deaths in bangladesh during 1971 war

8/10/2019 Deaths in Bangladesh during 1971 War

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Demographic Crisis:The Impact of the Bangladesh Civil War (1971)

on Births and Deaths in a Rural Area ofBangladesh

G E O R G E T. C U R L I N , L I N C O L N C . C H E N A N D S AY E D B A B U RH U S S A I N

Prior to the demographic transition in the now industrialized w orld, short-term fluctuationbirths and deaths due to disasters - famine, epidemic, w ar- w ere common events.^ In

because of the introduction of new technologies in agriculture and public health, industrialsocieties today are characterized by stable food supplies and adequate containment of demics. But, these advantages of modernization are not shared by the rapidly growing poptions of low-income countries. Over the past decade, there have been no less than ten mdisasters in these regions in the world as a w hole. In addition, the world-wide drought in 19marked the beginning of unprecedented international food scarcity.^ In that year, world fproduction declined for the first time in two decades; foodgrain prices escalated and freserves became depleted. Hardest hit have been less developed countries with rapid populagrowth and a chronic deficit of food. The possibility of Malthusian tragedies is a grim but prospect in the years ahead.

This paper presents the findings of an investigation in to the impact of one recent crisis, 1971 Bangladesh Civil War, on births and deaths in a population of approximately 120,00rural Bangladesh. Data for the analysis come from a longitudinal vital registration sysmaintained by the Cholera Research Laboratory (CRL) in Matlab Bazar thana (countyBangladesh.* Baseline trends of vital events for the years 1966-67 to 1970-71 are presenShort-term fluctuations in births and deaths during the disturbances of 1971-72 and in the subsequent years are analysed, and selected fertility and mortality rates are computeddocument the differential impact of the conflict on the population.

There are several reasons why research on the demographic consequences of disastersof interest First, mortality is considered to be one of the most sensitive and reliable measuof the extent and magnitude of a crisis. Famine, for example, has been defined as widesprfood shortage accompanied by an increase of deaths, and the death rate is considered as of the best indicators of the severity of famine. Secondly, studies of mortality differenfacilitate identification of sub-groups in a population which are at high risk to the imof a disaster. Information on mortality differentials, therefore, has obvious relevance preventive and remedial p rogrammes. Thirdly, short-term fluctuations in births and deaths hlonger-range demographic consequences, particularly on the age-sex composition of poptions. Accurate assessment of short-term changes in vital rates, therefore, may assist

^ E. A . W rigley, Population and History, Weidenfeld Nicolson, Lon don , 1969, pp. 62-76 .


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8 8 G . T. CU RL IN , L . C . CH EN A N D S . B . H U S SA IN

demographic analyses of population growth rates, population projections, and developlanning. Finally, investigations on the demographic characteristics of contemporary dismay offer insights to historical demographers in their study of pre-industrial populaBefore the demographic transition, short-term fluctuations in vital rates, particularly rates, were the rule rather than the exception. There is a paucity of detailed information r

ing these historical processes, and studies of modern phenomena may provide clues past.

T H E B A N G L A D E S H C I V I L WA R O F 1 9 7 1

At the pa rtition of British Ind ia in 1947, Bangladesh, then East Pakistan , joined West Paka region fiv imes its size bu t with a smaller population , to form the Islamic nation of PakDuring 24 years of union , the two wings of Pakistan enjoyed an uneasy partnership m arintermittent regional economic, political, and cultural conflict. Tension reached its heigh

the national elections of December, 1970 when one party from East Pakistan won an abmajority of seats in the National Assembly which had been apportioned on a population The m ilitary government, controlled by the W est wing, however, refused to convenNational Assembly, and in March 1971 tension escalated into a civil war.

March 1971, therefore, marked the beginning of the Bangladesh Civil War. In the par t of tha t month, the urban workers in Bangladesh went on strike, many returning tvillage homes. On 25 March, armed conflict between the Pakistan army and Bengali civerupted. Over the next nine months, a conventional army attempted to subdue a rebecivilian population. The conflict was not static. Initially the army held strategic positio

urban and transport centres and made periodic expeditions into the countryside. By June-Juhowever, a guerilla insurgency had developed and armed clashes in the countryside becommon.

These hostilities had a num ber of serious consequences. The fragile Bangladesh ecoground to a standstill; transport and communication facilities were paralysed; and, important, the supply of foodgrain was seriously compromised. Agricultural productiosharply because of dislocation of supplies and services. Food marketing was disturbedfood imports, representing about 15 per cent of normal foodgrain consumption, were deand could not be transported or distributed in the countryside.^ Bangladesh was threa

with a major famine.The severity of the food shortage was reflected by estimates of foodgrain (rice and w

availabilities. These staples constituted about 85 per cent of the calorie content of an avBengali diet.^ In the 1960s, cereal consumption averaged about 15 ounces per head During 1971, consumption probably fell to a near starvation level of twelve ounces The severof the shortage was substantiated by a nationwide nutrition survey conducted in May which showed that the proportion of severely malnourished children had nearly doduring the war year.^ M alnutrition was most acute in the autumn months, just before thrice harvest. Only the brevity of the conflict and the reduction in consumption followi

exodus of about 16 per cent of the population to India, prevented widespread famine.The conflict also precipitated one of the largest short-term international migratio


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B I RT H S A N D D E AT H S I N T HE B A N G L A D E S H C I V IL WA R 9

the religious minority in Bangladesh. The daily influx into India averaged 36,000 and dthe single month of May, there were nearly three million arrivals. The Indian governmentable to place most refugees in camps scattered along the India-Bangladesh border. Rpro gra m m es w ere instituted to shelter, clothe and feed the refugees, and w hile relief efforts massive, conditions in the camps were appalling by any standard.

