prof. abul barkat human development research centre 1

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STUDY ON SOCIAL, ECONOMIC AND CULTURAL FACTORS THAT INFLUENCES FP ACCEPTANCE IN LOW PERFORMANCE AREAS

Prof. Abul Barkat

Human Development Research Centre

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Contraceptive Prevalence Rate (CPR): Goal & Current Status

Population & Family Planning (FP) target in MDG (by 2015): Bangladesh

NRR=1 TFR=2.2 CPR=70-75

Current Status of CPR: Bangladesh CPR=61.2 (BDHS 2011) CPR=62.6 (BMMS 2011)

Highest Performing Division Rajshahi (CPR=69.5)

Lowest Performing Division Sylhet (CPR=44.7)

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Study Objectives

General objective:

To determine the social, economic and cultural factors that influence FP acceptance in low performance-areas in Bangladesh

Specific objectives:

a. To investigate the characteristics that are influencing low performance

b. To find-out the determinants of low performance

c. To determine what need to be done to increase acceptance of FP in low performing areas.

Study Locations and Sample SizeLow performance districts

Habigonj (Sylhet Div.) – 264 Eligible couples

Brahmanbaria (Chittagong Div.) – 266 Eligible couplesComparison (High performance) district

Thakurgaon (former Rajshahi Div.) – 192 Eligible couples

Selected SlumsSlum from Dhaka City Corp. – 177 Eligible couplesSlum from Chittagong City Corp. – 77 Eligible couples

Total Sample Size = 976 Eligible couples

Methodology & Implementation

Overall Sample DesignQuantitative and exploratory qualitative approaches with a focused (targeted) and comparable groups

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Methodology & Implementation … contd…

Study Respondents

MWRAs of the sample households (both user and non-acceptors) Frontline FP service providers (FWAs) Programme Managers

Techniques and Tools

Household Structured Interview with MWRAs Focused one-to-one In-depth Discussion with users and non-users Focus Group Discussion (FGD) with FWAs Key Informant Interviews (KIIs) with UFPOs

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FINDINGS

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Characteristics Influencing Low Performance

Household Size

2 persons (%)

3 persons (%)

4 persons (%)

5+ persons (%)

Mean size (person)

5.5

23.0

30.2

41.3

4.4

3.6

26.0

41.7

28.6

4.0

HPA LPA

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Characteristics Influencing Low Performance …contd…

Education of MWRAs (%)

No Education

Incomplete primary

Primary

VI-IX

SSC+

30.8

22.6

16.8

21.1

8.7

31.8

16.1

9.9

24.0

18.3

HPA LPA

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Education of Husbands (%)

No Education

Incomplete primary

Primary

VI-IX

SSC+

31.3

24.0

16.4

170

11.0

25.0

19.3

14.1

20.8

19.8

HPA LPA

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Religion (%)

LPA

HPA

72.6

90.1

27.4

9.9

Hinduism & others Islam

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Poverty (%)

Richest

Fourth

Middle

Second

Poorest

21.1

20.9

20.0

23.4

14.5

33.9

22.4

20.8

10.9

12.0

HPA

LPA

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Fertility History

Mean age (in yr.) at first marriage

Mean age (in yr.) at first pregrancy

16.8

17.8

15.8

16.8

HPA LPA

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Previous Practice and Discontinuation of FP Methods (%)

Ever discontinued FP

Mean duration of discontinuation (in months)

56.4

18.9

69.4

15.6

HPA LPA

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Sources of Receiving FP methods and/or Services (%)

Government Facility

NGO Workers/Clinics

Pharmacy

FWA

53.5

8.8

34.0

29.3

40.9

21.6

19.3

18.8

HPA LPA

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Quality of FP Services

Quality Issues LPA HPA

Mobility of FP field worker Limited Higher

Communication system Difficult Better

Misbehavior of service provider More Less

Client’s motivation towards visiting FWC/CC

Not motivated Motivated

Religious fanaticism Higher Less

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Intention to Accept FP in Future among non-users

