title: Family planning in Bangladesh: a mixed method study to investigate the challenges of reducing unmet need for better service provision
Creators: name: Hossain, Mohammad Badsha
Publisher: name: University of Reading
Year: 2024

description: In recent years, Bangladesh has undergone rapid fertility transition, along with notable progress in 
various family planning determinants, which is largely attributed to the Government Family Planning 
programme. Demographic and Health Survey data reveal that despite the formidable success in family 
planning, the programme has experienced slow progress overall and a plateau situation has been reached, 
specifically with regard to stagnant fertility, slow progress in unmet need reduction, and contraceptive 
use in the last decade. This study investigated and analysed potential gaps in family planning programme 
in order to improve contraceptive services and their provision and delivery, where the aim is to reduce 
unmet need which highlights the socio-cultural settings of the community and has shed light on the 
factors behind the slow progress of the current programme. The exploration of the existing gaps in unmet 
need for family planning has warranted some ways out for the increase of contraceptive use among 
married women, particularly by upholding their choices and preferences to have an impact on the 
reduction of maternal and child mortality generally. 
The study employed a mixed method approach, with greater emphasis placed on the qualitative online 
semi structured interviews conducted with 28 diverse stakeholders, including family planning 
practitioners, local government representatives, teachers, and religious leaders from both field and 
policy levels. The interviews were conducted between February to April 2022 during the peak time of 
the Covid-19 pandemic. Critical reviews of various Bangladesh demographic and health surveys with
other national and international organization data contributed to the quantitative part of the research. 
Selected variables from robust BDHS data sets facilitated the initial foundation of the research on which
extensive analysis with qualitative data was conducted leading it to a mixed method study. Quantitative
data supplement the views and opinions revealed by the respondents in the qualitative interviews.
The findings revealed that needs, preferences, and choices of women regarding access to contraceptives 
are often impacted by their autonomy along with sociocultural and religious factors embedded in the 
study settings. The influence within the family of husbands and in-laws and the socio-cultural and 
economic factors operating beyond the family have been identified as contributing factors in the creation 
of women’s unmet need for family planning. The lack of domiciliary and clinical staff, poor operational 
functions within the government facilities, and lack of policy initiatives from the organisational point of 
view, are also revealed as potential factors which have resulted in slow progress in fertility reduction, 
increased contraceptive use, and reduction in maternal and child mortality. The thesis concludes with 
recommendations for policy initiatives to address the service provisions and to improve the existing 
service provision to improve family planning outcomes in the community.