The conflict eventually engulfed India as well, and on 16 December the Pakistani surrendered to a joint India-Bang ladesh com man d. R ecovery in Bangladesh was no t imm eA new government was formed, but the industrial base and the transport and com mu nicinfrastructure h ad been destroyed. By the end of Feb ruary 1972, nearly all refugees ha d retuto their Bangladesh homes, requiring large-scale resettlement assistance. Over the next seyears, Bangladesh embarked on a massive rehabilitation effort with international assista

THE STUDY AREA

Matlab Bazar thana is an administrative unit in central Bangladesh. The area is situated fiat deltaic plain intersected by numerous rivers and canals, and is characterized by which tends to be deeply flooded during the monsoon season. Only recently has a dry-weroad been opened, linking the region with the district headquarters at Comilla. The climasub-tropical with three seasons: the mo nsoon June-S eptem ber), the cool-dry O ctoFebrua ry), and the hot-dry M arch -M ay). Agriculture is the dom inant economic activityfishing is the second most common occupation. There are three harvests annually; the amancrop, yielding over half the annual rice production in November and December, and smcrops are harvested at the end of the boro M arch-Apri l ) and aus Jun e-July ) seasons.

The population density exceeds 2,000 people per square mile, making Matlab Bazarof the mo st densely settled rura l regions in the wo rld. Villages average a bo ut 1,000 peop le lin separate housing compounds called baris which usually consist of patrilineally-relaresidents. A family on average consists of about six persons, who usually live in a one- or room hut with mud floors, jute stick walls, and thatch grass or galvanized iron roofingpeople in Matlab Bazar thana are nearly all indigenous Beng alis; abo ut 85 per cent are Mu sand 15 per cent are H indu s, reflecting the religious com position of the na tion as a who l

The war in Matlab Bazar followed the chronology of the national conflict. DuringMarch 1971 disturbances, many labourers returned to their village homes in Matlab BThe army made its first appearance in the area in April with an expedition to Chandpu

inland port ab ou t 13 miles south of M atlab Bazar. In June, the thana headqua rters were raidby the army, and in July the army instituted periodic counter-insurgency operations inarea. This precipitated o ut-migrations from the thana. As the confiict progressed, the insurgegrew in strength and the intensity of the hostilities increased. By November, insurgents trolled the entire thana. As with the rest of Bangladesh, independence marked the returnmany refugees to Matlab and the beginning of a difficult period of rehabilitation.

D T C O LL E CT I ON N D M E T H O D S

The CRL began a field research programme in Matlab Bazar thana in 1963, with the basaim of field-testing cholera vaccines. A small diarrhoea treatment unit was established i


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90 G. T. CU RL IN L . C . CHEN AND S. B . HUSSAIN

system in 1968, this study confines itself to the 1966 census population to permit a observation period for baseline trends.

Vital registration is conducted by several tiers of trained fieldworkers. In each villalocal female (often illiterate) resident visits each household daily to inquire about births, and migrations. A high-school educated male field assistant, who supervises three tfemale fieldworkers, visits each family weekly. He records all vital events on standard regtion forms. Male fieldworkers are supervised in turn by male sanitary inspectors whoeach household twice a month to check on the completeness and accuracy of registrationentire field staff is supervised by the field surveillance supervisor and his deputy whresponsible for the co-ordination of the fieldwork.

From 1966-67 to 1970-71 the registration system was believed to be reasonably comHow ever, the system suffered setbacks during the 1971 war. The speedboats were withdraApril, and in July the treatment unit was closed temporarily. In response to an unussevere cholera epidemic the unit was re-opened in September and remained active, alth

below complement, until the situation returned to normal in January 1972. In the field, male field assistants failed to make regular visits to households during the conflict. Somemembers temporarily moved away, and supervision at the sanitary inspection level was dic. Most female fieldworkers, however, stayed in their villages and continued to recordevents (with the assistance of village literates).

After the cessation of hostilities, the C RL launched a drive to correct the defective retion system. In July 1972, a new census was taken in 45 villages to estimate the errors had accrued in the vital events registration system during the disruption. This survey dstrated underregistration during 1971 as follows: births 2-7 per cent; deaths 4-9 per cen

migration 17-7 per cent; and out-migration 32-4 per cent. The major defects appeared migration data, and another drive was instituted to catch up on missed events. By July supervisors were of the view that any future efforts to register omitted events would fruitless.

The study population included only regular residents of the Matlab Bazar surveiarea. V isitors, guests and residents who lived elsewhere bu t who returned hom e less than month were excluded from the base population. Only births, deaths, and migrations occurred to regular residents were recorded, irrespective of the place of occurrence. The caledar year of registration ran from May to 30 April of the subsequent year, and the mid-

population estimate related to

November. All population estimates were based on the 1Census and subsequent v ital registration. The study year from 1 May 1971 to 30 Aprialmost coincided with the war and for the purposes of this analysis, 1971-72 was considerethe war year.

