A model for providing 24-hour normal delivery services at Union Health and Family Welfare Centers in Bangladesh

In rural areas of Bangladesh, emergency obstetric care services are available at the upazila level and above. At lower levels, Union Health and Family Welfare Centers (UHFWCs) located in the proximity of women’s homes provide normal delivery services. Recently, the Directorate General of Family Planning (DGFP) undertook an initiative to provide 24-hour normal delivery services in newly upgraded UHFWCs. The Population Council, with financial support from UKaid is providing technical assistance to the DGFP to implement an operations research study to test the effectiveness of this model. This brief presents an overview of the project, describes the implementation of project activities as of December 2015, and summarizes the key findings from the baseline survey

Union Health and Family Welfare Centers in Chittagong and Munshiganj: Are they ready to provide 24-hour normal delivery services?

To date, the Directorate General of Family Planning (DGFP) of Bangladesh’s Ministry of Health and Family Welfare has established approximately 3,900 Union Health and Family Welfare Centers (UHFWCs) in rural areas providing: family planning; menstrual regulation; vaccinations; and general, reproductive, and maternal health services six days a week. About 1,500 UHFWCs have been upgraded with the necessary staff and equipment to provide normal delivery services round-the-clock in rural areas. Yet, Family Welfare Visitors (FWVs) posted at UHFWCs perform only 0.3 percent of deliveries. This means that UHFWCs and FWVs are not optimally utilized to increase the rate of institutional deliveries. The Population Council is providing technical assistance to the DGFP to implement an Operations Research project that tests the effectiveness of a model to provide round-the-clock normal delivery services in 24 UHFWCs in Chittagong and Munshiganj districts. As part of the project, a situation analysis comprising a health facility assessment and provider survey was conducted. This report describes the outcome of this situation analysis activity

Understanding factors influencing adverse sex ratios at birth in Bangladesh

Nationally, the sex ratio at birth has persisted at its natural level of 105 male per 100 female newborns for the past half century in Bangladesh. However, at the regional level, Bangladesh is characterized by an east-west divide in sex ratios at birth. While the western region shows normal sex ratios at birth, the eastern region displays distorted sex ratios. To understand the factors that contribute to regional variations, a household survey was conducted among married women aged 18–49 years who had at least two living children. Views of health-care providers on gender-biased sex selection and of program implementers on the impact of gender-focused programs on the importance of having a daughter in the family were also gathered. The study was located in Comilla district which had an adverse sex ratio at birth, and Rangpur district having a normal sex ratio. Caution should be exercised in interpreting the findings, as the sample size of women interviewed was not adequate to reach a definitive conclusion. Future studies are needed that work with a larger sample

Evaluation of the impact of strengthening Union Health and Family Welfare Centers for providing 24/7 normal delivery services in Bangladesh

In Bangladesh, the majority of the infant deliveries in rural areas take place at homes where there is a higher risk of morbidity and mortality. Most Union Health and Family Welfare Centers (UHFWCs) are unable to provide 24-hour normal delivery services in close proximity to most rural women. With this point of view, the Population Council has provided technical assistance to the Directorate General of Family Planning to implement an operations research (OR) study in 24 UHFWCs to test the effectiveness of a model to strengthen UHFWCs so that they can provide such services. This report presents the findings of, broadly, three interventions—human resource strengthening, community participation, and referral linkage strengthening—that were implemented for 12 months. These findings provide useful insights for understanding the processes needed to provide 24-hour normal delivery services at the UHFWCs

Keeping girls in schools to reduce child marriage in rural Bangladesh: Endline assessment

This report describes findings of changes over time attributable to the “Keeping Girls in Schools” study in Bangladesh that implemented skill-building activities for a two-year period in the districts of Chapainawabganj, Kushtia, and Sherpur. The project sought to bring about change in child marriage norms prevalent in the area by offering young girls a safe place to meet after school hours with mentors and teachers and to offer girls tutoring support and life-skills. The project was implemented by the Population Council with the cooperation of secondary schools in the community and was supported by UNICEF under the aegis of the UNICEF-UNFPA Global Programme to End Child Marriage. The intervention targeted marginalized adolescent girls who had dropped out of school and girls who were underperforming at school which put them at higher risk of child marriage. The intervention provided tutoring support in math and English, skill-building, and life-skills awareness sessions. The project engaged female mentors from the community who led girls’ groups at the sessions, and liaised with teachers, school management committees, and the community at large

Keeping girls in schools to reduce child marriage in rural Bangladesh—Research Brief and Baseline Highlights

Bangladesh has made considerable progress in improving access to education at all levels for the last two decades. Despite these impressive gains, Bangladesh continues to face challenges of student dropout at the secondary level. Girls drop out of school earlier than boys because of child marriage. Targeted policies and interventions designed to improve mainstream educational attainment and decrease child marriage may be the effective and sustainable way to address both issues. The Population Council implemented the project “Keeping Girls in Schools to Reduce Child Marriage in Rural Bangladesh.” An intervention research study, the project tests a life-skills and tutoring support model to reduce school drop-out among secondary-school girls and to build aspirations for livelihood skills among unmarried girls who have dropped out of school—with the goal of delaying marriage. This brief provides an overview and summary of the project followed by highlights: research design and baseline characteristics, education, marriage and reproductive health, gender and rights, girls’ social lives, and livelihood

