1. I DENTIFY THE W AYS TO I NCREASE A CCESS OF FP S ERVICES IN H ARD TO R EACH A REAS AND U RBAN S LUMS Dr. Kazi Maruful Islam Eminence 3/6, Asad Avenue, Mohammadpur Dhaka- 1207.

2. O BJECTIVES Identify the constraints to increase FP users in hard to reach area and urban slums Define the factors that differentiate urban slum women in accessing FP services compared to hard to reach areas of rural women Find out means of reaching the FP services in hard to reach and urban slum areas

3. M ETHODOLOGY Methods used Quantitative -Survey with structured questionnaire with 1500 married women at reproductive age (Rural 700 and Urban 800) Qualitative -Document Review (Relevant documents and web portal) -Focused Group Discussion (14 groups) -Key Informant Interview (42 KII with government health service providers, pharmacy manager in urban areas, religious leaders and community leaders) -

4. M ETHODOLOGY Study areas Hard to reach areas in 7 Administrative divisions and urban slums of City Corporations Barisal: Barishal CC and Bhola Chittagong: Chittagong CC and Banderban Dhaka: Dhaka CCs and Jamalpur Char Khulna: Knulna CC and Satkhira Rajshahi: Rajshahi CC and Baghmara Rangpur: Rangpur Sadar and Ganchhara Sylhet: Sylhet CC and Habiganj

5. KEY FINDINGS

6. O BJ -1: C ONSTRAINTS IN PROVIDING FP S ERVICES IN H ARD TO R EACH AREAS AND U RBAN S LUMS Hard to Reach Areas Demand Side Desire for more children (34.2%) Denial of women (23.1%) Husband’s denial/opposition (28.3%) Religious barrier/misconceptions (15.3%) Supply Side Shortage of FP field workers Lack of training and motivation of field workers Communication and transport difficulty of field workers Location of Community clinics Unavailability of contraceptives as per demand and suitability.

7. O BJ -1: C ONSTRAINTS IN PROVIDING FP S ERVICES IN H ARD TO R EACH AREAS Urban Slums Demand Side Desire for more children (37.8%) Denial of women (18.9%) Husband’s denial/opposition (21.3%) Religious barrier (3.3%). Supply Side Absence of government FP workers Unavailability of contraceptives as per demand and suitability.

8. O BJ -2: D IFFERENTIATING FACTORS OF H ARD TO REACH AREAS AND U RBAN SLUMS IN ACCESSING TO FP S ERVICES Population density: Less in hard to reach than urban slums Availability of family planning services: Government workers in hard to reach areas; not in urban slums, only pharmacy and NGO workers Accessibility and affordability: Service is physically inaccessible in hard to reach areas, not depends much on even affordability; Hospitals and pharmacies are accessible in urban slums Religious and cultural barrier: Less in urban slums

9. O BJ -3: M EANS OF REACHING FP SERVICES Hard to Reach Areas Increase household visit of field workers (50.2%) Provision of alternative oral pills (26%) Correct advice from service providers (21.4%) Rigorous campaign and target male members of the family/husband (Qualitative methods) Urban Slums Provision of alternative short term methods (16.6%) Correct advice from service providers (19.1%) Alternatives for long term and permanent methods (24.2%) Provision of government family planning workers (24%) Frequent visit of FP workers according to clients’ time (12.1%)

10. LESSON LEARNT

11. In hard to reach areas community clinics/health complexes are sometimes physically inaccessible. Communities are not informed properly about the revised schedule of FP worker (e.g. FP workers are available in community clinics 3 days/week) Misconception about the government provided brands of FP method

12. LESSON LEARNT Clients discontinue methods because of unavailability of their preferred methods/brands Mismatch of timing between eligible couples in urban slums and health service providers. Males are less involved in in decision making, acceptance, and use of family planning Religious misconceptions higher in hard to reach areas

13. RECOMMENDATIONS

14. Special and organized drive to make FP services accessible and available in hard to reach areas Policy level decision on placement of field workers Introduction of systematic screening to identify individual suitability of the contraceptive methods

15. RECOMMENDATIONS Sensitization and motivation of eligible couples, religious leaders, LGI representatives and others through innovative ways of information dissemination and health education (e.g mobile based technology, khutba at weekly prayer etc) Encourage male participation in family planning and couple’s reproductive health

16. Thank You