Integrating health services into an MCH-FP program: lessons from Matlab, Bangladesh

Abstract

Since 1977 the International Centre for Diarrhoeal Disease Research, Bangladesh, has conducted a field experiment in family planning and MCH in its Matlab research station. The project began with an emphasis on family planning and MCH services were added in stages. This paper uses time series regression methods to address the question of whether the addition of health services contributed to family planning efficacy in Matlab in a program launched with minimal MCH services. The results show that some MCH interventions increased contraceptive prevalence, some decreased it, and others had no effect. The broader significance of these findings for implementing integrated programs is discussed.

PIP: Since 1977, the International Centre for Diarrhoeal Disease Research, Bangladesh, has conducted a field experiment in family planning in its Matlab research station. The project began with an emphasis on family planning; maternal-child health (MCH) services were added in stages. This analysis aims to determine whether additional health and MCH services enhance effectiveness of a comprehensive family planning program that contained limited MCH components from the beginning. Initial Family Planning and Health Services Project (FPHSP) effects on contraceptive prevalance were pronounced. Use prevalence increased to 25% in the 1st 6 months and to 32% within a year. This was followed by a general fertility decline of 25%. Prevalence gradually converged to 43%. The tetanus toxoid program--introduced to prevent tetanus neonatorum--did not discrup the contraceptive prevalence trend. Prevalence increased until 2 interventions for treating diarrhea were introduced: 1) packets, consisting of a premixed sugar and electrolyte powder that is dissolved in water; and 2) "labon-gur,"--a homemade mixture of locally available salt and molasses that has been shown to be as effective as the packets and costs less. The tetanus program was changed to as mass maternal immunization program. A measles immunization program was launched. This result in rising prevalence. Household insertion of IUDs (Copper T) resulted in a pronounced increase in IUD prevalence and concomitant decline in the prevalance of other methods. An antenatal care program was launched. It was followed by a program to train traditional birth attendants. This did not have much of an effect on contraceptive prevalence.