Bangladesh: COVID-19 Knowledge, Attitudes, Practices & Needs—Responses from three rounds of data collection among adolescent girls in districts with high rates of child marriage

From April 20–30, 2020, during a nationwide lockdown, the Population Council Bangladesh conducted the first round of a rapid phone-based survey on COVID-19 knowledge, attitudes, and practices. The survey randomly selected girls who had provided phone numbers during enrollment in a skills-building program that began before the pandemic. The survey’s objective was to assess the impact of COVID-19 on adolescent lives and to design programs that would contribute to protecting girls and meet social distancing guidelines imposed by the government. Phone interviews were conducted with 479 girls living in the districts of Chapainawabganj, Kushtia, and Sherpur who were participants in a program focused on reducing child marriage by increasing school attendance and grade progression among girls ages 12–15. A follow-up survey was conducted from June 12–22, 2020, prior to the introduction of virtual skills sessions as school closure and social distancing protocols were in effect. The nationwide lockdown had been withdrawn by that time. A third round of remote data collection took place September 5–11, 2020. This brief presents the findings and comparisons from the three rounds of phone surveys

Evaluation of the impact of the voucher program for improving maternal health behavior and status in Bangladesh

Vouchers, a demand-side financing (DSF) instrument for health-care services, were introduced in Bangladesh in 2006. The DSF program grants vouchers to pregnant women to receive free antenatal, delivery, and postpartum care services as well as free medicine, and financial assistance is provided for transportation. Deliveries with skilled service providers are financially incentivized and providers are reimbursed for their services from a special fund. After piloting DSF initially in 21 subdistricts (upazilas), the government expanded it to another 12 upazilas in 2007 (the second phase), and in its third phase in 2010 the program was expanded to another 11 upazilas. To measure DSF’s effect on improved access, quality, and reduced inequity for reproductive health services, during the third phase of the program the Population Council conducted a comprehensive evaluation with both baseline and endline surveys in 11 DSF upazilas and compared their outcomes with those from upazilas served by similar facilities not included in the DSF program. This final report contains key facility and policy program recommendations

Out-of-pocket expenses for maternity care in rural Bangladesh: A public-private comparison

Out-of-pocket expenses incurred by women for availing maternal healthcare services at public and private health facilities in Bangladesh were examined using a baseline household survey evaluating the impact of demand side financing vouchers on utilization and service delivery for maternal healthcare. The survey was conducted in 2010 among 3,300 women who gave birth in the previous 12 months from the start of data collection. Information on costs incurred to receive antenatal, delivery, and postnatal care services was collected. Findings reveal that the majority of women reported paying out-of-pocket expenses for availing maternal healthcare services both at public and private health facilities. Out-of-pocket expenses include registration, consultation, laboratory examination, medicine, transportation, and other associated costs incurred for receiving maternal healthcare services. On average, women paid US$3.60 out-of-pocket expenses for receiving antenatal care at public health facilities and US$12.40 at private health facilities. Similarly, women paid one and half times more for normal (US$42.30) and cesarean deliveries (US$136.20) at private health facilities compared to public health facilities. On the other hand, costs for postnatal care services did not vary significantly between public and private health facilities. Utilization of maternal healthcare services can be improved if out-of-pocket expenses can be minimized. At the same time, effective demand generation strategies are necessary to encourage women to utilize health facilities

Unintended pregnancy among rural women in Bangladesh

Unintended pregnancies are associated with unsafe abortion and greater risk of maternal morbidity and maternal deaths. In Bangladesh, approximately one-third of pregnancies are unintended. Considering the magnitude of the situation and its consequences, this article explores factors associated with the prevalence of unintended pregnancies in rural Bangladesh with implications for policy intervention. A total of 3,300 women were interviewed from 22 sub-districts to collect information on unintended pregnancy related issues. Findings reveal that about 29% of the pregnancies were unintended and the frequency of unintended pregnancy was higher among the older, less educated, higher parity, and poor women. Findings also suggest that unintended pregnancy rate was higher (33%) among women who used contraceptive before their last pregnancy than women (23%) who did not use any contraceptive. The rate of unintended pregnancy also varied, by the types of contraceptive methods used before their last pregnancy. The women who were using traditional methods or temporary modern methods were more likely to experience unintended pregnancy than longer acting method users. The findings underscore the importance of measuring contraceptive discontinuation rates in addition to prevalence of all modern methods. When discussing policy interventions to generate demand for family planning, consideration of differences in method-specific discontinuation rates is important if policy objectives to reduce unintended pregnancies are to be achieved