RESULTS

Fluctuations in rude ates

Table presents a summary of the vital rates in Matlab Bazar thana for eight complete y

from May 1966 to 30 April 1974.^ Over the five base years (1966-67 to 1970-71) thebirth rate averaged 45-0. During the year of the conflict (1971-72) there was no deteh i h bi h A ll b i ifi d li f h 41 8 (


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IRTHS AND DEATHS IN THE BANGLADESH CIVIL WAR

lower than the base level) was recorded in the year following the disturbance. By 1973-7birth rate h ad recovered fully; tha t ye ar s level, in fact, exceeded tho se of the four previo us y

In contrast to the modest changes in the birth rate, the crude death rate fluctumark edly an d simultaneously with the conflict. Du ring the base years, the death rate displremarkable stability at about 15-0 per 1 000; an exception was 1967-68 when Bangladesh perienced an epidemic of smallpox. In the war year, the death rate climbed sharply to 21 0 p e1 000 37 per cen t higher tha n the five-year averag e. By 1972-73, a significant recoverynoted (16-2 per 1,000), although the rate remained above normal levels. Full recoveryobserved in 1973-74, two years after the conflict.

Over a seven-year period the study population increased from 112,711 to 132,797. Thequivalent to an average annual growth rate of 23-7 per 1 000 which is less than the averacrude rate of natural increase during the base years (30-3). This diflerence is attributepart to two abnormal years (1971-72 and 1972-73) when the rate of natural increase declIn the earlier year the decline was due to an abnormally high death rate, and in the latter to a slightly lower birth rate and a modestly higher death rate. The major portion of the dence, however, is attributable to net out-migration from the Matlab Bazar study area. Duthe five base years, the net out-m igration rate averaged 4-9 per 1 000.

TA B L E 1. Mid-year population, crude birth rate, crude death rate, and crude rate of naturaincrease {per 1,000) in Matlab Bazar thana 1966-67 to 1973-74)

Mid-yearpopulationCrude birth rateCrude death rateCrude rate of

1966-67

112,77147-11 50

natural increase 32-1

1967-68

114,56145-416 6

28-8

1968-69

116,90946-61 50

3 1 6

1969-70

120,21745-314 9

3 0 4

1970-71

124,08243-5148

28^7

Five-yearaverage

(1966-71)

45-6153

3 0 3

(War)1971-72

127,8404 4 52 1 0

2 3 5

1972-73

130,2184 1 81 6 2

25-6

1973-74

132,7974 5 614 2

3 1 4

Figure 1 was constructed to show in detail the response of births an d d eaths to the In this figure the ranges of the lowest an d highest qu arterly b irth a nd d eath rates for the fiveyears are plotted. Superimposed upon these are quarterly birth and death rates during 197

and 1972-73. Quarterly rates are computed simply by dividing the registration year (MApril) into four three-m onth segm ents. Th e basic popu lation of the den om inato r ofquarterly rates is com puted by assum ing a linear change from one mid-year popu lation to the

The base birth curve in Figure 1 displays a m arked seasonal swing. Theo retically,could be due to either a corresponding variation in conceptions nine months earlier orseasonal variation in foetal wastage. Previous research has demonstrated that the seapa ttern of births is due to variations in the mon thly conception ra te.^ Th e factors responfor this fluctuation a re, howev er, un kn ow n. N otew orthy in Figure 1 nevertheless areamplitude of quarterly variations during the base period and the comparatively narrow

of extreme values over five consecutive years. In M ay -July and A ug ust-O cto be r 1971 quabirth rates lay within the range of the five previous years, but the rate for November

d d h l h f h f ll d l


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G. T. CURLIN, L. C . CHEN AND S. B. HUSSAIN

70

6 0

50

40

30

8o

Births

WA R

20

1 0 J _

_L _L _L _LMay Aug

1971

Nov Feb May

1 9 7 2

Aug Nov Feb May

1973

F I G UR 1. Lowest and highest quarterly birth and death rates (per 1,000 in Matlab Bazarihana during five baseline years (1966-67 to 1970-71) and q uarterly ra tes in 1971-7

and 1972-73.

irths

1. Base years: mean

highest valuelowest value

2 1970-72

Firs t(May-July)

3 1 4

3 9 127-62 8 9

Quarters

Second(Aug-Oct)

4 9 9

52-64 7 05 1 4

(months)

Third(Nov-Jan)

6 4 4

6 9 55 8 473-1

Quarter Feb-April)

4 1 0

44-73 6 138-4


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BIRTHS AND DEATHS IN THE BANGLADESH CIVIL WAR

durin g the conflict in the previous year. Births between M ay an d O ctober 1972 corresp ondconceptions nine months earlier, between August 1971 and January 1972. DisruptioM atlab Bazar thana as in B angladesh as a who le, was at its mo st severe during this period. reduction in conceptions could be attributed to numerous social and biological factors. Cfrequency may have been reduced because of voluntary (fear, anxiety) or involuntary (setion) factors. A desire to avoid pregnancy at a time of crisis could have resulted in a modition of reproductive behaviour. In addition, there was the possibility of biological impairof reproduction due to malnutrition and disease.

Less readily explainable was the increase of the quarterly birth rate for November 1January 1972. This may be due to errors of registration since this was the period of weafield staff pe rform anc e. A m ore likely explan ation , howe ver, is th at this rise was real an d reed an increase in conceptions between Fe brua ry and A pril 1971. Fro m the m on th beforonset of the conflict in M arch , civil disturbances were com mo n and , as was noted ea rlier, murb an w orkers went on strike and returned to their village home s. This situation con tinuedthe early months of the conflict, when rural areas had not yet been reached by the army

Ma tlab Bazar thana an area about 30 miles from Dacca, a significant proportion of the amale population were urban or industrial workers. As the proportion of cohabiting couplthe villages increased, this could have resulted in increased coital frequency, more conceptand more births nine months later.

