Bangladesh Official Report and 2014 Commitment Update

The Directorate General of Family Planning (DGFP) has taken several steps to reduce the discontinuation rates of temporary methods: Previously all doses of injectable contraceptives (DMPA) were given by the health facility based Family Welfare Visitors (FWV) only. Community level FP providers i.e. Family Welfare Assistants (FWA) were not allowed to give injectables. The policy has been changed and now FWAs are allowed to give injectable contraceptives (the 2nd dose onwards) during their domiciliary visits in the community while the screening and the 1st dose of injectables are given by FWVs at the health facility.

  • Oral contraceptive pills (OCP) and condoms are being made available in all community clinics (10,000+ in the country and on average there is one community clinic per 15,000 population) and distributed by FWAs and Community Health Care Providers (CHCP) 6 days of the week. This step is also contributing to reduce discontinuation of OCP and condom.
  • In the 62nd NTC meeting held in June 2014, a policy decision had been taken allowing the CHCPs (13,500 in number) of the Community Clinics to provide the second and subsequent doses of an injectable; this will further improve continuation of injectable doses.
  • In the 62nd NTC meeting, another policy decision has been made to provide Calcium tablets to injectable users to minimize side effects of injectable use.
  • In addition, initiatives have been taken to reorient FWAs with regard to screening, good counseling, proper contraceptive use, side effects and complication management and follow up.
  • The Government of Bangladesh/MOHFW commitment has been to increase the share of long acting reversible contraceptives (LARC-IUD and Implant) and permanent methods (PM) from 8 percent to 20 percent. Accordingly, the Ministry of Health and Family Welfare (MOHFW) convened a meeting involving officials of DGFP, DGHS, development partners, and national and international organizations, and set a goal of achieving 20 percent uptake of LARC/PM in the method mix by 2021. The specific objectives that will contribute towards achieving this goal are:
    • Strengthen service delivery and communication capacity by ensuring the availability of skilled service providers in all designated service centers giving much emphasis to the underserved and hard-to-reach areas
      • In this connection, MOHFW has recruited 1320 FWVs, among them 805 have already joined their posts and the remaining are receiving training.
    • Efforts are under way to improve the quality of LARC/PM services in all designated service centers, particularly strengthening through counseling and IPC with clients
      • In this connection, with support from MSD and in collaboration with EngenderHealth, a two dimensional video has been developed and loaded on to a tablet PC to be used during counseling with a FAQ booklet on LARC and PM.
    • Increase the provision of LARC/PM services through the private sector providers: DGFP has allowed SMC through their MIH project to market over branded IUDs and implants, and to train private providers in collaboration with EngenderHealth Bangladesh
      • In this connection, DGFP has set up a Technical Committee to support the Private Sector Initiative on LARC and PM under the leadership of Line Director, Clinical Contraception Service Delivery Programme (CCSDP), DGFP.
    • Ensure LARC/PM commodity security in the public and private sector
      • A public sector, DP and NGO Logistic Coordination Forum has been set up with the Director General, DGFP as the Chair.
    • Create an enabling environment to facilitate LARC/PM access for all couples intending long-term spacing or limiting, including addressing policy barriers
      • In this connection certain policies have been changed such as the relaxation in the two child restriction for sterilization and allowing nulliparous married women to accept implants, staff nurses to insert IUDs and female SACMOs to insert IUDs.
    • Increase the use of LA/PMs through demand creation and community mobilization among all couples
      • The IEM unit of DGFP has initiated several BCC activities with support from UNFPA.
    • Use satisfied LARC/PM acceptors to remove misperceptions of LA/PM and motivate prospective clients, and thus increase the uptake of LARC/PM
      • Orientation sessions of satisfied NSV acceptors with support from EngenderHealth have been carried out in more than 200 Upazillas (sub districts). A similar approach has been initiated using satisfied IUD acceptors.
    • Use religious leaders as advocates for increasing the uptake of LARC/PM in Bangladesh
      • A book published by DGFP in Bangla (local language) titled as “FP in the eyes of Islam” is used widely to orient Islamic religious leaders. This booklet is accompanied by a smaller FAQ type booklet.
    • Introduced availability of post-partum family planning services particularly post-partum bilateral tubal ligation (PPBTL) and post-partum IUD (PPIUD) services in the DGHS hospitals, DGFP facilities, private hospitals and NGO facilities and integrated FP in maternal health services.