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সর্ব-শেষ হাল-নাগাদ: ২২nd জুন ২০১৪

ন্যাশনাল কমিউনিকেশন স্ট্রাটেজি ফর এফপি- আরএইচ বাংলাদেশ

The National Communication Strategy for Family Planning and Reproductive Health

Ministry of Health and Family Welfare Directorate General of Family Planning Dhaka, Bangladesh

November 2008

National Communication Strategy for FP-RH

List of Reviewers:

 

Md. Nurul Ameen

Assistant Representative, UNFPA

Dr. Ahmed Al Sabir

Director (Research), NIPORT

Mohammad Shahjahan

Director & CEO, BCCP

Mohiuddin Ahmed

NPPP (BCC & Advocacy), UNFPA

Md. Shahadat Hossain

Family Planning Officer, IEM Unit, DGFP

Foreword

 

Secretary

Ministry of Health and Family Welfare

Peoples Republic of Bangladesh

 

Bangladesh has made remarkable success in family planning and reproductive health programmes over the last two decades but still we have to invest more in family planning and reproductive health programmes. At the beginning of the new millennium with new challenges and opportunities all sectors need to develop their own strategies to move from where we are now today and to where we want to go. In the health, nutrition and population sector programme (HNPSP), this need has become more obvious as the success of national economy is largely dependent on its performance.

 

As the field of reproductive health is shifting in response to the ICPD while the current communication programs and strategies continue to view their audiences as instrumental to achieving specific health objectives, such as increased contraceptive prevalence rates, a newer generation of programs is taking a broader approach, seeking to influence social and cultural norms that shape behavior, build skills to foster behavior change among individuals and communities. Because communication programs try to affect the normative environment which influences attitude and behavior of adolescents, women and men and thereby determines their family size, birth spacing, use of contraceptives, health seeking behaviour and gender relations within communities and societies.

 

Government underscores the potential power of communication programmes to spotlight pressing issues related to safe motherhood, maternal and child mortality rates, dropout of FP methods, unmet needs, permanent and long-term methods and total fertility rate (TFR) etc. Comprehensive communication programmes help break the stigma and change the culture of quiet acceptance surrounding adolescent sexual and reproductive health and rights, and gender concerns in FP-RH and HIV/AIDS. Timely and targeted communication materials can impact on people in profound ways, and support and empower them to initiate change.

 

In this connection, the Ministry of Health and Family Welfare has been fortunate undertaking the development of National Communication Strategy for Family Planning and Reproductive Health with the generous support from the United Nations Population Fund (UNFPA). We express our sincere appreciation to UNFPA Bangladesh. This strategy has been formulated based on the feedback and inputs received from a wide range of stakeholders i.e. programme managers, researchers, communication experts of home and abroad to filed level FP/health workers and NGOs. The intelligence, expertise and intellectual labor of many persons, including DGFP and his team, members of the BCC Task Force, field level family planning officials, NGOs who generously shared their creative ideas and inputs in transforming the dream into reality, we thank them all.

 

This strategy reflects our firm commitment to reverse the high rate of maternal and child mortality, TFR and also to improve RH-FP status in Bangladesh through an institutionalized and strategic communication approach. Besides identifying specific target audiences, the strategy has outlined implementation plans for undertaking research, advocacy and mobilization programmes to address the emerging challenge in reproductive health and family planning sector. With this comprehensive strategy now in place, I hope, the development partners particularly UNFPA Bangladesh will continue to provide generous support and technical assistance towards implementation of different components of this strategy.

 

 

 

A K M Zafar Ullah Khan

 

 

 

 

Message

 

 

 

Communication is an integral part of the family planning and reproductive health approach to population related activities. Fundamental to the Health, Nutrition and Population Sector Programme (HNPSP) is the underlying principle, which places communication at the centre of population and development concerns. The National Communication Strategy for Family Planning and Reproductive Heath has been published to help the programme managers develop their action plans, to address the needs and concerns of adolescents, young people and, women and men of reproductive age for their FP and RH related education, information, counseling and services. We would like to mention here that this strategy development was a unique effort of all stakeholders, where the Directorate General of Family Planning (DGFP) and Ministry of Health and Family Welfare (MOH&FW) took a lead role together with other ministries/departments, NGOs and development partners.

