Lack of modern contraception usage in Bangladesh linked to maternal and child health risks: Study

A study published by Nature has revealed the data surrounding the prevalence of non-use of modern contraception in Bangladesh.

The main aim of the study was to investigate spatial variations in the non-use of modern contraception in Bangladesh and identify associated individual, household, and community-level factors, reports Nature.

Approximately 20 lakh pregnancies occur in Bangladesh, where around half of these are reported as unintended, according to Nature. The prevalence of non-use of modern contraception in Bangladesh is high (58%). This places women and children at significant risk of adverse maternal and child health consequences due to abortion and unplanned birth.

Given that abortion is completely prohibited unless provided to save a woman's life, the rate is suspected to be higher in countries such as Bangladesh.

According to the study, due to family planning policies and programs in Bangladesh being mostly identical across the whole country with no area-specific programs available that consider the area-level factors that influence non-use of modern contraception, the difficulties are not only limited to access but also uptake of modern contraception and often results in the misuse of manpower and resources.

Among various ongoing challenges, maternal mortality in Bangladesh is also higher among women who choose to continue with their unintended pregnancies, largely due to lower use of intrapartum, birthing and postpartum care.

The analysis of this study was based on the data collected from 16,135 women, extracted from the 2017-18 Bangladesh Demographic and Health Survey. Additionally, to assess geographical heterogeneity in non-use of modern contraception, Moran's I statistics were applied, and Gettis-Ord Gi was calculated to measure spatial autocorrelation differences across various study locations.

This is the first study conducted in a Low or Medium Income Countries (LMIC), and particularly Bangladesh, to explore the geographical variation to identify areas where modern contraception non-use was clustered using sophisticated analysis techniques. The surveys took place in two stages. The first stage consisted of 675 area clusters randomly selected from a list of 293,579 area clusters, which the Bangladesh Bureau of Statistics generated as part of the 2011 Bangladesh National Population Census.

A total of 672 area clusters were retained after excluding three area clusters due to flood. A total of 20,160 households were selected. and 19,457 households completed the surveys (96% response rate). In these selected households, there were 20,376 women, of which 20,127 were interviewed (98.8% response rate).

The results indicated that 42.8% of respondents reported non-use of modern contraception in Bangladesh, with significant variation across geographical locations. Hot spots of high non-use were predominantly identified in the Sylhet, Barishal, and some areas of the Chattogram divisions, while cold spots of low use were concentrated in the Rangpur, Mymensingh, and some areas of Rajshahi divisions.

Notably, the likelihood of non-use was highest among women and partners with low levels of education. The analysis of other risk factors, such as partner occupation, community-level illiteracy, and poverty, revealed varying effects on the non-use of modern contraception across different locations within the country. The study's findings underscore the importance of targeted, area-specific policies and programs aimed at promoting knowledge and uptake of modern contraception in Bangladesh.

Similar to the data from previous studies conducted in Bangladesh, the study found that around 43% of the women in Bangladesh do not use modern contraception. Previous studies in Bangladesh also reported higher odds of modern contraception non-use in the Sylhet, Barishal and Chattogram divisions and lower odds of non-modern contraception in the Rangpur, Mymensingh and Rajshahi divisions.

Challenges such as the growing burden on the healthcare sector cannot be overcome without identifying the areas where non-use of contraception is highest as well as associated risk factors, reveals the researchers.

The study concludes by suggesting that the findings support the need for the design and implementation of area-specific policies and programs to increase modern contraception use currently being administered in Bangladesh.