Bangladesh 1993-1994 Demographic and Health ... - Measure DHS

Unmet Need for Family PlanningThe findings of the BDHS suggest that fertility will probably continue to decline in the future as ithasin the recent past. However, a number o f countries have experienced "plateauing" of contraceptive prevalencerates at various stages of development. One indicator that can throw light on whether contraceptive usein Bangladesh will continue to rise or not is the measure of unmet need ~ for family planning.The estimate of 19 percent unmet need from the BDHS (see Table 6.4), combined with the currentlevel of contraceptive use or met need, of 45 percent suggests that, theoretically, close to two-thirds of coupleswould use family planning if services were available. This would produce a total fertility rate of around 2.9,which is still well above the Government's replacement-level fertility goal. However, unmet need is not anabsolute value; it changes over time as desired family size decreases and there is greater awareness of thevalue of spacing births.With existing contraceptive protection being primarily in the form of short-term methods, thechallenge for program administrators is to increase demand for long-acting temporary methods, andpermanent methods, with greater efforts directed to the mass media to create positive images. While thereare reasons to be cautious about the ethical aspects of financial incentives, it is possible to promotesterilization and the IUD by ensuring the provision of high-quality services. This should decrease thereluctance of field workers to refer potential clients for these services.An often neglected aspect of unmet need is women who previously used contraception but havesubsequently stopped. In Bangladesh. this has consistently been almost one-third of ever-users. While theremay be numerous reasons for discontinuing, there is clear evidence that dissatisfaction with methods,primarily due to side effects, is by far the major reason. This reason accounts for two of five discontinuersof pills and condoms, and three of five in the case of the IUD and injectables (see Table 4.24). Amongcurrent users, one-third of pill users and almost half of injectable users complain of side effects.These findings imply that there is a need for increased frequency of contact between service providersand clients to provide counselling and support. Recently, there has been considerable discussion about themost effective and sustainable ways to achieve this end. One option is "doorstep" delivery of suppliesthrough regular household visits by field workers. A lower cost and less time consuming approach is throughoutreach or satellite clinics, which provide an intermediate link between the formal site such as the familywelfare center, and the client. These outreach centers should be well equipped to handle side effects ofmethods.There is also a need to educate clients about the management of side effects through the mass media,and through ensuring that field workers are well trained in this type of counselling. Routine follow up ofclients, and encouragement of interaction between satisfied users and potential new clients, may reduce theexcessively high discontinuation rates due to side effects.Unmet need refers to women who are currently married and who say either that they do not want any more childrenor that they want to wait two or more years before having another child, but are not using contraception.136