Abstract/Summary

In recent years, Bangladesh has undergone rapid fertility transition, along with notable progress in various family planning determinants, which is largely attributed to the Government Family Planning programme. Demographic and Health Survey data reveal that despite the formidable success in family planning, the programme has experienced slow progress overall and a plateau situation has been reached, specifically with regard to stagnant fertility, slow progress in unmet need reduction, and contraceptive use in the last decade. This study investigated and analysed potential gaps in family planning programme in order to improve contraceptive services and their provision and delivery, where the aim is to reduce unmet need which highlights the socio-cultural settings of the community and has shed light on the factors behind the slow progress of the current programme. The exploration of the existing gaps in unmet need for family planning has warranted some ways out for the increase of contraceptive use among married women, particularly by upholding their choices and preferences to have an impact on the reduction of maternal and child mortality generally. The study employed a mixed method approach, with greater emphasis placed on the qualitative online semi structured interviews conducted with 28 diverse stakeholders, including family planning practitioners, local government representatives, teachers, and religious leaders from both field and policy levels. The interviews were conducted between February to April 2022 during the peak time of the Covid-19 pandemic. Critical reviews of various Bangladesh demographic and health surveys with other national and international organization data contributed to the quantitative part of the research. Selected variables from robust BDHS data sets facilitated the initial foundation of the research on which extensive analysis with qualitative data was conducted leading it to a mixed method study. Quantitative data supplement the views and opinions revealed by the respondents in the qualitative interviews. The findings revealed that needs, preferences, and choices of women regarding access to contraceptives are often impacted by their autonomy along with sociocultural and religious factors embedded in the study settings. The influence within the family of husbands and in-laws and the socio-cultural and economic factors operating beyond the family have been identified as contributing factors in the creation of women’s unmet need for family planning. The lack of domiciliary and clinical staff, poor operational functions within the government facilities, and lack of policy initiatives from the organisational point of view, are also revealed as potential factors which have resulted in slow progress in fertility reduction, increased contraceptive use, and reduction in maternal and child mortality. The thesis concludes with recommendations for policy initiatives to address the service provisions and to improve the existing service provision to improve family planning outcomes in the community.