CONTEXT: In rural Bangladesh, family planning services--previously provided through household visits and satellite clinics--were transferred to static community clinics under the government's sectoral program for 1998-2003, but the next sectoral program reversed the change without a formal evaluation. It is important to assess changes in utilization and coverage to inform further development of the service delivery system. METHODS: Longitudinal data on use of family planning services and contraceptive methods were collected quarterly in 1998-2002 from married women in about 11,000 households in two rural surveillance areas--Abhoynagar and Mirsarai. Cross-sectional surveys were conducted among women and service providers in 2003 to gather detailed information about the transition to static clinics and women's response to the changes. Quarterly time series graphs of selected indicators were plotted for areas served by community clinics. RESULTS: In a time of considerable change in service delivery and sources of contraceptive supply, contraceptive prevalence remained constant in Abhoynagar and increased in Mirsarai. Community clinics quickly became the source of supplies for one-third of contraceptive users in Abhoynagar and one-fifth in Mirsarai. In wards where community clinics became operational (mostly in 2001-2002), three-quarters of women had used one at some time. CONCLUSIONS: Despite cultural constraints on mobility, women do not appear to have become dependent on home delivery of contraceptives.
CONTEXT: In rural Bangladesh, family planning services--previously provided through household visits and satellite clinics--were transferred to static community clinics under the government's sectoral program for 1998-2003, but the next sectoral program reversed the change without a formal evaluation. It is important to assess changes in utilization and coverage to inform further development of the service delivery system. METHODS: Longitudinal data on use of family planning services and contraceptive methods were collected quarterly in 1998-2002 from married women in about 11,000 households in two rural surveillance areas--Abhoynagar and Mirsarai. Cross-sectional surveys were conducted among women and service providers in 2003 to gather detailed information about the transition to static clinics and women's response to the changes. Quarterly time series graphs of selected indicators were plotted for areas served by community clinics. RESULTS: In a time of considerable change in service delivery and sources of contraceptive supply, contraceptive prevalence remained constant in Abhoynagar and increased in Mirsarai. Community clinics quickly became the source of supplies for one-third of contraceptive users in Abhoynagar and one-fifth in Mirsarai. In wards where community clinics became operational (mostly in 2001-2002), three-quarters of women had used one at some time. CONCLUSIONS: Despite cultural constraints on mobility, women do not appear to have become dependent on home delivery of contraceptives.