 

Based on this strategy, we have to develop action plans to work with a ‘bottom-up’ approach. UNFPA Bangladesh has the privilege to work in partnership with the government particularly the Ministry of Health and Family Welfare to support the initiative of developing action plan and its implementation.

 

In connection with the formulation of this strategy, I would like to take the opportunity to extend my sincere thanks and gratitude to all concerned particularly the Joint Secretary (Dev), MOH&FW and his team, Director General of Family Planning and the members of the BCC Task Force who have contributed in making the ‘National Communication Strategy for Family Planning and Reproductive Health’ a reality.

 

This strategy will help guide all of us in designing IEC/BCC interventions to address the needs and choices of target audiences envisaged in the strategy. UNFPA believes that programme managers together with other stakeholders will take account of this strategy while designing and implementing IEC/BCC interventions in order to address the special needs and choices of the target population.

 

Let us intensify our coordinated and collective efforts towards making a long lasting impact in the lives of the people of the country in bringing a positive social change that will make every birth a safe and desired one and no woman dies while giving life because every one counts.

 

 

 

 

Arthur Erken

UNFPA Representative

Bangladesh

Table of Contents

 

Acronyms .................................................................................................................. vi

 

Executive Summary....................................................................................................1

 

Introduction................................................................................................................. 3

 

Methodology.............................................................................................................. 4

 

How to Use This Strategy.......................................................................................... 5

 

Current Family Planning and Reproductive Health Indicators for Bangladesh ........5

 

Past and Present Communication Initiatives to Address the

FP/RH Situation in Bangladesh ................................................................................. 7

 

Lessons Learned....................................................................................................... 10

 

Challenges to Communication, Advocacy, and Mobilization (CAM) in Bangladesh .....11

 

Goal and Strategic Objectives ................................................................................... 12

 

The Strategic Approach............................................................................................. 13

 

The Intended Audiences ........................................................................................... 14

Audience 1: Newlyweds and Low Parity Women ................................................. 14

Audience 2: Married Couples with Desired Family Size....................................... 17

Audience 3: Husbands/Males .............................................................................. 18

Audience 4: Poor and Underserved Populations ................................................. 21

Audience 5: Adolescents...................................................................................... 23

Audience 6: Unmarried Youth .............................................................................. 26

Audience 7: Service Providers ............................................................................. 28

Audience 8: Programme Managers and Supervisors........................................... 30

Audience 9: Religious and Community Leaders .................................................. 32

Audience 10: Political Leaders/Policy Makers...................................................... 33

Audience 11: Mass Media Personnel................................................................... 35

 

Program Monitoring and Management ...................................................................... 37

 

Communication Materials Development and Training Capacity-Building ................. 38

 

Outcome Evaluation .................................................................................................. 39

 

Implementing the Strategy ........................................................................................ 39

 

References ................................................................................................................ 43

 

Annexes ....................................................................................................... ............. 45

Annex A: Task Force Committee Members................................................. ............. 45

Annex B: Implementation Plan .................................................................... ............. 46

Annex C: Key FP/RH Behaviors and Messages ......................................... ............. 47

Acronyms

AIDS : Acquired Immune Deficiency Syndrome ARSH : Adolescent Reproductive and Sexual Health BCC : Behavior Change Communication

BCCP : Bangladesh Centre for Communication Programmes

BCCU : Behavior Change Communication Unit

BHE : Bureau of Health Education (DG-Health Services) BINP : Bangladesh Integrated Nutrition Programme BRAC : Bangladesh Rural Advancement Committee CBCC : Center for Behavior Change Communication CBOs : Community Based Organisations

CC : City Corporation/Community Clinic CPAP : Country Programme Action Plan CPR : Contraceptive Prevalence Rate CSW : Commercial Sex Workers

