Family Planning Commodity Projection for
2014-2021
National Institute of Population Research and Training (NIPORT)
Conducted by
Center for Development Studies
Lorna Office Complex (1st floor)
94/A New Eskaton Road
August 2013
1
Director General
National Institute of Population Research & Training (NIPORT)
Ministry of Health and Family Welfare
Dhaka
Foreword
The National Institute of Population Research and Training (NIPORT) has been providing
information support to the national family planning program of the MOHFW by conducting
studies on different issues relevant to achievement of targets under the family planning program
initiated by the Government of the People’s Republic of Bangladesh. As the program continues
to expand, flourish and consolidate, it needs, in the process, to look at the demand that program
has to meet over a longtime perspective in terms of family planning commodities which are
essential for ensuring success.
A study to make projections on family planning commodity requirements from 2014-2021 was
therefore in order. This exercise, therefore, is an attempt to provide the government, as well as
the policy planners, with precise family planning commodity requirements in order to help them
work out a road map for the program from 2014 through 2021.
I firmly believe, the recommendations put forward in the study would be useful guidelines for the
program planners to plan out the future needs with immaculate precision and result.
We thank the Center for Development Studies for their excellent job done. We appreciate
their sincerity and commitment.
Shelina Afroza, PhD
2
Director (Research)
National Institute of Population Research & Training (NIPORT)
Ministry of Health and Family Welfare
Dhaka
Preface
We are happy to note that the study entitled: Family Planning Commodity Projections for 20142021—has been successfully completed with sincere effort put in by the Center for
Development Studies, Dhaka. This is, indeed, something that NIPORT always appreciates.
This study is a part of NIPORT’s continuous effort to provide the policy planners and decisionmakers with appropriate knowledge, information and necessary data to enable them to be
abreast of actual situation at the field and thus design the program based on that. We believe,
the findings and recommendations made under this study will be another milestone in that
regard in feeding them with appropriate knowledge and information which they would find useful
for application.
We appreciate the Center for Development Studies for their excellent work. We hope, they
would continue to maintain the same standard and excellence in conducting similar studies in
the event they are given the responsibility.
Finally, I would like to appreciate the NIPORT team, too, for their persistent effort and hard work
in facilitating conduct of the study.
(Md Rafiqul Islam Sarker)
3
Acknowledgement
The Management of the Center for Development Studies acknowledges, with deep sense of
gratitude, the opportunity that NIPORT has given to CDS for being part of this important work
accomplished for the interest of the program in the population sector. The Director General,
Director Research, and the Evaluation Specialist and Deputy Program Manager, as well as all
other officials, staff and personnel of the NIPORT family extended valuable support and
cooperation that CDS needed in getting the task completed within the stipulated timeframe.
The Core Study Team demonstrated the highest sense of responsibility in accomplishing the
task with immaculate precision and correctness warrants special appreciation. All of them
maintained strict time-schedule for the discussion meeting called for sharing the views and
making the analysis of the materials, data and information collected for the task. We thank all of
them.
The support staffs were also alert for extending every support the CST needed for the task.
They even worked beyond normal office hours with smiling faces, taking it as a challenge to
beat the clock under exigency.
Finally, it is the concerted effort of all the people involved in the process that required extreme
level of determination and commitment. We owe them a lot for what we obtained through their
sincere support beyond our expectation. May Almighty Allah bless them and us all.
Iftekhar Uddin Ahmed
Chairman
Center for Development Studies
4
Contents
Foreword
Preface
Acknowledgement
Abbreviations
Executive Summary
2
3
4
6
7
Chapter 1
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
Introduction
Background
Rationale
Objectives of the Study
Scope of Services
Methodology
Scenarios of Projection Data
Projection of Scenarios and Baseline Input Data
Data Collection
Chapter 2
2.1
2.2
Findings
Introduction
Projected number of users and acceptors according to
scenario-I
Projected family planning commodities requirements according
to scenario-I
Projected number of method users and acceptors according to
Scenario-II
Projected family planning commodity requirements according to
Scenario-II
Projected number of method users and acceptors according to
scenario-III
Projected family planning commodities requirements
according to scenario-III
Projected number of method users and acceptors according
to scenario-IV
Projected family planning commodities requirements according
to scenario-IV
Conclusion and Policy Implications
Introduction
Reaching Unmet Need for Contraception for Limiters and Spacers
Transforming Intenders into Users
Shifting Traditional Method toward Modern Methods
Achieve TFR= 1.7 per woman
Formulating the Quality Strategy
Policy Implications
Limitations
Recommendations
2.3
2.4
2.5
2.6
2.7
2.8
2.9
Chapter 3
3.1
3.2
3.3
3.4
3.5
3.6
3.7
3.8
3.9
Bibliography
Appendix-A/B
Research Team
11
12
12
13
13
19
20
23
25
25
28
29
31
33
34
36
37
38
38
38
39
39
39
40
40
40
42
44/48
54
5
Abbreviations
BBS
Bangladesh Bureau of Statistics
BDHS
Bangladesh Demographic and Health Survey
CPR
Contraceptive Prevalence Rate
CYP
Couple Year Protection
DDS
Drugs and Dietary Supplements
DGFP
Directorate General of Family Planning
FP
Family Planning
GoB
Government of Bangladesh
HPNSDP
Health, Population and Nutrition Sector Development Program
IP
Infection Prevention
IUD
Intrauterine Device
LAPM
Long Acting Permanent Method
LA/PM
Long Acting/ Permanent Method
LMIS
Logistics Management Information System
MIS
Management Information System
MOHFW
Ministry of Health and Family Welfare
MWRA
Married Women of Reproductive Age
NGO
Non-Government Organization
NIPORT
National Institute of Population Research and Training
OP
Operation Plan
RH
Reproductive health
TFR
Total Fertility Rate
UNFPA
United Nations Population Fund
WHO
World Health Organization
WRA
Women of Reproductive Age
6
EXECUTIVE SUMMARY
Traditionally, family planning program plans contain specific targets. A demographic target, in
terms of fertility rates is set first for a specified year in the future. Based on this target, required
numbers of acceptors1 and users2 are projected under different assumptions. Target-setting by
planners without consideration for the needs of the clients, most of whom are women, often
leads to unsatisfactory and inefficient use of contraceptives. The clients and potential clients are
those couples who intend to use family planning services to limit the total number of children
they would like to have and to space those children. The family planning program should
provide them with appropriate contraceptives that fit their specific needs. A related issue is the
quality of services, which, reportedly being unsatisfactory, is ‘often the reason why couples are
not using family planning services even when they have the need, or are not using a method
that is appropriate for them'. A client-oriented approach would focus on ways to: (l) expand the
program to serve couples who intend to use family planning services' and (2) improve the
quality of services so that more clients will use appropriate methods correctly and longer.
The purpose of this exercise is to project the contraceptive commodity requirements keeping in
mind the vision of the family planning program. The objectives of the exercise are to:
 Outline the vision of reproductive health and family planning in the future;
 Identify strategies, under different scenarios, to achieve reproductive health and family
planning goals; and
 Develop specific recommendations for utilization of effective strategies to achieve
Program goals
The projection for strategic planning was derived by using the microcomputer-based FamPlan
system of models. A total of four sets of projections and associated contraceptive commodity
requirements were made using the FamPlan model. The FamPlan system of models is
designed to help development planners to transform their population policies into
implementation and operational plans. It is also aimed at helping family planning managers to
estimate contraceptive commodity requirements and to allocate resources effectively among
different family planning delivery systems.
The different scenarios generated in this study include:
 Develop year-wise Family Planning Commodity Projections for 2014-2021 in
Bangladesh assuming that all unmet need for family planning will be satisfied by 2016 as
specified in the HPNSDP, and it should also be based on the medium variant projections
of the United Nations Population Division projections that assume a more gradual
contraceptive prevalence increase based on historical trends;
 Develop year-wise projections of contraceptive commodities for 2014-2021 considering
three key factors: a) growth in the numbers of women of reproductive age as a
consequence of high fertility rates in the past; b) increasing demand for family planning;
and, c) changes in the family planning methods used, particularly the shift from
traditional to modern methods as programs mature;
1
Acceptors are the number of new users required to achieve the specified growth in total users (users next year minus users this year) plus the number of new users
required to replace those that discontinue use, age out of the age group, or die, minus the number of current users aging into the age group.
