**_Th MahabP_** _roject_

**_11_**

women on due dates often in household kitchens without the knowledge of male members. When discontinuation rates of injectables began to increase because of their side effects, decision was taken in 1981 to encourage women for switching to IUD. The negative impact of discontinuation of reversible methods on total contraceptive prevalence was minimized to a great extent in the Treatment Area because of Matlab Project's provision of wider choice of contraceptives and special care taken by the CHWs to help women in method-switching (Phillips et al. 1988).

Ihere are a few important differences between the Matlab Treatment Area and Bangladesh in the prevalence pattern of contraceptive methods: (i) the method which has contributed most to contraceptive prevalence in 1985 is injectable (37 percent of total) in the Treatment Area and tubectomy (26 percent of total) in Bangladesh; (ii) the prevalence of injectables has always been proportionately much less in the national program than in the Matlab Project; (iii) the relative prevalence of vasectomy, condom, and traditional methods has always been higher in the national program; (iv) the prevalence of pill was proportionately much higher in the national program initially but the difference has gradually diminished; and (v) the prevalence of IUD was proportionately similar initially but has increased in the Treatment Area more rapidly than in the national program.

The difference in the prevalence pattern of contraceptive methods between the Treatment and Comparison Areas would be the same as that between the Treatment Area and Bangladesh if the national program would have functioned in the Comparison Area exactly in the same way as in average Bangladesh, but apparently it did not. The contribution of tubectomy in the contraceptive prevalence of the Comparison Area was proportionately higher than in the Treatment Area and in Bangladesh in 1979 and the differences were much sharper in 1985. It was perhaps due to the introduction of relatively better tubectomy services in the Project's central clinic at Matlab Bazar in 1981 which were open to the tubectomy clients of both the Treatment Area and Comparison Areas. The prevalence of injectables in the Comparison Area always remained marginal as in the country as a whole. For reasons not clear, the prevalence of IUD in the Comparison Area proportionately increased and that of pill decreased during 1979-85.

# _Impact on_ **_Fe,tilfty_**

Significantly higher prevalence of modern contraceptives in the Treatment Area than in the Comparison Area and in Bangladesh as a whole is likely to bring sharper fertility decline in the Treatment Area but since fertility is also affected by other proximate variables such as age at marriage, fecundability, and induced abortion (Bongaarts 1978), the fertility differentials between the Treatment Area and others may not exactly correspond to those of contraceptive prevalence. The mean yearly fertility levels, as measured by general fertility rate and total fertility rate, in the Treatment and Comparison Areas from 1978 to 1985 are presented in Table 3.

It can be observed from Table 3 that in all the years from 1978 to 1985 both general fertility rates and total fertility rates were lower in the Treatment Area than in the Comparison Area. An analysis of monthly total fertility rates (Figure 1) shows that while total fertility rates for the two Areas were approximately equivalent in the pre-Project period, a marked differential arose in 1978 and has been sustained over time (Phillips et al. 1988). The significant rise in contraceptive prevalence in the Treatment Area since 1982 did not get fully reflected in the fertility rates up to 1985 not only because of the time lag between contraceptive use and its effect