Ara Tasnim, Sathi Shahnaj Sultana, Shiblee Shafayatul Islam, Esha Sumaiya Nusrat, Amin Md Tazvir, Rahman Md Mahabubur
Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh.
International Center for Diarrhoeal Disease and Research, Bangladesh, icddr,b, GPO Box 128, Dhaka, 1000, Bangladesh.
Reprod Health. 2024 Dec 18;21(1):186. doi: 10.1186/s12978-024-01922-x.
Despite high coverage of antenatal care (ANC) and family welfare assistant (FWA) visits, emergency contraceptive pill (ECP) awareness is critically low in Bangladesh. We aim to investigate the missed opportunities in generating ECP awareness through ANC and FWA visit programs; and assess the missed opportunities and sociodemographic discrimination in receiving family planning (FP) counseling during ANC.
We used data from the nationwide Bangladesh Demographic and Health Survey 2017-18. Sample includes 5012 reproductive-aged women who gave live birth in the last 3 years preceding the survey. We used mixed-effect multiple logistic regression considering women nested within clusters to conclude.
Nationally, 79% of women who gave live birth in the last 3 years preceding the survey were unaware of ECP. The estimated missed opportunities in generating ECP awareness was 59.5% in ANC, 0.9% in FWA visits, and 12.3% in both ANC and FWA visits. While FWA visit was not associated with ECP awareness, receiving FP counseling during ANC was significantly associated. About 88.4% of women remained unexposed to FP counseling through ANC during their last pregnancy. Missed opportunities in FP counseling during ANC was 80.4% of which 72% points were from qualified providers. The odds of missed opportunities was not associated with provider type, rather significantly increased among women with low education, lower parity, and poor socioeconomic status.
This study highlights the fragile status of FP counseling during ANC and FWA visits in generating ECP awareness. A prominent provider bias is excluding women of the disadvantageous sociodemographic group from receiving FP counseling.
尽管孟加拉国的产前保健（ANC）和家庭福利助理（FWA）访视覆盖率很高，但紧急避孕药（ECP）的知晓率极低。我们旨在调查通过ANC和FWA访视计划提高ECP知晓率方面存在的错失机会；并评估在ANC期间接受计划生育（FP）咨询方面的错失机会和社会人口统计学歧视。
我们使用了2017 - 18年孟加拉国全国人口与健康调查的数据。样本包括在调查前过去3年中生育活产的5012名育龄妇女。我们使用考虑妇女嵌套在聚类中的混合效应多元逻辑回归来得出结论。
在全国范围内，在调查前过去3年中生育活产的妇女中有79%不知道ECP。在ANC中提高ECP知晓率的估计错失机会为59.5%，在FWA访视中为0.9%，在ANC和FWA访视中均为12.3%。虽然FWA访视与ECP知晓率无关，但在ANC期间接受FP咨询与ECP知晓率显著相关。在她们上次怀孕期间，约88.4%的妇女在ANC期间未接受FP咨询。ANC期间FP咨询的错失机会为80.4%，其中72个百分点来自合格提供者。错失机会的几率与提供者类型无关，而是在教育程度低、产次少和社会经济地位差的妇女中显著增加。
本研究强调了在ANC和FWA访视期间进行FP咨询以提高ECP知晓率方面的薄弱状况。一个突出的提供者偏见是将处于不利社会人口统计学群体的妇女排除在接受FP咨询之外。
