Saving Lives of Women and Children: Pharmaceutical Systems Strengthening Approaches to Improve Access to Contraceptives in Bangladesh

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Access to family planning (FP) commodities saves women’s and children’s lives by allowing women to delay and limit pregnancies in a healthy manner. The Government of Bangladesh, with support from donors and development partners, has undertaken targeted interventions to increase access to and availability of contraceptives over the years. These interventions, coupled with the increased public demand for FP services, have helped make some noteworthy progress. From 2001 to 2014, the total fertility rate (TFR) decreased from 3.0 to 2.3 births per woman and the maternal mortality ratio decreased from 322 to 194 maternal deaths per 100,000 live births. These results are consistent with the increased use of contraception among married women, from 61% in 2011 to 62% in 2014. As part of the FP2020 global partnership, Bangladesh has committed to further reduce the TFR to 2.0 by 2021. However, to sustain the reduction in fertility rate, it is essential to ensure that women and their partners have access to a range of safe and high-quality contraceptives at the point of need.

Over the last 25 years, USAID has been providing support to the Directorate General of Family Planning (DGFP), which is responsible for contraceptive security for the whole country, to strengthen its FP program. This support has included assistance to improve systems for supply chain management of contraceptives and ensuring their availability at each tier, including the service delivery point (SDP) level. Although improvements were made, ensuring a continuous supply of contraceptives down to the SDP level remained a challenge for the DGFP even a few years ago. The DGFP had an inadequate tracking system that caused delays in procurement of contraceptives and contributed to chronic stock-outs at SDPs. Procurement managers did not have access to the list of in-country registered medicines. This, coupled with inaccurate forecasting, led to the procurement of incorrect products and, ultimately, the unavailability of required products. A lack of accurate and real-time logistics data from the SDP, limited access to data, and poor feedback mechanisms only added to the DGFP’s challenges. This increased the risk of unwanted pregnancies and endangered the lives of women and children.