Presentation by ARK Foundation on assessing access to family planning services for the urban poor. First presented at the 12th International Conference on Urban Health 2015, Dhaka, Bangladesh.

1. Assessing access to family planning services for the
urban poor in Bangladesh
The 12th International Conference on Urban Health
24-27 May, 2015
Dhaka, Bangladesh

2. Background
• Bangladesh facing serious demographic crisis
in terms of growing population and
urbanization
• Total fertility rate (TFR) reduced but the
contraceptive rate (CPR) declined due to:
insufficient policy promotion
low contraceptive use
declining trend in Long Acting Reversible
Contraceptive (LARC)

3. Aim
We carried out a context review with the aim of
developing a Public-Private Partnership (PPP) model
to increase access to LARCs for the urban poor.
The specific objectives of the context review were:
– To assess the problems and prospects for LARC
service provision in urban areas
– To design a partnership model

4. Methods
Study area: 2 urban areas in Dhaka
Study design: Mixed methods
Data collection methods:
- In-depth Interviews
- Focus Group Discussions
- Service Statistics
Respondents:
 Policy makers
 Service providers and facility managers
 Exit clients

5. Results
• Short acting methods are popular
• Use of Long Acting Reversible Contraceptives
(LARC) is low due to:
– Misconception:
LARC has side effects
Using LARC is uncomfortable
Reduces reproductive ability
– Social Norms:
Male dominance
Religious restriction

6. Use of FP Methods
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
SAM LARC PM
95.7%
3.1%
1.2%

7. Results
• Diverse providersː
 LARCs available in public and NGO facilities; a few
PMPs provide LARCs.
 Two of six NGO clinics only provide IUD, not implant
• Service charge variesː
 No service charge for LARC at public and some NGO
facilities, only membership fee (15 to 40 taka)
 Clients receive LARCs at a subsidized price at NGO
clinics (200 taka for Implant and IUD)
 Pay full costs at PMPs chambers

8. Results
• Incentives vary:
Clients receive 150 taka for IUD in public and some
NGO facilities
No Incentive in some NGO facilities and PMPs
chambers
Incentives for referring LARC clients vary from no
incentive to 90 Taka
Providers receive 50 Taka at public and some NGO
facilities (but actual payment varies in reality)

9. Results
• Processes vary:
 Registers and health cards: Public and NGO clinics
maintain where as PMPs do not
 Follow-up: NGO community health workers provide
door-to-door services, with no mechanism for follow-
up
 Weak referral: PMPs not providing LARCs often refer
patients to NGO clinics, no referral form
• Capacity varies:
 Inadequate knowledge of LARCs among general PMPs
 Limited space and staff at PMP chambers
 PMPs not aware of the incentives

10. Way forward
• We aim to:
 Develop a Public Private Partnership (PPP) model to
increase access and method choice of FP for the
urban poor
 Involve PMPs as the urban poor people also visit
PMPs
 Involvement of other stakeholders

11. PPP Service linkage model for FP service provision: the current
process

12. Conclusion
• Assessment of the model to measure the
feasibility
• Dissemination of research report in near
future
This project was funded with UK
aid from the UK government