualitative data from Bangladesh to explore this debate, distinguishing between different categories of work and using measures of women’s empowerment which have been explicitly designed to capture the specificities of local patriarchal constraints.Le débat sur le potentiel d’autonomisation de l’accès des femmes aux opportunités du marché du travail est ancien, mais il connaît un regain de vie grâce à la féminisation croissante du travail rémunéré dans le contexte de la libéralisation économique et grâce à l’intérêt croissant de la communauté de l’aide au développement international. Les points de vue contradictoires reflètent des différences dans la façon dont l’autonomisation elle-même est comprise ainsi que des variations dans les significations culturelles et l’acceptabilité sociale des différents types de travail rémunéré. La recherche sur cette question dans le contexte du Bangladesh n’a pas permis de régler ces questions, car les définitions du travail ont tendance à être très restrictives et les concepts de l’autonomisation, très étriqués. Cet article utilise une combinaison de données quantitatives et qualitatives du Bangladesh pour explorer ce débat en distinguant différentes catégories de travail et en utilisant des indicateurs d’autonomisation des femmes qui ont été explicitement conçus pour saisir les spécificités des contraintes patriarcales locales.

Cultural norms, economic incentives and women's labour market behaviour: Empirical insights from Bangladesh

Abstract This paper sets out to explore a seeming puzzle in the context of Bangladesh. There is a considerable body of evidence from the country pointing to the positive impact of paid work on women’s position within family and community. Yet, according to official statistics, not only has women’s labour force participation risen very slowly over the years, but also a sizeable majority of women in the labour force are in unpaid family labour. We draw on an original survey of over 5000 women from eight different districts in Bangladesh to explore some of the factors that lead to women’s selection into the labour force, and into different categories of labour market activity, with a view to gaining a better understanding of the combination of cultural norms and economic considerations that explain these findings.

Female Labor Market Participation in Bangladesh: Structural Changes and Determinants of Labor Supply

Bangladesh has experienced moderately sustained economic growth (annual GDP growth of 6–7%) over the past two decades, as well as a fairly rapid demographic transition that began earlier, leading to sustained and steep declines in fertility levels and mortality rates. An accompanying feature of these socioeconomic trends has been the rising participation of women in the labor market, with the female labor force participation expanding from around 8% in the mid-1980s to 30% in 2010. While rising female labor force participation in Bangladesh denotes progress for women in a relatively conservative society, and has significant implications for economic growth and poverty alleviation of the country, there remain critical aspects that need examination. First, women’s workforce participation is still very low compared to men’s, despite the fact that women attach value to having their own independent incomes. Moreover, compared to men, women remain locked into fewer sectors and types of activities that offer fewer hours of employment and lower remuneration. Often, women have little choice but to contribute as unpaid labor to the family enterprise. Second, and related to the first, is that increase in formal school enrolment, better health, lower burden of childbearing (more time) are not translating into secure full-time employment, indicating that expansion in participation is supply driven rather than demand driven. Hence, female labor market participation and its dimensions deserve an in-depth analysis from both an academic point of view and also from a policy perspective. In this paper, we attempt to examine the change over time in the nature of the female workforce and to identify factors affecting the labor supply decision of women in Bangladesh using Labor Force Survey data of several rounds (2005 and 2010 in particular) conducted by the Bangladesh Bureau of Statistics.

Bangladesh: The Limits of a Developmental Welfare State under Governance Dysfunction

Bangladesh portrays the image of a developmental welfare state, as reflected in the country’s Constitution and in numerous official policy documents including the successive Five-Year Plans. The implementation of the policies and programmes, however, has to contend with a serious problem of governance dysfunction, as the country is rated very poorly according to most global indicators of political and economic governance. Yet, somewhat paradoxically, the state appears to deliver on many of the welfare promises, as witnessed in the remarkable achievements in human development indicators and reduction in poverty levels taking place during the last two decades or so. In this paper, we try to explain this paradox in respect of the effectiveness of welfare-oriented policies like ensuring food security and provisioning of public services and social protection. In doing so, we look at the underlying political incentives and accountability mechanisms, while pointing to the limits of further progress under governance constraints. The paper does not, however, deal with the broader question of how governance impacts on the welfare of the poor through the mediation of the links between governance and the overall economic performance of the country.