Population Council Research that makes a difference

2011 International Conference on Family Planning
29 November–2 December 2011

Abstract

"Increase the rational use of modern contraceptive methods through community approach"
Moshiur Rahman and Ubaidur Rob

Significance/background
Over the last three decades, Bangladesh has made considerable achievement in decreasing the total fertility rate with a corresponding increase in the contraceptive prevalence rate. Despite these achievements, contraceptive-use is tilted towards temporary methods and the use of long-acting and/or permanent methods has decreased over time. At present, many women in Bangladesh begin and end their reproductive lives as oral pill users even when more appropriate methods are available for them. Low acceptance of permanent or long-term family planning methods remains a major programmatic issue. The 2007 Bangladesh Demographic and Health Survey suggests that combined current use of the intrauterine device, Norplant®, and sterilization comprises only 15 percent of all modern contraceptive method use in Bangladesh. Findings also suggest that approximately 60 percent of oral pill users have completed their desired family size by age 25. Moreover, half of contraceptive method users discontinue their method within one year of initiating it.

Main question/hypothesis
It was hypothesized that involvement of community support groups and satisfied couples of modern contraceptive method users might be a useful resource to increase the rational use of modern contraceptive methods and decrease the discontinuation of family planning method.

Methodology
Population Council conducted an operations research study to increase appropriate use of contraceptives based on the reproductive life cycle and decrease discontinuation of family planning methods. The 12-month project tested innovative approaches to involving community support groups and satisfied couple of contraceptive method users as peer promoters in health and family planning programs. Each community support group consisted of approximately seven to eleven members including elected representatives of the local government, field workers, religious leaders, teachers, social activists, satisfied contraceptive users, rich and poor community members. Community support groups were formed at ward level (covering approximately 2,500–3,000 populations) to increase awareness of FP issues and ensure availability of services at health facility. On the other hand, 2 satisfied couples of contraceptive users were selected as peer promoters from each ward. Those who were satisfied users of any modern contraceptive methods and who had good communication skills, mobility, at least five years of schooling, and acceptability in the community were given priority in the selection process. In total, 36 community support groups and 164 peer promoters were selected from the four intervention unions of the two sub-districts. A quasi-experimental design was used in two rural sub-districts from October 2007 to September 2008. A total 2,718 currently-married women aged 18–45 years, who had ever-used modern contraceptives, were interviewed before and 2,726 after the intervention to evaluate the impact of interventions.

Results/key findings
Findings suggest that peer promoters can play an effective role in motivating temporary family planning method users who have completed their desired family size to accept long-acting methods. The use of long-acting and permanent methods increased from 5.8 to 10.0 percent, while no significant change was observed in the control areas. Furthermore, a moderate increase in the use of all modern contraceptive methods was registered in intervention areas. The proportion of respondents currently using long-acting and permanent methods increased more among those with higher parity in the intervention areas. Intention to use long-acting and permanent methods in the future increased in intervention areas than control areas. The overall discontinuation rate of the IUD and injectables reduced over the intervention period. It was also found that community support groups helped to improve service delivery and also to raise awareness of health and family planning services to increase utilization of facilities.

Knowledge contribution
This research finding will help stakeholders and policy makers to understand how the community stakeholders and satisfied couples of contraceptive users were involved in the family planning programs to increase rational use of modern contraceptive method throughout reproductive life cycle. The key lessons learned from the study include: i) involvement of stakeholders in family planning activities, such as through community support groups and peer promoters, is an effective strategy for raising community awareness about family planning and reproductive health issues and increase knowledge and use of modern contraceptive methods, especially long-acting and permanent methods; and ii) peer promoters, in general, are effective in disseminating information on family planning/reproductive health issues among their peers and motivating them to accept modern contraceptive methods. Peer promoters who are long-acting and permanent method users are more effective.

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