2
Users: The number of women who are using some form of contraception.
7


Develop year-wise family planning commodity projection for 2014-2021 on the
assumption that the private sector provides an important share of family planning
services in Bangladesh;
Assess the complete family planning commodity projection for 2014-2021 status on the
basis of Demographic Pressures: More Couples of Reproductive Age, Increasing
Demand for Contraceptives, Contraceptive Users and Method Mix;
Comparative pictures of all scenarios indicate which one is most effective and which one is less
effective. Among the scenarios generated, the most effective scenario is achieving unmet need
of family planning and the less effective is the elimination of traditional methods. Given the
situation, this suggests that there is a scope for increasing CPR. If unmet need can be reduced
at all stages, then it will have significant impact on the commodity requirements as well as
reaching demographic goals by 2016. Second set of projection for the contraceptive
requirements is made under the assumption that the replacement fertility will be achieved by
2016. For instance, under the assumption of eliminating unmet need for poor contraception, the
acceptors will be almost doubled between 2014 and 2021.
Long acting methods like IUD is also effective for a country like Bangladesh. It has
demonstrative effect on the achievement of fertility and consequently on contraceptive
commodity requirements. However, to implement IUD quality services need to be ensured along
with side-effect management. It is important to mention here that in rural Bangladesh RTI is high
among the IUD users. Therefore, management of RTI and counseling to mothers are important
determinants of IUD use. Considering that, couples who do not want any more children should
be segmented for IUD use.
One of the problems of male and female sterilization users is that by the time they come to
accept sterilization, they have already achieved desired fertility, and thus leave little
demographic impact, excepting the fact that the increased use of these methods reduces the
burden of other modern methods, such as pill and condom, and in the long run commodity
requirements will become lower and the program will be cost-effective to some extent. What will
be contraceptive commodity requirements if the male sterilization can be increased? Projected
information shows that there will be fewer users than it would be required under the other
assumptions. The increased use of male sterilization has significant effect on the achievement
of replacement fertility, because relatively lower CPR would be required to meet the
demographic goal. Under this assumption, there will be less requirement of pill and increased
requirement of male sterilizations. If this could be done, then the program will be sustainable
and in the long run it will be more cost-effective.
Future Strategies to achieve Demographic Objectives: The family planning program should
provide acceptors and users with appropriate contraceptives that fit their specific needs. A
related issue is the quality of services. A common reason why couples do not use family
planning services even when they need them, or are not using the method best suited to them,
is unsatisfactory quality of services. The quality of services can be ensured through regular
visits of the households and management of side-effects when they need them. About 50
percent users of pill discontinue within one year. Discontinuation is the highest for condom
users with only third clients continuing up to one year; discontinuation for IUD users is 35
percent indicating that IUD use would be more crucial to achieving demographic target. Fear of
side-effect is a major reason for non-use. Side-effect management services are not welldeveloped. There is an inadequate monitoring and supervision system. A client-oriented
approach would focus on ways to improve the quality of services so that more clients will use
appropriate methods correctly and longer.
8
Raising continuation Rates and improving use-Effectiveness: The current rates of
continuation and use-effectiveness are less satisfactory than the desired level. If the program is
to achieve its demographic goals, all possible efforts should be directed toward enhancing these
rates. Strategically, this implies improved quality of care and services. A coordinated set of
health and family planning services would be necessary to implement the quality strategy. The
following issues need to be addressed for any improvement in the quality of care and services:
Identifying, monitoring, and providing treatment of side-effects and complications strengthening
the chain of supervision for ensuring side-effect management.
It is assumed that improvements in the quality of care and services and realization of the
expectations of the current intenders will result in a shift in the contraceptive method mix toward
longer-acting methods. Currently, the family planning program favors the modern, reversible
methods. Some of the important issues regarding low use of longer-term methods are: lack of
adequate and hygienic service facilities for inserting and removing IUDs; noncompliance with
minimum aseptic measures (e.g., washing hands before examination, using sterilized gloves,
etc.), noncompliance with the standard technical procedures (e.g., taking weight, measuring
blood pressure, enquiring about pelvic bleeding, performing pelvic examination, etc.); lack of
appropriate brands of IUDs with fewer side-effects and complications;
Although fertility in Bangladesh has been declining, it is not, however, enough to reduce
population growth because of population momentum which is due to high fertility in the past.
The proportion under 15 is high, and as a result of the young age structure of the population, the
population will continue to grow for several decades even if we achieve replacement fertility as
targeted.
Delay in age at marriage, increasing the age at first birth, spacing of births and widely dispersed
births may reduce population momentum. Therefore, accessibility of contraceptives is crucial to
the newly married couples and adolescents to accelerate the demographic transition. Program
should also ensure uninterrupted contraceptive supplies to them and it should get appropriate
emphasis in the program, such as providing an uninterrupted supply of contraceptive
commensurate with needs, more trained manpower within logistics management system, etc.
The training, either formal or informal, should continue, as it helps increase the knowledge and
skill of the personnel, especially the storekeepers at the warehouses, which is consistently
related to achieving the effective contraceptive distribution.
9
CHAPTER 01
INTRODUCTION
1. Background
The Government has developed the National Population Policy which seeks to reduce fertility to
replacement level by 2015. This requires a further TFR decline of 0.3 children per couple
compared to current TFR 2.3 children per couple (BDHS 2011). But, even at replacement
fertility, the country will be adding two million annually to the population due to high fertility in the
past, and many in the population field feel that the decline needs to be greater, with a target of
1.0 below present fertility (i.e. to TFR 1.7), projected to have substantial benefits across many
sectors. It will not fall any lower, so all future population growth will be determined entirely by the
fertility level.
High rate of population growth and the resultant increase in population size impede the process
of achieving the objectives in various sectors of the economy. Therefore, those ministries and
agencies whose target population is affected by population growth would have to share the
burden of responsibility of population control and family planning, in addition to the targeted
interventions of MOHFW.
The development issues relating to the population of Bangladesh are convincing the families of
the need and benefits of delayed marriage for their daughters; newly-wed couples should wait
before having their first child, especially if the bride is young; small and medium scale
employment opportunities for young women be generated in rural areas, so that marriage does
not have to follow so closely on school drop-out; high school drop-out rates be reduced;
services can be designed to more effectively educate unmarried adolescents on reproduction,
and alternative options to early marriage. A social movement to eliminate dowry needs to be
encouraged and supported. All these challenges are to be addressed through the interventions
of other relevant ministries, in addition to the interventions within MOHFW’s jurisdiction.
The Family Planning (FP) Program has built a nationwide community-based FP service delivery
system, relying primarily on non-clinical methods such as oral pills and condoms. The current
pattern of temporary contraceptive use, with oral pill users being close to 30% of all married
couples, is reaching saturation (only two other developing countries exceed this proportion), but
other individual methods do not even account for 10% each. With persistent early marriage and
high fertility, many women have completed their childbearing by the mid late twenties, leaving
them with two decades of reproductive life to avoid unwanted pregnancies. However, the
proportions of couples relying on long-acting or permanent FP methods (IUD, implants, male or
female sterilization) remains very low (less than 15%). Diversified and mass-scale FP services
will need to be undertaken to bring back the tempo of 1980s and achieve the target of fertility to
replacement level.
As per BDHS report-2011, CPR is 61.2% and TFR is 2.3 which were respectively 55.8% and
2.7 in 2007 (BDHS-07). Under the HPNSDP, CPR and TFR having been targeted as 72% and
2.00 /women respectively by the year 2016, the following strategies will be pursued to achieve
the targets: (i) Increasing the contribution of long-acting and permanent methods to the method
mix; (ii) Reducing the unmet need from 17.1% (BDHS-07) to 9%; (iii) Ensuring uninterrupted
supply of logistics; (iv) Implementing special interventions/programs for the low-performing and
hard-to-reach areas; and (v) Massive awareness development program.