While the baseline curve of deaths also exhibited seasonal variations, the swings werepronounced. Nevertheless, the quarterly death rates during and immediately after the confluctuated considerably. The quarterly death rate for May-July, 1971 was already higcontinued to climb thro ug ho ut 1971, paralleling the conflict. The fall began with the cessof hostilities, and by May-July 1972, the quarterly death rate had returned to normal li

Thereafter, the rate remained within normal limits until the end of the observation perioThe death rate therefore appeared to be very sensitive to the disturbances. In fact

fluctuation in the death rate in 1971-72 ran parallel with the severity of the conflict anassociated civil strife and food shortage. While the overall increase in the annual death ra1971-72 was 40 per cent above base value; during the conflict itself the quarterly rates higher. In Aug ust-Octob er 1971, for exam ple, the qu arterly rate was per cent above base valu

Fertility Rates

Table 2 presents various fertility an d repro duc tion rates of the study popu lation from 196

to 1972-73. In the five-year base period, the general and total fertility rates averaged 206-36-3, respectively. The gross and ne t reprod uction rates were comp uted as 3-1 and 2-2 respecly. An interesting feature of the data in Table 2 was the trend of these rates during the period. In each case the rate showed a consistent decline over time. Between 1966-671970-71 the general fertility rate fell from 223-7 to 191-1 per 1,000 (15 per cent) and thefertility ra te declined from 6-7 to 5-9 births p er wom an (twelve per ce nt). Similarly, the re protion rates declined by 12 to 17 per cen t over the sam e p eriod .

This is the first instanc e in which B ang ladesh s rec ent fertility decline has been dmented by longitudinal observation. Several previous studies have reported, on the bas

retrospective data, a decline of fertility in Bangladesh during the 1950s and 1960s.^^decline is apparently not entirely due to the impact of the national family planning progra


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94 G. T. CU RL IN L . C . CHEN AND S. B HUS SAIN

An analysis of the causes of this trend lies beyond the scope of this paper. The relfinding is that the decline in fertility appeared to have been arrested in the war year. Thein fact, suggestive evidence that the level of fertility may have increased slightly during thyear, consistently with the findings shown in Figure 1. A significant decline was obsehowever, in 1972-73 the year after the war.

The gross reproduction rate closely followed the trend of general and total fertilityduring and after the war. Interestingly, the net reproduction rate fell sharply in 1971-72occurred despite reasonably stable fertility levels. The cause of the decline obviouslypoorer survivorship, particularly of children. During the base period, about 72 per celive-born children survived to age 27-5 years. In 1971-72, however, only 6 per cent lived to tage. The low net reproduction rate in 1972-73, the year after the war, reflected both a dein fertility and an incomplete recovery in the mortality rate.

TA B L E 2 . Genera l fertility rate, total fertility rate, gross reproduction rate, and net reproduc

rate in Matlab Bazar thana 1966-67 to 1972-73)

1966-67 1967-68 1968-69 1969-70 1970-71

Five-yearaverage

1966-71) War)

1971-72 1972-7

General fertility rate*Total fertility rateGross reproduction rateNet reproduction ratef

223-76-73-32-4

214-56-33-12-2

212-46-33-12-2

193-76-13-02-1

191-15-92-92-0

206-36-33 12-2

196-46-02-91-7

181-25-52-71-8

* Births per 1,000 w omen ages 10-49 ye ars.t Computed by applying five-year mortality schedule to annual fertility schedules

TA B L E 3 . Age specific fertility rates per 1,000 in Matlab Bazar thana 1966-67 to1972-73)

Age-group

10-1415-1920-2425-2930-3435-3940-4445-49

1966-67

8-6238-6331-4306-9248-8138-5

50-015-4

1967-68

8-6232-3333-6297-3204-3127-944-219-3

1968-69

20-9204-2357-9292-3227-3101-340-012-4

1969-70

25-3205-8302-9320-3197-6117-730-99-9

1970-71

18-7199-1275-2280-9192-2142-2

53-414-9

Five-yearaverage

16-4216-0300-2299-5214-0125-543-714-4

War)1971-72

4-6192-0260-0318-8207-1159-447-914-6

1972-73

5-5139-0282-8276-7220-7117-953-3

8-8

In Table

we show the trend of age-specific fertility rates during the study period. Dthe pre-war base period most age groups experienced a modest, though unsteady fdecline Some of the inconsistencies in age specific trends are probably due to faulty ag


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of th youngest two age groups (under 20 years). One explanatory factor may be relevanpostponement of marriage during periods of social disruption, a phenomenon reportprevious studies of historical populations.^ A po st-war survey cond ucted in M atla b Bfound that during the conflict deferment of marriage was common, which, in turn, ledmarked increase of marriages during the year following the war.^^

Mortality Rates

The stillbirth ratio and infant m ortality rates during the study period a re shown in Table 4a closer scrutiny of the age group under one year, the infant mortality rate has been fusub-divided into neo-natal (0-29 days) and post-neo-natal (30 days-11 months) rates. Bexamining the fluctuations in these rates, two aspects of the base infant mortality rates decomment. First, the ratio of neo-natal to post-neo-natal deaths in this population was neo-natal deaths in Bangladesh constituted about 68 per cent of all infant deaths durinlast three years of the base period. In a developing country with this level of mortalpreponderance of post-neo-natal infant deaths due to the effects of poverty, malnutritioninfectious diseases could n orm ally be expected. ^ N eo -na tal dea ths are believed to be primrelated to the quality of maternity care and biological variables, and as such are noresponsive to malnutrition and infection. Stoeckel and Chowdhury have previously rep

