Constraints on supply and demand for family planning: evidence from rural Bangladesh.

Factors which restrain demand on family planning (FP) services in rural Bangladesh also restrain supply on these services. Men determine demand on FP services. Womens movement and activities are restricted making it difficult for female FP service providers to venture from their household area. Those women who do FP service outreach to other villages are often harassed and abused making it difficult to recruit women as outreach workers. Yet women and unrelated men tend not to associate let alone discuss FP and reproductive health. So it is very important that these workers be female. Low levels of female education also restrict FP service delivery. The government of Bangladesh requires outreach workers to have at least 10 years of schooling but only 16% of adult females are literate and a much smaller percentage of women went to school for at least 10 years. Thus many field worker positions remain vacant. Low levels of development also restrict demand for and supply of FP services. This includes but is not limited to the lack of basic infrastructure (roads bridges electricity water and communication systems) inability of employers to grant living wages and insufficient resources to support an effective FP service program. In rural Bangladesh kinship and social networks have more influence on childbearing than does community institutions such as the local posts of the national FP program which results in low demand and high fertility. Thus weak institutions often staffed with people loyal only to family and kin and supervisors not from the local area cannot provide adequate FP services. Researchers compare 2 FP projects in rural Bangladesh (Jessore and Sirajganj) and eastern Chittagong with the rest of rural Bangladesh to illustrate the overlapping in demand and supply obstacles and address the them when designing and implementing services.