CWFP : Concern Women for Family Planning

FP : Family Planning

FPAB : Family Planning Association of Bangladesh

FWAs : Family Welfare Assistants

GO : Government Organizations

GTZ : The German Agency for Technical Co-operation

HCP : Health Communication Partnership

HIV : Human Immune Virus

HNPSP : Health, Nutrition & Population Sector Programme

HPSP : Health and Population Sector Programme

ICDDR,B : International Centre for Diarrhoeal Diseases and Research, Bangladesh

ICPD : International Conference on Population and Development

IEC : Information, Education and Communication

IEM : Information, Education and Motivation

IPC : Inter-personal Communication

IUD : Intra Uterine Device

LGRD : Local Government Rural Development

MDG : Millennium Development Goals

MOE : Ministry of Education

MOHFW : Ministry of Health and Family Welfare

MOY : Ministry of Youth

NCAP : National Council for AIDS Prevention

NGO : Non-Governmental Organization

NIPORT : National Institute of Population Research & Training

NSV : Non-Scalpel Vasectomy ORT : Oral Rehydration Therapy PHC : Primary Health Care

PLA : Participatory Local/Learning Appraisal

RBM : Results-Based Management

RH/FP : Reproductive Health/Family Planning

SAWA : South and West Asia

SDPs : Service Delivery Points

SMC : Social Marketing Company

SRH : Sexual and Reproductive Health

STIs : Sexually Transmitted Infections

TA : Technical Assistance

TBA : Traditional Birth Attendant

TFR : Total Fertility Rate

UNESCO : United Nations Educational, Scientific and Cultural Organization

UNFPA : United Nations Population Fund

UNICEF : United Nations Children Fund

USAID : United States Agency for International Development

WHO : World Health Organization

WID : Women in Development

Executive Summary

 

Bangladesh, with an estimated population of 144.6 million (BBS-2008) crammed in an area of 147,570 sq km (BBS-2008) has the highest density of population in the world (979/sq. kilometer; BBS-2008). Following a very successful population programme, TFR fell from 6.3 in mid 1970s to 2.7 in 2007 (BDHS-2007) and population growth rate has declined from 3 per cent to 1.39 per cent over the same period (BBS-2008), TFR plateaued for about a decade at 3.3 (1994-2002) and started declining again and reduced to 2.7 in 2007 (BDHS: 2007).

 

The demographic structure, particularly the young people (about 40% in age 10-24 years) will cause the population to continue to increase and may stabilize at around 250 million in 2075: even if the replacement level of fertility is reached in 2010. Contraceptive Prevalence Rate (CPR) has increased to 55.8 per cent in 2007 from 44.6 per cent in 1994 (BDHS: 2004). The use of modern methods constitutes 47.5 per cent, where pill is by far the most widely used method (28.5%; BDHS: 2007), followed by injectables (7.0%), female sterilization (5.0%) and condom (4.5%; BDHS: 2007). Discontinuation rate is also high and varies by method, ranging from 71.3 per cent for condom to 38.7 per cent for injectables and 44.4 per cent for pills (BDHS: 2007).

 

Unmet need for family planning has declined, from 15 per cent in 1999-2000 to 17.6 percent in 2007 (BDHS: 2007). There are marked regional variations in the total fertility rate and contraceptive usage. Some key factors contributing to this phenomenon are low educational levels, continued son preference, high infant mortality, gender inequality, and poor status of women. About a quarter of the population consists of adolescents. Some of the problems concerning adolescents include early marriage, high fertility and low levels of secondary and tertiary education. Maternal Mortality Ratio (MMR) among adolescents is almost double than the national average (320/100000 LB) and the Infant Mortality Rate (IMR) is also 30 per cent higher than national average (52/1000 live births; BDHS: 2007).

 

Statistics show that approximately half of the women in Bangladesh are less than 18 when they marry, and 58 per cent of girls become mothers or pregnant with first child before the age of 20. Early marriage and early first birth therefore go hand in hand. Consequently, adolescent fertility in Bangladesh is still one of the highest in the world, with 127 births per 1000 women below 20 (BDHS: 2007). This has a direct impact on the country’s total fertility rate. Young people are also particularly vulnerable to STI/HIV/AIDS and drug abuse. Because of their curiosity, inadequate knowledge and peer pressure many of them get involved in unprotected sex and drug use. Access to appropriate SRH information and services for this group is inadequate.

