Introduction of emergency contraception in Bangladesh: Using operations research for policy decisions

The Directorate of Family Planning, Bangladesh, the Population Council, Pathfinder International, and John Snow Incorporated collaborated to conduct this operations research study to assess the acceptability and feasibility of providing emergency contraception pills (ECP) as a backup support to existing family planning methods. The study demonstrated that all categories of health providers, including NGO outreach workers, could be effectively trained to provide ECP services. The study also demonstrated high acceptability of ECP and revealed that if used correctly, the success rate in avoiding unwanted pregnancy was extremely high. The positive findings of the study have helped the Ministry of Health and Family Welfare, Government of Bangladesh, to approve introduction of ECP in the National Family Planning Program. The present study thus also serves as a good demonstration of how operations research can contribute in policy decisions and how research findings can be translated into action

Maternal health commodity landscaping exercise: A snapshot of the Bangladesh program

Despite consistent efforts of the government and national stakeholders, every year in Bangladesh over 5,000 mothers and thousands of children die. Most of these deaths would be preventable with increased access to quality services including existing medicines and other health commodities. The United Nation’s Commission on Life-Saving Commodities for Women and Children suggests that an important cause of these deaths is lack of access and appropriate use of 13 life-saving commodities. This document describes an effort by the Population Council to assess the country’s policies, guidelines, and availability for these 13 life-saving commodities as well as engaging with key stakeholders to implement the UN Commission’s recommendations in conjunction with this assessment’s findings. This assessment validated the availability of the 13 commodities in three districts at district, subdistrict, and community levels, and within drug stores, in 15 government facilities and 27 private drug stores. Key stakeholders were consulted. A national workshop stimulated discussion, identified national priorities and information gaps, and identified areas requiring policy review. This stakeholder engagement helped identify opportunities for organizations’ contributions to implementing the recommendations

Introducing emergency contraception in Bangladesh: A feasibility study

Approximately 28,000 maternal deaths occur every year in Bangladesh due to pregnancy and delivery-related complications, while many more women suffer major physical and psychological injuries. Available statistics indicate an increase in menstrual regulation (MR) and abortions, most performed by untrained practitioners under unhygienic conditions. Introducing emergency contraception (EC) in the national family planning (FP) program in Bangladesh could substantially reduce unwanted pregnancies and as result MR/abortions should also decrease. Because MR/abortions in Bangladesh significantly contribute to high maternal morbidity/mortality, introducing EC could be an important reproductive health intervention to provide couples with a back-up support to prevent unwanted pregnancy. EC could also reduce the psychological worries and health risks associated with unwanted pregnancies, MR, and abortions. The Directorate of Family Planning in collaboration with the Population Council’s Frontiers in Reproductive Health Project, Pathfinder International, and John Snow Inc., is conducting this feasibility study to develop, test, and document operational details for introducing EC as a back-up support for existing FP methods. This report is an interim update of the study’s accomplishments so far

Training service providers on emergency contraception: Lessons learned from an OR study

The Bangladesh Directorate of Family Planning in collaboration with the Population Council, Pathfinder International, and John Snow, Inc. is conducting an operations research project to test the feasibility of introducing emergency contraceptive pills (ECP) in the national family planning (FP) program and to answer operational questions on implementing the use of ECP efficiently. In Bangladesh, 1.2 million births are unplanned and the number of menstrual regulation/abortions is increasing. ECP could be a good reproductive health intervention for women since it gives them a chance to avoid unwanted pregnancy. ECP does not induce abortion. In fact, it helps in reducing the number of abortions. In Bangladesh, emergency contraception is relatively new and there is general lack of knowledge even among doctors. Thus, training providers will be a critical element for the introduction of ECP. The present feasibility study, detailed in this research update, has been undertaken to answer operational questions that need to be addressed while introducing ECP in the national FP program. The study has been carried out in two districts, Tangail and Mymensingh

Introduction of emergency contraceptive pills in the public health system of Pakistan: A south-to-south collaboration

This report describes a south-to-south collaboration to assist the Ministry of Health of Pakistan to introduce emergency contraception (EC) into its family planning program, supported by the Population Council’s USAID-funded Frontiers in Reproductive Health (FRONTIERS) program. The collaboration consisted of a three-day visit by senior managers from the Pakistani health authorities to Bangladesh to familiarize them with the EC program in that country, followed by a two-day consultative meeting in Islamabad to draw up concrete plans for introduction of the method into the Pakistan system. Participants at the consultation developed plans to introduce EC into both community-based distribution and clinical programs. The plans included staff training; commodity logistics; and development of information, education, and communication materials, many of which will be adapted from materials used in other EC projects in the region supported by FRONTIERS. The activity successfully met its goals. Providing south-to-south technical assistance was demonstrated to be an effective strategy for introducing sensitive services and is recommended for other regions and similar services

