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

Family Planning Outreach/Satellite ClinicsThe Satellite clinic approach is considered by many to be the most important FP/MCH servicedelivery strategy. However, the BDHS data show that family planning accounts only for 11 percent ofservices reported by women attending the satellite clinics (see Table 4.31). Immunization and child careservices constitute the bulk of the services provided. What is not clear is whether women who go to thesatellite clinics are not aware that family planning services are available and, if they are aware, whether theychose to obtain those family planning services elsewhere (e.g., from field workers).Injectables have been available to a limited extent for a decade, but, since 1990, have become morepopular than the IUD, condoms, and male sterilization. While one-third of injectable users obtain theirsupplies from Family Welfare Assistants, and almost the s~/zne proportion from Family Welfare Centers,satellite clinics are now supplying injectables to about one in eight users (see Table 4.22), a proportion whichwill probably continue to rise.Thus, it appears that the mix of services provided by the satellite clinics has favored matemal andchild health services, especially immunization, where they have played an important and effective role. Inthe future, it is highly desirable that the package of services should have a more balanced mix of familyplanning, maternal and child health, and primary health care services, and the relev ant staff should be orientedto optimize utilization of this strategy. If satellite clinics are to play as important a role in family planningservice delivery as they do in the Expanded Programme on Immunization (EPI), there would be much to gainfrom an IEC campaign to highlight and promote the range of services offered by the clinics.Geographic Differences in Family PlanningAlthough actual levels of family planning use in all divisions have more than doubled over the pastdecade, the contraceptive prevalence rate in Chittagong Division has persistently lagged behind, at two-thirdsthe national level, and just half that of Rajshahi Division.While cultural variables not measured in the BDHS may well have a role, the socioeconomic anddemographic characteristics of individual couples in Chittagong Division do not explain the low level ofcontraceptive use. One possible factor is the low field worker visitation rate in Chittagong Division duringthe six months preceding the survey (29 percent versus 38 percent nationwide) (see Table 4.30). It wouldbe useful to review the ratio of field workers to eligible couples in areas with difficult terrain such as is foundin Chittagong Division. Rather than selecting on the basis of a fixed ratio per union, some factor could beconsidered which would take into account the difficulty of travelling in hilly or remote areas, and areasflooded in the monsoon season.Background information suggests that limited female mobility is another factor suppressingcontraceptive use in Chittagong Division, and that this may be exacerbated by insufficient field workercontact. There is some support for this view in the relatively low proportion of women who have visited asatellite clinic in their community (see Table 4.31). Among those who have, the purpose has mainly been toobtain EPI services rather than family planning services. This observation is consistent with the limited useof family planning observed in Chittagong Division, compared with the country as a whole, in which thedeficit can be accounted for by methods provided by field workers (pills, condoms), and less so by femalesterilization.138