Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Mymensingh, Bangladesh.
Maternal and Child Health Division, icddr,b, Mohakhali, Dhaka, Bangladesh.
PLoS One. 2023 Aug 18;18(8):e0290468. doi: 10.1371/journal.pone.0290468. eCollection 2023.
In low- and middle-income countries (LMICs), including Bangladesh, modern contraception use remains lower than desired, resulting in a higher unmet need. A potential factor contributing to lower contraceptive use is reduced access to and use of lower tiers of government healthcare facilities, including home visits by family welfare assistants (FWAs), as well as women's visits to community and satellite clinics. These relationships, however, are still unexplored in Bangladesh and LMICs more broadly. The aim of this study was to explore the effects of lower tiers of government healthcare facilities on unmet needs for contraception and contraception use in Bangladesh.
Data from 17,585 sexually active married women were analyzed from the 2017 Bangladesh Demographic and Health Survey. The outcome variables were any contraceptive use, modern contraceptive use, unmet need for contraception, and unmet need for modern contraception. The explanatory variables considered were respondents' home visits by FWAs, respondents' visits to a community clinic, and respondents' visits to a satellite clinic. Multilevel mixed-effect Poisson regression with robust variance was used to determine the association between the outcome and explanatory variables, adjusted for individual-, household-, and community-level factors.
Approximately 18% of respondents were visited by FWAs in the three months prior to the survey date and only 3.4% and 3.1% of women attended community and satellite clinics, respectively. Women who reported being visited by FWAs in the three months prior to the survey were approximately 36% less likely to report an unmet need for modern contraception and 42% more likely to report using modern contraception than women who did not report such a visit. A higher likelihood of unmet need for contraception and a lower likelihood of contraception use were found among women who did not visit these community or satellite clinics or visited these clinics for other reasons than collecting contraception as compared to women who visited these clinics to collect contraception.
Home visits by FWAs to respondents' homes to provide contraception as well as respondents' visits to satellite and community clinics play a major role in Bangladesh to ensure contraception use and reduce the unmet need for contraception. However, their coverage is quite low in Bangladesh. The findings suggest an urgent need for greater government initiatives to increase the number of FWAs and proper monitoring of them at the field level.
在低收入和中等收入国家（LMICs），包括孟加拉国，现代避孕方法的使用率仍然低于预期，导致未满足的需求更高。导致避孕方法使用率较低的一个潜在因素是，包括家庭福利助理（FWAs）家访以及妇女到社区和卫星诊所就诊在内的，对较低层级政府医疗设施的利用和使用减少。然而，这些关系在孟加拉国和更广泛的 LMICs 中仍未得到探索。本研究的目的是探讨孟加拉国较低层级政府医疗设施对避孕未满足需求和避孕使用的影响。
本研究分析了 2017 年孟加拉国人口与健康调查中 17585 名有性行为的已婚妇女的数据。因变量是任何避孕方法的使用、现代避孕方法的使用、避孕未满足需求和现代避孕未满足需求。考虑的解释变量是受访者在过去三个月内接受 FWAs 的家访、受访者访问社区诊所以及受访者访问卫星诊所的情况。使用多水平混合效应泊松回归模型和稳健方差来确定结局和解释变量之间的关联，同时调整了个体、家庭和社区层面的因素。
大约 18%的受访者在调查日期前三个月内接受了 FWAs 的家访，只有 3.4%和 3.1%的妇女分别参加了社区和卫星诊所。与没有接受家访的妇女相比，在调查前三个月内接受过 FWAs 家访的妇女报告现代避孕未满足需求的可能性低 36%，使用现代避孕方法的可能性高 42%。与因其他原因而不是领取避孕方法而访问这些社区或卫星诊所的妇女相比，没有访问这些诊所或访问这些诊所领取避孕方法的妇女报告避孕未满足需求的可能性更高，而报告使用避孕方法的可能性更低。
FWAs 家访为受访者提供避孕方法以及受访者访问卫星和社区诊所，在孟加拉国发挥了重要作用，确保了避孕方法的使用并减少了避孕未满足需求。然而，这些服务在孟加拉国的覆盖率相当低。研究结果表明，迫切需要政府采取更多措施增加 FWAs 的数量，并在实地层面进行适当监测。
