Demand-based Reproductive Health Commodity Project: Increasing the Rational Use of Modern Contraceptive Methods During the Reproductive Life Cycle
Operations research in Bangladesh sought to increase the appropriate use of contraceptives based on the reproductive life cycle and decrease discontinuation of methods.
In rural Bangladesh, many women 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 (IUD), 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.
An operations research study was conducted 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 members in health and family planning programs; helped build the capacity of service providers and field workers; strengthened health facilities; and created awareness through behavior change communication activities.
Project results suggest that peer promoters can play an effective role in motivating oral pill users who have completed their desired family size to accept longer-acting methods. Community support groups helped improve service delivery and also raised awareness of health and family planning services to increase utilization of facilities.
The proportion of respondents citing health and family welfare centers and family welfare assistants as their source of family planning methods increased significantly in intervention areas compared to control areas. The proportion of women who had knowledge of all modern contraceptive methods increased from 65 percent to 82 percent in Raipur and from 52 percent to 73 percent in Nabiganj. Furthermore, the use of long-acting and permanent methods increased from 6 percent to 10 percent in Raipur and from 12 percent to 15 percent in Nabiganj, and sterilization increased from 0.8 percent to 2.4 percent in Raipur and from 4.2 percent to 6.9 percent in Nabiganj.
During the intervention period, family planning visits increased from 24 percent to 38 percent in Raipur and from 15 percent to 18 percent in Nabiganj. Furthermore, the quality of services provided by health facilities improved considerably within the intervention period. The intervention sites improved in the following areas as well: greeting clients in a friendly manner, providing counseling on family planning methods, maintaining confidentiality, using behavior change communication materials, and requesting follow-up visits.
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Location: Bangladesh (Habiganj District, Sylhet Division; Lakshmipur District, Chittagong Division)
Duration: 2/2007 - 3/2009
John Snow, Inc./DELIVER
Canadian International Development Agency