Women's Health Commons^™

Reduce Contraception Discontinuation In Bangladesh By Improving Counseling On Side Effects, Fauzia Akhter Huda, Sabiha Chowdhuri

Reproductive Health

High rates of contraceptive discontinuation and method failure could cause Bangladesh to lose the progress made in increasing contraceptive use over the past 20 years. This policy brief concludes that if women are adequately counseled and supported to sustain their use of more effective contraceptive methods, they will need less medical attention, have fewer unintended pregnancies, and reduce the workload for medical clinics. Furthermore, if providers are adequately trained and supported in counseling and managing side effects and in helping women to switch methods when they do have a problem, the Family Planning Clinical Contraception Services Delivery Program would meet …

Assessment Of Sex Selection In Bangladesh, Md. Noorunnabi Talukder, Ubaidur Rob, Forhana Rahman Noor

Reproductive Health

According to UN estimates, the sex ratio at birth (SRB) has persisted at its natural level of 105 male per 100 female newborns for the past half century in Bangladesh. Generally, the SRB becomes skewed in a setting where fertility is declining or low and where son preference exists. Strong son preference compounded by the availability of measures to implement such preference can lead to increased SRB. For example, the increasing availability of prenatal diagnostic technologies, together with declining fertility desires and persistent son preference, has contributed to increased gender-biased sex selection in several Asian countries, including China and India. …

Balika Fact Sheet: Highlight On Gender And Rights, Population Council

Poverty, Gender, and Youth

Data presented in this Bangladeshi Association for Life Skills, Income, and Knowledge for Adolescents (BALIKA) fact sheet, “Highlight on Gender and Rights,” reveal that attitudes about gender equitability differ across domains and by the background characteristics of respondents in terms of education, marital status, and age. Those who are married, less educated, and young are less aware of gender equality and rights including domestic violence, autonomy, and confidence. The data suggest specific areas where interventions may produce positive outcomes. The BALIKA survey included a number of questions to measure the values held about gender equality in terms of marriage expectations, …

Balika Fact Sheet: Highlight On Marriage, Population Council

Poverty, Gender, and Youth

Early marriage deprives girls of the opportunity for personal development and their rights to full reproductive health and well-being, education, and participation in civil life. Bangladesh stands out in international comparisons as having an extraordinarily early age at marriage for girls and a considerable average age difference in marriage between girls and their husbands. This Bangladeshi Association for Life Skills, Income, and Knowledge for Adolescents (BALIKA) fact sheet, “Highlight on Marriage,” concludes: In Bangladesh, marriage remains early by most standards and the majority of girls still get married before reaching the legal age of 18 years. By age 19, more …

Evaluation Of The Impact Of The Voucher Program For Improving Maternal Health Behavior And Status In Bangladesh, Md. Noorunnabi Talukder, Ubaidur Rob, Syed Abu Jafar Md. Musa, Ashish Bajracharya, Kaji Tamanna Keya, Forhana Rahman Noor, Eshita Jahan, Md. Irfan Hossain, Jyotirmoy Saha, Benjamin Bellows

Reproductive Health

Vouchers, a demand-side financing (DSF) instrument for health-care services, were introduced in Bangladesh in 2006. The DSF program grants vouchers to pregnant women to receive free antenatal, delivery, and postpartum care services as well as free medicine, and financial assistance is provided for transportation. Deliveries with skilled service providers are financially incentivized and providers are reimbursed for their services from a special fund. After piloting DSF initially in 21 subdistricts (upazilas), the government expanded it to another 12 upazilas in 2007 (the second phase), and in its third phase in 2010 the program was expanded to another 11 upazilas. To …

Maternal Health Commodity Landscaping Exercise: A Snapshot Of The Bangladesh Program, Sharif M.I. Hossain, Saumya Ramarao, Ismat Ara Hena, Ubaidur Rob

Reproductive Health

Despite consistent efforts of the government and national stakeholders, every year in Bangladesh over 5,000 mothers and thousands of children die. Most of these deaths would be preventable with increased access to quality services including existing medicines and other health commodities. The United Nation’s Commission on Life-Saving Commodities for Women and Children suggests that an important cause of these deaths is lack of access and appropriate use of 13 life-saving commodities. This document describes an effort by the Population Council to assess the country’s policies, guidelines, and availability for these 13 life-saving commodities as well as engaging with key stakeholders …