10
On the other hand, unmet need for Family Planning was 14% (BDHS-11). The reasons for
higher unmet need were as follows: (i) Stock-out of contraceptives at the field level; (ii) Shortage
of manpower at the field level: (iii) Below par monitoring and supervision; (iv) Inadequate
program interventions for the low-performing and hard-to-reach areas. During the last few years,
required numbers of manpower were recruited and contraceptives forecasting and procurement
had been made time-bound.
Special activities were undertaken to ensure effective monitoring and supervision at all levels. In
addition, considering the initiatives taken so far, and the program interventions made under
various OPs of DGFP for the HPNSDP, it will be possible to reduce the unmet need to 9% in
2016 from 17.1 % (2007).
The demand for family planning services is defined as the sum total of unmet need and total
contraceptive use. The 2011 BDHS shows that demand for family planning services is 75
percent and proportion of demand satisfied (total contraceptive use divided by the sum of total
unmet and total contraceptive use) is 82 percent (BDHS: 2011). The Health Population Nutrition
Sector Development Program (HPNSDP) has set a target of reducing unmet need for family
planning services to 9 percent by 2016 (BDHS 2011).
1.2 Rationale
Good reproductive health programs depend on a reliable supply of certain essential
commodities. When supplies are inadequate, or are interrupted, even well-planned interventions
may falter and opportunities may be lost. The importance of these essential items comes into
sharp focus when supply shortages, or stock-outs, occur. Nationally, progress towards family
planning goals is now measured by tracking the number of additional users of family planning.
To accomplish the tasks defined and get the program going from the present level of attainment
to targeted attainment, there needs to be made comprehensive and trend-based projections on
the commodity that the program will need through 2014-2021 in order that the program
implementation does not suffer from any shortcomings and lack of supply and support
essentially needed for targeted achievements. The commodity projection will help, using the
number of additional users as the indicator, to measure progress in family planning
interventions. The proposed study is designed to make that projections based on various
assumptions with the target to achieve the following objectives:
1.3 Objectives of the study
The broad objective of this exercise is to assess the future needs for contraceptive commodities
through projecting Family Planning Commodity Projection for 2014-2021 in Bangladesh under
different assumptions.
The specific objectives of the study are to:
i. Develop year-wise Family Planning Commodity Projections for 2014-2021 in
Bangladesh assuming that all unmet need for family planning will be satisfied by 2016 as
specified in the HPNSDP, and it should also be based on the medium variant projections
of the United Nations Population Division-projections that assume a more gradual
contraceptive prevalence increase that is based on historical trends;
ii. Develop year-wise projections of contraceptive commodities for 2014-2021
considering three key factors: a) growth in the numbers of women of reproductive age as
a consequence of high fertility rates in the past; b) increasing demand for family
11
planning; and, c) changes in the family planning methods used, particularly the shift from
traditional to modern methods as programs mature;
iii. Develop year-wise family planning commodity projection for 2014-2021 on the
assumption that the private sector provides an important share of family planning
services in Bangladesh;
iv. Assess the complete family planning commodity projection for 2014-2021 status on
the basis of Demographic Pressures: More Couples of Reproductive Age, Increasing
Demand for Contraceptives, Contraceptive Users and Method Mix;
v. Generate a set of recommendations for implementation of the year-wise family
planning commodity projections in Bangladesh in consultation with different stakeholders
including Directorate of Family Planning.
1.4
Scope of services
Commodity needs are projected according to population data, contraceptive prevalence trends,
anticipated changes in the contraceptive method mix, and average annual supply costs per
method. Bangladesh Demographic Health Survey 2011 data have been used to make estimates
and projections for numbers of women aged 15-49 and total fertility rates (TFRs). Standard UN
procedure has been used to create a schedule of the family planning commodity projection. The
procedure of the projections has been defined. The projection results have been shared with
different stakeholders including Logistics Unit of Family Planning Directorate under guidance of
NIPORT before finalization of the report.
1.5
Methodology
1.5.1 Family Planning Commodity Projection
Ideally, quantification for projection is an activity that includes constant monitoring of inventory
levels, product consumption rates, and other information—including programmatic and
environmental factors— that may affect future demand. If the logistics management information
system (LMIS) is designed well and kept up-to-date, the staff responsible for quantification and
procurement will have with them all the consumption and stock level information they need.
While consumption data is considered as the gold standard for contraceptive projection, such
data are not always accurate, reliable, or readily available. Below are the descriptions of the
product characteristics and special projection considerations for the different types of family
planning methods; different types of data to be used for projecting family planning commodity
supplies; and the steps in the projection methodology, including guidance on how to adjust
for problems with data quality and how to analyze the validity of different projections.
1.5.2 Projection Considerations
When projecting for short-acting contraceptive methods, we have considered the following product
characteristics:
Oral contraceptive pills
For non-emergency oral contraceptives, two types are usually available: combined oral
contraceptives (COCs-the most popular), and progestin-only oral contraceptives (POCs).
Women who cannot take products that contain levonorgestrel (due to side-effects), or lactating
women, can take progestin-only oral contraceptives. The number of users of combined orals in
12
any situation almost always exceeds the number of users of progestin-only orals. In addition,
many service providers do not have clear guidelines about how to counsel women who might be
eligible to use progestin-only orals—this makes it more difficult to accurately estimate the
demand for POCs.
Injectables
Injectables are available in one-month, two-month, and three-month forms (i.e., a woman
receives an injection once a month, every two months, or every three months). The most
popular is the three-month injectables. When projecting for injectables, included in the forecast
are syringes and the correct size needles.
Condoms
Male and female condoms are barrier devices that are used during sexual intercourse to prevent
pregnancy and reduce the transmission of the human immunodeficiency virus (HIV) and sexually
transmitted infections (STIs). Male condoms are inexpensive and easy to use, with few sideeffects (usually an allergic reaction to latex). It does not require a visit to a clinic or a medical
prescription; public sector health programs often offer them for free or at nominal price. The use of
the male condom depends on the initiative and motivation of individual men.
Use of the female condom, while controlled by women, requires practice to learn how to use
correctly and has a significantly higher per unit cost. The female condom has few, if any, sideeffects, and current evidence indicates that it can be reused after washing, disinfection, and relubrication. Using it in our FP Program is still a long way off.
E m e r g e n c y c o n t r a c e p t i ve p i l l
The emergency contraceptive pill (ECP), provided in a one-pill or two-pill pack, has a high
dose of the same hormones used in non-emergency oral contraceptives (the number of pills
depends on the brand). ECP can be either combination or progestin-only pills. The population
that uses these products is a sub-set of the total population interested in using a modern
method of contraception. For example, if a woman is using a condom and it breaks, if she
forgets to take her pill, or if she receives her injection late, she would know immediately that
her short-acting method had failed. If she knew about ECP, she could use it as a back-up
method. However, a woman using LA/PM would not necessarily know immediately if her
method had failed; therefore, users of LA/PM are less likely to use ECP.
C yc l e b e a d s
Cycle beads are based on the standard-days-method, a non-hormonal method of contraception
that relies on fertility awareness (knowing the days of her menstrual cycle when a woman is most
likely to become pregnant— on those days, she either avoids sex or uses a backup method).
Cycle beads are often recommended for women who either do not wish to or are unable to use
hormonal or barrier methods of contraception. Users of cycle beads usually (1) have a
religious/moral objection to barrier, hormonal, or permanent methods; (2) are interested in
modern methods but may have experienced side-effects; or (3) may not have regular access
to services. However, because some women may use a backup method during the days when
they are most likely to conceive, the use of cycle beads may overlap with other methods.
As with any new method, it is important to train providers to counsel women on the appropriate
use of cycle beads; they are not appropriate for all women (women whose cycles are irregular
or are outside the 26–32-day range). Likewise, to establish the size of the potential user
population, determine if only certain service providers will carry cycle beads and the locations
of the SDPs. It is unlikely that a woman already using a modern method of contraception would
13
switch to cycle beads, so new users of cycle beads are likely to be those who are using
traditional methods or no method. Cycle beads do not have an expiry date; however, a small
rubber ring that accompanies the beads may wear out after a few years and, over time, the
calendars inside the packages may become outdated.
