Increasing rational use of modern contraceptives in Bangladesh:
Experiences from an operations research Md Mahabub-ul Anwar Ubaidur
Rob Ismat Ara Hena 139th APHA Annual Meeting & Exposition in
Washington, DC October 31, 2011 Slide 2 Background Low
contraceptive use rate and high regional variation Overall 55.8%,
Rajshahi 65.9% and Khulna 63.1 Sylhet 31.5% and Chittagong 43.9%
Contraceptive use tilted towards temporary methods 30% of oral
contraceptive users completed desired family size Over
three-fourths of women with four or more living children want no
more children, and yet only 10 percent use LA/PMs 56.5% of all
contraceptive users stop using their chosen method within 12 months
of initiation (Source: NIPORT, Mitra and Associates, and ORC Macro
2009) Contd.. Slide 3 Background Community identification and
prioritization of family planning (FP) and reproductive health (RH)
problems study identified that... Lack of in-depth knowledge about
FP methods Misconceptions about FP methods Social and religious
barriers Training needs assessment survey identified that...
Providers need training on contraceptive methods and counseling
technique Providers need training on syndromic management of
RTI/STI Providers tend not to use behavioral change communication
(BCC) materials Slide 4 Objectives Overall objective The aim of the
study is to examine the impact of a service delivery model to
enhance the rational use of modern contraceptives Specific
objectives Increase acceptance of modern contraceptives by 10%
Decrease discontinuation of modern contraceptives by 10% Rationale
Considering the problems and needs an operations research study
Increasing rational use of modern contraceptives was introduced
Slide 5 METHODOLOGY Slide 6 Study design Experimental groupO1 XO2
Nonequivalent control group O3O4 Quasi-experimental nonequivalent
control group design Enhancing technical capacity of service
providers Strengthening physical infrastructure and supply system
of health facilities Involving community through community support
group and peer promoters Creating awareness of family planning and
reproductive health issues 12 months Slide 7 Timeline Study
duration : July 2007 to March 2009 Pre-intervention data collection
: July - September 2007 Intervention : October 2007 - September
2008 Post-intervention data collection : October - December 2008
Slide 8 Study site Intervention sites Two unions from Nabiganj
Upazila of Habiganj District Two unions from Raipur Upazila of
Lakshmipur District Control sites One union from Bahubal Upazila of
Habiganj District One union from Ramganj Upazila of Lakshmipur
District Slide 9 INTERVENTIONS Slide 10 Enhancing technical
capacity of service providers Service providers (9) Four-day
training on modern contraceptives and counseling Five-day training
on syndromic management of RTIs/STIs Field workers (48) Four-day
training on modern contraceptives and counseling Service providers
and field workers Orientation on team building and appreciative
inquiry Slide 11 Strengthening physical infrastructure and supply
system of health facilities Ensured necessary supplies and
equipments Improve physical environment Garden, pond Tables,
chairs, fans Signboard displayed available services and service
hours Co-ordination between service providers Slide 12 Involving
community through community support group and peer promoters 36
community support groups Formed Trained Monthly meeting 139 peer
promoters Selected Trained Refresher training Monthly evaluation
Slide 13 Creating awareness of family planning and reproductive
health issues BCC activities Interpersonal communication Cultural
program Raffle draws at health facilities Slide 14 FINDINGS Slide
15 Observations on community support groups monthly meetings
ObservationsRaipurNabiganj Category of members attending meeting
Male UP member 45.274.8 School teacher 36.063.1 Religious leader
47.890.2 FWA/HA 90.689.5 Information about meeting Held on time
89.791.9 Held on schedule date 80.383.7 Meeting minutes discussed
65.899.2 Peer promoters activities discussed 71.699.2 Specific
agenda for the meeting 82.997.6 Discussion held according to agenda
88.998.4 Service-related issues discussed 100.099.2 Total number of
observations 117 123 Slide 16 Performance of peer promoters
IndicatorRaipurNabiganj Greeted participants82.6100.0 Created
friendly environment58.798.7 Explained topic clearly58.769.8
Summarized key findings of the session14.984.9 Provided correct
information76.083.0 Provided information on sources of FP and
STI/RTI services 96.791.8 Used BCC materials91.766.7 Distributed
BCC materials47.956.6 Number of peer promoters observed121159 Slide
17 Percent distribution of respondents by knowledge on modern
contraceptives Methods M RaipurNabiganj
InterventionControlInterventionControl PrePostPrePostPrePostPrePost
Know seven modern methods 64.781.9***65.574.9***52.473.0***46.752.6
Pill100.099.9100.0 99.9100.099.8 100.0
Condom94.997.1*97.599.4*78.886.4***79.1
Injectables99.699.799.4100.097.9 98.5 98.9 Norplant87.6
91.9**92.593.491.8 95.2**85.194.6*** IUD95.396.295.697.091.8
94.183.2 90.2**
Vasectomy75.290.0***69.580.9***65.384.7***53.365.3***
Tubectomy95.599.0***97.794.994.898.1***89.8 94.8** N956 941 478 467
815 858 469460 M Multiple responses; Significant at *p
