Background: Despite high coverage of antenatal care (ANC) and family welfare assistant (FWA) visits, emergency contraceptive pill (ECP) awareness is critically low in Bangladesh. We aim to investigate the missed opportunities in generating ECP awareness through ANC and FWA visit programs; and assess the missed opportunities and sociodemographic discrimination in receiving family planning (FP) counseling during ANC.
Methods: We used data from the nationwide Bangladesh Demographic and Health Survey 2017-18. Sample includes 5012 reproductive-aged women who gave live birth in the last 3 years preceding the survey. We used mixed-effect multiple logistic regression considering women nested within clusters to conclude.
Results: Nationally, 79% of women who gave live birth in the last 3 years preceding the survey were unaware of ECP. The estimated missed opportunities in generating ECP awareness was 59.5% in ANC, 0.9% in FWA visits, and 12.3% in both ANC and FWA visits. While FWA visit was not associated with ECP awareness, receiving FP counseling during ANC was significantly associated. About 88.4% of women remained unexposed to FP counseling through ANC during their last pregnancy. Missed opportunities in FP counseling during ANC was 80.4% of which 72% points were from qualified providers. The odds of missed opportunities was not associated with provider type, rather significantly increased among women with low education, lower parity, and poor socioeconomic status.
Conclusions: This study highlights the fragile status of FP counseling during ANC and FWA visits in generating ECP awareness. A prominent provider bias is excluding women of the disadvantageous sociodemographic group from receiving FP counseling.
Keywords: Antenatal care; Awareness; Bangladesh; Emergency contraceptive pills; Family planning; Family welfare assistance; Provider bias.
Emergency contraceptive pill (ECP) awareness is low in Bangladesh, particularly among women with low education, and poor socioeconomic status. However, the extent to which the antenatal care (ANC) and family welfare assistant (FWA) programs fail to generate ECP awareness is never measured.To address this knowledge gap, we estimated the missed opportunity to generate ECP awareness through ANC and FWA programs. Further, we investigated the missed opportunity and sociodemographic discrimination in receiving family planning counseling during ANC. We scrutinized the Bangladesh Demographic and Health Survey 2017–18 data of 5012 women who gave their last live birth 3 years preceding the survey.About 73% of women remain unaware of ECP despite receiving ANC or getting FWA visits at home. Family planning counseling during ANC increased ECP awareness but the FWA program did not. Women from rural areas, with low education, limited media exposure, and from lower wealth quintiles are still left unaware of ECP. The missed opportunity of providing family planning counseling during ANC is high (80.4%), particularly among women with low education, lower parity, and poor socioeconomic status.The study provides valuable insights to the policy planners for rectifying the family planning program of ANC and FWA visits in Bangladesh. Findings reveal the disadvantaged women who know less about ECP and are informed less about family planning during ANC which may help programs to reach the unreached women.
© 2024. The Author(s).