For Long-Acting and Permanent Methods of Contraception, intrauterine devices [IUDs],
hormonal implants, female and male sterilization have been considered. It has lagged behind
for several reasons, despite their high effectiveness and popularity with users.
For several reasons, contraceptive supplies for Long-Acting and Permanent Methods
(LA/PM) are more complicated to forecast than short-acting methods. For implants and IUDs, in
addition to the device itself, additional products are required for both insertion and removal.
Female and male sterilization requires special clinical training, administration of anesthesia,
and use of drugs for pain management. All LA/PM require infection prevention equipment and
supplies for health worker protection and for decontamination and sterilization of instruments.
Projection of LA/PM will require special consideration. In general, when projecting for LA/PM,
the projection will include the estimated quantity of the contraceptive device (IUD, hormonal
implant) plus the quantities of reusable instruments, disposable instruments and expendable
medical supplies; and, for female and male sterilization, anesthesia drugs and supplies, and
pain management drugs. The following product characteristics will be considered when
projecting supplies for the LA/PM of contraception:
Hormonal implants
Hormone-containing contraceptive implants are a highly effective, long-acting, and immediately
reversible method of contraception. The implant is inserted under the skin in a woman’s upper
arm and remains effective for three to five years, depending on the implant used. Hormonal
implants have a small, flexible plastic rod, about the size of a matchstick that releases a
progestin hormone. Three types of implants are currently available:



Jadelle, a two-rod implant with 75 milligrams (mg) of levonorgestrel in each rod, with a
use life of five years
Implanon, a one-rod implant with 68 mg of etonogestrel, with a use life of three years
Sino-implant II, a lower cost, two-rod implants with 75 mg of levonorgestrel in each rod,
with a use life of four years; provided with a disposable trocar.
Insertion and removal of implants require a minor surgical procedure. Providers require specific
training on insertion, removal, counseling, management of side-effects, infection control
procedures, disinfection or sterilization of medical instruments, and disposal of sharp and
contaminated wastes.
To safely and effectively provide the method, all required equipment, medical instruments,
expendable medical supplies, infection prevention, and disinfection/sterilization supplies must be
available. These supplies are not packaged in a self-contained kit; therefore, forecast will be made
separately for procurement.
I n t r a ut e ri n e d e vi c e
To prevent pregnancy, a trained provider inserts the IUD, a small, flexible plastic frame, into a
woman’s uterus. An IUD is a long-acting, safe, and effective contraceptive method that is quickly
reversed by removing the device. The most commonly offered IUDs include the copper T
14
intrauterine device (TCu)-380A and the Multiload-375; both copper bearing IUDs can be used for
12 years or more; and the hormonal IUD—the levonorgestrel-releasing intrauterine system (LNGIUS)—effective for at least five years. A specific set of sterile medical instruments and expendable
medical supplies are required for both insertion and removal of an IUD.
Sterilization
Female and male sterilization are surgical procedures that provide permanent, lifelong protection
against pregnancy, and is therefore an option for men and women who do not want more children.
Sterilization, one of the most effective contraceptive methods, has a low failure rate, depending on
the surgical technique used. In resource-constrained settings, the surgical techniques used most
often are mini-laparotomy for women and non-scalpel vasectomy for men. Because sterilization is
permanent, it is critical for the client to receive counseling and to give informed consent.
Both procedures are non-invasive, relatively simple surgeries, but they must be performed
by a specially trained provider (usually a physician or nurse-midwife). A mini-laparotomy
must be performed under partial anesthesia, as an incision is made into the abdomen to lift out
the fallopian tubes, which are cut and tied, or cauterized. Vasectomy, which only requires local
anesthesia, is performed through a small incision in the scrotum where the vas deferens are
located, cut and tied, or cauterized. For vasectomy, the procedure is not fully effective for three
months; during this time, the couple must use condoms or another contraceptive method.
Both mini-laparotomy and vasectomy require specific medical equipment and instruments,
and many expendable medical supplies, anesthesia drugs and supplies, and pain management
drugs, as well as supplies for infection prevention and disinfection/sterilization of reusable
instruments. See appendix C for a list of the products required.
1.5.2. Medical instruments and supplies, drugs, and infection prevention supplies
Cont racept i ve devi ces, di sposabl e i nst rument s, and expendabl e medi cal
suppl i es
While estimating the number of procedures to be performed, the following will be
considered:


For each product that is inserted or only used once, the quantity needed will be calculated on
a direct one-to-one ratio (1:1) to the number of insertions, removals, or surgical sterilization
procedures.
When more than one unit of the product is needed for each procedure (e.g., sterile gauze
pads, surgical drapes), the standard quantity of each product needed will be multiplied, per
procedure, by the estimated number of procedures.
It will not be possible to use historical consumption data on products with multiple uses for
projection of LA/PM, unless the product is used exclusively for projecting the specific LA/PM, or the
quantities used for LA/PM are reported separately.
Infection prevention (IP) supplies are typically among the expendable supplies purchased
and made available for general, multi-purpose use by health facility staff. While a specific
quantity of infection prevention items required per procedure is estimated, (e.g., disposable
15
gloves or disinfectant solution), these products may not be used exclusively for LA/PM—unless
they are part of a pre-packaged, sterile IUD, implant, or surgical kit.
Reusabl e medi cal inst rument s
Certain reusable medical instruments are required for insertion and removal of IUDs and
implants, and for performing female and male surgical sterilization via mini-laparotomy and
non-scalpel vasectomy.
Regardless of the type of data used, the forecaster will —

Determine whether the reusable instruments are already available and will be used exclusively
for LA/PM, or if the instruments are routinely used for other types of procedures. If these
reusable instruments have multiple uses, that may affect their availability for LA/PM.

Consider the level and type of facility where the method is being provided. For example,
mini-laparotomy kits for use in mobile units will contain all medical instruments and supplies
required for one procedure, but the availability of the same medical instruments at a district
hospital may affect whether the method can be provided or not.

Include the expendable medical supplies for disinfection and/or sterilization of reusable
instruments, as well as supplies of personal protective equipment (PPE) for health workers
(e.g., exam gloves, masks), based on the estimated number of procedures that will be
performed.
Anest hesi a drugs a nd suppl i es, and pai n management drugs
Drugs and supplies are required for female and male surgical sterilization (usually a minilaparotomy and non-scalpel vasectomy).
When projecting for these products, it will be ensured that—

The quantities of local anesthesia drugs and supplies, distilled water for dilution, and pain
management drugs required for each surgical sterilization procedure are standardized for
each procedure and should include the dosage form, strength, and dosing schedule for
each type of pain management drug. (The correct use of these products should be
documented in the clinical protocols for each LA/PM).

Ensure that clinical protocols for LA/PM are current and that they specify the drug products
and drug combinations, and how they should be administered for pain management during a
mini-laparotomy and non-scalpel vasectomy.
Alternative combinations and dosages of pain management drugs will also be forecast if the
percentage of clients that will be prescribed with one, or the other, combination of drugs can
be estimated. Some clients may not be able to tolerate the pain management drugs as set out in
the clinical protocols because of allergies, side-effects, or other sensitivities. Other clients may
require higher dosages, or more frequent dosing, if they have a low pain threshold. If the number
16
of cases requiring alternative combinations and dosages of pain management drugs
represents a significant percentage of the total number of procedures performed, then these
cases may be forecast separately.
Kits
If procuring and supplying contraceptive devices in kits that include all the disposable
instruments and expendable medical supplies required for insertion or removal of IUDs or
implants, or for performing mini-laparotomy or no-scalpel vasectomy, there will be no need to
forecast for these supplies separately, if—
 quantities supplied in the kit are sufficient to perform one procedure correctly
 supplies in the kit are used exclusively for the designated LA/PM procedure.
