Assessing access to family planning services for the urban poor in Bangladesh The 12 th International Conference on Urban Health may, 2015 Dhaka, Bangladesh

Background Bangladesh facing serious demographic crisis in terms of growing population and urbanization. Total fertility rate (TFR) reduced but the contraceptive rate (CPR) declined due to: insufficient policy promotion low contraceptive use declining trend in Long Acting Reversible Contraceptive (LARC).

Aim We carried out a context review with the aim of developing a Public-Private Partnership (PPP) model to increase access to LARCs for the urban poor. The specific objectives of the context review were: – To assess the problems and prospects for LARC service provision in urban areas – To design a partnership model

Methods Study area: 2 urban areas in Dhaka Study design: Mixed methods Data collection methods: -In-depth Interviews -Focus Group Discussions -Service Statistics Respondents: Policy makers Service providers and facility managers Exit clients

Results Short acting methods are popular Use of Long Acting Reversible Contraceptives (LARC) is low due to: – Misconception: LARC has side effects Using LARC is uncomfortable Reduces reproductive ability – Social Norms: Male dominance Religious restriction

Use of FP Methods

Results Diverse providersː LARCs available in public and NGO facilities; a few PMPs provide LARCs. Two of six NGO clinics only provide IUD, not implant Service charge variesː No service charge for LARC at public and some NGO facilities, only membership fee (15 to 40 taka) Clients receive LARCs at a subsidized price at NGO clinics (200 taka for Implant and IUD) Pay full costs at PMPs chambers

Results Incentives vary: Clients receive 150 taka for IUD in public and some NGO facilities No Incentive in some NGO facilities and PMPs chambers Incentives for referring LARC clients vary from no incentive to 90 Taka Providers receive 50 Taka at public and some NGO facilities (but actual payment varies in reality)

Results Processes vary: Registers and health cards: Public and NGO clinics maintain where as PMPs do not Follow-up: NGO community health workers provide door-to-door services, with no mechanism for follow- up Weak referral: PMPs not providing LARCs often refer patients to NGO clinics, no referral form Capacity varies: Inadequate knowledge of LARCs among general PMPs Limited space and staff at PMP chambers PMPs not aware of the incentives

Way forward We aim to: Develop a Public Private Partnership (PPP) model to increase access and method choice of FP for the urban poor Involve PMPs as the urban poor people also visit PMPs Involvement of other stakeholders

PPP Service linkage model for FP service provision: the current process

Conclusion Assessment of the model to measure the feasibility Dissemination of research report in near future