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

(72 percent) and withdrawal (55 percent) are considerably higher than for the IUD (37 percent) and the pill(45 percent). However, discontinuation rates for injection are relatively high, considering that one dose isusually effective for three months. Fifty-eight percent of injection users discontinue within one year ofstarting, a rate that is higher than for the pill.A sizeable proportion of women using injection, female sterilization, the IUD and the pill reportedhaving health problems with their methods. Common complaints were feeling weak or tired and havingheadaches.Availability of Services. Health and family planning services are widely available in Bangladesh.BDHS data indicate that 97 percent of ever-married women live in areas covered by family planning fieldworkers and the vast majority also have health workers and satellite clinics available.Social Marketing. After a decline between 1989 and 1991 in the proportion of both pill and condomusers supplied through the Social Marketing Company, market share has been increasing slightly for pills andsubstantially for condoms. In 1993-94, 14 percent of pill users were using social marketing brands, upslightly from 1991. The proportion of condom users using social marketing brands dropped from 62 percentin 1989 to 41 percent in 1991 and then rebounded to 52 percent in 1993-94.Family Plamfing Field Workers. Field workers are providing a slightly larger share of familyplanning services now than in 199142 percent of modem method users in 1993-94 vs. 38 percent in the1991 CPS. This no doubt reflects the fact that most of the increase in modem method use since 1991 is dueto increased use of the pill, which is distributed primarily by field workers. The proportion of servicesprovided through either pharmacies or shops has remained steady since 1991. Although still not a majorsource of family planning services, satellite clinics have gained slightly in importance, due ahnost entirelyto an increase in the proportion of injection users who obtain services there.Field Worker Visitation. Despite the impressive coverage in placement of family planning fieldworkers, survey data show only a slight increase in field worker visitation rates over time. In 1993-94, 38percent of currently married women said they had been visited by a family planning field worker in theprevious six months, up from 36 percent in 1991. Some women are more likely than others to have beenvisited by a field worker. Younger and older women are less likely to have been visited, presumably becausethey are either more likely to want to get pregnant or to be either infccund or sterilized. Women inChittagong and Dhaka Divisions are less likely and those in Khulna Division more likely to have been visitedby a field worker than women in Barisal or Rajshahi Divisions.MATERNALAND CHILD HEALTHDeclining Childhood Mortality. Survey results indicate an improvement in child survival since theearly 1980s. Under-five mortality has declined from 180 deaths per 1,000 births in the period 10-14 yearsbefore the survey (approximately 1979-82) to 133 for the period 0-4 years before the survey, a decline of 26percent. The infant mortality rate declined by 25 percent over the same period (from 117 to 87 per 1,000births). Further evidence of a decline in childhood mortality comes from a comparison of data from the 1993-94 BDHS with previous data sources, which shows a general downward trend. Under-five mortality hasdeclined from almost 190 deaths per 1,000 births in 1979-83 to 133 for the period 1989-93. Althoughencouraging, the BDHS rates show that almost one in seven children born in Bangladesh dies before reachingthe fifth birthday, an indication that there is still much improvement to be made.Childhood Vaccinatlon Coverage. One possible reason for the declining mortality is improvementin childhood vaccination coverage. The BDHS results show that 59 percent of children 12-23 months arexxiv