1.6 Sources of Projection Data
Census and Survey Data
Three types of data can be used for projecting the consumption of contraceptive supplies:
consumption data, services data, and demographic data. We consider program targets
expressed as a projected number of people to be served. Census 2011 data used for
projecting target people and national survey (Bangladesh Demographic and Health Survey)
morbidity data used for projection commodities.
We used the different types of data to prepare separate forecasts of the estimated
consumption for each product. Then, we compared the results of the different forecasts and
reconciled them to determine the final estimate of consumption for each product, which we
then used as the starting point for projecting quantity.
Other sources of data (Consumption Data)
Consumption data are historical data on the actual quantities of products dispensed to users,
or used to provide a specific service, during a specified period of time. These data are
usually the most reliable in mature, stable programs that have a full supply of products and a
robust LMIS.
Strengths

Forecasts based on historical consumption data usually require fewer assumptions than
other types of data, in part because consumption data are already expressed in the unit of
measure that is being forecasted—quantities of products dispensed to users. Usually,
the fewer the assumptions, the lower the possibility for error in the forecast. Forecasts
based on good quality consumption data, if available, are often the most reliable.
17

Supply chain and service delivery constraints that may have affected product availability, or
access to services, are automatically reflected in historical consumption data. A supply
chain cannot distribute more products for consumption than the program can procure; or
that its existing warehouses, delivery systems, or staff can handle.
Challenges

Past consumption may not be predictive of future use, especially when new methods or
products are being introduced, or when existing services or availability will be scaled up
during the quantification period. In this case, the quantities based on past consumption
could underestimate a forecast needed.

Past consumption data may reflect periods of stock-outs, supply imbalances, or other
factors that affected the availability or use of the products. Using these data could result in
projections of past errors, stock-outs, or supply imbalances, rather than the quantities of
products that are needed.
1.7 Projection Scenarios and Baseline input data
1.7.1 Base Population and fertility, mortality assumptions
For commodity projection, we used the DemProj (DemProj 2008) model to calculate the number
of women of reproductive age developed by Futures Group and the Research Triangle Institute.
However, the base population of the model is taken from Population and Housing Census 2011
(Census 2011) given in Table 1.1. The life expectancy for male is 67 years and for female is 69
years [Sample Vital Registration System (SVRS 2009)] in base year (2011). Life expectancy at
birth for males is assumed to be 69 years and for females is 71 years with a view to averaging
longevity which will be 70 in 2021 under the national strategic plan (GoB 2012). The sex ratio at
birth is assumed to be 105. TFR: 2.3 in 2011 (BDHS 2011) and 1.7 target (set in the
Perspective Plan Projection) for 2021 (GoB 2012). The mortality input to DemProj, life
expectancy at birth, indicates overall mortality in a population. But DemProj also needs the
pattern of mortality in order to produce mortality rates by age group. Specifically, the rates
required by DemProj are survival ratios, which will survive one age group into the next five year
group. The best way is to use data on age specific mortality for a country with the mortality
pattern at the corresponding level of life expectancy for each of the model tables. The UN South
Asian model life table is considered for this exercise.
18
Table 1.1: Adjusted Population by Age and sex: Bangladesh 2011
Age group
0-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80+
Total
Male
7940842
9691237
8957038
6769650
6008978
6474284
5282247
4885149
4451977
3497551
3070186
2000104
2163739
1195016
1253976
507585
830820
74980379
Female
7717178
9200703
8350602
6606392
7822601
7543339
5636625
5052596
4139048
3136646
2702632
1639914
1925885
1001994
1065773
401647
848398
74791973
Total
15658020
18891940
17307640
13376042
13831579
14017623
10918872
9937745
8591025
6634197
5772818
3640018
4089624
2197010
2319749
909232
1679218
149772352
For commodity projection, we used the FamPlan (Spectrum) model under different scenario and
assumptions. The different input data for this projection model are given below:
1.7.2 Method Mix
The contraception prevalence rate among currently married women has been increased from 49
percent in 1996-97 to 61 percent in 2011 (Table 1.2). The use of modern methods is increased
by 5 percentage points in the past four years from 47 percent in 2007 to 52 percent in 2011. The
following table shows that the proportion of pill users increased about 10 percent during the last two
decades. But in the last decade it is increased only by 4 percent. The acceptance of permanent
methods such as female sterilization and male sterilization are constant over the last decade. It
is also observed that the acceptance of condom and injectables has increased slightly during recent
years. Similar increases were observed for Implant and Norplant as well. The decline in the
acceptance of IUDs from 2.2 percent to 0.7 percent indicates that the method has been losing
popularity quite rapidly among potential clients. We assumed that the method mix of 2011 will continue
over the whole projection period i. e. (2014-2021).
19
Table 1.2: Change in the Contraceptive Method Mix since 1996-97 BDHS to 2011 BDHS
Methods
Any modern method
Pill
IUD
Implants
Injectables
Condom
F Sterilization
M Sterilization
Any traditional
Periodic Abstinence
Withdrawal
Others
Total
1996-97
BDHS
41.5
20.8
1.8
0.1
6.2
3.9
7.6
1.1
7.7
5
1.9
0.8
49.2
199-2000
BDHS
43.4
23.0
1.2
0.5
7.2
4.3
6.7
0.5
10.4
5.4
4.1
0.9
53.8
2004 BDHS
47.3
26.2
0.6
0.8
9.7
4.2
5.2
0.6
10.7
6.5
3.6
0.6
58.0
2007
BDHS
47.3
28.5
0.9
0.7
7.0
4.5
5.0
0.7
8.4
4.9
2.9
0.6
55.7
2011 BDHS
51.9
27.2
0.7
1.1
11.2
5.5
5.0
1.2
9.2
6.9
1.9
0.4
61.1
1.7.3 Contraceptive Effectiveness
Table below (1.3) shows the effectiveness of different methods of contraception. The
effectiveness of pills is assumed to be 92%, because both workers and clients do not know
about the proper use of pills i.e. they are unaware of what to do if clients miss one or two or
three pills. This increases the method failure in defining the effectiveness of pills. In the absence
of any direct estimates of contraceptives effectiveness, we use the contraceptive effectiveness
suggested by Bongaarts (Bongaarts and Potter l983), which appears in the accompanying
Table. The effectiveness of each method will be constant over the projection period.
Table 1.3 Contraceptive Effectiveness by Method
Methods
Condom
Female sterilization
Injectable
IUD
Male sterilization
Implant
Pill
Traditional
Other
Source: Spectrum (FamPlan) Manual
Effectiveness
81
100
100
96
100
100
92
50
50
1.7.4 Contraceptive Commodities Requirement per CYP
For estimating couple year protection (CYP), the following attributes are used. It has been
assumed that 120 pieces of condoms, 15 cycles of pills and 4 doses of injectables are required
per couple years of protection (CYP). Previously, IUD retention rate was 5 years. The average
age of male sterilization is assumed to be 36 and average age at female sterilization is assumed
20
to be 27 years respectively. The mean duration of use of IUD and implant are assumed 3.5
years each (Table 1.4).
Table 1.4: Contraceptive Commodities Requirements per CYP
Commodities
Requirement per CYP
Condoms/CYP
120
Female Ster. average age
27
Injections/CYP
4
IUD duration of use (yrs)
3.5
Male Ster. average age
36
Implant duration of use (yrs)
3.5
Pill cycles/CYP
15
Source: Spectrum (FamPlan) Manual
1.7.5 Percentage of Women in Union and Postpartum Insusceptibility
After analyzing BDHS data it is assumed that 80% of the women are to be sexually active and
this remains constant over the projection period. Among the proximate determinants of fertility,
duration of breastfeeding plays an important role. The mean duration of postpartum
insusceptibility has decreased slightly during 2000-2011 period. The mean duration of
postpartum insusceptibility for the forecasting period is assumed 8.5 months.
1.7.6 Abortion/MR rate
In developing countries like Bangladesh, it is very difficult to obtain a good empirical estimate of the
proportion of unwanted pregnancies which terminate in induced abortions. This type of information
needs to come from surveys—but abortions are notably underreported in surveys, especially in
countries where abortion is illegal and/or is socially disapproved. Due to uncertainty regarding the
estimation of abortion, we assume that the abortion rate of 0.1, estimated in 2011, would continue
to remain unchanged during the projection period.