T A B L E 4 . Stillbirth ratio, infant mortality rate {in luding neo-natal and post-neo-natalrates) in Matlab Bazar thana 1966-67 to 1972-73)

Stillbirth ratio*Infant mortality

rate*neo-natal

1966-67

3 3 0

11075 9 5

post-neo -natal 51 2

1967-68

42-6

125-467-857-6

1968-69

39-6

123-882-940-9

1969-70

35-4

127-587-540-0

1970-71

33-2

131-389-941-4

Five-yearaverage(1966-71)

37-6

127-5t86-8t40-8t

(War)1971-72

37-8

146-686-959-7

1972-73

40-6

127-7ll-l56-0

* Per 1,000 live births.t Average of 3 base years (1968-69 to 1970-71),

this unusual observation in the M atlab Bazar popu lation and po stulated tha t dispropo rtiunderreporting of neo-natal deaths could in part explain the weaknesses of some preresearch. ^^ W hate ver the cause of this high ra tio , the relevan t aspect of this relations hip toinvestigation is a relatively greater contribution of neo-natal deaths (nearly double) thpost-neo-natal deaths to overall infant mortality. Secondly, there is evidence of registrerrors in the first two years, when fieldwork had just begun. The infant mortality rate of 1per 1,000 live births in the first year (1966-67) was lower than in any other study year. M

over, in both the first (1966-67) and second (1967-68) years, the ratio of neo-natal to neo-na tal dea ths was less than durin g the last three years of the base period . With newly trfi ld k i i ibl h l d h ld h b i d


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BIRTHS AND DEATHS IN THE BANGLADESH CIVIL WAR 9

deaths per 1 000 the death rate at these ages increased to 2-2 and 2-0 in 1971-72 and 197respectively. The persistent rise in the death rate in 1972-73 in these age groups was dupost-conflict epidemics of smallpox and dysentery.

The fluctuations in death rates in the 15-44 and 45-64 year age groups paralleledconflict and they returned to norm al levels in 1972-73. In the 15 ^4 year age group , the d

rate increased by 38 per cent and in the 45-64 year age group it remained unchanged. Ivery elderly age group (65 and over) the rate increased by 63 per cent in the war yearremained high in 1972-73.

The differential impact of th war on sex-specific death rates is also shown in Table 5. differentials were apparent in most rates during the base period. Infant mortality rates higher among males but higher death rates in most other age groups were observed amfemales. This pattern is typical of most Asian populations; the higher male rate in inf

TA B L E 5. Age-specific death rates {per 1,000 in Matlab Bazar thana il966-67 to1972-73

Age

Under1

1-4

5-9

10-14

15-44

45-64

Allages

Sex

Males*FemalesTota lMalesFemalesTota lMalesFemalesTotalMalesFemalesTotalMalesFemalesTotalMalesFemalesTota lMalesFemalesTotalMalesFemalesTotal

1966-67

1175104111072 0 02 9 924-9

3-74 54 11 22-31-73 94-24 1

15015-715-35 9 88 0 66 7 914 515-515 0

1967-68

1271123-8125424-633-52 9 4

5 05 15 01 62 62 14-24-64-4

18-017-717-977-981-479-316-516-716-6

Study year1968-69

134-3113-7123-822-525-223-8

4-03-73-91-61-91-73-04-43-7

15-619-717-468-883-474-415-114-915-0

1969-70

137-2117-4127-5

18-621-123-1

3-03-63-30-81-31-03-74-03-8

16-919-217-968-275-471-115-014-814-9

1970-71

134-7127-9131-321-234-927-9

1-43-32-31-51-11-32-13-22-7

15-812-714-463-886-472-913-915-714-8

Five-yearaverage

135-4119-7127-521-430-225-8

3-44-03-71-31-81-63-44-13-7

15-117-016-667-781-473-115-015-515-3

(War)1971-72

149-3143-8146-628-945-336-99-4

13-411-42-02-52-25-24-95-1

23-016.320-0

112-6128-6119-120-721-321-0

1972-73

126-3129-2127-717-328-522-712-715-514-1

1-72-42-02-13-62-9

16-113-014-792-5

102-296-515-617-016-2

* Infant deaths per 1,000 live births.

reflects the universally higher biological risk of new-born males and the relatively hifemale rate in childhood presumably reflects differential parental concern and greater carsons. In the reproductive ages, maternal mortality would be expected to lead to higher fe

death rates.^^During the year of the conflict, sex differentials remained intact in most age group


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98 G. T. CURLIN, L. C. CHEN AND S. B. HUSSAIN

number of deaths is projected in Table 6. In this table the average age-sex specific death rfor the five base years are computed. M ultiplying these rates by the mid-year popu lation dduring the war year provided an estimate of the anticipated or projected number of deaths bage and sex. These figures, when com pared with actual deaths, provide a crude estimate excess deaths.

Overall, the actual number of deaths (2,688) in 1971-72 exceeded the projected numb(1,820) by 868. This excess was equally shared by the two sexes, but the impact varied different ages. Particularly striking was the larger number of deaths among female childaged 1-4; there were nearly twice as many female deaths in this age group as of males. Counbalancing this predominance of female deaths was the larger num ber of male deaths in the agroup 45-64 years, and 65 years and over. In these two age groups combined, there were 16male excess deaths compared with only 68 excess female deaths.

