Abstract
BackgroundThree-year duration Demand-Based Reproductive Commodity Project (DBRHCP) was launched in three low performing areas: rural Nabiganj (population 323,357), Raipur (population 260,983) and urban slum in Dhaka (population 141,912). Objectives: Assessing changes in knowledge among married women of reproductive age on selected reproductive health issues and to explore their service utilization patterns over the project period in selected low performing areas of Bangladesh.MethodsThe study adopted a pre- posts design. In the project areas, the entire chain of service provision were modified through the interventions under the DBRHCP, including training of the providers, enhanced behavioral change communication activities, follow-up and counseling, record keeping, reporting and monitoring, as well as improvement in logistics and supplies. Peer promoters were established as linkages between clients and service providers. All households were enlisted. Baseline and end line surveys were done using representative simple random sampling method, capturing changes over one year intervention period. Descriptive analysis was done using SPSS package, version 10. Proportional tests using Stata, version 8 were done to assess changes from baseline to end line.ResultsThe overall contraceptive prevalence was markedly different in the three study areas but significantly increased in both Dhaka urban slums and Nabiganj. In the rural areas, a higher proportion of the women in endline compared to baseline obtained contraceptive methods from the public sectors. Irrespective of study sites, significantly higher proportion of women received ANC (Antenatal Care) and PNC (Post natal care) in endline compared to baseline. In all study sites higher proportions of women were aware of maternal complications at endline. Services were obtained from qualified persons for reported symptoms of sexually transmitted infections by a higher proportion of women at endline compared to baseline. There were improvements in other RH indicators, such as use of skilled birth attendants and overall utilization of health care facilities by women.ConclusionsThe improvements in several important RH indicators in the intervention areas suggest that the interventions affected selected outcomes reported in the study. The study findings also suggest that investment in the reproductive health sector, particularly in existing government programs, improves RH outcomes.
Highlights
Three-year duration Demand-Based Reproductive Commodity Project (DBRHCP) was launched in three low performing areas: rural Nabiganj, Raipur and urban slum in Dhaka
In addition to the problem of stagnant or slow fertility decline, reproductive health in Bangladesh faced other challenges, one of the most important being the lack of acceptance of different types of available methods leading to discontinuation of method use
Issue based street drama were conducted at market places to increase awareness in the community, on family planning, maternal health, pregnancy complications and utilization of health care
Summary
Three-year duration Demand-Based Reproductive Commodity Project (DBRHCP) was launched in three low performing areas: rural Nabiganj (population 323,357), Raipur (population 260,983) and urban slum in Dhaka (population 141,912). One of the challenges in Bangladesh is to achieve replacement level fertility. Previous family planning and reproductive health programs in Bangladesh have traditionally been supplyoriented; they aimed to provide the means of effective contraception and family planning. This strategy was remarkably successful in the 1980s and early 1990s when the total fertility rate declined rapidly [2]. In addition to the problem of stagnant or slow fertility decline, reproductive health in Bangladesh faced other challenges, one of the most important being the lack of acceptance of different types of available methods leading to discontinuation of method use. A study conducted in rural Bangladesh reported that discontinuation of oral pill user was 43% and the commonest reason was perceived side effects [3]
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