The effect of female family planning workers on the use of modern contraception in Bangladesh

Abstract

The increase in Bangladesh's contraceptive prevalence rate since 1978 has placed the country in the third stage of fertility transition and is largely due to the efforts of the female, grassroots family planning workers known as family welfare assistants (FWAs). Thus, in 1991, the government decided to recruit an additional 10,000 FWAs. This study provides justification for this decision by evaluating the impact of FWA household visits on the use of modern contraception using data from the 1991 Contraceptive Prevalence Survey of 11,065 women (conducted before the new FWAs were recruited). Two statistical models were constructed: one for acceptors of permanent methods and one for modern reversible acceptors (use of traditional methods was considered nonuse in this study). Logistic regression analysis of the use of modern methods on socioeconomic and demographic factors revealed that the most significant determinant of use in a rural area was a visit by an FWA within the past 3 months. After a FWA visit, odds of use in rural women increased eight times, and odds of use in urban women increased 2.6 times. Participation in a nongovernmental organization program was the most significant determinant of sterilization (and doubled the odds). A visit by a FWA in the past 3 months reduced the odds of sterilization. These findings explain the huge increase in use of modern reversible methods in Bangladesh since 1975. Because a recent study has indicated that the contraceptive failure rate is also high, the role of the FWAs should be expanded to include more follow-up and personalized supervision (with more attention paid to quality of care rather than quantity of acceptors). FWAs should 1) receive regular training, 2) be trained in additional aspects of reproductive health care, 3) be well supervised, and 4) be rewarded for their efforts with housing and transportation. In addition, low prevalence areas should be targeted.