Reducing Unsafe Menstrual Regulation Through Medication In Bangladesh, Ubaidur Rob, Ismat Ara Hena, Nargis Sultana, Md. Irfan Hossain, Reena Yasmin, Tapash Ranjan Das, Farid Uddin Ahmed

Reproductive Health

The Population Council and Marie Stopes Bangladesh, in collaboration with the Directorate General of Family Planning and with funding from the World Health Organization, tested the feasibility of introducing menstrual regulation with medication (MRM) in Bangladesh and assessed the acceptability of providing MRM using the combination drug regimen mifepristone and misoprostol in urban and rural public health facilities. As reported in this policy brief, the study demonstrates that it is feasible and safe to introduce MRM in rural and urban public health facilities. Given the choice, almost two-thirds of women preferred MRM to manual vacuum aspiration and women receiving MRM …

Prevalence Of Unintended Pregnancy And Needs For Family Planning Among Married Adolescent Girls Living In Urban Slums Of Dhaka, Bangladesh, Fauzia Akhter Huda, Sabiha Chowdhuri, Bidhan Krishna Sarker, Noushin Islam, Anisuddin Ahmed

Reproductive Health

This STEP UP research report examined the prevalence and basic underlying factors of unintended pregnancy among married adolescent girls in five urban slums in Dhaka, Bangladesh. The specific objectives of the study were to: 1) document the prevalence of unintended pregnancy among married adolescent girls aged 15–19 years living in urban slums of Dhaka; 2) identify the factors associated with or which contribute to unintended pregnancy among urban married adolescent girls; 3) estimate the proportion of married adolescent girls who have an unmet need for family planning (FP) services; and 4) explore the barriers to access and effective use of …

Introducing Medical Mr In Bangladesh: Mrm Final Report, Ismat Ara Hena, Ubaidur Rob, Nargis Sultana, Md. Irfan Hossain, Reena Yasmin, Tapash Ranjan Das, Farid Uddin Ahmed

Reproductive Health

The Population Council Bangladesh, in collaboration with the Directorate General of Family Planning and Marie Stopes Bangladesh, with funding from the World Health Organization and the DFID-supported STEP UP project, conducted an 18-month operations research study from January 2012 to June 2013. This operations research tested the feasibility of introducing menstrual regulation with medication (MRM) in Bangladesh and assessed accessibility of the combination regimen of mifepristone and misoprostol in urban and rural health facilities. Based on this study’s results, the feasibility of introducing MRM services in Bangladesh is clear, and women receiving MRM were satisfied with their overall quality of …

Understanding Unintended Pregnancy In Bangladesh: Country Profile Report, Fauzia Akhter Huda, Sabiha Chowdhuri, Yolande Robertson, Noushin Islam, Bidhan Krishna Sarker, Ashrafi Jahan Azmi, Laura Reichenbach

Reproductive Health

The objective of this report is to identify the determinants of unintended pregnancy and unmet need for family planning in Bangladesh and therefore provide a strong body of evidence that will contribute to issue identification, evidence generation, and communication for use of evidence in policy and programming. The evidence generated can be used to find ways to reduce the rate of unintended pregnancy and hence reduce the risk of abortion-related morbidity and mortality; ultimately this will aid Bangladeshi couples in reaching their fertility goals. Results demonstrate that Bangladesh has shown progress and promise in several areas of family planning and …

Slides: Draft Power In Developing Country Agriculture--South Asia, Arjun Makhijani

2012 Energy Justice Conference and Technology Exposition (September 17-18)

Presenter: Dr. Arjun Makhijani, President, Institute for Energy and Environmental Research (IEER)

13 slides

Incentivizing Providers To Improve Maternal, Newborn And Child Health Services In Bangladesh: Pay-For-Performance Model Refinement And Advocacy (P4p Mra) Final Report, Md. Noorunnabi Talukder, Ubaidur Rob, Laila Rahman, A.K.M. Zafar Ullah Khan, Riad Mahmud, Azizul Alim, Ismat Ara Hena, Farhana Akter, Anup Kumar Dey

Reproductive Health

An operations research project by the Directorate General of Health Services (DGHS) of the Ministry of Health and Family Welfare, Government of Bangladesh tested the feasibility of a pay-for-performance (P4P) approach, which offered financial incentives to reward service providers for meeting and exceeding specified performance targets for maternal, newborn, and child health services. In response to the encouraging findings, the DGHS implemented a follow-up project, with technical assistance from Population Council and UNICEF, to utilize the experiences and findings of the P4P OR project. Despite it short duration, implementation of the revised P4P scheme induced improvements in service volume and …

