Reconsidering the doorstep-delivery system in the Bangladesh family planning program

The government of Bangladesh is currently testing and implementing strategies to change its family planning program from a reliance on field-workers who conduct home visits to a conventional fixed-site delivery system. Researchers have made two suggestions: First, the program should encourage women to switch from nonclinical methods delivered by family planning workers to more cost-effective clinical methods such as sterilization, and second, field-workers should not be resupplying nonclinical methods, but should focus their attention on motivating nonusers to practice contraception. Longitudinal data from the Maternal and Child Health-Family Planning Extension Project of the International Centre for Diarrhoeal Disease Research, Bangladesh, are analyzed to show that a better strategy might be to target visits to women according to their educational level and area of residence. For uneducated women living far from clinics, access to contraceptives is likely to be a problem, and home visits for resupply might have a larger impact on the contraceptive prevalence rate than would field-workers' visits to motivate nonusers.