_3_

**_The_** _Matlab Project_

served only by the regular Bangladesh government program was designated as the Comparison Area (Stinson et al. 1982).1 The 1974 baseline survey of eligible women in 233 CDP villages showed that only one percent were current contraceptive users but another 32 percent expressed a desire to cease childbearing and to use contraception in the future; this supported the latent demand hypothesis. The actual behavior, however, did not support the existence of high latent demand for contraception. Although the proportion of contraceptive users in the Treatment Area rose from about 1 percent at program initiation to about 18 percent after three months, it fell to about 14 percent at the end of the first year and to about 12 percent at the end of the second. A major reason for the decline was a low continuation rate for pill acceptors because of improper use, unattended side effects and concern about risks. These were also the reasons for a general failure to recruit new users after the first intensive round in late 1975. The prevalence rates in the Comparison Area held at about 3 to 4 percent throughout the program period (see Langsten and Chakraborty 1978, Osteria et al. 1978; Rahman et al. 1980).

The CDP findings suggested that ubiquitous availability of contraceptive supplies alone was not a solution to high birth rate in Bangladesh, but they also indicated that there might indeed be a possibility to extend contraceptive use through provision of a wide variety of methods, more intensive followup, and care of users, and recruitment of workers with higher credibility. The Matlab Project, designed to fulfil these requirements, was launched by the ICDDR,B in October 1977.

# **_Service Stnruww_** _of the_ **_Matiub_** _Project_

The geographical demarcation of the Treatment and Comparison Areas in the Mattab Project are different from those or the former CDP. Seventy villages of Matlab belonging to the Matlab Project Treatment Area is comprised of 39 villages of the CDP Treatment Area and 31 villages of the CDP Comparison Area; 79 villages of the Matlab Project Comparison Area is comprised of 54 villages of the CDP Treatment Area and 25 villages of the CDP Comparison Area (Phillips et al. 1982).

The Treatment Area is divided into four blocks for project operation purposes. Basic domiciliary services for pill, condom, foam tablet, and injectable (depo-provera) and clinical services for IUD, menstrual regulation, and sterilization were introduced in all four blocks in 1977 when the project was initiated, but components of MCH services were introduced in different blocks at different times. For example, in 1979, lobon-gur (salt-molasses) strategy as oral rehydration therapy for diarrhea was introduced in blocks B and D, and WHO oral rehydration solution (ORS) formula in blocks A.C; in 1981, there was a switch over to ORS in blocks B and D; measle vaccination began in blocks A and C in 1981 and in blocks B and D in 1985. Service strategies and intensities changed in accordance with the lessons learnt. For example, tetanus toxoid immunization was administered to pregnant mothers only when it was initially introduced in 1979 in all four blocks but the experience let the project managers to extend it to all mothers of childbearing age subsequently.

'hT **villages cvered** in **tho Trement** **_Ae_ and "Comparion** Aea" in **the** CDP were different fiom **those covered** in **the -Treatenot Ara** and **'Comparisn Area"** of **the** MCH-PP Project.