Bangladesh, a developing country, faces severe socio-economic challenges due to rapid population growth, affecting essential resources such as food security, housing, healthcare access, and employment opportunities [¹,²]. With approximately 1,265 people per square kilometer, Bangladesh remains one of the most densely populated countries globally [³,⁴]. Illiteracy and limited reproductive health education contribute to high fertility rates, and rural communities, in particular, experience significant barriers to contraceptive adoption due to socioeconomic and cultural constraints [⁵]. To address this issue, the government has integrated population control education into primary school curricula to raise awareness about contraceptive methods and reproductive health. However, despite these efforts, contraceptive awareness and utilization remain low, especially in lower-income and rural populations [⁵]. Organizations such as the Bangladesh Demographic and Health Survey (BDHS), National Institute of Population Research and Training (NIPORT), UNESCO, WHO, USAID, BRAC, and Marie Stopes have played an active role in family planning initiatives, yet gender inequality, financial limitations, and socio-religious opposition continue to hinder contraceptive adoption. Das et al. (2021) highlight that media exposure significantly impacts family planning by increasing awareness and acceptance of contraceptive methods, which is crucial for understanding the role of education in promoting birth control practices in Bangladesh [⁶].

Understanding the factors influencing contraceptive use is essential for improving reproductive health policies in Bangladesh. The Health Belief Model (HBM) suggests that individuals are more likely to adopt contraceptive methods if they perceive the benefits and understand the risks of unprotected intercourse e[⁷]. Accurate data collection and analysis are crucial for evaluating the impact of primary education on birth control practices, as highlighted by the importance of data quality in understanding public health issues in Bangladesh [⁸]. The significant impact of external stressors on mental health, such as those observed during the COVID-19 pandemic [⁴], parallels how socioeconomic factors influence contraceptive use. The study by Al Kharusi et al. (2021) on compliance with oral hormonal therapy for breast cancer at Oman National Oncology Center highlights the importance of patient adherence to prescribed treatments, which is crucial for understanding the impact of primary education on birth control practices [⁹]. Microbial resistance poses significant health risks for mothers and children, leading to drug-resistant infections that are harder to treat and can result in prolonged illness and higher mortality rates. This issue exacerbates health disparities and stigma, discouraging affected individuals from seeking timely medical care. Addressing this requires better diagnostics, responsible antibiotic use, and increased awareness [¹⁰].

Additionally, the Theory of Planned Behavior (TPB) explains how attitudes, social norms, and perceived behavioral control influence contraceptive decision-making [¹¹]. These behavioral theories provide a strong foundation for analyzing the role of education in contraceptive adoption. Prior research has established that women with at least primary education are significantly more likely to use modern contraceptive methods than those with no formal education [⁵]. However, barriers such as economic instability, lack of healthcare infrastructure, and cultural opposition remain major challenges for widespread adoption. While the government has included reproductive health education in school curriculum, the effectiveness of such interventions remains uncertain, making further research essential.

The relationship between primary education and birth control practices has been extensively studied, particularly in developing countries like Bangladesh. Research consistently shows that primary education significantly influences the adoption of contraceptive methods. Educated individuals are more likely to be aware of and use modern contraceptive methods, which are crucial for controlling population growth and improving maternal and child health. Studies, such as those by Hossain et al. (2024) and Kundu et al. (2022), highlight that modern contraceptive methods are more prevalent among educated women and those living in urban areas, underscoring the role of education in promoting contraceptive use [¹²,¹³,¹⁴]. In addition, excessive consumption of sugary drinks is linked to numerous health issues, including obesity, type 2 diabetes, heart disease, and dental problems, significantly impacting overall health and increasing healthcare costs [¹⁰].

Socio-economic and demographic factors also play a significant role in influencing contraceptive use. Higher income levels, better educational qualifications, and urban residency are associated with higher adoption rates of modern contraceptive methods [⁷,¹⁵]. Psychosocial determinants, such as work stress and social support, significantly impact the mental health of medical professionals and the academic performance of students, influencing their overall well-being and effectiveness in their respective roles [¹¹,¹⁶]. Addressing psychosocial factors in health education, including contraceptive use, is crucial for improving health outcomes [¹⁶,¹⁷]. However, challenges such as cultural and religious beliefs, lack of access to education and healthcare services, and socio-economic constraints continue to hinder contraceptive use, especially in rural areas [¹⁸]. Addressing these barriers through targeted interventions, improving access to education and healthcare, and engaging both men and women in family planning programs are essential steps for promoting contraceptive use and achieving population control in Bangladesh [¹⁹].

This study aims to assess the impact of primary education on birth control adoption in Bangladesh while examining key socio-economic and cultural determinants influencing contraceptive use. Specifically, it explores the relationship between primary education and contraceptive adoption, identifies socio-economic factors affecting contraceptive decision-making, and analyzes the role of cultural and religious beliefs in shaping contraceptive behaviors. Additionally, the study provides policy recommendations to strengthen reproductive health education in Bangladesh, ensuring improved awareness and accessibility of contraceptive methods.

