The Demographic Transition and its

Challenges

Dr A H Md Moinul Ahsan

Student, MPH in NCD

Department of Noncommunicable Diseases (NCD)

Bangladesh University of Health Sciences (BUHS)

Topics to be discussed:

• the basic concept of Demographic transition

• the stages of demographic transition

• Factors acting behind transition

• Demographic Transition of Bangladesh

• Challenges and solution

• Health Transition

Demographic and epidemiologic changes that

have occurred in the last five decades in many

developing countries and that are

characterized by major growth in the number

and proportion of middle-aged and elderly

persons and in the frequency of the diseases

that occur in these age groups. The health

transition is the result of efforts

to improve maternal and child health via primary

care and outreach services and such efforts have

been responsible for a decrease in the birth rate;

reduced maternal mortality; improved preventive

services; reduced infant mortality, and the

increased life expectancy that defines the

transition. (From Ann Intern Med 1992 Mar

15;116(6):499-504)

Introduction

Demographic Transition Model (DTM)

Represents a nation’s transition through

industrialization

Commonly involves 4 stages

An idealized picture of population change in a

country

Stage 1: Pre-Industrial Period

Crude Birth Rate: High

Crude Death Rate: High

Rate of Natural Increase: Fluctuating

Examples: Britain in the 17th and 18th century;

some remote Amazon tribes

Stage 1: Birth Rate

Birth Rate is high due to:

Lack of family planning

High Infant Mortality Rate

Need for workers in agriculture

Religious beliefs

Children as economic assets

Lack of future planning about heath sector

Stage 1: Death Rate

Death Rate is high due to:

Disease

Famine

Lack of clean water and sanitation

Lack of health care

War

Limited food supply

Lack of education

Stage 1: Population Change

Population Change

Due to high birth and death rates,

population is stable

Population Growth Rate:

≤ 1%

Doubling Time: ~100 years

Stage 1: Age Structure

Population Pyramid Shape: Concave triangular

Age Structure of Population:

Rapid fall in each age group due to high death rates

Short life expectancy

10 8 6 4 2 0 2 4 6 8 10

0-4

5-9

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+

Percent (%)

Age Class % Females

% Males

Stage 2: Transitional Period

Crude Birth Rate: High

Crude Death Rate: Decreasing

Rate of Natural Increase: Increasing

Examples: Britain late 18th Century to mid-19th

Century, Kenya

Stage 2: Birth Rate

Birth Rate remains high due to:

Total Fertility Rate (TFR): 4.56

People are used to having many children.

Takes time for culture to change

Religious beliefs

Lack of family plaaning.

Stage 2: Death Rate

Death Rate decreasing due to:

Improved hygiene

Improve health care system

Improved sanitation

Improved food production and storage

Improved transport for food

Stage 2: Age Structure

Population Pyramid Shape: Triangular

Age structure of Population:

Growing young dependant population

Increasingly youthful age structure

Accelerating population growth

8 6 4 2 0 2 4 6 8

0-45-9

10-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-84

85+

Percent (%)

Age Class % Females

% Males

Stage 3: Industrial Period

Crude Birth Rate: Decreasing

Crude Death Rate: Continues to decrease

Rate of Natural Increase: Increasing but at a

slower rate

Examples: Present Bangladesh. Britain

early 20th century; Brazil; Mexico

Stage 3: Birth Rate

Birth Rate decreasing due to:

TFR: 2.05

Improve maternal and child health

Improvements in contraceptive technology

Changes in values about children and sex

Parents need fewer children

Rising costs of dependent children to a family

Valuation of women beyond motherhood

Working women have less time to devote to child

rearing

Stage 3: Death Rate

Death Rate low due to:

Better Health Care

Vaccinations

Better understanding of the spread of

diseases

Pre-natal care

Control of communicable diseases.

Improved sanitation (i.e. indoor plumbing)

Improved quality and quantity of food

Stage 3: Age Structure

Population Pyramid Shape: Columnar

Age structure of Population:

Decreasing TFR

Bulge in the reproductive cohorts

Narrowing pyramid base

5 4 3 2 1 0 1 2 3 4 5

0-45-9

10-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-84

85+

Percent (%)

Age Class % Females

% Males

Stage 4: Post-Industrial Period

Crude Birth Rate: Low

Crude Death Rate: Low

Rate of Natural Increase: Stable

Examples: Britain late-20th century; Sweden; Japan

Stage 4: Birth Rate

Birth Rate low due to:

TFR: 2.1

Family planning

Good health

Improved status of

women

Later marriages

Stage 4: Death Rate

Death Rate low due to:

Improved health care

High quantity and quality of food supply

Stage 4: Age Structure

Population Pyramid Shape: Inverted

Age structure of Population:

Characterized by stability

Age structure becomes older

5 4 3 2 1 0 1 2 3 4 5

0-45-9

10-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-84

85+

Percent (%)

Age Class % Females

% Males

A Fifth Stage?

The original Demographic Transition Model has just four stages;

however in some cases the fertility rate falls well below replacement

level and population decline sets in rapidly. It is theorized that a fifth

stage is necessary to account for this demographic stage.

02468

1012141618202224

CBR CDR Population

Example: Romania, Italy

CBR: 10.53

CDR: 11.88

TFR: 1.39

Population Growth : -0.147%

What are the stages

Demographic Transition of Bangladesh

• Population trends in Bangladesh show that

Bangladesh is well into third phase of demographic

transition, having shifted from a high mortality-high

fertility regime to a low mortality-low fertility one

Graphical presentation of demographic

transition of Bangladesh

Challenges Bangladesh will to face

1.Proper education for the growing number of

children and young generation

2.Adequate and specialized health service for the

communicable disease and increase number of

NCD

3.Huge nutritional production for active workforce.

3.Improve geriatric health system for ageing people

4.Providing inequality in all sector

5.Suitable cheap, low area consuming housing for

middle class people

6.Control social and political unrest

7.Improve the status of women

8.To reduce the rate of unemployment

Our country is facing the crude reality of

demographic transition along with the whole

world. We have no way to avoid these changes.

But still we are not ready locally , nationally ,

logistically and structurally. To get maximum

benefit and avoid negative impact of

demographic transition we must prepare

ourselves.

Thank You all