Mehran Sajjad
North South University
Bangladesh’s fall in infant mortality is widely celebrated, and rightly so. The national infant mortality rate (IMR) declined from roughly 100 deaths per 1,000 live births in 1990 to about 20.76 in 2024, with a projection near 19.95 in 2025 (UN data). That is close to an 80 percent reduction across three and a half decades, a pace few low-income countries have matched. Under five mortality tells a similar story: Bangladesh’s rate of 31 per 1,000 live births in 2019 sat below both India (34) and Pakistan (65), despite comparatively modest resources. A recent article published in the bulletin has covered it.
Yet a single national number can hide as much as it reveals. Bangladesh is administratively divided into eight divisions, Barishal, Chattogram, Dhaka, Khulna, Mymensingh, Rajshahi, Rangpur, and Sylhet, and health outcomes across them are not uniform. This article dives deeper into this comparison, primarily to address the gaps in the previous attempt to this in the same bulletin.
Sylhet Against the National Average
The one division for which detailed figures are available is Sylhet, which has long carried the country’s highest neonatal mortality burden. Its rate stood at 81.7 deaths per 1,000 live births in 2000 and fell to 37.5 by 2017. That improvement is genuine, yet the 2017 Sylhet figure remained far above the contemporaneous national average, illustrating that a division can move in the same positive direction as the country while still lagging badly behind it.
Placing these numbers against the United Nations Sustainable Development Goals (UNSDG) sharpens the picture further. SDG target 3.2 asks every country to bring neonatal mortality down to 12 or fewer deaths per 1,000 live births and under five mortality to 25 or fewer per 1,000 live births by 2030. Nationally, Bangladesh’s under five rate of 31 in 2019 was already closing in on that threshold, and by the mid-2020s the aggregate trend suggests the country could plausibly approach the SDG benchmark at the national level.
Sylhet’s neonatal figure of 37.5 in 2017, however, was more than three times the SDG neonatal target, a gap that a national success narrative easily obscures. Even allowing for continued improvement since 2017, a division starting so far above the target is unlikely to have closed that distance as quickly as the country as a whole, given that the disparities driving it, adolescent motherhood, low maternal education, poor sanitation coverage, and thin healthcare infrastructure, are structural rather than incidental.
This is where the previous article’s own framing becomes a problem worth naming directly. It sets out, correctly, to discuss “the reality of inequality” behind Bangladesh’s national figures, and it does gesture toward rural versus urban gaps and wealth-based gaps in mortality. But when it comes to actual division level evidence, it offers only Sylhet, and even that appears mainly as an example rather than as part of a genuine eight division comparison. Barishal, Chattogram, Dhaka, Khulna, Mymensingh, Rajshahi, and Rangpur are never mentioned by name in connection with mortality data at all. A reader is left assuming that Sylhet is the sole outlier and that the rest of the country tracks the national curve closely, an assumption the article never actually tests or supports with figures.
This gap matters because Bangladesh’s regions differ substantially in poverty incidence, female literacy, road access, and distance to tertiary healthcare, all factors the article itself lists as drivers of child mortality. Rangpur and Mymensingh, for instance, are widely recognized in the country’s own poverty mapping as having some of the highest poverty concentrations outside Sylhet, which raises a reasonable expectation that their child health indicators also diverge from the national average, yet the article provides no data to confirm or refute this.
A National Policy Frame Applied to a Regional Problem
The policy section discussed in the previous article compounds the problem: five of six recommendations are pitched at the national level, and only one, a “special action plan,” is targeted regionally, and even that targets Sylhet alone. A genuinely comparative regional analysis would require division specific mortality series, ideally drawn from Bangladesh Demographic and Health Survey rounds disaggregated by division, set against both the national trend line and the SDG 3.2 thresholds for neonatal and under five mortality.
Until such disaggregated reporting becomes standard, claims that Bangladesh is “on track” for its child survival targets should be read as claims about the national average only. The country’s genuine achievement in lowering infant mortality does not, by itself, tell us whether all eight divisions are converging toward the SDG benchmarks together or whether some are being carried toward the goal only on paper, by more prosperous divisions pulling the national figure down while others remain well short.
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