The study conducted across various districts in Bangladesh provided valuable insights into the demographics, educational qualifications, income levels, and birth control practices of the service recipients [²⁰,²¹]. The highest percentage of male service recipients (35%) falls within the 37-47 age group, while the highest percentage of female service recipients (41%) is in the 30-40 age group [²²]. The majority of service recipients are Muslims (63%), followed by Hindus (31%). Educational qualifications varied, with 41% having secondary education and only 6% being illiterate. The number of children among service recipients ranged from 0-4 (40%) to 8-9 (9%), with a higher percentage (56%) adopting temporary birth control methods compared to permanent methods (44%) [²³]. Income distribution showed that 56% of service recipients earned between 4000-5000 Taka per month, while only 3% earned more than 7000 Taka per month [²⁴,²⁵]. Microbial imbalance, along with environmental [¹⁷] and socio-economic factors, can significantly impact children’s health, leading to issues such as digestive disorders, weakened immune systems, and developmental delays [²⁶] .

The data indicated significant relationships between educational qualifications, income levels, and the adoption of birth control methods. Higher education levels correlated with higher adoption rates of birth control practices, and higher income groups generally had fewer children[²⁸]. Despite challenges such as a lack of sufficient and reliable statistical data, transportation and infrastructure limitations in rural areas, and sample errors due to the large population size, the survey provided valuable insights into the current circumstances of service recipients[²⁹]. These findings will be instrumental for future research and policymaking in the area of population control in Bangladesh. 63% of the service users are Muslim, 31% are Hindu, 3% are Buddhist, and 3% are Christian . The distribution of service users by education level shows that the majority (41%) have a secondary education, while the lowest percentage (6%) are illiterate . The distribution of respondents is based on the number of children, showing the number and percentage in each category. The number of children in the (0-4) category is 40% which is the highest and the number of children in the (8-9) category is 9% which is the lowest among the users . The distribution of service recipients by birth control method shows that 56% have adopted temporary methods, while 44% have opted for permanent methods .

Income distribution among service recipients, the majority (56%) of service recipients earn between 4,000 and 5,000 Taka, while only 3% earn 7,000 Taka or more, the lowest income group. . The majority of service recipients have a secondary education, with 40 males and 25 females .

Our study found that higher education levels significantly increase contraceptive adoption (p < 0.001), indicating that individuals with more formal education are more likely to use birth control methods. Additionally, income level plays a crucial role, with higher-income groups showing a greater likelihood of contraceptive use (p < 0.01). Geographic location also influences adoption rates, as urban residents use birth control at higher rates than those in rural areas (p = 0.01). However, religious beliefs were not found to be a statistically significant predictor of contraceptive use (p = 0.11), suggesting that socioeconomic and educational factors have a more substantial impact (Supplementary file).

This study examined the impact of primary education on birth control adoption in Bangladesh, analyzing 160 service recipients across four districts. The findings revealed that education level is a significant predictor of contraceptive use, with higher educational attainment strongly associated with an increased likelihood of adopting birth control methods (p < 0.001). Participants with higher secondary education were more than three times as likely to use contraceptives compared to those with no formal education (OR = 3.12, 95% CI: 1.95 - 4.98). These results align with previous studies, including those by Hossain et al. (2024) and Pazol et al. (2015), which found that women with formal education demonstrate greater awareness and adoption of modern contraceptive methods [¹³,³⁰]. The findings support the premise that education enhances reproductive health knowledge, improves family planning decision-making, and increases women’s autonomy in contraceptive choices. Expanding educational access, particularly in rural areas, could significantly improve contraceptive uptake and contribute to effective population control strategies in Bangladesh.

In addition to education, income disparities also influence contraceptive adoption. The analysis showed that higher-income participants were significantly more likely to use birth control than those from lower-income groups (p < 0.01). Participants earning more than 7000 Taka per month had 2.75 times higher odds of using contraceptives (OR = 2.75, 95% CI: 1.58 - 4.62). These results are consistent with prior research by Canning and Schultz (2012) and Lu et al. (2016), which highlight financial stability as a key enabler of healthcare access, including family planning services [³¹,³²]. Economic constraints limit access to contraceptives among lower-income groups, reinforcing the need for government-subsidized contraceptive programs to bridge the affordability gap. Given that cost is a substantial barrier to contraceptive use, financial assistance, and healthcare subsidies should be prioritized to increase accessibility, particularly in underserved communities. Geographic disparities further influence contraceptive adoption, with urban residents reporting significantly higher birth control usage than rural populations (p = 0.01, OR = 1.93, 95% CI: 1.28 - 3.12). Studies by El Arifeen et al. (2013) and Hossain et al. (2018) support these findings, noting that rural women face greater challenges in accessing reproductive health education and contraceptive services [³³,¹⁶]. The lack of healthcare infrastructure, particularly in remote areas, limits the availability of family planning resources, contributing to lower contraceptive adoption rates. Additionally, cultural stigmas surrounding contraception are often stronger in rural settings, further restricting usage. Expanding mobile health clinics, community outreach programs, and targeted awareness campaigns could improve contraceptive access and reduce disparities between urban and rural populations.

