Can the Bangladeshi family planning program meet rising needs without raising costs?

Efforts to expand Bangladesh's government-sponsored family planning program to meet the needs of more women while raising overall contraceptive prevalence may increase costs to unacceptably high levels. A 1993-1994 study examined this problem using data for both clinics and home visits. Results show that costs per couple-year of protection are affected by the overlap between the home service delivery and clinic systems, since fieldworkers visit couples of reproductive age in their homes, regardless of couples' method choice or source of supply. For example, in the case of IUDs, 39% of costs per couple-year of protection are accounted for by follow-up home visits, yet some users receiving these visits go to clinics for follow-up services. Furthermore, costs could be reduced if worker productivity improved. For instance if fieldworkers eliminated unauthorized leave and increased the time they spent working each day from four to five hours, the labor cost per couple-year of protection for the pill would decline by about one-third, from $3.05 to $1.97; similarly if clinic workers reduced their unused time, the clinic costs associated with IUD use would fall by one-third, from $1.94 to $1.32 per couple-year of protection. Moreover, increased productivity would enable the existing systems to meet the projected demand in 2004.