Exploring rise of pregnancy in Bangladesh resulting from contraceptive failure

Abstract

The objective of this study was to determine how changes in pre-pregnancy contraceptive methods used between 2011 and 2017/18 contributed to the changes in pregnancy resulting from contraceptive methods failure in Bangladesh. We used 2011 and 2017/18 Bangladesh Demographic and Health Survey data. Pre-pregnancy contraceptive methods failure was our outcome of interest, which was determined using women’s response about whether they became pregnant while using contraceptives before the most recent pregnancy. The year of the survey was the main explanatory variable. Descriptive statistics were used to describe the characteristics of the respondents. The difference in contraceptive methods failure across the socio-demographic characteristics was assessed by Chi-squared test. Multilevel poison regressions were used to determine the changes in the prevalence ratio of contraceptive methods failure across the survey years. Contraceptive methods failure rate increased between the surveys, from 22.8% in 2011 to 27.3% in 2017/18. Also, male condom use increased by 2.8%, while withdrawal/periodic abstinence and/or other methods decreased by 2.9%. The failure rates in these two categories of contraceptive methods increased substantially by 4.0% and 9.0%, respectively. Compared to the 2011 survey, the prevalence ratio (PR) of contraceptive methods failure was 20% (PR 1.2, 95% CI 1.1–1.3) high in the 2017/18 survey. This PR declined 13% (PR 1.1, 95% CI 1.04–1.2) once the model was adjusted for women’s and their partner’s characteristics along with the last contraceptives used. This study provides evidence of increasing rates of pregnancy due to contraceptive failure in Bangladesh. Given that this type of pregnancy is known to cause adverse pregnancy outcomes, including abortion, pregnancy complications, maternal and early child morbidity and mortality, policy and programs are needed to reduce its prevalence. Effective coordination between the contraception providers at the healthcare facilities and the households and a proactive role of family planning workers to make couples aware of the effective use of contraceptives are recommended.

A population-level data linkage study to explore the association between health facility level factors and unintended pregnancy in Bangladesh

“…The rate is slightly higher in Bangladesh, with over 33% of the total pregnancies 20 . There is also evidence that pregnancy due to contraceptive methods failure is increasing in Bangladesh 21 . This higher rate of contraception failure and related unintended pregnancy in LMICs and Bangladesh are mostly linked to policy-level challenges.…”

Effects of lower tiers of government healthcare facilities on unmet need for contraception and contraception use in Bangladesh

“…Bangladesh has achieved historic progress in expanding access to contraception use over the last 50 years with around 54% of the total eligible population now using modern contraception compared to 7% in 1974 [15]. This historic progress is largely due to the government efforts that began in 1972 by initiating an independent family planning division under the Ministry of Health and Family Welfare that has invested in and delivered major policies and programs in the subsequent years [23].…”

“…Family planning services in most LMICs, including Bangladesh, play a critical role in providing access to, and use of, contraception [14,15]. However, evidence suggests a significant decline in reliance on family planning services in Bangladesh in recent years, possibly due to the government's focus on maternal and child health issues over family planning services [14].…”

“…However, evidence suggests a significant decline in reliance on family planning services in Bangladesh in recent years, possibly due to the government's focus on maternal and child health issues over family planning services [14]. As a result, there has been an increase in births resulting from contraception failure in Bangladesh in recent years [15]. Bangladesh has strong family planning services network countrywide through (i) Family Welfare Assistants' (FWAs) visits to eligible couples' (sexually active married women) homes every 14 days, (ii) providing access to contraception at the community level through 18,000 community clinics, and (iii) ensuring availability of contraception at satellite clinics [2].…”

“…Therefore, their contributions in providing contraception to eligible couples is low. As a result, the government network continues to be the dominant source of contraception provision to eligible couples [2,15]. However, little is known about the contribution of government sources of contraception provision, particularly with respect to the unmet need for contraception.…”