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

The source a woman uses to obtain contraceptive methods is related to the type of method she is using.The vast majority (70 percent) of pill users obtain their method from field workers, although 20 pereent obtainsupplies from pharmacies and shops. On the other hand, most IUD users (80 percent) obtained their methodfrom government facilities, such as family welfare centers and thana health complexes. Most users ofinjection are served by government facilities, especially the family welfare centers, although field workerssupply over one-third of injection users. Half of condom users say their method is obtained from pharmaciesand shops, while more than one-third obtain condoms from field workers. As expected, both female and malesterilizations are mainly performed in government facilities.Field workers are providing a slightly larger share of family planning services now than in 1991 42percent of modem method users in 1993-94 vs. 38 percent in the 1991 CPS (Mitra et al. 1993:66). This nodoubt reflects the fact that most of the increase in modem method use since 1991 is due to increased use ofthe pill, which is predominantly provided through field workers. The proportion of services provided througheither pharmacies or shops has remained steady since 1991, although it has shifted away from pharmaciestowards shops (to the extent that respondents can distinguish the two adequately). Although the codingcategories are not exactly comparable in the two surveys, it appears that fixed health facilities such ashospitals and clinics account for a smaller share of family planning service provision in 1993-94 than in 1991.Satellite clinics have gained slightly in importance, due almost entirely to an increase in the proportion ofinjection users who obtain services at these facilities; however, they are still not a major source of familyplanning services.4.13 Contraceptive DiscontinuationA key concem for family planning programs is the rate at which users discontinue use of contraceptionand the reasons for such discontinuation. Life table contraceptive discontinuation rates based on informationcollected in the 5-year, month-by-month calendar in the BDHS questionnaire are presented in Table 4.23.All episodes of contraceptive use between April 1988 (the first month of the Bengali year 1395) and the dateof interview were recorded in the calendar, along with the main reason for any discontinuation of use duringthis period. Unlike the DHS surveys in some other countries, women in Bangladesh who were using in April1988 were not asked when they started that period of use. Thus, the discontinuation rates presented here arebased on all segments of use that started between April 1988 and three months prior to the date of interview.Table 4.23 Contraceptive discontinuation ratesFirst-year conUaceptive discontinuation rates due to method failure, desirefor pregnancy, health reasons, or other reasons, according to specificmethods, Bangladesh 1993-94Reason for discontinuationMethodTo Side AllMethod become effects/ other Allfailure pregnant Health re~ons I reasonsPill 1.7 7.1 25.6 10.6 45.0IUD 0,3 1,8 29,9 5,1 37,1Injection 1.1 4.8 40.0 11.7 57.6Condom 5.9 13.6 13.8 38.8 72.0Periodic abstinence 8.6 12.3 2.0 21.8 44.7Withdrawal 8.8 11.5 5.4 29.3 55.0Other 16.5 3.2 9.1 17.7 46.6Total 3.5 7.7 20.8 15.8 47.81Includes discontinuations with missing reasons61