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ORIGINAL ARTICLE
Open Access

The Mayer Hashi Large-Scale Program to Increase Use of Long-Acting Reversible Contraceptives and Permanent Methods in Bangladesh: Explaining the Disappointing Results. An Outcome and Process Evaluation

Mizanur Rahman, M Moinuddin Haider, Sian L Curtis and Peter M Lance
Global Health: Science and Practice August 2016, 4(Supplement 2):S122-S139; https://doi.org/10.9745/GHSP-D-15-00313
Mizanur Rahman
aUniversity of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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  • For correspondence: rahmanm@email.unc.edu
M Moinuddin Haider
bInternational Center for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
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Sian L Curtis
aUniversity of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Peter M Lance
aUniversity of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Figures & Tables

Figures

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  • FIGURE 1.
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    FIGURE 1.

    Percentage of Facilities Having BCC Materials/Products on LARCs/PMs at Endline, Mayer Hashi Provider Survey, 2013

    Abbreviations: BCC, behavior change communication; LARCs, long‐acting reversible contraceptives; PMs, permanent methods.

  • FIGURE 2.
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    FIGURE 2.

    Use of LARCs/PMs and Other Methods, by Program vs. Nonprogram Districts, 2010 and 2013, Mayer Hashi Evaluation

    Abbreviations: LARCs, long‐acting reversible contraceptives; PMs, permanent methods.

Tables

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    TABLE 1. Sample Sizes and Response Rates for the Household and Provider Surveys
    Survey and RespondentsProgram DistrictsaNonprogram Districtsb
    NumberResponse Rate (%)NumberResponse Rate (%)
    Household survey of CMWRA
     Baseline – 2010 (BMMS)22,14593c9,89393c
     Endline – 2013 (MH Program)3,89495d1,97093d
    Provider survey, 2013
     FWAs11810062100
     FWVs118986298
     UFPOs59713183
     MOs–MCH59323161
     RMOs53792879
     OB/GYNs53342836
     All providers4607724282
    • Abbreviations: BMMS, Bangladesh Maternal Mortality Survey; CMWRA, currently married women of reproductive age; FWAs, family welfare assistants; FWVs, family welfare visitors; MH, Mayer Hashi; MOs–MCH, medical officers–maternal and child health; OB/GYNs, obstetrician/gynecologists; RMOs, resident medical officers; UFPOs, upazila (subdistrict) family planning officers.

    • ↵a Barisal, Patuakhali, Comilla, Cox’s Bazaar, Moulvibazar, Sunamganj.

    • ↵b Kishoreganj, Mymensingh, Narsingdi.

    • ↵c 93% for program and nonprogram districts together.

    • ↵d 94% for program and nonprogram districts together.

    • View popup
    TABLE 2. Background Characteristics of Sampled Women
    Program DistrictsNonprogram Districts
    2010201320102013
    Age, years, mean30.631.430.331.5
    No. of children, mean2.62.72.52.6
    No education, %31.128.536.732.0
    Lowest 2 quintiles, %39.942.340.735.6
    Non-Muslim, %13.710.45.73.5
    Urban, %33.525.644.327.0
    • Source of data: 2010 baseline data are from the Bangladesh Maternal Mortality Survey; 2013 endline data are from the Mayer Hashi endline survey.

    • View popup
    TABLE 3. Provider Practice (%) at Endline, Mayer Hashi Provider Survey, 2013
    FWAsFWVsMOs–MCH
    ProgramNonprogramProgramNonprogramProgramNonprogram
    (n = 118)(n = 62)(n = 116)(n = 61)(n = 19)(n = 19)
    Pre-counseling for implant clients
     Explain advantages and disadvantages9798312395100
     of implants
     Ensure informed choice39231473726
    Mention probable side effects of implants
     Amenorrhea6481222068100
     Spotting475822117495
    Post-counseling for IUD clients
     Provide the follow-up card547374905895
     Determine that clients understand key3189102116
     counseling points
    Post-counseling for female sterilization clients
     Provide the follow-up card536866875895
     Determine that clients understand key938152126
     counseling points
    • Abbreviations: FWAs, family welfare assistants; FWVs, family welfare visitors; IUD, intrauterine device; MOs–MCH, medical officers–maternal and child health.

    • View popup
    TABLE 4. Women’s Reports of Client–Provider Contact, Informed Choice, and Exposure to Information on LARCs/PMs, Mayer Hashi Household Survey, 2013
    PercentageSample SizeP Value
    ProgramNonprogramProgramNonprogram
    Provider contact with CMWRA (in last 3 months)
     Visited by family planning workers13233,1941,637<.001
     Sought health care from government facilities30443,1171,544<.001
     Sought health or family planning care from government facilities44553,1171,544<.001
    Informed choice – Received family planning or LARC/PM information from providers or facilities (in last 3 months)
     Temporary method acceptors who were told about PMs4033410174NS
     Injectable, IUD, and implant acceptors who were told about side effects384921679NS
     Injectable, IUD, and implant acceptors who were reminded about follow-up visits314821679<.05
     CMWRA who sought health or family planning care and noticed BCC materials with LARC/PM messages42431,369854NS
    Exposure to LARC/PM Information – Heard, saw, or read messagesa (in last 3 months) about:
     IUDs15213,1941,637<.001
     Implants22403,1941,637<.001
     Tubectomy29353,1941,637<.001
     No-scalpel vasectomy17133,1941,637<.001
     LARCs/PMs38503,1941,637<.001
     PMs31353,1941,637<.001
    • Abbreviations: BCC, behavior change communication; CMWRA, currently married women of reproductive age; IUD, intrauterine device; LARCs, long-acting reversible contraceptives; PMs, permanent method; NS, not significant.

