Consequences of the shift from domiciliary distribution to site-based family manning services in Bangladesh

Context: Concerns about financial sustainability and the need to offer a br oader range of reproductive health services to clients have led the Banglad esh family planning program to shift from conventional door-to-door (domici liary) distribution to static (fixed) site-based service delivery However, it is of critical importance to carefully examine the consequences of the c hangeover on family planning performance. Methods: Using data from the longitudinal surveillance systems of the Opera tions Research Project of the international Centre for Diarrhoeal Disease R esearch, Bangladesh (ICDDR, B), a before-and-after analysis of the contrace ptive prevalence, method mix, source mix, new acceptance rate and dropout r ate was conducted to assess the consequences of the shift in service delive ry approach. Results: The shift from domiciliary distribution to clinic-based service de livery appears to have resulted in a slight increase in contraceptive preva lence in the urban study area, from 54-56% before the shift to 55-57% after ward The changeover did not produce any discernable variation in the method mix, the proportion of new accepters of family planning or the contracepti ve dropout rate. This apparent lack of change can be explained by increased use of alternative sources, with a substantial rise among users in relianc e on pharmacies and shops (30-35% before vs. 42-50% after). In two rural st udy areas, the shift from domiciliary distribution to service delivery from static sites known as cluster spots resulted in an increase in the prevale nce rate, from 52% to 57% in Palm and from 40% to 45-46% in Durgapur. The c hangeover coincided with greater use of injectable contraceptives and decre ased reliance on traditional methods among rural contraceptive users. A not able immediate increase in new accepters also was evident as was a long-ter m decline in dropouts. in Paira, following the shift, 43-44% of current use rs obtained their contraceptive supplies from cluster spots, as did 32-33% in Durgapur. Conclusions: The recent change in the family planning program toward clinic -based delivery of an integrated package of essential health and family pla nning services appears likely to maintain, and perhaps even increase, contr aceptive prevalence levels in Bangladesh.