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The International Centre For Diarrhoeal Disease Research, Bangladesh, has found that the modified strategy of its Family Planning Health Services Programme (FPHSP), which is oriented toward meeting women's contraceptive needs within a full range of services, is more effective in helping women sustain contraceptive practice than the original household distribution program (CDP), which simply made oral contraceptives and condoms available. Only 40% of acceptors in the original CDP continued use after 1 year, compared to over 80% in the FPHSP. Prior to the FPHSP, pills were the most popular method, accounting for 49.7% of users. Only 40% of women who adopted DMPA prior to the FPHSP continued use at 1 year and most discontinuers did not adopt another method. After the FPHSP, the approximate all-method continuation rate was 73% at 18 months. DMPA and tubectomy accounted for 70% of all users by April 1979. A key feature of the FPHSP strategy was careful personal follow-up and continued counseling to help make a choice, support practice, and encourage dissatisfied users to change methods. The person-oriented approach necessary to a program offering a choice of contraceptive methods depends on well trained workers, careful record keeping especially for resupply, a strong chain of supervision, and effective medical support. The long term human and economic gains from such a program should more than justify the additional costs.
Bhatia et al. (Sun,) studied this question.