TA B L E 6. Projected actual and excess number of deaths in MatlabBazar thana by age and sex during the year of the angladesh Civil

War {1971-72)

Sex/Age

MalesUnder 11 ^5-910-1415^445-6465 all males

FemalesUnder 11-45-910-1415-44

45-6465all females

All

Five-year average(1966-71) death rate

135.42 1 4

3 41-33-4

15-167-7

119-730-2

4-01-84-1

17-08 1 4

Number of deaths

Projected

324178

351383

116154903

284241

3915

109

104125917

1,820

Actual

430241

9619

127176256

1,345

40335913121

132

1001971,3432,688

Excess

1066361

64460

102442

11911892

623

- 47242 6868

These results, in general, conform to historical observations of death patterns at timessevere food shortage and civil unrest. It has been repeatedly observed that in times of focrisis, the most vulnerable age groups are young children and the elderly. W omen and youadults tend to have survived better than men and older adults.^^

Some of the reasons underlying these differentials are illustrated by the da ta presentedTable 7, where cause-specific death rates are shown for the entire study period. These caspecific dataare in non exclusive categoriesand were obtained from death reports compl


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Age-specific death rates from acute diarrhoea and other gastro-intestinal causesdepicted in Figu re 2. For all practical pu rposes there is no distinction between these two cof death; most are undoubtedly related to infectious diarrhoeal diseases. Most of these doccurred am ong y oun g children, particularly un der the age of five years. Only mod est incrwere noted in the adult and elderly age groups. This age differential was not surprisinthese diseases are known to attack young children disproportionately, particularly recweaned children who are no longer protected by breast milk, and who may eat contamifood.

Three further aspects deserve comment. First, an underlying condition associated many of these deaths was undoubtedly malnutrition. It is commonly acknowledged that deaths from malnutrition are not classified as due to starvation per se; but that the cause often given as diarrhoeal disease, an illness associated with or precipitating the terminal eSecondly, there is evidence that many of these deaths were due to either cholera or shidysentery. Admission statistics of the treatment unit in Matlab Bazar as well as the Ch

T A B L E 7 . Cause-specific death rate in Matlab Bazar thana 1966-67 to 1972-73)

Cause of death

FeverAcute diarrhoeaOther gastro-intestinal

causesRespiratoryMeasles/smallpoxAccidentsUnknownOthersAll causes

1966-67

2-60-4

1-81-50-50-73-14-5

15-0

1967-68

2-60 2

1-81-41-30-83-35-2

16-6

1968-69

3-60-2

1-80-40-50-74-33-5

15-0

1969-70

1-60-1

1-72-00-20-84-93-6

14-9

1970-71

2-10-2

1-91-60-50-84-83-0

14-8

Five-yearaverage

1966-71)

2-50-2

1-81-40-60-84-13-9

15-3

War)1971-72

2-51 0

4-81-50-40-95-34-6

21-0

1972-73

2-70-4

3-10-71-00-74-33-4

16-4

Hospital in Dacca indicated that the annual cholera epidemic in the autumn of 1971 wamost severe in the past decade. There were, in addition, large numbers of shigella dysecases, with higher case fatality rates tha n p reviously. The reaso ns for these epidem ics in 197

are not known but may be related to a general reduction of host resistance as a sequmalnutrition or to the unusually large number of migrants who were likely both to condiseases and to transmit them more widely. Another reason why diarrhoeal deaths incremarkedly was the temporary closure of the CRL diarrhoeal treatment unit in Matlab BThe withdrawal of these services probably led to more deaths from diarrhoeal disease would have occurred had the treatment unit been fully operational.

An increase in the death rate from measles/smallpox shown in Table 6 occurred one after the war in 1972-73. The base rate of 0-6 per 1,000 remained unchanged in 1971-72increased to 1-0 in 1972-73. Because two different causes of death are combined, it is dif

to separate the relative contribution of measles and smallpox. An a ttem pt to d o this is showFigure 3 which illustrates the age-specific death rates from the two diseases combined fo


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1 00 G . T. C U R L I N , L. C. C H E N AND S. B. H U S S A I N

16

14

12

10

OTHER GASTRO INTESTINAL CAUSES

1 4

WAR

ACUTE DIARRHOEA

< 1

66 67 67 68 68 69 69 70 70 71 71 72 72 73

FIGURE 2. Age-specific death rate per 1,000) due to acute diarrhoea and othergastro-intestinal causes in Matlab Bazar thana 1966-67 to 1972-73).

Age-group

Under 1

1966-67

1-7

1967-68

1-7

Study year1968-69 1969-70

Acute diarrhoea1-2 0-2

1970-71

0-8

War)1971-72

4 6

1972-73

2 3


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BIRTHS AND DEATHS IN THE BANGLADESH CIVIL WAR IO

WAR

1 4

MEASLES A ND SM A LLPO X

66 67 6 7 6 8 6 8 6 9 6 9 7 70 71 71 72 72 73

F I G U R E 3. Age-specific death rates per 1,000) due to measles and smallpox inMatlab Bazar thana (1966-67 to 1972-73).

