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Renewing focus, widening access to family planning

Dr Md Rajib Hossain
Currently, 12 out of 100 women in Bangladesh have an unmet need for contraception — the lack of access to contraceptive for those who do not want any more children or want to delay pregnancy The higher number of unmet need leads to higher number of unwanted pregnancy, many of which end in unsafe abortion and its complications including even to death.
Up to a third maternal mortality can be averted by ensuring effective use of contraceptives.
According to Bangladesh Demographic and Health Survey (BDHS) 2011, 61% of married women are currently using a contraceptive method. There are regional differences in the use of contraceptive — it is highest (69%) in Rangpur whereas Chittagong (51%) and Sylhet (45%) are lagging behind in the adoption of family planning.
The Health Population and Nutrition Sector Development Programme (HPNSDP) of Bangladesh aims to increase overall use of contraception to
72% by 2016 which means an increase in 11% in 5 years. Past record in 2004-2011 showed that contraceptive use increased 3% — which means the target is a tough challenge and we have to emphasise more and increase efforts than ever before to fulfill.
The survey revealed that pill is by far the most widely used method (27%). Experts recommended shifting in contraceptive use patterns towards long-
acting and permanent methods from short-term hormonal and traditional methods. Studies showed that long-acting methods like intrauterine devices (IUDs), under-the-skin implants and Depo-Provera injections are cost-effective with fewer failure rate and less side effects than that of short acting methods — the transdermal patch (contraceptive drug patch placed in skin), the vaginal ring or the birth control pill.
IUDs are least used (0.7%) contraceptives in Bangladesh, and unfortunately it has been gradually decreasing. Although long-acting injectable contraceptive use has increased up to 11.2%, the number is much lower than that of pill users.
Md. Humayun Kabir, Senior Secretary, Ministry of Health and Family Welfare informed Star Health that initiatives have been taken to expand contraceptive coverage and to create awareness and promote long-acting contraceptives both in government and private settings. He identified high discontinuation rate, stock shortage, job vacancy, less use of long acting methods, cultural and religious barriers in some parts of Bangladesh put challenge on further progress.
Better contraception coverage means not just better prevention of unwanted pregnancy. It means less chance of dying from complications of abortion, pregnancy or childbirth, better child health, better family and social life. Only a concerted effort can overcome the challenges to ensure contraceptive accessible to all.
E-mail: rajib.hossain@thedailystar.net