Doctor's Perception and Prescription of Oral Contraceptives: a Social Marketing Study in Bangladesh

Doctor's perception of oral contraceptive products is very important for social marketing. Though the obvious and important use of oral contraceptives is to prevent unwanted pregnancy, it is also found that awareness regarding non-contraceptive health benefit use of oral contraceptives is increasing. As oral contraceptives have a lot of side effects, normally doctors go for low dose pills to avoid inconvenience and risk when prescribing a patient. In many cases, doctors give their own judgment on the basis of a number of factors in defining low dose pills. It is evident that Nordette 28 and Marvelon are considered to be almost near considering the attributes – less side effect, low dose, reasonable price and patient's preference. Femicon is separated from the rest of the group due to its low price and is perceived by the doctors as the least quality oral contraceptive. Doctors usually like to prescribe Ovostat and Marvelon to those patients who have more purchasing ability and considers price as a quality factor. INTRODUCTION Bangladesh, a least developed country, is burdened with its huge population (130 million with a population density of 850 per square kilometer) and its growth. This is resulting into poor quality of life of the citizens – in general, and women members – in specific. The government, non-government and international organizations are well aware of this population boom problem. At present a good number of social welfare organizations in cooperation with the government, nongovernmental organizations and international agencies are involved in the family planning, reproductive and nutritional programs of the country. The purpose of these institutions is to use social marketing and supportive information, education and motivation programs to enhance the quality of life of Bangladeshi people living in rural and urban areas. They also focus on producing and marketing products and services that offer improved health and welfare benefits to the members of society. Among such products and services, a variety of high quality non-clinical contraceptives, condoms, oral contraceptive pills, and packaged oral re-hydration 13 Muhammad Ziaulhaq Mamun salt are available in the market. In an effort to make the price itself a motivational factor, these products are made available at highly affordable, subsidized and competitive prices. The aim is to help develop habit among low income people the use of contraceptives to lead a better quality life. In this process, both the doctors and social marketing companies understanding is important. In this respect if the companies can understand doctors perception and prescription pattern regarding the products and services they are marketing will help them in order, supply and distribution of such products. In this paper, the focus is to find out the considerations of the doctors in prescribing the different brands of oral contraceptives available in the market for social marketing of oral contraceptives in Bangladesh. Even in oral contraceptive supply and distribution, customer segmentation is very much important. It is observed that doctors – the prescribers themselves – segregate the brands of oral contraceptives in different groups according to their ability to satisfy different customer needs. Therefore, if the marketers place and promote these brands in line with the thoughts of the physicians, it would bring them more benefits both in terms of social responsibility and financial sustainability. The study will help the social marketers to have a clear idea about the doctor's perspectives on oral contraceptives, which in turn will facilitate them to update and standardize their product line for a better achievement and response from the community market. RESEARCH OBJECTIVES Keeping the above context in mind the main objective of the study is set to find out doctors' perception towards different aspects related to the use of oral contraceptives. Specifically this study will look into (a) reasons for recommendations of oral contraceptives by the doctors, (b) doctors' quality perception about different brands of oral contraceptives, and (c) factors influencing doctors' advising a particular brand. METHODOLOGY The research is mainly exploratory in nature. Information was collected through a pre-designed questionnaire. As a convenience sampling a total of one hundred (100) doctors were interviewed in four major cities of Bangladesh: 50 from Dhaka City, 30 from Chittagong and 10 each from Khulna and Rajshahi metropolitan cities. The respondents were selected purposively. The main selection criteria of these doctors were: (a) at least an MBBS degree or its equivalent approved by Bangladesh Medical and Dental Council, (b) being 14 Doctor's perception and prescription of oral contraceptives engaged in practicing medicine, and (c) advising and/or prescribing oral contraceptives at the time of conducting the study. The study made use of sophisticated statistical tools to strengthen its findings. Other than simple frequency distribution and bi-variate contingency table, the study made use of 5-point Likert scale to determine quality perception of the brands. To further analyze the findings of mean preference score for different quality dimensions (i.e., less side effect and acceptability of the brands to the patients), statistical measures like analysis of variance (ANOVA) and Tukey's critical value were used. Finally a correspondence analysis tool is used to measure the relationship between the factors that influence the doctors to prescribe a certain brand of oral contraceptive. DOCTOR'S PERCEPTION OF ORAL CONTRACEPTIVES Reasons for Recommendations of Oral Contraceptives There are a number of reasons noted to recommend oral contraceptives by the physicians. The seven major reasons identified for which doctors usually recommend oral contraceptives is shown in Table 1. TABLE 1 REASONS OF ORAL CONTRACEPTIVE RECOMMENDATION Reasons Response (%) 1. Birth control 33 2. Dysmenorrhea (difficulty in menstruation) 28 3. Irregular menstruation 14 4. Anemia due to blood loss 10 5. For abnormal menstrual bleeding 6 6. For excessive menstrual bleeding 5 7. Salpingitis (infection of fallopian tubes) 4 Total 100 The study noted that in only 33% cases doctors advise oral contraceptives for birth control purposes, but the rest 67% of the cases the doctors recommend to use oral contraceptive are other non contraceptive health benefits. The main other use of pills are for treatment of dysmenorrhea (28%). The doctors are also found to prescribe oral contraceptive to cure or allay menstrual infirmities of their patients, e.g., to regularize menstruation (14%), cure anemia (10%), reduce the abnormal menstrual blood (6%), and help excessive loss of menstrual blood (5%). Only 4% doctors administered oral contraceptives for salpingitis to cure infection of fallopian tubes.