Levin A, Caldwell B, Khuda B
Partnerships for Health Reform, University Research Corporation, Bethesda, MD 20814, USA.
Soc Sci Med. 1999 Jul;49(1):1-15. doi: 10.1016/s0277-9536(99)00059-3.
The Family Planning Program in Bangladesh has been very successful. The contraceptive prevalence rate (CPR) has increased from 13% in 1979 to 49% in 1996. Now that the program has matured and demand for family planning has been created, the Ministry of Health and Family Welfare (MOHFW) of the Government of Bangladesh is concerned with increasing its financial sustainability. Options to increase financial sustainability include cost sharing and a gradual transition from doorstep to static clinic delivery of contraceptives. Many of these alternatives would involve additional travel time or charges for consumers, and it is important to estimate the effect that these additional prices would have on the use of contraception. The effect of economic constraints, such as cash price and access to services on contraceptive method use, the choice of contraceptive method and provider choice, has been analyzed, taking into account the socioeconomic factors that influence decision-making for individual family members. Two data sources have been used for this analysis: (1) a survey on use of contraception and (2) two baseline surveys of 1993 and 1994 in the two field sites of the MCH-FP Extension Project (Rural) of International Center for Diarrhoeal Disease Research, Bangladesh. No effect of cash prices was found on the probability of use of any contraceptive method, but clients were to a limited extent responsive to price in making choices about contraceptive methods and providers. In addition, couples were less likely to use contraception or choose methods if the travel time to fixed clinics was greater than 30 min.
孟加拉国的计划生育项目非常成功。避孕普及率（CPR）已从1979年的13%提高到1996年的49%。鉴于该项目已经成熟，并且已经产生了对计划生育的需求，孟加拉国政府卫生和家庭福利部（MOHFW）关注提高其财务可持续性。提高财务可持续性的选择包括成本分担以及从上门提供避孕药具逐步过渡到在固定诊所提供。这些替代方案中的许多都会给消费者带来额外的出行时间或费用，因此估计这些额外价格对避孕措施使用的影响很重要。考虑到影响个体家庭成员决策的社会经济因素，分析了经济限制因素，如现金价格和获得服务的机会对避孕方法使用、避孕方法选择和提供者选择的影响。本分析使用了两个数据源：（1）一项关于避孕措施使用的调查，以及（2）1993年和1994年在孟加拉国腹泻病研究国际中心妇幼保健-计划生育扩展项目（农村）的两个实地站点进行的两次基线调查。未发现现金价格对使用任何避孕方法的可能性有影响，但客户在选择避孕方法和提供者时对价格有一定程度的反应。此外，如果前往固定诊所的时间超过30分钟，夫妇使用避孕措施或选择避孕方法的可能性较小。