Interestingly, religious beliefs were not found to be a statistically significant predictor of contraceptive use (p = 0.11), suggesting that socioeconomic and educational factors play a more substantial role in shaping reproductive health decisions. Research by Joshi and Schultz (2013) and Kabir et al. (2023) indicates that while religious opposition to contraception exists, it is often outweighed by practical concerns such as economic stability, healthcare access, and education [⁸,¹¹]. These findings challenge traditional assumptions that religious beliefs are the primary barrier to birth control adoption and suggest that family planning initiatives should prioritize educational interventions over addressing religious concerns directly. Future studies should explore how intersecting factors such as education, income, and cultural beliefs influence contraceptive decision-making within different religious communities.

The study by Al Kharusi et al. (2021) on compliance with oral hormonal therapy for breast cancer at the Oman National Oncology Center provides valuable insights into patient adherence to prescribed treatments [³]. This is crucial for understanding the impact of primary education on birth control practices in Bangladesh, as both contexts involve patient compliance and education. In the context of breast cancer treatment, the study highlights how factors such as patient education, socioeconomic status, and healthcare support systems influence adherence to oral hormonal therapy. Similarly, in the context of birth control practices in Bangladesh, primary education plays a significant role in promoting awareness and acceptance of contraceptive methods. The study’s findings suggest that higher levels of education correlate with better adherence to prescribed treatments, whether it be oral hormonal therapy or birth control methods. By drawing parallels between these two contexts, we can infer that improving primary education in Bangladesh could lead to better compliance with birth control practices. Educated individuals are more likely to understand the importance of adhering to prescribed methods and are better equipped to make informed decisions about their reproductive health. This underscores the need for targeted educational interventions to enhance compliance and improve health outcomes in both scenarios. Moreover, this study integrated the Health Belief Model (HBM) and the Theory of Planned Behavior (TPB) to explain how education influences contraceptive adoption. By enhancing individuals’ perceptions of the benefits and control over contraceptive use, education shapes positive attitudes and social norms toward family planning, demonstrating its crucial role in promoting effective contraceptive practices. This study contributes new knowledge to the field by providing empirical evidence on the significant role of primary education in enhancing contraceptive adoption in Bangladesh. The findings highlight the importance of educational attainment in improving reproductive health outcomes and underscore the need for targeted educational interventions to promote family planning practices. By identifying key socio-economic determinants such as income and geographic location, this study offers valuable insights for policymakers to design effective strategies that address the barriers to contraceptive use. The integration of behavioral theories, such as the Health Belief Model (HBM) and the Theory of Planned Behavior (TPB), provides a comprehensive understanding of the factors influencing contraceptive decision-making, thereby advancing the theoretical framework in this domain.

Despite the valuable insights provided by this study, some limitations that must be acknowledged. The relatively small sample size of 160 participants may limit the generalizability of the findings to the broader Bangladeshi population. While the stratified random sampling technique aimed to ensure representativeness, the sample may not fully capture the diversity of the entire country. Therefore, the results may not represent the whole country’s picture. Future research should include larger, nationally representative samples to enhance the external validity of the findings. Additionally, the cross-sectional nature of this study prevents the establishment of causality, as it only captures associations at a single point in time. Longitudinal studies tracking contraceptive behavior over time would provide a more comprehensive understanding of the long-term impact of education on birth control practices. Potential selection bias must also be considered, as data were collected from family planning offices, where participants may have greater awareness of contraceptive options than the general population. Further studies should incorporate non-users of family planning services to provide a more balanced perspective. Self-reported data on contraceptive use may also introduce social desirability bias, emphasizing the need for future research to validate responses using clinical records or mixed-method approaches.

This study highlights the critical role of primary education in enhancing contraceptive adoption and improving reproductive health outcomes in Bangladesh. Education empowers individuals to make informed family planning decisions, reduces socio-economic barriers to contraceptive access, and addresses regional healthcare disparities. The findings emphasize the importance of expanding educational programs and implementing targeted interventions to improve reproductive health awareness. Despite the valuable insights provided, the study’s limitations, including a small sample size and cross-sectional design, may affect the generalizability and causality of the results. Future research should include larger, nationally representative samples and longitudinal studies to better understand the long-term impact of education on birth control practices. Addressing potential selection bias and validating self-reported data with clinical records are also recommended. By prioritizing education, healthcare accessibility, and policy reforms, significant progress can be made in improving reproductive health outcomes and ensuring sustainable development in Bangladesh.