Consequences of the Shift from Domiciliary Distribution to Site-Based Family Planning Services in Bangladesh

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Using data from the longitudinal surveillance systems of the Operations Research Project of the International Center for Diarrheal Disease Research Bangladesh a before-and-after analysis of the contraceptive prevalence method mix source mix new acceptance rate and dropout rate was conducted to assess the consequences of the shift in service delivery approach. The shift from domiciliary distribution to clinic-based service delivery appears to have resulted in a slight increase in contraceptive prevalence in the urban study area from 54-56% before the shift to 55-57% afterward. The changeover did not produce any discernable variation in the method mix the proportion of new acceptors of family planning or the contraceptive dropout rate. This apparent lack of change can be explained by increased use of alternative sources with a substantial rise among users in reliance on pharmacies and shops (30-35% before vs. 42-50% after). In two rural study areas the shift from domiciliary distribution to service delivery from static sites known as cluster spots resulted in an increase in the prevalence rate from 52% to 57% in Paira and from 40% to 45-46% in Durgapur. The changeover coincided with greater use of injectable contraceptives and decreased reliance on traditional methods among rural contraceptive users. A notable immediate increase in new acceptors also was evident as was a long-term decline in dropouts. In Paira following the shift 43-44% of current users obtained their contraceptive supplies from cluster spots as did 32-33% in Durgapur. The recent change in the family planning program toward clinic-based delivery of an integrated package of essential health and family planning services appears likely to maintain and perhaps even increase contraceptive prevalence levels in Bangladesh. (authors)