Effectiveness of the family planning intervention to improve reproductive health of married female adolescents in urban slums of Dhaka, Bangladesh : a quasi-experimental study

Abstract

Background: In Bangladesh, early marriage and childbearing has led to an adolescent fertility rate that is among the highest in the Asia pacific. More than half of the pregnancies (53%) among married adolescents in the country’s urban slums is being unintended and is largely due to non-use or discontinuation of use of modern contraceptive methods. This study was aimed to assess the effectiveness of a married adolescent girls’ club (MAG club) in terms of measuring differences in knowledge, attitude, practices, and unmet need for family planning among the married adolescent girls in urban slums of Dhaka, Bangladesh.

Methods: This was a quasi experimental study with post-test only control group design and was conducted from July 2014 – August 2016 among married adolescent girls’ (14-19 years) in four urban slums of Dhaka city (two intervention, two control) using both quantitative and qualitative data collection methods. The intervention involved creation of a marriage adolescent girls’ club that included club sessions, club leaders, family planning pocket book, behaviour change communication materials, indoor games, edutainment activities (learning through drama, music) and assessment tests. Club sessions was conducted once in a month and continued over 12-months. The control areas had routine health and family planning services but no MAG Club. Evaluation of intervention was done through a community based survey with 1601 respondents (799 in intervention areas and 802 in control areas) and in-depth interviews with twenty respondents in the intervention areas. Descriptive statistics, Pearson’s Chi-Square test, two sample independent t-tests, two sample proportion test, and Fisher’s exact test were used for quantitative data analysis. The intervention was considered to be effective if significant change in the key outcome indicators were observed in the experimental than in the control areas. p-value less than 0.05 were considered as statistically significant. Content analysis was done to examine qualitative data.

Results: Of 1601 respondents interviewed, majority (73%) was >18 years, 26% was between 15-17 years, and the remaining was less than 15 years of age. Among all the respondents, 68% from the experimental area and 85% from the control area had no employment history; a significant difference was observed in types of work between the two groups. Mean age at marriage (with standard deviation) of the respondents was 14.6 (±1.6) years in experimental areas and 15.2 (±1.8) years in control areas. More than half of the respondents in both the areas had history of a single pregnancy. Nearly one-third (30.8%) of the respondents in the experimental area and around one-fifth (18.6%) of the respondents in the control area had history of 2 or more pregnancies.

Almost all the respondents (1601) could mention oral pill as a contraceptive method. Significant difference in knowledge on other contraceptive methods was observed between the two groups. Knowledge difference on potential problems of adolescent pregnancy was also found significantly higher in intervention areas than the control areas. A few (0.9%) of the respondents in the experimental areas and 4.5% of the respondents in the control areas did not support family planning method use. Major reasons for not supporting family planning method use included misconceptions and myths around side effects of methods, religious prohibition and perceived risks of method failure.

Respondents in the experimental area discussed more about family planning methods with their husbands (97.5%) compared to their counterparts in the control area (84.7%). Any modern family planning method use was also found significantly higher (72.6%) among respondents in the experimental area than that of the control area (63.5%). Proportion of unmet need for family planning was found significantly lower among respondents in the experimental area (16.2%) than that of the control area (20.7%).

Findings from in-depth interviews showed that the MAG club empowered the respondents with the rare opportunity to assemble in a common platform to socialize and to share their experiences and challenges related to early marriage, early pregnancy and family planning. The MAG club has also provided with the opportunity to the married adolescent girls to open up, spread time and make a social network with their peers.

Conclusion and recommendations: A noteworthy number of married adolescent girls had received family planning information from the MAG club that had significant effects in their reproductive lives. The MAG club played a substantial role in reducing unmet need for family planning among the target population. It is important to design sustainable programs and interventions like the MAG club, and thus integrate them in the existing formal healthcare system to increase family planning method utilization among the married adolescent girls in urban slums of Bangladesh which in turn will help in reducing unintended pregnancy and unsafe abortions related maternal morbidity and mortality. To measure the effect of integrated intervention package in terms of reducing unmet need for family planning and unintended pregnancy, a longer duration follow up research study should also be carried out.