Defining Effective Voucher Management Information Systems: A Blueprint For Information Systems To Support Scalable Reproductive Health Voucher Programs, Based On System Evaluations With Programs In Bangladesh, Cambodia, Kenya, Uganda, And Tanzania, Mahad Ibrahim, Benjamin Bellows, Jaspal S. Sandhu

Reproductive Health

This document defines the key elements of information systems to support the development of effective, scalable voucher information systems. It is based on an engagement between the Gobee Group and the Population Council to strengthen information systems of reproductive health voucher programs in five countries in 2011–12. At the time of publication of this document, the Population Council was in the midst of a multiyear evaluation of five of the biggest reproductive health programs worldwide, an effort supported by the Bill & Melinda Gates Foundation. While the work supporting this report has been focused on reproductive health voucher programs—which provide …

Costing And Economic Analysis Of Strengthening Union Level Facility For Providing Normal Delivery And Newborn Care Services In Bangladesh, Sushil Ranjan Howlader

Reproductive Health

For a long time, the reduction of the maternal mortality ratio has constituted a major challenge for the health, nutrition, and population sector of Bangladesh. The objectives of this Population Council study is to estimate the costs of the additional inputs required for strengthening Health and Family Welfare Centers (HFWC) for providing normal delivery and newborn care services, the cost-effectiveness, and the financial implications of the addition of capacity. Results clearly show that the benefit-cost ratio for the intervention will be quite high. Some additional measures on the demand side should thus adopted. Intensive behavior change communication activities including interpersonal …

Innovative Financing Through Pay-For-Performance For Providers To Improve Quality Of Care In Bangladesh: Transforming Research Into Action, Md. Noorunnabi Talukder, Ubaidur Rob, Laila Rahman, Ismat Ara Hena

Reproductive Health

To improve access to and use of facility-based obstetric and newborn care, the Government of Bangladesh is implementing two innovative performance-based financing programs, namely demand-side financing (DSF) and pay-for-performance (P4P). With the purpose of identifying the lessons learned, limitations of the P4P and DSF models, and scopes for cross learning, a two-day workshop was organized in Dhaka. This workshop report, prepared by the Population Council, resulted in several recommendations to modify DSF and P4P schemes. In Bangladesh, the need for continuing performance-based financing programs to meet MDGs and other health indicators is beyond argument, but it is urgently required to …

Expanding Access To Safe Abortion And Post-Abortion Care: Recommendations Of A South Asia Regional Consultation, Population Council

Reproductive Health

A South Asia Regional Consultation, organized by the Population Council with representation from governments and key stakeholders of Bangladesh, India, Nepal, and Pakistan, was held in New Delhi, to discuss ways of expanding women’s access to safe abortion services. The Consultation deliberated on ways of expanding the provider base for safe induced abortion so as to overcome inadequate and inequitable access to safe abortion. They also looked to expand access to services for the management of incomplete abortion and complications of unsafe abortion that persist in the region and, thereby, to reduce morbidity and mortality resulting from unsafe abortion. In …

A Pay-For-Performance Innovation Integrating The Quantity And Quality Of Care In Maternal, Newborn And Child Health Services In Bangladesh, Laila Rahman, Ubaidur Rob, Riad Mahmud, Azizul Alim, Ismat Ara Hena, Md. Noorunnabi Talukder, Md. Hafizur Rahman

Reproductive Health

The Population Council explored the possibilities of introducing a Pay-for-Performance (P4P) scheme in Bangladesh to improve maternal, newborn and child healthcare (MNCH) services. Based on the consultation and with guidance from the Government of Bangladesh, the Population Council and UNICEF provided technical assistance to the Directorate General of Health Services (DGHS) to test two P4P strategies for MNCH service providers to improve service volume and quality of care, and for poor clients to receive services subsidized through vouchers or coupons. The first strategy is a combination of pay-for-performance for providers and subsidized coupons for poor pregnant women, newborns, and under-five …

Kishor-Kishorider Jonno Ortho Sikkha [Financial Education For Adolescents], Sigma Ainul, Marzina Khatun, Najneen Mahbooba

Poverty, Gender, and Youth

No abstract provided.