1.7.7 Sterility Co-efficient
The sterility co-efficient is set 1.7% for the whole projection period (2014-2021).
1.7.8 Projection Scenarios
To meet the objectives, the study sets a number of simulations for accurate estimates of the
family planning commodities. Applying the projection tools with the input data, the study explore
the number of user as well as required commodities in each of the following scenario. They are:
Scenario-I: Unmet need for family planning will be satisfied by 2016
Scenario-II: If CPR will be 72% and traditional method shift to modern method by 2021
Scenario-III: If CPR will be 80% (Current CPR + Percent women intent to future use) by 2021
Scenario-IV: If we achieve TFR=1.7 per woman by 2021
21
1.8
Data Collection
Data collected from various sources like NIPORT, DGFP, DGHS, UNFPA, Department of
Statistics, University of Dhaka, Bangladesh Bureau of Statistics (BBS), Ministry of Health &
Family Welfare (MOHFW), and NGOs working in the sector. It was also necessary to
procure/purchase some documents and materials from market other than the collections from
aforementioned sources. Browsing internet for collection and cross-checking of
information/data/statistics collected/received were profusely used in order to make a full-proof
projection. Consultations were held, off and on, with various stakeholders including NIPORT to
extract their outlook, opinions, suggestions, recommendations and approach with regard to
various indicators, methods, approach and technical points surrounding the quantification of the
commodities.
1.9 Data Processing and Analysis
Data collected were organized and fed into computer for systematic analysis and output
generation. The system analyst worked in close connection with the study team to design the
data analysis format and generate output to help the study team make desired
recommendations and report. Spectrum and MS Excel were used to analyze and producing
report for this study.
22
CHAPTER 02
FINDINGS
2.1 Introduction
The main objective of this chapter is to create different pragmatic projection scenarios and
estimate the contraceptive commodities requirements and outline the strategies to achieve
demographic objectives. Contraceptive acceptors, contraceptive users and contraceptive
commodity requirements are projected considering various assumptions associated with the
fertility goal.
2.2 Projected number of users and acceptors according to scenario-I
The objective of this chapter is to develop year-wise Family Planning Commodity Projections for
2014-2021 in Bangladesh assuming that all unmet need for family planning will be satisfied by
2016 as specified in the HPNSDP, and it should also be based on the medium variant
projections of the United Nations Population Division-projections that assume a more gradual
contraceptive prevalence increase that is based on historical trends.
We first raised question on what would be the requirement of contraceptive commodity if unmet
need for contraception (both spacers and limiters) as found in the 2011 BDHS are captured as
users between 2011 and 2016. In order to meet these objectives the baseline input data and the
method attributes were used. The associated summary outputs for the first goal i.e. scenario-I is
shown in Table-2.l. The summary table for output shows that if unmet need for contraception
can be converted into users effectively, then contraceptive acceptors will increase from about
421.7 thousand in 2014 to 721.2 thousand in 2021 and the users will increase from 22.35 million
in 2014 to 29.75 million in 2021.
Table 2.1: Projected number of women of reproductive age (WRA), married women of
reproductive age (MWRA) and number of family planning (FP) methods user according to
scenario-I in period 2014-2021
Year
WRA (in Million) MWRA (in Million) User (in Million) Acceptor (in thousand)
2014
42.81
34.25
22.35
421.7
2015
43.87
35.10
23.37
437.6
2016
44.93
35.94
24.42
452.7
2017
45.97
36.77
25.48
634.9
2018
46.98
37.58
26.55
656.1
2019
47.96
38.37
27.63
676.6
2020
48.90
39.12
28.70
695.6
2021
49.79
39.83
29.75
721.2
Figure 2.1: Projected WRA, MWRA and FP methods user under scenario-I for 2014-2021
23
60
50
In Million
40
45
44
43
35
34
30
38
38
37
36
23
25
22
24
27
2014
2015
2016
2017
2018
50
49
48
47
46
39
40
28
29
30
2019
2020
2021
20
10
0
WRA
MWRA
User
If we achieve the first simulation by 2016, the condom users will increase from 2.01 million in
2014 to 2.68 million in 2021 (Table 2.2). Table 2.2 also shows that the LAPM users will also
increase from 2.95 million in 2014 to 3.94 million in 2021.
Table 2.2: Projected number of family planning (FP) methods user by specific method
(under assumptions scenario I) in period 2014-2021 (in Million)
Method
Condom
Female
sterilization
Injectables
IUD
Male
sterilization
Implant
Oral Pill
Traditional
Total
2014
2.01
2015
2.1
2016
2.2
2017
2.29
2018
2.39
2019
2.49
2020
2.58
2021
2.68
1.83
4.07
0.27
1.92
4.25
0.28
2
4.45
0.29
2.09
4.64
0.31
2.18
4.83
0.32
2.27
5.03
0.33
2.35
5.22
0.34
2.44
5.42
0.36
0.45
0.4
9.97
3.35
22.35
0.47
0.42
10.43
3.51
23.37
0.49
0.44
10.89
3.66
24.42
0.51
0.46
11.37
3.82
25.48
0.53
0.48
11.84
3.98
26.55
0.55
0.5
12.32
4.14
27.63
0.57
0.52
12.8
4.3
28.7
0.6
0.54
13.27
4.46
29.75
24
Figure 2.2: Projected number of methods acceptors under scenario-I for 2014-2021
800
700
635
656
677
696
2018
2019
2020
721
In thousand
600
500
422
438
453
2014
2015
2016
400
300
200
100
0
2017
2021
Year
Figure 2.3 Projected Short acting method users by specific method under scenario-I for 20142021(in Million)
14
12
In million
10
10
10
12
11
11
13
13
12
8
Oral Pill
6
4
4
4
3
2
4
4
2
5
4
2
5
4
5
4
2
2
5
4
2
5
4
3
4
3
0
2015
2016
2017
2018
Year
25
2019
2020
Injectables
Traditional
2
2014
Condom
2021
Figure 2.4 Projected Long-acting and permanent method users by specific method under
scenario-I for 2014-2021(in Million)
3.0
2.5
In million
2.0
1.8
2.2
2.1
2.0
1.9
2.3
2.4
2.4
Female sterilization
1.5
Male sterilization
IUD
1.0
0.5
0.5 0.4
0.3
0.5 0.4
0.3
0.5 0.4
0.3
0.5 0.5
0.3
0.5 0.5
0.3
0.6 0.5
0.3
0.6 0.5
0.3
2014
2015
2016
2017
2018
2019
2020
0.6 0.5
0.4
2021
Implant
0.0
Year
2.3 Projected family planning commodities requirements according to scenario-I
The contraceptive commodity requirements under the assumption that if all unmet need will be
satisfied by 2016 clearly demonstrate that demographic target can be achieved. Table 2.3
shows the method specific requirements. If unmet need for contraception is achieved by 2016,
the estimated condom required for the year 2014 and 2021 are 241.4 million and 321.3 million
respectively. The required number of oral pill for the projected period is 1393.3 million. The
other commodities such as injectables, IUD and Implant required for the projected period are
151.6 million, 0.82 million and 1.22 million respectively. The required commodities by sources
are shown in Appendix table-3.