Age group

Under 11 ^

5-14 5 +

All ages

1966-67

2-72-20-20-50-5

1967-68

5-35 70-70-41 3

Study year1968-69

1-82-30-20-20-5

1969-70

0 41-40-10-2

1970-71

2 63 00-10-5

(War)1971-72

1-02-00-50-5

1972-73

2-14-31-30 11-0

with no reported cases in late 1970. But by early 1972, smallpox was again prevalent in epidemproportions as a result of importation of the disease by the returning refugees from India. TheBengali age group found to be at highest risk to smallpox in the 1972 epidemic was th at of 5-9-year-old children. The age-specific rates for this group in Figure 3 reflect this national pattevery well. Peaks were noted in 1967-68 and 1972-73 with few cases in between, suggesting thmost, if not all, of the deaths in this age group were due to smallpox. Measles deaths usuaoccur among younger children.

The rates for the age groups under and 1-4 years, therefore, probably represent a combination of both measles and smallpox, with measles being a significant cause. It seems likethat measles caused the peak in the mortality rate for 1970-71 when no smallpox was noted i


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102 G. T. CU RL IN L . C . CHEN AND S. B . HUS SAIN

DISCUSSION

Because this study has focused on short-term fluctuations in births and deaths caused bBangladesh civil war, the first issue that deserves comment is the quality of the registdata, particularly during the conflict when fieldwork was severely disrupted. We have reason to believe that registration of births and deaths was reasonably complete durinwa r year. Th e doc um enta tion of only 2-7 and 4-9 per cent underreg istration of births an d drespectively, in 1971-72 against retrospective histories obtained at the July 1972 Cenenc ou rag ing. F ur th er m or e, the birt h rat e itself failed to vary significantly from th e fivbase level. Underregistration of births if significant, would have resulted in a lower ratereliability of birth data is such that quarterly rates showed remarkable conformityexpectation, given the timing of the major disruptions during the conflict.

The death data seemed to be equally valid, showing an overall increase of 40 perabove base level. Interestingly, the Matlab Bazar crude death rate in 1971-72 at 21-4 wasimilar to that estimated for the entire nation in a national sample nutrition survey condimm ediately after the war.^ Qu arterly dea th rates, moreo ver, showed a sm ooth progre

The chief deficiency in these data centres around migration. The weakness of migregistration during the conflict was confirmed by the July 1972 Census which showed registration of 17-7 and 32-4 per cent for immigration and emigration respectively. Becauthese deficiencies, migration has been excluded from the current analysis. Migration, howdoes enter into the computation of the base population and, thus, of the denominator rates. Fortunately, the CRL definition of migration (permanent move lasting six montlonger), minimized the potential magnitude of the error. Those migrants who moved frostudy area to elsewhere within Bangladesh or even to India, bu t who re turned within six mwere considered resident for the entire duration of their absence; vital events occurring igro up w ere registered up on their return . The brevity of the conflict a nd the timing of m ig(beginning May-July 1971 and ending between December 1971 and January 1972) implmost movements were temporary, rather than permanent.

The second point is the relevance of this analysis to the nation as a whole. The coundoubtedly had different impacts on different geographical areas within Bangladesh.genous food production and the distribution of imported foods varied between one loand a noth er. M oreover, those areas containing large num bers of Hin du s, the religious minor those in which fighting actually took place were more severely affected. Matlab Bazar th nwas not a t the extreme on a ny of these factors. Ho wever, it is uniq ue in that the p opu latioserved by a diarrhoea treatment unit; this unit provided care to about 2,500 in-patients aThe base crude death rate in Matlab Bazar of 15-3 per 1,000 is thus probably lower than nation as a whole, commonly estimated at 17-0. Withdrawal of diarrhoea treatment duriconflict cou ld have led to a further increase in the dea th rate.-^* T hu s, the im pac t of th e Matlab Bazar, while not representative of the nation as a whole, illustrates and reflectqualitative sense the consequences of the civil war.

Accep ting these limitations, it appe ars useful to estimate the prob ab le overall d emogimp act of the war on Bang ladesh. Assuming a nationa l pop ulatio n of 70 million in 1971-the Matlab Bazar base vital rates, there would have been about 3-20 million births andmillion d eaths in 1971-72 in the absence of the war. Th e decline in the crude b irth rate b


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per cent in 1972-73 suggested that there were approximately 260,000 births either averpostponed by the conflict. With increases in the death rate in 1971-72 and 1972-73, of 4six per cent respectively, this implies an overall excess number of deaths of nearly 500,00any standard this was a major disaster.

In 1971, there was considerable dispute w hether Bangladesh w as actually exp erienc

^^ As no ted in the introd uc tion , prob ab ly the mo st useful definition of faminwidespread food shortage ac com panied by a significant increase of the death rate.^ In MBazar and in Bangladesh as a whole, these two criteria were unquestionably fulfilled. Thudata presented in this paper strongly suggest that a major famine did occur in Banglduring 1971.

Th e mo st prom ine nt feature of fertility du ring and after the conflict was its relative stabAs recorded in quarterly b irth rates, a small increase was noted in No vem ber 197 1-Jan1972 and a mod est decrease in M ay -Oc tobe r 1972. Each reflected correspo nding alteratioconception rates nine mon ths earlier. C onsidering the intensity of the social uph eava l, the variation in births may appear surprising. It is, however, consistent with what happenedemographic crises among pre-industrialized populations and fully confirmed by the reprtive pattern of the Bangladesh population.