    • ↵a From TV, radio, newspaper/magazine, billboard/poster, folk song/theater, courtyard meeting, health/family planning worker, health facility, or friend/relative.

    • View popup
    TABLE 5. Change in LARC/PM Method Use Among CMWRA Between 2010 and 2013, Mayer Hashi Program
    % Reporting Use
    20102013Change
    IUD
     Program0.50.4-0.1
     Nonprogram0.40.60.2
    Implant
     Program0.71.20.5
     Nonprogram0.81.91.1
    Tubectomy
     Program3.74.91.2
     Nonprogram3.25.72.5
    NSV
     Program0.41.00.6
     Nonprogram0.50.80.3
    Any LARC/PM
     Program5.37.52.1
     Nonprogram5.08.94.0
    • Abbreviations: CMWRA, currently married women of reproductive age; IUD, intrauterine device; LARC, long-acting reversible contraceptive; PM, permanent method; NSV, no-scalpel vasectomy.

    • View popup
    TABLE 6. Multinomial Logit Coefficient Estimates and Estimated Program (Interaction) Effect for LARC/PM Use and Other Method Use, Mayer Hashi Evaluation, 2013 (N = 37,902)
    LARCs/PMsOther Methods
    CoefficientSEP ValueCoefficientSEP Value
    Program (ref: nonprogram)–0.0840.088.34–0.2430.049<.001
    Year 2013 (ref: 2010)0.6160.157<.0010.1450.070.04
     Program X Year–0.3590.182.05–0.2230.093.02
    Age, years (ref: 25–29)
     <20–2.3960.280<.001–0.8120.072<.001
     20–24–1.0390.166<.001–0.2830.056<.001
     30–340.6910.122<.0010.2470.072.001
     35–391.0710.127<.0010.4600.071<.001
     40–440.4870.155.002–0.0540.078.49
     45–490.1690.157.28–1.2690.081<.001
    Education (ref: no education)
     Primary incomplete0.2420.110.030.1890.057.001
     Primary complete–0.1640.127.200.2730.053<.001
     Secondary incomplete–0.2760.140.050.2310.061<.001
     Secondary complete or higher–0.5890.197.0030.2790.085.001
    Wealth quintile (ref: lowest)
     Second–0.2070.115.070.0640.056.25
     Middle–0.2850.124.02–0.1390.061.02
     Fourth–0.2630.135.05–0.2210.072.002
     Highest–0.3800.171.03–0.3780.083<.001
    Religion (ref: Muslim)
     Non-Muslim0.5450.137<.0010.2780.063<.001
    Sector (ref: rural)
     Urban0.2780.115.020.2860.054<.001
     Constant–1.9880.129<.0010.3800.073<.001
    Program effecta
     Interaction effect–0.0170.011.14–0.0380.021.07
    • Abbreviations: LARC, long-acting reversible contraceptive; PM, permanent method; SE, standard error.

    • ↵a Estimated from the predicted probabilities of LARC/PM use or other method use obtained from the model for each program area by survey year combination, in line with the difference-in-difference approach to estimate program impact, as described in the main body of the article.

    • View popup
    TABLE 7. Indicators of Regional Health System Strength and Increase in LARC/PM Use, Mayer Hashi, 2013
    Program DistrictsNonprogram Districts
    Eastern regionSouth-central regionNorth-central region
    Vacancy of UFPO, %364710
    Vacancy of MO–MCH, %563819
    CMWRA visited by FWA and other family planning worker,a %131223
    CMWRA sought health/family planning care from facilities, %414955
    CMWRA heard, saw, or read about LARCs/PMs, %383750
    Increase in LARC/PM use between 2010 and 2013, percentage pointsb1.63.34.0
    • Abbreviations: CMWRA, currently married women of reproductive age; FWA, family welfare assistant; LARC, long-acting reversible contraceptive; MO–MCH, medical officer–maternal and child health; PM, permanent method; UFPO, upazila (subdistrict) family planning officer.

    • ↵a Although FWAs are supposed to make home visits every 2 months, in practice less than 20% of CMWRA reported that they were visited by a family planning worker in the 6 months prior to the 2011 Demographic and Health Survey.9

    • ↵b It was not possible to match the program and nonprogram districts in the health system characteristics that may affect couples’ LARC/PM use.

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Global Health: Science and Practice: 4 (Supplement 2)
Global Health: Science and Practice
Vol. 4, No. Supplement 2
August 11, 2016
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The Mayer Hashi Large-Scale Program to Increase Use of Long-Acting Reversible Contraceptives and Permanent Methods in Bangladesh: Explaining the Disappointing Results. An Outcome and Process Evaluation
Mizanur Rahman, M Moinuddin Haider, Sian L Curtis, Peter M Lance
Global Health: Science and Practice Aug 2016, 4 (Supplement 2) S122-S139; DOI: 10.9745/GHSP-D-15-00313

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The Mayer Hashi Large-Scale Program to Increase Use of Long-Acting Reversible Contraceptives and Permanent Methods in Bangladesh: Explaining the Disappointing Results. An Outcome and Process Evaluation
Mizanur Rahman, M Moinuddin Haider, Sian L Curtis, Peter M Lance
Global Health: Science and Practice Aug 2016, 4 (Supplement 2) S122-S139; DOI: 10.9745/GHSP-D-15-00313
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