Table 2.3: Projected number of family planning (FP) commodities under Scenario-I in
period 2014-2021 (in Million)
Method
Condom
Injectable
IUD
Implant
Oral Pill
2014
241.4
16.3
0.09
0.13
149.5
2015
252.5
17.0
0.09
0.14
156.4
2016
263.8
17.8
0.10
0.14
163.4
2017
275.2
18.6
0.10
0.15
170.5
26
2018
286.8
19.3
0.10
0.16
177.6
2019
298.4
20.1
0.11
0.16
184.8
2020
309.9
20.9
0.11
0.17
192.0
2021
321.3
21.7
0.12
0.17
199.1
Total
2249.2
151.6
0.82
1.22
1393.3
Figure 2.5: Projected number of FP commodities (short acting) under Scenario-I for 2014-2021
(in Million)
350
300
In million
250
252
241
200
199
192
185
178
170
163
156
150
287
275
264
321
310
298
150
100
50
16
17
18
19
19
20
21
22
0
2014
2015
2016
2017
Condom
Oral Pill
2018
2019
2020
2021
Injectable
2.4 Projected number of method users and acceptors according to scenario-II [If CPR will
be 72% and traditional method shift to modern method by 2021]
The objective is to assess what would be the contraceptive commodity requirements if we
achieve CPR=72 by 2016 and traditional method shift to modern method in 2021. The summary
results of the projection are given Table 2.4. As expected, there will be no change in the women
in the reproductive ages and the currently married women. The only change will occur in the
contraceptive acceptors, users and the commodity requirements. Table 2.4 also shows the
number of acceptors and users. The projected data imply that more acceptors and users will be
required to achieve replacement fertility by 2021. For instance, new acceptors need to be
increased from 480.0 thousand in 2014 to 872.5 thousand in 2021, while users need to be
increased from 22 million to over 28 million during the projected period.
27
Table 2.4: Projected number of women of reproductive age (WRA), married women of
reproductive age (MWRA) and number of family planning (FP) methods user according to
scenario-II in period 2014-2021
WRA (in Million)
MWRA (in Million)
User (in Million)
42.81
43.87
44.93
45.97
46.98
47.96
48.90
49.79
34.25
35.10
35.94
36.77
37.58
38.37
39.12
39.83
22.07
23.00
23.94
24.89
25.84
26.80
27.75
28.68
Year
2014
2015
2016
2017
2018
2019
2020
2021
Acceptor (in
thousand)
480.0
504.5
528.4
733.2
766.7
799.8
831.6
872.5
Figure 2.6: Projected long acting commodities under scenario-I for 2014-2021
180
160
In thousand
140
120
130
120
140
130
120
100
80
80
2014
2015
90
90
90
2016
2017
2018
140
100
150
100
160
100
80
60
40
20
0
Implant
2019
2020
2021
IUD
Contraceptive commodity requirement for various methods will vary and are shown in Table 2.5.
The table shows the projected users by contraceptive method mix for different methods. Results
indicate an increase in users of pills, injectables, implants, and permanent methods. If the
traditional method can be shifted to modern method by 2021, the total method users will
increase to 22.1 million in 2014 and 28.7 million in 2021. Among them, 19.8 million and 28.7
million couples will be modern method users in 2014 and 2021 respectively. The results also
indicate that the total cumulative modern method users during the projected period will be 203
million.
28
Table 2.5: Projected number of family planning (FP) method’s users by specific method
(under assumptions scenario II) in period 2014-2021 (in Million)
Year
Condom
Female
sterilization
Injectables
IUD
Male
sterilization
Implant
Oral Pill
Traditional
Total
2014
2.1
2015
2.2
2016
2.3
2017
2.5
2018
2.6
2019
2.8
2020
2.9
2021
3.0
1.9
4.2
0.28
2.0
4.5
0.3
2.1
4.7
0.31
2.3
5.0
0.33
2.4
5.3
0.35
2.5
5.6
0.37
2.6
5.9
0.39
2.8
6.1
0.4
0.46
0.42
10.4
2.3
22.1
0.49
0.44
11.0
2.1
23.0
0.52
0.47
11.6
1.8
23.9
0.55
0.5
12.3
1.5
24.9
0.58
0.52
13.0
1.2
25.8
0.61
0.55
13.6
0.8
26.8
0.64
0.58
14.3
0.4
27.8
0.67
0.61
15.1
0.0
28.7
If we achieve CPR=72 and traditional method shifted to modern method, it clearly demonstrates
that demographic target i.e replacement fertility can be achieved. The results are shown in
Appendix Table 2.
2.5 Projected family planning commodities requirements according to scenario-II
Contraceptive commodity requirement for various methods will vary and are shown in Table 2.6.
By applying CYP of each method, the required condom, injectables, IUD, implant and oral pill
for the projected period are 2451.4 million, 165.2 million, 0.93 million, 1.38 million and 1518.5
million respectively (Table 2.6).
Table 2.6: Projected number of family planning (FP) commodities under Scenario-II in
period 2014-2021 (in Million)
Method
Condom
Injectable
s
IUD
Implant
Oral Pill
2014
251.0
2015
265.9
2016
281.4
2017
297.3
2018
313.7
2019
330.4
2020
347.3
2021
364.4
Total
2451.4
16.9
0.1
0.14
155.5
17.9
0.1
0.15
164.7
19.0
0.11
0.16
174.3
20.0
0.11
0.17
184.2
21.1
0.12
0.18
194.3
22.3
0.12
0.19
204.7
23.4
0.13
0.19
215.2
24.6
0.14
0.2
225.7
165.2
0.93
1.38
1518.5
If all unmet need will be converted into users by 2016, it clearly demonstrates that demographic
target i.e. replacement fertility can be achieved. We also estimated contraceptive requirement
by sources if unmet need for contraception is achieved by 2016. The results are shown in
Appendix Table 5.
29
Figure 2.7: Projected number of short acting family planning (FP) commodities under
Scenario-II
400
350
In million
300
261
247
250
200
214
205
196
187
179
170
162
153
303
288
274
345
331
317
150
100
50
17
18
19
19
20
21
22
23
2014
2015
2016
2017
2018
2019
2020
2021
0
Condom
Injectables
Oral Pill
Figure 2.8: Projected number of family planning (FP) Long-acting commodities under
Scenario-II
200
180
In thousand
160
140
150
170
160
150
140
120
100
90
100
100
110
110
170
120
180
120
190
130
80
60
40
20
0
2014
2015
2016
2017
IUD
2018
Implant
30
2019
2020
2021
2.6 Projected number of method users and acceptors according to scenario-III [If CPR will
be 80% (Current CPR + Percent women intent to future use) by 2021]
The BDHS data show that 61.2% of the currently married were the current users and 38.8%
never users. The never users were asked whether they intend to use in future. Among the nonusers about 65% reported that they intend to use in future. In our projection, among these 65%
intenders of future use being converted into users by 2021, the total users will stand for
approximately 80%. If this can be implemented, then the associated acceptors, users and
commodity requirements will stand as shown in Table 2.7 and Table 2.9. If we achieve this
demographic goal, new acceptors need to be increased from 456.5 thousand in 2014 to 801
thousand in 2021 while users need to be increased from 22.9 million to over 31 million during
the projected period.
Table 2.7: Projected number of women of reproductive age (WRA), married women of
reproductive age (MWRA) and number of family planning (FP) methods user according to
scenario-III in period 2014-2021
Year
WRA (in Million)
MWRA (in Million)
User (in Million)
2014
2015
2016
2017
2018
2019
2020
2021
42.81
43.87
44.93
45.97
46.98
47.96
48.90
49.79
34.25
35.10
35.94
36.77
37.58
38.37
39.12
39.83
22.89
24.12
25.38
26.65
27.95
29.25
30.56
31.86
Acceptor (in
thousand)
456.5
476.5
495.6
689.9
716.9
743.1
768.0
801.0
The table 2.8 shows the projected users by contraceptive method mix for different methods.
Results indicate an increase in users of pills, injectables, implants, and permanent methods. If
the future intender can be shifted to modern method by 2021, the total method users will
increase to 22.9 million in 2014 and 31.9 million in 2021. Among them, 3.02 million and 4.22
million couples will be LAPM users in 2014 and 2021 respectively.
31
Table 2.8: Projected number of family planning (FP) methods user by specific method
(under assumptions scenario III) in period 2014-2021 (in Million)
Method
Condom
Female
sterilization
Injectables
IUD
Male
sterilization
Implant
Oral Pill
Traditional
Total
2014
2.06
2015
2.17
2016
2.29
2017
2.4
2018
2.52
2019
2.64
2020
2.76
2021
2.88
1.88
4.17
0.27
1.98
4.39
0.29
2.08
4.63
0.3
2.19
4.86
0.32
2.3
5.1
0.34
2.41
5.34
0.35
2.51
5.58
0.37
2.62
5.82
0.38
0.46
0.41
10.22
3.42
22.89
0.48
0.43
10.77
3.59
24.12
0.51
0.46
11.33
3.77
25.38
0.53
0.48
11.91
3.96
26.65
0.56
0.5
12.49
4.14
27.95
0.59
0.53
13.08
4.32
29.25
0.61
0.55
13.67
4.51
30.56
0.64
0.58
14.26
4.69
31.86
2.7 Projected family planning commodities requirements according to scenario-III
Contraceptive commodity requirement for various methods will vary and are shown in Table 2.9.