During a famine in seventeenth-century France, Wrigley also found only modest flutions in birth rates.^^ According to parochial records, the number of births decreased, rather than during the famine and then only by a small amount. Following the decline, was an increase in births to above base levels before full recovery. The Matlab Bazar cbirth rate in 1972-73 fell, but in 1973-74 it increased to 45-6. While this level was withifive-year base range, it was nevertheless higher than in the four previous years and crepresent a post-conflict rise. Only more detailed disaggregation of the data would permit substantiate this rise more precisely.

The explanation of this modest post-conflict decline and subsequent rise, lies in the rductive pattern in Bangladesh. Both in seventeenth-century France and in Bangladesh tothe populations are essentially non-contracepting.^^ On average, it takes a married fewom an ab out 30 mo nths to produ ce a pregnancy.^^ Of this time, only eight mo nths are spean ovulatory state when the woman is menstruating regularly and at risk of conceiving.remaining time is characterized by periods of temporary sterility, due to either post palactational amenorrhoea or pregnancy. At any one time, therefore, only about 30 per (8/30) of married fecund women are at risk of pregnancy. With disruptions of brief duraonly a small portion of the reproductive population would be at risk and only the concerate of these women would be affected. Women in a state of temporary sterility would fidifficult, even if they desired to do so, to modify their fertility during the brief crisis.

A post-conflict rise in fertility could be explained by several factors. Th e con ceprate is the outcome of two variables: the conception rate among women at risk of pregnand the pro po rtion of wom en in the ovulatory state. High death rates of children d uring thecould have led wom en who h ad lost children to a ttem pt to replace them. Th is would be exprby an increase in the conception rate of women exposed to the risk of pregnancy. Sucexplanation, unfortunately, can neither be confirmed nor refuted in this investigation. T

additional factors, increasing the num ber of wom en exposed to the risk of pregnan cy, howmay be more pertinent. Because the fertility decline reflected reduced conception rates am


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104 G- T. CU RL IN , L. C. CHEN AND S. B. HUSSAIN

high dea th ra te would further increase those at risk after th e conflict because child de aths prematurely interrupt lactation which in turn would hasten the return of post partu m ovuSome of those women therefore who would normally have been temporarily sterile aftwar would, because of child deaths, be exposed to the risk of another pregnancy. Finalnoted earlier, preliminary data from Matlab Bazar showed that marriages were delayed d

the war. After the confiict ended, there was an increase in marriages causing a sudden inin the number of women exposed to the risk of pregnancy.In contrast to fertility, mortality proved to be very sensitive to social disruption. The

of death rates as measures of the extent and severity of a crisis was evident in three ways.mortality levels corresponded well with the intensity of the conflict. Secondly, temfluctuations in mortality followed the course of the confiict closely. There was little or nbetween the two events. Finally, age-sex differentials in mortality appeared to providcriminating guidelines to the impact of the disruption on various sub-groups of the popuThe very young and very old experienced high mortality. Young adults and women

comparatively better. Interestingly, the infant mortality rate, commonly assumed to bmost reliable measure of the health status of a community, was only a fair indicator ocrisis. So, too, were stillbirths. The relative constancy of these ratios presumably refiectebrevity of the crisis and the impo rtance of biological and matern ity-care variables in Bangwhere neo-natal mortality predominates in infant mortality.

At highest risk were children under the age of ten years. Many excess deaths occurthe 1-4 y ear age gro up . In this gro up female d eaths far ou tnum bere d male death s. Surprithe death rate at ages 5-9 was most sensitive to the disruption, and nearly trebled. Thian unexpected finding. One possible explanation is age misreporting but this is unl

given the registration system which started in 1966. Most 5-9 year olds in 1971-72 wouldbeen aged 0-4 years in 1966-67, an age where errors would not have been large. A plausible explanation is that when infectious diarrhoeal diseases occurred in epidemic large numbers of children were involved and the death rate among the older groupincreased. Base death rates in the 1-4-year-old age grou p w ere alread y very high (25-8 per 1,000com pared with the correspo nding level amon g 5-9 year olds (3-7 per 1,000 . Because of relatily lower base rates among 5-9-year-old children, the increase would have been larger th1-4 year age group. All of this suggests that in future disasters, the 5-9 year age group mthe most sensitive sub-group as an index of the severity and duration of crisis. Rem

programmes will need to focus on this age group as well as on younger children.Although there are limitations to the interpretation of cause-specific data, certain

clusions can be drawn by noting trends in the registration system. Expected numbers of from specific causes are more reliable for categories which are not subject to epidemic fltions. Thus, the expected number of deaths due to smallpox and measles, based solely average of the previous five years, may be misleading, for smallpox occurs in epidemic foBangladesh in a five-year cycle. In the base period, deaths due to acute diarrhoea andgastro-intestinal causes did not ex hibit any notable pe riodicity, but since mo st events category a re due to infectious diarrh oeal diseases, this rate, too , could have been influen

epidemics. After the war, vastly increased numbers of cases of Shigella dysentery werethro ug ho ut Bangladesh.^ ^ This was also the experience within M atla b Bazar thana. Ev


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B I RTH S A N D D EATH S I N TH E B A N G LA D ES H C I V I L WA R IO

were in the diarrhoeal categories. Excess deaths among children in the 1-4 and 5-14 yeargroups attributable to the two diarrhoeal disease categories am ounted to 65 and 73 per cethe total respectively. Most deaths from dysentery in the treatment unit occurred in sevmalnourished children and it is not unreasonable to speculate that excess deaths in tcategories were a reflection of a combination of higher than expected attack rates andgenerally poorer nutritional state which existed following the war.


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deaths in bangladesh during 1971 war

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