**_The Mat_**

_Projea_

**_19_**

the preexisting demand to postpone childbearing was higher than that to terminate childbearing. The prevalence rate in the Treatment Area is not expected to decline if the supply system retains its high quality care.

The contraceptive prevalence in the Treatment Area was higher than in the Comparison Area primarily because the supply components of the Project were more successful in minimizing the constraints or costs involved in using contraceptives more than the supply components of the government program did in the Comparison Area. The available literature on the reasons for KAP-gap and on the socioeconomic condition in rural Bangladesh suggest the presence of one or more of the following four constraints or costs involved in the use of contraception: (i) inaccessibility of high-quality service; (ii) physical/health constraints (mainly side-effects); (iii) psychic and social constraints; and (iv) monetary constraints. As an impact of the better service of the Matlab Project, each of these constraints became less in the Treatment Area than in the Comparison Area (Nag and Duza 1989).

(i) Density of village-level female workers and their communication with elig;ble women, an important dimension of accessibility, was at a much higher level in the Treatment Area, particularly because of their more frequent home visits. Choice of contraceptives, another important dimension, was wider in the Treatment Area because of the provision of injectables since the initial stage of the Project as a domiciliary service. More frequent contact with the village-level workers and their better knowledge of contraceptive methods allowed Treatment Area women to switch over more easily from one method to another.

(ii) In the focus group study mentioned above (Nag and Duza 1989), complaints about side-effects of sterilization and reversible methods were more or less similar in the Treatment and Comparison Areas. Village-level workers could not provide any medicine to alleviate the suffering from side-effects in any of the Areas. But they caused a lesser constraint on contraception use in the Treatment Area because of better quality of counselling by workers, more frequent contact between workers and villagers, and higher confidence of villagers in the Treatment Area that workers would take appropriate action for their relief, if the side-effects would cross acceptable limits. In case of unacceptable menstrual disruption caused by reversible methods, workers in the Treatment Area would advice switch over to another method or take clients to the central clinic, often by using the country boats at their disposal.

(iii) One main source of psychic and social constraint on the use of contraception by a woman in both the Treatment and Comparison Areas is the opposition from husband. The focus group discussions revealed the following common reasons for husband's opposition: (a) he resented the sexual abstinence forced on him and his wife's inability to do household work because of side-effects; (b) he is more concerned than his wife about monetary cost if the wife has to go to a local medical practitoner for alleviating side-effects. There were two factors for which the opposition from husband was a lesser constraint in the Treatment Area: (a) the higher frequency of contact of Treatment Area women with better-trained workers equipped the former to deal with their side-effects as well as with their husbands' opposition more efficiently; (b) the greater visibility of femiale workers and their role not only as family planning workers but often as respected arbiters of family disputes had perhaps contributed to raise the status of women in the Treatment Area enabling them to have a more equitable relationship with their husbands than in the Comparison Area.