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  • Title: Preserving the gains of the past: training for surgical contraception in Bangladesh.
    Author: Vansintejan G.
    Journal: AVSC News; 1992 Sep; 30(3):Insert 2-3. PubMed ID: 12285830.
    Abstract:
    In 1974, Bangladesh began providing voluntary sterilization services. The number of sterilizations rose consistently until 1984 (600,000) but by 1991 they dropped to 170,000. To understand why demand fell, the government requested that the Association for Voluntary Surgical Contraception bring together specialists to investigate the causes and consequences of this drop in demand for sterilization and a concurrent drop in demand for IUDs. It also wanted the team to examine general family planning needs and to provide recommendations. In April 1992, 4 team members observed certain clinics during the field visits while the other 4 members observed another set of clinics for a total of 30 clinics. Most health providers with whom the team spoke believed insufficient training in sterilization and IUDs as well as the rising availability of other contraceptives (oral contraceptives, injectables, and condoms) accounted for the decrease in demand. The team noted that the decrease in demand was concentrated among younger women who preferred temporary methods. Physicians and family welfare visitors provided most all family planning services, but most physicians did not learn about voluntary sterilization while in medical school. On the other hand, family welfare visitors who were all women underwent 18 month training at 1 of 12 training institutes. Family planning made up 1 of the 10 training modules. The students learned about IUD insertions and follow up, injectables, how to help with sterilizations, and counseling for family planning. After they finished their training, they worked in health centers. Despite the fall in demand for IUDs and sterilization, contraceptive prevalence increased from 7% to 40% (1975-1991). The team recommended that the Ministry of Health require comprehensive family planning training for physicians assigned to family planning clinics, refresher courses for physicians already at the clinics, and expansion of existing refresher courses for family welfare visitors.
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