Intention Factors LPA HPA

Have intention to use FP in Future 79% 97%

Reasons for not willing to use FP in future• Want more children

• Unfavourable health condition

• Opposition from husband

• Religion does not permit use of FP

29%

28%

15%

13%

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Household Decision Maker for Acceptance of FP (%)

Jointly with Husband

Woman herself

Husband

82.2

12.3

4.7

90.1

7.3

2.6

HPA LPA

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Determinants of Low Performance

Results of Hypothesis testing and Odds ratio estimates

Couples more likely to use any modern FP method are-

Middle class households (third quintile) Educated women Women married at age of 20 years and above Couples taking family planning decisions together Husbands not opposing use of FP methods Religious norms not confronting FP use Less travelling time to CCs, NGO Clinics or FWCs Regular visitation of family planning workers.

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Factors Influencing Low Performance

Programmatic Factors

Field worker visitation to HHs

Location of SDPs (FWC, CC, SC, NGO Clinic)

Client’s motivation to visit SDP

Non-availability of contraceptives methods

Non-Programmatic Factors

Social factors –Education of husband/wife

Cultural -Religiosity, Non-cooperation from family

Demographic –Age at marriage, Son/daughter preference, Wants more children

Economic- Poor / Rich

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Actions Suggested to Increase Performance

Suggestions from low performance areas

FWC/CC should be set up nearby/common place & opened timely FWA/HA should visit home more frequently Motivate males to use FP method Inform people that FP method is not harmful for female Early marriage should be discouraged Delayed pregnancy after marriage should be encouraged Extensive services should be provided through mobile outreach Post-partum counseling on FP during PNC/Neonatal care

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CONCLUSIONS1. Weakness exists in program management, leadership and commitment.

2. Weaknesses persist in terms of shortage of manpower at field level, and inadequacy and non-availability of contraceptives at grass-root level.

3. Social factors such as family (husband and elders) support towards FP is weak, and community cooperation is almost non-existent.

4. A large part of society are still not practicing the marriageable age of 18 years for girls, and being mothers before knowing anything of FP.

5. Religious misconception (FP is sin) is still a factor influencing FP acceptance in low performing areas.

6. Motivation (in other words, BCC) on FP is not much effective.

7. Performance monitoring on a regular basis and supportive supervision appeared weak and not up to the mark.

8. Activities of field force, as it was observed and as reported, was less than satisfactory. They lack skill and empathy in dealing with the clients.

9. Role of local government bodies and also NGOs appeared to be marginal.

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RECOMMENDATIONS1. Launch effective behavioral change communication (BCC) campaign

with greater focus on low-performing areas (including urban slums).2. Establish a chain of quality FP services and follow-up care to counter

fears of side-effects and misconceptions.3. Create a social movement to stop marriage of girls below the age of 19

years.4. Increase number of service-providers (FWAs, FWVs) and other field-

level staff. 5. Ensure uninterrupted availability of FP methods near the

community/family.6. Involve local government institutions and NGOs.7. Enhance rates of compensation package to the acceptors of FP

terminal methods.8. Promote the cause of education in a wider-scale.9. Hold a workshop with all concerned stakeholders to develop an

implementable Action-Plan to meet the study objectives.

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RECOMMENDATIONS …contd…

Activities to be accomplished within short & medium-term period

1. Fill up all (100%) vacant posts within 3-4 months.2. Recruit village-level volunteers as supporting hand to FWA and

deploy them after proper training within a period of 6 months.3. Take out-sourcing as an interim approach to provide field level

services in some low performing areas with shortage of field staff.

Activities to be carried out as a continuous process (non-stop)4. Ensure need-based procurement and supply of FP methods both for

reserve stock as well as for regular consumption. 5. Ensure strong monitoring of FP method use and growing needs of

contraceptives, so as to avert stock-out situation.6. Make available FP methods at FWC and CC and ensure that these

facilities remain open as per given time schedule.7. Involve private sector/NGOs in strengthening supply line of FP

methods at the periphery. 8. Involve local government bodies in promotion of FP.

Thank You

prof. abul barkat human development research centre 1

Documents

low performance areas

low performanceareas

low performance contdsources

low performance contdintention

fp acceptance

low performing areas

eligible couplesslum

current status of cpr