Training Service Providers on Emergency Contraception: Lessons Learned from an OR Study

The Bangladesh Directorate of Family Planning in collaboration with the Population Council, Pathfinder International and John Snow, Inc. is conducting an operations research project to test the feasibility of introducing Emergency Contraceptive Pills (ECP) in the national family planning (FP) program and to answer several operational questions on how to implement the use of ECP efficiently. ECPs are increased doses of " regular " oral contraceptive pills (OCP) taken in two doses to avoid pregnancy from unprotected intercourse. The first dose must be taken within 72 hours of unprotected intercourse and the second dose 12 hours after the first dose. The earlier the pills are taken, the more effective they are. The most common ECPs are " combination pills " that contain estrogen and progestin hormones. ECPs containing progestin only are also available (e.g., Postinor 2) which are relatively more effective and have less side-effects than combination pills. In Bangladesh 1.2 million births are unplanned and the number of MR/abortions is increasing (Box 1). ECP could be a good reproductive health intervention for women since it gives them a chance to avoid unwanted pregnancy. ECP does not induce any abortion. In fact, it helps in reducing the number of abortions. A recent WHO publication indicates that use of ECPs could reduce the induced abortion rate as much as 50 percent (WHO, 2001). In Bangladesh, the concept of emergency contraception (EC) is relatively new and there is general lack of knowledge even among doctors (Chowdhury et al. 1998). Thus, training providers will be a critical element for the introduction of ECP. The present feasibility study has been undertaken to answer several operational questions that need to be addressed while introducing the ECP method in the national FP program (see Box 2). The study has been carried out in two districts, Tangail and Mymensingh. For more details on the intervention see Research Update 1 (Khan and Sharif 2001). The key factors for introducing ECP are increasing community awareness about the method, making it widely and easily accessible, promoting its appropriate uses, returning clients to regular contraception after using ECP, and managing side-effects, if any. Proper training of the service providers, an effective and sustained educational campaign among potential clients, and a guaranteed regular supply of the pills can help in addressing these issues. Given the low level of education of many grass roots workers, the study sought to assess whether the workers …