Yet Bangladesh, through a combination of smart government planning and massive infusions of foreign aid and expertise, is finally managing to slow down its once staggering rate of population growth. In a nation battered by cyclones, famines and droughts, this is a rare piece of good news.
The Health Minister, Kamal Ibne Yusuf Chowdhury, said: 'It is a success story. Usually family planning works only in affluent, educated countries. We've defied the experts.' Bangladesh still has far to go: 20 years ago, the average family had seven children; today it has just over four.
In Bangladesh three strangers think nothing of sharing a vacant chair; families of five can be seen balanced on motor scooters. Bus drivers often cannot see the road ahead for all the passengers riding on the bonnet and need a man on the roof to shout 'Left]' or 'Right]' to warn of bends.
The 1991 cyclone, which killed at least 130,000 people, took such a huge toll because pressure on land had forced millions to live in dangerously low-lying areas by the sea.
One major breakthrough was persuading Bangladesh's conservative Muslim clergy that without family planning the country, which already has a population of 120 million, would be swamped with more people than it could stand. More than 50,000 social workers distribute free contraceptives and explaintheir use.
Bangladesh, where 70 per cent of the population already live in poverty, hopes to reach a goal of 2.2 children per family by 2005. The consequences will be dire if it fails.