Increasing rational use of modern contraceptives in Bangladesh: Experiences from an operations research

Despite a considerable achievement in increasing the contraceptive prevalence rate from 8% to 56%, discontinuation rates remain high in Bangladesh. Moreover, contraceptive use is tilted towards temporary methods and the use of long-acting and/or permanent methods (LA/PM) has decreased over time. In order to increase the rational use of modern contraceptives and decrease discontinuation rates, an operations research was conducted in selected six low-performing rural areas in Bangladesh. Four major interventions were introduced: (a) enhancing technical capacity of service providers; (b) strengthening physical infrastructure and supply system of health facilities; (c) creating awareness of family planning (FP) and reproductive health (RH) issues; and (d) involving community through community support group (CSG) and peer promoters. Results show that there was a significant increase in the use of LA/PMs in the intervention areas, while little change was observed in the control areas. Furthermore, a moderate increase in the use of all modern contraceptives was registered in all intervention areas. The overall discontinuation rate of the IUD and injectables was reduced. Research suggests that participation of community stakeholders in FP/RH activities through CSG is a critical intervention, contributing considerably to achieving the objectives of the study. This strategic intervention helped increase awareness of FP and RH issues and availability of services for the community, resulting in increased use of those services by the community people. The peer promoters were found to be effective in motivating potential clients. Findings will help researchers develop effective interventions to increase rational use of modern contraceptives.