Kishor-Kishorider Jonno Ortho Sikkha: Shikkhok Shahayika [Financial Education For Adolescents: Teacher's Manual], Sigma Ainul, Marzina Khatun, Najneen Mahbooba

Poverty, Gender, and Youth

No abstract provided.

Kishor-Kishorider Jonno Ortho Sikkha: Dishari Shohayika [Financial Education For Adolescents: Mentor's Manual], Sigma Ainul, Marzina Khatun, Najneen Mahbooba

Poverty, Gender, and Youth

No abstract provided.

Manual On Financial Mechanism For The Health Facilities: Introducing Pay-For-Performance Approach To Increase Utilization Of Maternal, Newborn, And Child Health Services In Bangladesh, Laila Rahman, Dipak Kumar Shil, Md. Mamun-Or Rashid, Ismat Ara Hena, Md. Noorunnabi Talukder, Farhana Akter, Anup Kumar Dey, Ripa Ali, Joynal Abedin, Mursheda Rahman, Md. Ataur Rahman, Md. Julkarnayeen, Arifur Rahman, Md. Abdur Rab Sardar

Reproductive Health

The Population Council initiated an operations research study to test two Pay-for-Performance (P4P) strategies to improve maternal, newborn, and child health (MNCH) services in Bangladesh in 2010. The P4P study is being implemented as part of the two ongoing MNCH and maternal and newborn health (MNH) projects of the United Nations Children’s Fund (UNICEF) implemented by the Directorate General of Health Services, Government of Bangladesh. The study has been testing two strategies. The first introduces incentives tied with performance for motivating service providers to improve the quantity as well as quality of services, and enable poor pregnant women, and mothers …

Facility Assessment Report: Introducing Pay-For-Performance (P4p) Approach To Increase Utilization Of Maternal, Newborn, And Child Health Services In Bangladesh, Md. Noorunnabi Talukder, Ubaidur Rob, Laila Rahman, Ismat Ara Hena, Farhana Akter, Mohammad Ataur Rahman, Md. Julkarnayeen, Md. Akteruzzaman, Md. Sohel Rana, Ripa Ali

Reproductive Health

Under the leadership of the Directorate General of Health Services, the Population Council in collaboration with James P. Grant School of Public Health, BRAC University and with support from UNICEF is testing an innovative service delivery model to provide financial incentives to institutions to enhance their performance on maternal, newborn, and child health (MNCH) services in three districts of Bangladesh as part of GOB-UNICEF’s ongoing MNCH/MNH projects. A comparative analysis on the availability and condition of physical and human assets across 16 health facilities will inform what is needed in a facility in terms of inputs and processes. This report …

Future Of Family Planning Program In Bangladesh: Issues And Challenges, Ubaidur Rob, Md. Noorunnabi Talukder, A.K.M. Zafar Ullah Khan

Reproductive Health

Bangladesh experienced large population growth in the past, but due to a successful family planning program, the total fertility rate (TFR) declined rapidly until the mid-nineties. Over the last decade, the country experienced a slow pace in fertility decline with a small increase in the contraceptive prevalence rate (CPR). This slow pace in fertility decline is causing serious concern for reaching replacement level fertility by 2015. CPR increased seven-fold from 1975 to 2000, but there was no significant increase from 2000-09, demonstrating the weakness of present program efforts. This raises concern among researchers, policymakers, and program managers about the prospect …

Urban Family Planning Program Of Bangladesh: Issues And Challenges, Ubaidur Rob, Md. Noorunnabi Talukder, A.K.M. Zafar Ullah Khan

Reproductive Health

Extremely inadequate government primary health care (PHC) structure exists in cities in Bangladesh. Nongovernmental organizations (NGOs) play an important role in providing basic health and family planning services to a limited proportion of the urban population. However, NGO programs are time-bound and subject to the availability of development assistance. Bangladesh has one of the highest rates of growth of urban populations among developing countries. For this teeming urban population, there is no structured family planning service. To ensure continuous family planning services in urban areas it is critical to develop a sustainable primary health care structure with the thrust on …

Workshop Report: Introducing Pay-For-Performance (P4p) Approach And Increase Utilization Of Maternal, Newborn, And Child Health Services In Bangladesh, Md. Noorunnabi Talukder, Ubaidur Rob, Ismat Ara Hena, Farhana Akter, Mohammad Ataur Rahman, Md. Julkarnayeen

