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Assessing the effectiveness of targeted approach for neonatal health and family planning (FP) services in rural Bangladesh

A health worker explains family planning methods to village mothers at an ICDDR,B satellite clinic in Matlab, Bangladesh. © 1990 Ansem Ansari, Courtesy of Photoshare

Research Overview 

TRAction is funding research examining the effectiveness of targeted interventions and services with emphasis on improving access to family planning and outcomes among high-risk populations in Bangladesh.

Bangladesh has made significant progress in approving maternal and child health, a key metric – the national maternal mortality ratio (MMR) – reduced by nearly 40% over the last ten years to 176 per 100,000. Similarly, the national neonatal mortality rate declined by over 30% to 23 per 1,000 while infant and under-five mortality are 32 and 40 per 1000 live births respectively. Though Bangladesh has experienced significant gains in improving population-level health, these rates remain unacceptably high.

As the MMR remains unacceptably high, reducing Bangladesh’s total fertility rate (TFR) at 2.3 is a priority concern.  Smaller family sizes illustrated through reductions in the TFR have proven positive externalities for female health: education rates increase while mortality rates decrease, rates of stunting and wasting decrease, and cycles of poverty may be interrupted.  To meet these ends, countries will invest in programs aimed at increasing awareness of and access to different family planning methods.

Most programs working to improve maternal, neonatal, and child health adopt a “universal approach,” integrating maternal health services with family planning.  This approach often fails to differentiate the content and intensity of services to effectively reach high-risk and disadvantaged groups, and hard-to-reach populations.  Such an approach also fails to meet specific needs of individuals/clients. There is a need to develop a method for targeting high-risk individuals and those with specific needs, to improve health outcomes.  Investigating sets of differential interventions to increase the utilization of maternal and newborn health and family planning services, leading to reduction of maternal, neonatal, and child mortality and fertility, therefore remains, a top health priority for Bangladesh.

Study Approach

Primary Objective: To assess the effectiveness of targeted and differential interventions in reducing neonatal and perinatal mortality as well as increasing contraceptive use including improved contraceptive method mix.

Secondary objectives:

  1. To assess the effectiveness of targeting approaches for appropriate identification of high risk individuals or couples with specific needs,
  2. To estimate the economic benefits of the intervention in terms of outcomes and investment,
  3. To compare the changes in quality of life among TB patients in different study groups

Researchers evaluated interventions using a pre-post quasi-experimental design. Two sub-districts (one as intervention and one as comparison) were randomly selected from the Sylhet and Brahmanbaria districts. Data was obtained from randomly selected longitudinal records and community surveys in the selected districts. Community volunteers were recruited and Community Action Groups (CAG) were formed to update the family planning and pregnancy information system, and to assist in identifying high-risk groups.  Main effects of the interventions were evaluated through statistical comparison of indicators before and after the intervention, and between the intervention and comparison areas. The key maternal and neonatal health indicators were perinatal and neonatal mortality rates. Family planning indicators included the contraceptive prevalence rate, nonscalpel vasectomy and tubectomy use rate, and continuation rates of pills, injectables, and IUD. A number of focus group discussions and key informant interviews were also conducted to add context to quality of service delivery.

Research into Action

The study’s results will be helpful for improving the design of targeted MNCH and family planning interventions, with focus on improving effectiveness of identifying and reaching high-risk populations.   



Implemented by 

International Centre for Diarrheal Disease Research (icddr,b)

Project Status 

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