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Cycle 9 (2020 Deadline)

Engaging the private sector in increasing voluntary use of longa-cting reversible contraceptives and permanent family planning methods in rural areas of Bangladesh

PI: Md. Jasim Uddin (, International Centre for Diarrhoeal Disease Research, Bangladesh
U.S. Partner: Sian Curtis, University of North Carolina at Chapel Hill
Project Dates: June 2021 - May 2024

Project Overview:
 9-441_Uddin_review mtg
 Review meeting with District and Sub-district level MOHFW and private clinic providers. Photo credit: Dr. Uddin
 9-441_Uddin_counsilors' mtg
 Counselor’s consultation area. Photo credit: Dr. Uddin
The overall aim of the research is to reduce unmet need for family planning (FP) and increase the use of effective contraception among post-partum women in rural Bangladesh through engaging the private sector. The specific objectives of the study are to (1) develop and test a mechanism to engage private clinics at the Upazila (sub-district) level in order to improve postpartum family planning (PP-FP) services and (2) increase access to long-acting reversible contraceptives and permanent methods (LARC/PM) during the postpartum period among women who gave birth. The interventions to be tested include identifying and preparing a list of pregnant women in the study area; developing and sending short message service (SMS) texts to identified pregnant women to promote institutional delivery and PP-FP after delivery; counseling pregnant women on antenatal care (ANC), hospital delivery, and the use of PP-FP when they come to private clinics for maternal health services; training private clinic staff on technical and ethical issues; and providing services.

The trained providers at the clinics will provide effective counseling to the mothers after delivery and provide PP-FP services as per choice of the mothers. The private clinics will receive a supply of FP methods from the local Upazila Family Planning Office of the Ministry of Health and Family Welfare (MoHFW) as per a recently introduced policy. To ensure the quality of FP services at the private clinics, including compliance with ethical standards, a team consisting of doctors from local public and private facilities and Upazila and District level managers of MoHFW, representatives from the Directorate General of Family Planning (DGFP), and study investigators will be involved in monitoring the study activities at the private clinics. Evaluation of the effectiveness of the interventions is planned after 36 months of implementation of the study, and analysis will be done comparing the outcomes of selected indicators for a cohort of pregnant women in intervention and comparison clinics. This innovative study will develop a mechanism to engage private sector providers to accelerate access to postpartum family planning services which can be scaled up in other areas of Bangladesh.

Project updates

As of July 2023, the Implementation of the interventions of this study has stayed on track. As planned, a total of 1,180 pregnant women from each study site have been enrolled. About 1,135 (96.2%) of enrolled women in intervention area and 923 (78.2%) in the comparison area gave birth in the meantime.  

Following the decision of monitoring committee meeting, Upazila Family Planning Office of MOHFW, Baraigram, Natore started providing training on Family Planning methods (Implant, IUD and short acting methods) to the private clinics.

In terms of sending the text messages to enrolled women at intervention area, text messages on healthy lifestyle for pregnant women, promoting institutional delivery, ANC and PP-FP methods continued being sent to the enrolled women of the intervention areas. Since the number of RDWs increased during April-June 2023 reporting period, the study team has been focusing more on PP-FP method- related text messages.
In terms of potential development impacts, an effective partnership between private and public sector service providers has formed and is currently ongoing. Upazila Family Planning Office of MOHFW continues their supply of LARC methods to the selected private clinics of the intervention area. In the upcoming months,  the team will continue providing  counseling to enrolled and recently delivered women on PP-FP, they will also continue SMS messaging and as well as distribution of leaflets. A review meeting will be organized and key informant interviews with service providers and FGD with counselors and record-keepers will be conducted prior to data analysis.

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