Reproductive Health

In Bangladesh, improving skilled birth attendance at delivery and access to facility-based obstetric and newborn care are vital to improving maternal and neonatal health. The health system in Bangladesh faces a critical challenge on the supply side: unavailability of quality services at public health facilities, due to inadequately motivated providers, vacant positions, and provider absenteeism. As well, salaries of public-sector providers do not depend on quality of work or quantity of services provided. Paying an incentive to facilities based on a performance benchmark has the potential of increasing the quantity and quality of maternal, neonatal, and child health (MNCH) care. …

Brief Report: Activities And Achievements Of The P4p Project—Introducing Pay-For-Performance (P4p) Approach To Increase Utilization Of Maternal, Newborn, And Child Health Services In Bangladesh, Population Council

Reproductive Health

A pilot study was initiated in Bangladesh for testing Pay-for-Performance for providers and clients in improving maternal, newborn, and child health (MNCH) services by addressing supply and demand-side barriers. With funding from UNICEF, the Population Council provided technical assistance for the operations research study implemented by the Directorate General of Health Services, Ministry of Health and Family Welfare of the Government of Bangladesh. Necessary and key human resource placement and training on integrated management of childhood illness, emergency operations centers, newborn care, infection prevention, and waste management are important for better performance in all facilities. In spite of existing barriers, …

Guidelines For Pilot Study On Introducing Pay-For-Performance (P4p) Approach To Increase Utilization Of Maternal, Newborn And Child Health Services In Bangladesh, Directorate General Of Health Services (Dghs), Population Council, Unicef

Reproductive Health

The Population Council launched a pilot study to test two Pay-for-Performance (P4P) strategies to improve MNCH services in Bangladesh. This document presents guidelines for offering incentives to providers, distributing coupons, and forming P4P and/or Coupon Committees and Quality Assurance Groups. The guidelines were developed over the course of five policy-level and consensus-building workshops with national and local-level program managers and service providers, organized under the leadership of the DGHS, in consideration of the local context and sustainability in case of nationwide replication in the country. These guidelines will come into effect upon receiving approval from the DGHS, Ministry of Health …

Improving The Quality Of Family Planning And Reproductive Tract Infection Services For Urban Slum Populations: Demand-Based Reproductive Health Commodity Project, Md. Noorunnabi Talukder, Ubaidur Rob, Md. Mafizur Rahman

Reproductive Health

Quality of care has been a neglected dimension of family planning (FP) services for a long time in Bangladesh. Furthermore, effective programs are yet to be implemented to address the imbalance in contraceptive method mix. As outlined in this report, efforts were made through an operations research project to improve the quality of FP and reproductive tract infection (RTI) services provided by NGO clinics in selected slums in Bangladesh. The capacity of these NGO clinics to offer high-quality services to slum neighborhoods was strengthened by training service providers, strengthening service delivery points, and improving counseling services to ensure client satisfaction. …

Bangladesh: Rh Curriculum Enhances Vocational Students' Knowledge And Behavior, Frontiers In Reproductive Health

Reproductive Health

In 2004, the Population Council’s FRONTIERS Program and the Bangladesh Ministry of Youth and Sports collaborated on an intervention to introduce reproductive health education into government-run vocational-training courses. The training, offered to males and females aged 15–30, includes livestock husbandry, electronics, and secretarial work. The intervention built upon the positive results of the 1999 Bangladesh Youth Reproductive Health Study, which introduced a life-skills curriculum into secondary schools. The interactive reproductive health curriculum was modified to suit older adolescents and youth attending courses at vocational training centers. Topics included reproductive biology, family planning, pregnancy, sexually transmitted infections, critical thinking, and negotiation …

Health Systems And Maternal Mortality, Neonatal Mortality And Child Health: Review Of Selected Service Delivery Models, Md. Noorunnabi Talukder, Ubaidur Rob

Reproductive Health

Effective maternal and child health services at the community level in developing countries are rarely available. In many developing countries the health systems cannot provide quality maternal and child health care services due to lack of adequate human resources; shortages of equipment, drugs, and supplies; and absence of proper referral mechanisms. Strengthening health systems is central to improving maternal and child health. A variety of targeted interventions have been implemented in the health systems of developing countries. This study was conducted to identify the health service delivery models that have contributed to the reduction of maternal, infant, and child mortality …