Contraceptive use in Matlab, Bangladesh in 1990: levels, trends, and explanations

Abstract

The results of a 1990 knowledge, attitudes, and practice survey in Matlab, Bangladesh, indicate that contraceptive prevalence has risen to 57 percent in the maternal and child health/family planning project area. Between 1984 and 1990 significant increases were registered in the proportions of women using contraceptives for the purposes of spacing and limiting births. By 1990 fertility control in the intervention area had become so widely diffused that educational differentials in contraceptive practice were no longer evident. Although significant gains in contraceptive use were also evident in the neighboring comparison area during this period, at 27 percent, prevalence there still remained substantially below the levels in the intervention area. The disparity in contraceptive use between the two areas is adequately explained neither by differences in socioeconomic conditions nor in the demand for family planning, but rather by differences in the intensity, coverage, and overall quality of their family planning programs.

PIP: The International Center for Diarrheal Disease Research, Bangladesh (ICDDR,B) has conducted research and program intervention on maternal and child health and family planning (FP) since October 1977. The rural study area was in Matlab, a cluster of 149 villages with a population of 180,000. This article reports on recent contraceptive use changes from the FP knowledge, attitudes, and practices (KAP) survey in 1990. Prior surveys in 1984, 1977, and 1975 were also used to show time trends. Current contraceptive use for all currently married women 15-49 years was 57% in the intervention area (IA) and 27% in the comparison area. 94% of contraceptive prevalence (CP) was for modern methods in the IA of which 50% were injectables, 21% pills, and 15% female sterilization. CP constituted 35% for female sterilization, 30% pill use, and 26% traditional methods for the comparison area. The greatest difference in method use between areas was in modern contraceptive use; spacing and limitation differences showed 71% used for limitation in the IA versus 37% in the comparison area. 42% used contraception for spacing in the comparison area. In the IA, contraceptive use levels were associated with maternal age, number of living children, and number of sons; educational level no longer had a dominant effect. Increases in contraceptive use for spacing were evident between 1984 and 1990 and between 1977 and 1984. Limiting increased significantly more after 1984. Increases between 1977 and 1984 were due to primarily increases in injectables, female sterilization, and the IUD; increases after 1984 were due to injectables and the pill. Almost all demographic subgroups experienced CP increases after 1984 in either area. Compared with trends throughout Bangladesh, contraceptive use levels in the rural Matlab IA were higher than the rural national average, while the comparison area remained somewhat lower. Matlab is the socioeconomically least developed region in the country and it was expected that there would be a lag. Discussion includes an explanation for the high levels of use and the nature of the study area, differences in socioeconomic conditions and in demand for family planning, and in service delivery programs. The implication is that carefully planned programs can be successful even under unfavorable conditions.