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The 1994 Cairo Conference on Population and Development consensus called for actions that will make family planning programmes oriented to the needs and concerns of women that are served. This paper, based on data from Bangladesh, presents an illustrative analysis of how an outreach programme can be evaluated by this criterion. A scale for perceived service quality is developed from five indicators of desirable characteristics of services. Regression methods are used to assess the impact of outreach service encounters on the perceived quality scale. Econometric methods are used to adjust for endogeneity that arises from the selectivity of outreach encounters and the selective service exposure of contraceptive users. Results show that increasing contact with outreach workers increases client satisfaction with the overall quality of the Bangladesh family planning programme.

BACKGROUND Reproductive Health now commands the attention of the international community; it has numerous components, including early marriage, and early births, unwanted births, pregnancy-related care, contraceptive use, and maternal mortality. The government has taken major steps to improve reproductive health, with major infrastructure improvements and encouragement of the private sector. Against that background it is important to identify the apparent effects and to trace changes in reproductive behavior to measure the extent of change in each indicator. METHODS Eight Demographic and Health Surveys (DHS) in Bangladesh over a 24-year period to 2017-18 provide trends for all women and for various subgroups. These are nationally representative and are analyzed by cross-tabulations, with graphical displays of results. RESULTS During major efforts by the government to advance reproductive health, most indicators have moved favorably over the decades: there are fewer early marriages and births, fewer high-order and short-interval births, fewer unwanted births, more contraceptive use, and lower maternal and infant/child mortality. Especially, reproductive equity between the poor and the rich has improved. CONCLUSIONS These remarkable developments appear to reflect the series of national policies and programs undertaken by the Government, through both public and private sectors. Those should be augmented, and the revolution in reproductive behavior that has occurred should be repeatedly traced. This documentation of the changes in Bangladesh should gain the attention of other countries in the region. The latest survey, now in the field, will test the favorable trends so far against the impact of the Covid 19 pandemic.