 

Behaviour Change Communication (BCC) played a key role in the success of health and family planning programme in Bangladesh. Commendable achievement in the child immunization programme with resultant decrease in child mortality, notable increase in contraceptive prevalence rate with resultant decline in fertility and in the health and family planning programmes have been possible due to a number of successful programme interventions and, undoubtedly, communication was a major element. A close look into the past communication strategies reveals that in the 1950s, selected institutions based IEC programmes were conducted.

In the 1960s, IEC activities mainly concentrated on clinic-based counseling and limited sensitization campaigns; the next decade (1970s) witnessed a shift from clinic-based counseling to a community mobilization through involvement of different opinion leaders and domiciliary visits by the field workers; and in 1980s involvement of NGOs and private sector and a functional integration of FP and MCH was operationalized.

 

In 1993, Ministry of Health and Family Welfare developed the first ever IEC strategy called National FP-MCH IEC Strategy (1993-2000). Built on the past programme achievements, this strategy emphasized on fostering community ownership, improving client-provider interaction, increasing focus on low performing areas, developing audience-specific materials, promoting service sites and providers and IEC capacity building. A special feature of this strategy was its emphasis on greater use of mass media along with IPC and on following appropriate steps for IEC material production and implementation plan.

 

In this strategy, basic strategic concepts have been clarified, major challenges encountered on FP/RH programmes have been identified, strategic communication process have been described and functional components of strategic communication have been considered. The key communication intervention objectives are to: enhance institutional strength; reduce maternal mortality; reduce infant and child mortality; increase CPR/CAR and reduce TFR; control communicable and infectious diseases and reduce malnutrition. Here the target audiences have been brought under three broad categories: service receivers, service providers and tertiary group.

 

With regard to media design, greater use of mass media has been emphasized side by side with strengthening IPC, local communication networks and social and community- based institutions. Major focuses in message design are: IEC/BCC messages need to be target audience specific, messages to be designed on the basis of interpreting research findings and pre-testing; functional linkage of messages on HNPSP, NNP and HIV/AIDS; prioritize needs of poor, women, adolescents and children; address the special needs of the target population and clients’ rights, providers’ obligation to clients; training/orientation and advocacy programmes.

 

This strategy also suggests to have strong coordination among the key stakeholders, including sectoral ministries in implementing the suggested interventions. IEM Unit will be responsible for identifying an action-oriented coordinating body to spearhead the communication strategy for family planning and reproductive health, and to monitor and evaluate the activities conducted to achieve the goals and objectives of this strategy which can help achieve HNPSP objectives along with relevant MDGs.

Introduction

 

The Bangladesh Communication Strategy for Family Planning and Reproductive Health is designed to serve as a roadmap for (1) increasing knowledge, improving attitudes, and changing behaviors, with regard to family planning and reproductive health, (2) improving the quality of reproductive health services, and (3) increasing stakeholders’ participation and coordination in the areas of family planning and reproductive health, in Bangladesh.

 

Individuals and communities must understand basic facts about family planning and reproductive health in order to change attitudes, learn a set of skills and must be given access to appropriate commodities and services. Reproductive health is defined as all health events related to reproduction in the life cycle. Its components include family planning, safe motherhood, reproductive tract infections, sexually transmitted diseases, HIV/AIDS, reproductive health services for adolescents, maternal and infant nutrition, prevention of unsafe abortion, cancer of the reproductive tract, infertility, neonatal care and gender-based violence.

 

Communication is the process of exchanging information or ideas; it is an active process that involves encoding, transmitting, and decoding messages between intended audiences and senders. Strategic communication refers to the assessment of communication approaches or channels available to a given program, and the subsequent selection of those channels to achieve the program’s objectives. Strategic communication builds on theoretical and conceptual models of intrapersonal, interpersonal, and community-level behavior change, and provides a framework for addressing the needs of specific intended audiences.