Country Office Annual Report 2021 Bangladesh - 5070 Update on the context and situation of children Severe health, economic and social crises caused by COVID-19 slowed Bangladesh’s economic growth and development in 2020, continuing into 2021. Gross domestic product (GDP) grew by only 3.5 per cent in 2019/20 – an 18-year low for Bangladesh. The impact has been most severe for children: according to a Multidimensional Poverty Index (MPI) analysis by UNICEF, Bangladesh Bureau of Statistics (BBS) and General Economics Division (GED) in 2020, more children (42.1 per cent) than adults (32.9 per cent) in Bangladesh are multidimensionally poor. The second wave of the COVID-19 pandemic hit in March 2021, instigating a national lockdown that prolonged school closure, disrupted supplies and logistics (e.g., nutrition supplies, antiretroviral therapy [ART] stocks) and hampered field interventions such as training and in-person monitoring. Signs of improvement emerged in late 2021, and the World Bank forecasts GDP growth of 6.4 per cent in 2021/22. Bangladesh remains on track to graduate from the United Nations list of least developed countries in 2026. Despite significant socio-economic progress before COVID-19, infant mortality remained comparatively high (34 deaths per 1,000 live births: Multiple Indicator Cluster Survey [MICS] 2019). Early pregnancy among adolescents remains a growing problem for illiterate women and those from lower-income households. One in four women aged 20–24 years had a child before age 18 (MICS 2019). Furthermore, 46.4 per cent of births are at home. Antenatal care visit coverage had improved pre-pandemic. In 2019, 75 per cent of pregnant women had one or more visits – although one third of infants had no post-natal care (MICS 2019). Most young people (88 per cent) lack knowledge of HIV prevention, but 39 per cent know the modes of mother-tochild transmission (MICS 2019). In 2020, COVID-19 led to more births outside of medical facilities/without skilled birth attendance, with increased neonatal mortality likely. In 2021, lockdown, fear of infection, and suspended services reduced pregnant mothers’ hospital attendance and service uptake. COVID-19 shutdowns negatively affected HIV testing and hindered HIV-positive pregnant mothers’ access to ART. Cold chain and human resources requirements for COVID-19 vaccination in 2021 initially strained routine immunization. Routine immunization coverage dropped to 84 per cent in July 2021, but was recovered to more than 92 per cent by October 2021 (Directorate General of Health Services [DGHS], 2021). Stunting dropped dramatically from 42 per cent in 2012–2013 to 28 per cent in 2019. In 2019, 98.5 per cent of babies were breastfed (but only 62.6 per cent exclusively). Wasting reduction stagnated between 2012–2013 and 2019 (9.6 and 9.8 per cent respectively). Among infants aged 6–23 months, 66 per cent obtained the minimum meal frequency, but just 27 per cent received the minimum acceptable diet. In 2019, 76 per cent of households used iodized salt (MICS 2019). COVID-19 restrictions affected distribution of emergency nutrition supplies in 2021. Essential maternal, infant and young child nutrition coverage declined from January to July but was reversed from August to October. Pre-pandemic, primary school net attendance grew to 85.9 per cent; 57.8 per cent of adolescents Page 1 of 10 Page 1 of 10