The Matlab Family-Planning Health Service Project. Impact on family planning fertility and child survival: an executive summary of a report of key findings and their policy implications.

A project launched by the International Center for Diarrheal Disease Research Bangladesh (ICDDRB) in 1977 popularly known as the Matlab Family Planning Health Services Project has provided important evidence regarding the question of whether health and family planning programs can succeed in traditional rural societies. Contraceptive prevalence rates in Matlab program areas rose from under 10% in 1977 to 33% by 1979; this pattern of rapid increase was not recorded in comparison areas. There is evidence however that simple household distribution of 1-2 contraceptive methods without ancillary maternal-child health care and continuous consultative support will not be sufficient. Services must be delivered to women at their homes encompass a variety of contraceptive options include frequent follow-up and counseling and provide clinical care for side-effects. The changed fertility aspirations noted among couples in the Matlab project areas are attributed to demographic pressures in rural Bangladesh which are placing increased economic pressures on households as well as the widespread availability of information about fertility control. In addition even in the absence of modernization there have been changes in the economic value of children and womens roles that seem to have affected reproductive preferences. Also noted in the project areas was a dramatic increase in child survival rates following the declines in fertility indicating that family planning is an important maternal-child health intervention. Neonatal rates fell by 8% postneonatal rates by 30% and child (1-4 years) mortality by 35%. This project has many operational implications for public sector health and family planning programs. Careful planning is required to ensure that new services can be absorbed by the existing system without overburdening health personnel; incremental enrichment of services appears to be a sound strategy.