Assessment of family planning outreach workers' contact and contraceptive use dynamics in rural Bangladesh using multilevel modelling

In Bangladesh, the family planning services are provided by government outreach workers; the Family Welfare Assistants (FWAs). The FWAs are the main link between the program and the rural women. The role of FWAs is to provide information about family planning, motivate women to accept a method and ensure convenient contraceptive services. Research has demonstrated that a tangible demand for family planning has been met, contraceptive use has increased and fertility has started to decline.Women living in the areas served by the same FWA may have access to similar services and demonstrate similar patterns of contraceptive use. A hierarchical structure arises if the data are collected using multistage sampling or overtime. In a longitudinal study, observations made on the same individual over time may lead to two-level hierarchical data structure in which observations for an individual at a successive point of time are nested within the individual. The data for this research come from the Sample Registration System, a longitudinal surveillance system of the Operations Research Project of International Centre for diarrhoeal Disease Research, Bangladesh. In this research, longitudinal data for the period 1986-1992 were used.The results show that the FWAs contact is associated with the increase in contraceptive use, adoption and continuation. This research clearly points out that FWA contact is associated with the increase in the risk for a woman to switch from one modern method to another modern method and decrease in the risk to discontinue using any modern method and be at risk of unintended pregnancy. These analyses for estimating the impact of FWAs contact on contraceptive use dynamics in Bangladesh provide the evidence of impact of family planning program in the demographic transition. This research suggests that, if the FWA house visits are maintained and if the FWAs are trained in managing and treating side effects, the contraceptive use and the continuity of use will be increased and will eventually have an increasing impact on fertility transition in the country.