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Long Acting Reversible Contraceptive Program - Expanding Use of Long Acting Reversible Contraceptives through the Private Sector

Social Marketing Company (SMC) is marketing IUD and Implants, both of which are long acting reversible contraceptive (LARC) methods, through trained private sector doctors and hospitals/clinics under the USAID funded Marketing Innovation for Health (MIH) Program. Prior to MIH, there has been no major concerted effort to expand access to LARC through private sector graduate providers or health facilities. The program is being implemented in close collaboration with the Directorate General of Family Planning (DGFP), and the Obstetrics and Gynecologist Society of Bangladesh (OGSB). MIH training partner, EngenderHealth is providing the necessary training and following up on quality assurance.

The need to shift the method mix more in favor of long acting and permanent methods is a policy objective of the Government of Bangladesh. But doing so particularly for methods like IUD is going to bea challenging task considering the image problems emerging from side effects due to improper and unhygienic insertions in the past. To help overcome some of these perceptual problems, SMC decided on a strategy to reposition IUD and Implant through over branding of IUD as Relax and Implant as I-Plant. Relax IUD is a TCu 380A that is effective for 10 years once inserted and is manufactured by Injeflex, Brazil. I-Plant is a two-rod implants whose efficacy lasts for 5 years after insertion. It is a progestin only formulation manufactured by Bayer Schering, Germany. Both products have been donated by USAID and as such the pricing has been kept at very affordable levels.

To be eligible to participate in the LARC training and receive product supplies from SMC, a provider must be a graduate private practitioner either having her/his own chamber or practicing through a private sector clinic or facility or both. These providers are identified by the SMC Program Officers in collaboration with Sales Promotion Officers after extensive mapping. Providers who are found to have large women clientele, good reputation within the community, have adequate space for counseling and insertion, have signed a consent form to participate in the training and purchase the over branded IUDs and Implant from SMC are finally selected to be a part of the network.

An extensive below-the-line communications campaign is being implemented to create awareness of Relax IUD and I-Plant. These include distribution of brochures and leaflets to potential customers and placing signboards, billboards, banners and posters around the catchment area of the health service providers to advertise the availability of the product. SMC also has published advertisements in the major national and regional newspapers that has included the names and addresses of the doctors by districts. SMC plans to launch an aggressive TV and Radio campaign towards the end of FY 2014 when it expects to have a fairly large number of providers trained on LARC methods.

The initial response to the program is encouraging. The graduate doctors, in many cases, are proactively discussing with the clients on various family planning methods and informing them about the availability of LARC and Injectable services. SMC has observed that the use of Relax, i-plant and SOMAJECT (Depo-Provera) administrations are gradually increasing through this network. Around 265 doctors and 35 health facilities are currently offering LARC services. SMC plans to expand the number to 700 doctors/clinics across 64 districts by the year 2016.

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