Providing affordable, high-quality reproductive health services will succeed in attracting clients in Bangladesh.
Despite remarkable progress at the national level, Bangladesh grapples with wide geographic and social variations in demand for and use of reproductive health services. With support from CIDA and in collaboration with multiple partners, the Population Council designed and implemented an intervention to increase demand for reproductive health services by making them more affordable, more accessible, more welcoming, and higher quality. The project focused on three areas of reproductive health care where use of services had been low:
In Bangladesh, maternal mortality has declined sharply in the past three decades. But the number of women dying in childbirth remains high. And although affordable obstetric care is generally available throughout Bangladesh, poor women in some areas are still unlikely to give birth in a clinical setting.
Many Bangladeshi women begin and end their reproductive lives using oral contraceptives, even though most have had as many children as they want by age 25 and could be better served by a long-acting method. In addition, half of all contraceptive users discontinue their method within a year of starting it.
Care for men and young people
Family planning clinics in Bangladesh are oriented toward serving married women and children and may not be welcoming to men or adolescents. Partly as a result, many men are poorly informed about reproductive health issues, particularly symptoms, transmission, and prevention of reproductive tract infections (RTIs) and sexually transmitted infections (STIs). Awareness of contraception and reproductive health issues is similarly low among young people—particularly rural, unmarried youth—and most young people do not seek services for illnesses from qualified providers.
The Population Council designed and evaluated four interventions to address these three areas of care.
Through operations research in one sub-district, the Council identified cost as a major barrier to seeking pregnancy care and helped to alleviate this by providing financial assistance through vouchers that could be redeemed for services. For example, pregnant women were provided with a transportation voucher to allow them to quickly reach a facility using motorized transport when needed, and a voucher for buying medicines.
The Council examined two interventions aimed at increasing demand for contraceptive services, one focused in rural areas and the other in urban slums.
The Council worked in two rural sub-districts over 12 months to ensure that women were using the most appropriate method for each phase of the reproductive life cycle, and to decrease method discontinuation. The intervention used a combination of community support groups, strengthened health facilities, and raising awareness of long-acting methods through behavior change communication.
The second intervention delivered services in urban slum communities through NGO clinics that have typically been evaluated on achieving numerical targets rather than on providing quality of care. The Council trained providers in interpersonal interactions with clients, including contraceptive counseling and asking about previous symptoms or signs of RTIs.
Care for men and young people
The Population Council conducted operations research in two rural sub-districts aimed at providing RTI and STI services for men and youth at female-focused health centers without compromising the services provided to women and children. The Council trained service providers in the technical knowledge and skills required to provide services to men and youth; strengthened infrastructure and logistics systems to create space for men and young people within clinics; and raised awareness about reproductive health needs and services for men and youth through community support groups, peer promoters, and behavior change communication.
Each of the project’s four interventions succeeded in increasing the use of reproductive health services, and many of the piloted approaches are currently being implemented nationwide. Maternal health vouchers, for example, are in use across one-quarter of the country, and STI and RTI services as well as services for men are increasingly being offered at family planning clinics.
Specifically, this research showed that:
- Following the introduction of maternal health vouchers, the proportion of women giving birth in health facilities increased from 2.3% to 18.3%.
- Use of antenatal care from trained providers increased from 54% to 100%, and the proportion of women receiving postnatal care services from trained providers increased from 22% to 100%.
- With the introduction of male- and youth-friendly spaces at family planning clinics, the proportion of men seeking treatment for RTIs/STIs increased from 48% to 61%.
- More young people visited clinics (from 11% of both young men and young women to 14% of young men and 19% of young women), and knowledge about reproductive health issues, contraception, maternal health, HIV and AIDS, and STIs increased considerably among young people, while misconceptions about adolescent reproductive health issues (such as menstruation, ejaculation, masturbation, and wet dreams) were reduced.
- In urban slum clinics, the proportion of clients who were asked about their fears and misconceptions about contraceptive methods tripled, as did the number of clients asked about previous symptoms, signs, or treatment for RTIs.
- The proportion of clients at urban slum clinics who were given complete and accurate information about the contraceptive method they selected increased to 81% from just 28% before the intervention.