Expanding access to family planning for married adolescent girls in the urban slums of Dhaka

Early pregnancy is associated with adverse health, social, and economic consequences for girls, and Bangladesh has an adolescent fertility rate that is among the highest in the region. Poor, slum-dwelling girls are especially vulnerable. This policy brief outlines a project that icddr,b, a STEP UP project partner, initiated to test three innovative strategies aiming to support the unmet family planning needs of these girls. This brief concludes with government-level policy and program recommendations based on the evidence of this project for leveraging existing government health programs to better serve the needs of married adolescent girls and reduce their risks of early pregnancy

Reduce contraception discontinuation in Bangladesh by improving counseling on side effects

High rates of contraceptive discontinuation and method failure could cause Bangladesh to lose the progress made in increasing contraceptive use over the past 20 years. This policy brief concludes that if women are adequately counseled and supported to sustain their use of more effective contraceptive methods, they will need less medical attention, have fewer unintended pregnancies, and reduce the workload for medical clinics. Furthermore, if providers are adequately trained and supported in counseling and managing side effects and in helping women to switch methods when they do have a problem, the Family Planning Clinical Contraception Services Delivery Program would meet its goals and reduce discontinuation by over half by 2016. The brief offers a number of recommendations to the program, health providers, and donors to improve these services

Importance of Appropriate Counselling in Reducing Early Discontinuation of Norplant in a Northern District of Bangladesh

Bangladesh has achieved a considerable decline in fertility level in the past four decades through a strong family planning programme in spite of its poor social and economic growth. However, discontinuation of contraceptive methods and decline in the use of long-acting and permanent methods (LAPMs) are still the major concerns of the family planning programmes. This paper describes various factors that lead to the acceptance of the long-term method\u2014Norplant and those that lead to early discontinuation. This descriptive, cross-sectional study was conducted in the Family Planning Association of Bangladesh (FPAB), Dinajpur, during March\u2013June 2005 among 73 women who visited the clinic to remove their Norplant before its usual duration (5 years). The women were in the 25-31 years age-group\u2014around two-thirds of them (57.5%) without formal education, and three-fourths of them (75.3%) were housewives. Most of them had been married for nine years, on average, and had two and/or more children. Sixty-seven percent of the women experienced regular menstruation, and 95% had used other contraceptive methods prior to using Norplant. Past users of Norplant were the single-most important source of information for about threefourths of the women (74%); half of the women (51%) had discussed the method with their husbands, and majority (96%) of the husbands were informed about the women\u2019s decision on accepting the method before its implantation. All women were aware about the usual length of the effectiveness of Norplant. The most common reason for early removal of Norplant was menstrual disorder (59%), followed by desire for children (16%), husband\u2019s death, for abandonment or residing abroad (8%), anorexia, nausea, vomiting (7%), weight gain (4%), husband\u2019s objection (3%), and religious beliefs (3%). Service providers should properly counsel the couple before providing any contraceptive method, informing them about method-related side-effects and clearing any religious misconceptions. They should also explore the perception of women as well as their partners\u2019 desire for children; couples who would like to have a baby within a year or two can be encouraged to use a short-term method that can be more easily discontinued

Introduction and approval of menstrual regulation with medication in Bangladesh: A stakeholder analysis

Despite the significant progress that the government of Bangladesh has made toward introducing menstrual regulation with medication (MRM) into the national health program, there has been no systematic documentation on the introduction of MRM in Bangladesh, and on the approval process of local manufacturing of the mifepristone-misoprostol combination for menstrual regulation. This Research Report presents findings from the stakeholder analysis which was initiated to document the entire process of introducing MRM in the country. Findings from key informant interviews indicated some crucial factors that facilitated the process; these are presented here according to a four-part policy analysis framework: context, content, process, and actors

Prevalence of unintended pregnancy and needs for family planning among married adolescent girls living in urban slums of Dhaka, Bangladesh

This STEP UP research report examined the prevalence and basic underlying factors of unintended pregnancy among married adolescent girls in five urban slums in Dhaka, Bangladesh. The specific objectives of the study were to: 1) document the prevalence of unintended pregnancy among married adolescent girls aged 15–19 years living in urban slums of Dhaka; 2) identify the factors associated with or which contribute to unintended pregnancy among urban married adolescent girls; 3) estimate the proportion of married adolescent girls who have an unmet need for family planning (FP) services; and 4) explore the barriers to access and effective use of FP and menstrual regulation services among married adolescent girls in urban slums. The report details findings and suggests a number of programmatic actions based on these results

Expanding access to integrated family planning intervention packages for married adolescent girls in urban slums of Dhaka, Bangladesh

This research report describes an intervention study conducted among married adolescent girls aged 15–19 years in four urban slums of Dhaka, Bangladesh. Objectives of the study were to examine the acceptability and feasibility of forming married adolescent girls’ clubs, and involving community health volunteers (Shasthya Skebikas) and marriage registrars to increase access to family planning (FP) information and services, to promote the uptake of long-acting reversible contraceptive methods, and to provide FP information to newlywed couples at the time of marriage registration. The study findings revealed that a noteworthy number of married adolescent girls received FP-related information, mostly from the married adolescent girls’ clubs and Shasthya Skebikas, that had significant effects in their reproductive lives. Results indicated that the capability of the married adolescent girls that was developed through the study interventions can assist them to overcome family planning and unintended pregnancy-related knowledge and service gaps in the future

Contraceptive Method Attributes and Married Women's Intention to Use the Pill or the Injectable in Rural Bangladesh.

CONTEXT: The factors underlying contraceptive method choice are poorly understood in many countries, including Bangladesh. It is important to understand how Bangladeshi women's perceptions of a method's attributes are associated with their intention to use that method. METHODS: Data on 2,605 married women aged 15-39 living in rural Matlab were taken from a baseline survey conducted in 2016. Conditional logit analysis was used to examine associations between 12 method attributes and intention to use the pill or the injectable among the 583 fecund women not currently using a method. Method attributes included those relating to ease of obtainment and use, efficacy, health effects, husband's approval, the experiences of the respondent and the experiences of women in the respondent's social network. RESULTS: Women tended to perceive the pill more positively than the injectable. For example, greater proportions of women reported believing that the pill is easy to use (90% vs. 72%) and does not cause serious health problems (75% vs. 38%). The likelihood that a woman intended to use a method was positively associated with her perception that it is easy to use (odds ratio, 2.9) and does not cause serious health problems (1.7) or affect long-term fertility (2.9). Satisfied past users of a method were more likely than never users to report intending to use the method (5.2). Intention to use the pill rather than the injectable was positively associated with education (2.0-3.6) and having a migrant husband (1.7). CONCLUSIONS: Negative beliefs not supported by evidence, particularly about the injectable, are associated with women's intention to use a contraceptive method. The results may be useful in improving contraceptive care, counseling and training

Understanding unintended pregnancy in Bangladesh: Country profile report

The objective of this report is to identify the determinants of unintended pregnancy and unmet need for family planning in Bangladesh and therefore provide a strong body of evidence that will contribute to issue identification, evidence generation, and communication for use of evidence in policy and programming. The evidence generated can be used to find ways to reduce the rate of unintended pregnancy and hence reduce the risk of abortion-related morbidity and mortality; ultimately this will aid Bangladeshi couples in reaching their fertility goals. Results demonstrate that Bangladesh has shown progress and promise in several areas of family planning and contraceptive use. Collaboration between the government and the private sector and nongovernmental organizations needs to: address the needs of young people, especially young couples; reduce regional disparities, work with leaders and communities to delay early marriage and childbirth; and increase male involvement