Developing regional capacity in operations research and economic evaluation in South Asia

This project contributed significantly to the capacity-building of regional professionals in planning, implementing, and monitoring of reproductive health programs in South Asia. During 2001–05, professionals from 17 countries received training in various aspects of reproductive health in nine workshops, including operations research, economic evaluation, qualitative research methods, proposal writing, and process documentation and enhancing the utilization of research findings in reproductive health programs. Forty-three percent of workshop participants were program managers from government health programs and nongovernmental organizations. Success in leveraging resources from other collaborating agencies and other donors helped the project to organize more workshops than originally planned and train more professionals than expected. A survey of the workshop participants four to 38 months after training revealed that 70 percent of respondents were using their newly acquired skills in programmatic improvement, program development, and conducting operations research

Bangladesh: Using strong evidence and strategic collaboration to increase access to menstrual regulation with medication

Through close cooperation with the Ministry of Health and Family Welfare of Bangladesh, and other partners, STEP UP generated strong evidence and cultivated ongoing collaboration that contributed to policy changes and program expansions to increase access to menstrual regulation with medication (MRM). Study results demonstrate that MRM is acceptable and effective in Bangladesh, and has thus been legalized and folded into the national FP program and scaled up nationwide. However, ongoing observation and studies are still needed to understand whether the efficacy and acceptability of MRM remains the case when services are delivered at scale on a national level. Furthermore, the role of the private sector in women’s access to MRM, especially considering that the government has little control over the drugs sold in pharmacies, must be considered

Strengthening emergency contraception in Nepal

A national workshop on emergency contraception was organized in Nepal by the Family Health Division within the Ministry of Health in 2004, with technical assistance provided by the FRONTIERS program of the Population Council. Among many conclusions from the workshop, one recommendation was that emergency contraceptive pills (ECP) should be introduced through the government family planning program to assist in reducing unwanted pregnancies. Based on the Population Council’s past experiences with introducing and mainstreaming ECP services in Bangladesh and India, a phase-wise introduction of ECP in Nepal was recommended. The project findings suggest that Nepalese women continue to face an unmet need for ECP, and expansion of the program to additional regions within Nepal is necessary. In addition, there is an urgent need for capacity-building among providers, given their consistently weak supervision and monitoring by the health system

Involving private medical practitioners in family planning services in Bangladesh

The project Involving Private Medical Practitioners (PMPs) in Family Planning Services is an innovative initiative to involve PMPs in protecting the reproductive health (RH) of couples, attract private investment in the family planning (FP) sector, and eventually reduce the increasing financial pressure on the government. The project was implemented in two phases. In phase I, qualified PMPs from urban areas were given training on FP. In phase II, nonqualified PMPs were given training on FP. PIACT Bangladesh, a local NGO, conducted two pilot projects to involve the PMPs in FP. The first one was to involve qualified PMPs in urban areas (Dhaka) and the second one was to involve nonqualified PMPs in rural areas (Komalganj Thana of Moulvibazar District). Qualified PMPs are medical graduates and nonqualified PMPs are rural medical practitioners (RMPs) who are not medical graduates. The overall objective of the pilot projects was to explore the feasibility of involving PMPs and RMPs in providing selected FP services on a commercial basis with emphasis on counseling and side-effect management. The findings of both projects are presented in this report

Implementing components of the primary health care pre-eclampsia/eclampsia model in Bangladesh: A cost analysis

Between 2016 and 2018, the Population Council, in collaboration with the Directorate General of Family Planning and Obstetrical and Gynecological Society of Bangladesh, implemented an intervention to confront pre-eclampsia/eclampsia (PE/E). This was part of the Ending Eclampsia project, a five-year USAID investment that implemented aspects of the Primary Health Care (PHC) PE/E Model in Bangladesh, Nigeria, and Pakistan. The intervention in Bangladesh comprised two components of the PHC for PE/E Model: 1) Task sharing to detect and manage PE/E (MgSO4 and referral) with PHC providers (Family Welfare Visitors, Sub-Assistant Community Medical Officers, and Nurse-Midwives), and 2) Introducing antihypertensive drug provision at the PHC level. This brief describes the true cost for implementing the two components in Bangladesh and includes a brief description of the activities within each component. Lessons from implementation of the PHC PE/E Model in Bangladesh could lead to cost savings in future interventions