analysing the relationship between family planning workers’ contact and contraceptive switching in rural bangladesh using multilevel modelling

Abstract

With a population of over 131 million and a fertility rate of 29.9 per 1000, population growth constitutes a primary threat to continued economic growth and development in Bangladesh. One strategy that has been used to cease further increases in fertility in Bangladesh involves using family planning outreach workers who travel throughout rural and urban areas educating women regarding contraceptive alternatives. This study uses a longitudinal database to assess the impact of family planning outreach workers' contact upon contraceptive switching and upon the risk of an unintended pregnancy. Using longitudinal data on contraceptive use from the Operations Research Project (ORP) of the International Centre for Diarrhoeal Disease Research (ICDDR,B) in Bangladesh, multiple decrement life table analysis and multilevel, discrete-time competing risk hazards models were used to estimate the cumulative probabilities of switching to an alternative form of contraceptive use after a woman engaged in a discussion with an outreach worker. After controlling for the effects of socio-demographic and economic characteristics, the analysis revealed that family planning outreach workers' contact with women significantly decreases the risk of transitioning to the non-use of contraceptives. This contact also reduces the risk of an unintended pregnancy. Family planning workers' contact with women is associated with the increased risk of a woman switching from one modern method to another modern method. The study results indicate that side-effects and other method-related reasons are the two primary reasons for contraceptive discontinuation in rural Bangladesh.

Contraceptive practices among married women of reproductive age in Bangladesh: a review of the evidence

“…Secondly, in order to sustain the declining trend of method discontinuation, family planning programs should consider restoring field workers’ provision of door to door visit to ensure supplies of contraceptive methods as it has been shown to facilitate continuation of methods [19]. Field workers need to be uniquely placed to provide timely and relevant information to each woman they visit, and to promote the use of government health facilities and family planning services that are available.…”

The Reliability of Calendar Data for Reporting Contraceptive Use: Evidence from Rural Bangladesh

“…The calendar included in earlier rounds, however, also gathered information regarding sexual unions, breastfeeding experience and duration, amenorrhea status, and sexual abstinence (Macro International 1990). Data collected via the calendar are widely used in analyses of contraceptive-use dynamics, including discontinuation, as well as of abortion, breastfeeding, and abstinence trends (Becker and Ahmed 2001; Steele, Goldstein, and Browne 2004; Hossain 2005; Baschieri and Hinde 2007; Creanga et al 2007; Bradley, Schwendt, and Khan 2009; Ali and Cleland 2010). …”

The influence of socioeconomic status on women's preferences for modern contraceptive providers in Nigeria: a multilevel choice modeling

“…On this basis, this research has been conducted to fill the gap in knowledge from a multilevel modeling perspective 34. Multilevel modeling techniques have been used to examine contraceptive use dynamics in several countries 27,28. However, its application in furthering the understanding of contraceptive provision in SSA and Nigeria is lacking.…”