By applying CYP of each method, the required condom, injectables, IUD, implant and oral pill
for the projected period are 2366.7 million, 159.5 million, 0.9 million, 1.35 million and 1466.1
million respectively (Table 2.9).
Table 2.9: Projected number of family planning (FP) commodities under Scenario-III in
period 2014-2021 (in Million)
Method
2014
Condom
Injectable
s
IUD
Implant
247.42
Oral Pill
153.26
16.68
0.09
0.14
2015
260.7
8
17.58
0.1
0.15
161.5
4
2016
2017
2018
2019
2020
2021
Total
274.47
288.4
302.52
316.76
331.07
345.31
2366.7
18.5
0.1
0.15
19.44
0.11
0.16
20.39
0.11
0.17
21.35
0.12
0.17
22.32
0.12
0.18
23.28
0.13
0.19
159.5
0.9
1.3
170.02
178.65
187.39
196.22
205.08
213.9
1466.1
Compared to other two goals, both users and acceptors will be slightly higher from the scenario
I, if intenders could be converted into users. This is attributed to the fact that the rate of use to
be increased. This is also reflected in the present projection. The associated demographic
impact is also expected to be improved. For instance, the associated contraceptive prevalence
rate will be 80% in 2021 and implied TFR will be 1.3. The result is given in Appendix Table 7.
32
Figure 2.9: Projected number of short term family planning (FP) commodities under
Scenario-III
400
350
In million
300
250
261
247
200
214
205
196
187
179
170
162
153
303
288
274
345
331
317
150
100
50
17
18
19
19
20
21
22
23
2014
2015
2016
2017
2018
2019
2020
2021
0
Condom
Injectables
Oral Pill
Figure 2.10: Projected number of long-acting family planning (FP) commodities under
Scenario-III
400
350
In million
300
250
274
261
247
200
214
205
196
187
179
170
162
153
317
303
288
345
331
150
100
50
17
18
19
19
20
21
22
23
2014
2015
2016
2017
2018
2019
2020
2021
0
Condom
Injectables
33
Oral Pill
2.8 Projected number of method users and acceptors according to scenario-IV [If
TFR=1.7 will achieve by 2021]
Table 2.10 shows that the projected number of women of reproductive age, married women of
reproductive and family planning method user will be 42.8 million, 34 million and 22 million
respectively in 2014 under the assumption that current TFR will be 1.7 by 2021. Table 2.10 also
shows that projected users will be 28.9 million and acceptor will be 691 thousand by 2021.
Table 2.10: Projected number of women of reproductive age (WRA), married women of
reproductive age (MWRA) and number of family planning (FP) methods user in period
2014-2021 (in Million)
Year
2014
2015
2016
2017
2018
2019
2020
2021
WRA
42.81
43.87
44.93
45.97
46.98
47.96
48.90
49.79
CMWRA
34.25
35.10
35.94
36.77
37.58
38.37
39.12
39.83
FP User
22.14
23.09
24.05
25.02
26.00
26.98
27.95
28.91
Acceptor
408.4
422.8
436.3
614.0
633.0
651.3
668.2
691.1
The projected number of user by contraceptive method mix for different methods given in Table
2.11 indicates an increase in users of pills, injectables, implants, and permanent methods. If the
method mix of 2011 continues through 2014-2021, the total method users will be increased to
22.14 million in 2014 and 28.9 million in 2021. Among them, 18.8 million and 24.6 million WRA
will be modern method users in 2014 and 2021 respectively.
Table 2.11: Projected number of specific family planning (FP) methods user (under
Scenario-IV) in period 2014-2021 (in Million)
Method
2014
2015
2016
2017
2018
2019
2020
2021
Condom
1.99
2.08
2.16
2.25
2.34
2.43
2.52
2.6
Female
sterilization
1.82
1.89
1.97
2.05
2.13
2.21
2.29
2.37
Injectables
4.03
4.2
4.38
4.55
4.73
4.91
5.09
5.26
IUD
0.27
0.28
0.29
0.3
0.31
0.32
0.34
0.35
Male
sterilization
0.44
0.46
0.48
0.5
0.52
0.54
0.56
0.58
Implant
0.4
0.42
0.43
0.45
0.47
0.49
0.5
0.52
Oral Pill
9.87
10.3
10.73
11.16
11.6
12.03
12.47
12.9
Traditional
3.32
3.46
3.61
3.75
3.9
4.05
4.19
4.34
Total
22.14
23.09
24.05
25.02
26
26.98
27.95
28.91
2.9 Projected family planning commodities requirements according to scenario-IV
Based on CYP attributes, we estimated that 2205 million condoms, 1366 million cycles of pills,
and 148.6 million doses of injectables are required for 2014-2021. The other commodities are
34
implants (one and two-rod) and IUDs at 1.16 million and 80 thousand, respectively, for 20142021 (Table 2.12).
Table 2.12: Projected number FP Commodities (under scenario-IV) in period 2014-2021
(in Million)
2014
2015
2016
2017
2018
2019
2020
2021 Total
Condom
239.11 249.33 259.75 270.26 280.82 291.39 301.91 312.26 2204.8
Injectables
16.12
16.81
17.51
18.22
18.93
19.64
20.35
21.05
148.6
IUD
0.09
0.09
0.09
0.1
0.1
0.1
0.11
0.11
0.80
Implant
0.13
0.14
0.14
0.15
0.15
0.16
0.16
0.17
1.2
Oral Pill
148.11 154.45 160.9 167.41 173.95 180.5 187.02 193.43 1365.8
The required commodities by sources are given in appendix (Table-9)
35
CHAPTER 03
CONCLUSION AND POLICY IMPLICATIONS
Introduction
The immediate vision of Bangladesh Family Planning Program is to achieve replacement level
of fertility. If it can be achieved, what would be contraceptive commodity requirements? To
assess this, several scenarios were drawn up and contraceptive requirements are projected for
2014 to 2021. The baseline and input data including proximate determinants are discussed in
terms of their contributions in fertility reductions.
Because of variation in the theme of the assumptions, the users, acceptors and contraceptive
commodity requirements also varied. The important question is which strategy or strategies
should be used to achieve demographic objectives of the government and the associated
contraceptive requirements need to be debated on, on the basis of past experiences.
3.2
Reducing Unmet Need for Contraception for Limiters and Spacers
Converting unmet need for limiters and spacers into users have significant impact on the
achievement of demographic goal because of the fact that if they can be converted into users,
the contraceptive use rate will be about 74.7%. If this can be achieved, Bangladesh will be able
to achieve replacement fertility immediately. If we put this CPR in the regression line TFR = 7.15
- 0.0688 CPR, then TFR will be 2.0 children per woman (which is the replacement fertility) and
corresponding population growth will be zero percent (zero population growth). The
contraceptive requirement will vary by methods, with pill and condom dominating in it. The
quality strategy, without emphasizing specific targets, will help increase contraceptive
prevalence rate from the current 61 to 74.7 by 2021 if unmet need for contraception can be
reduced, and, consequently, it will lower the fertility rate from 2.0, suggesting that replacement
fertility will be achieved.
3.3
Transforming Intenders into Users
Converting intenders have more demographic impact than reducing unmet need for
contraception. The reason for this is that the majority of the intenders will be modern temporary
method users and some of them may be traditional method users. The total CPR will be 80%
and corresponding TFR will be less than 2.00. However, to convert intenders into users, the
important strategic issues to be given top priorities are: identification of intenders (among the
never-users who intended to use in future and converting them into users) and client
segmentation, special IEC, procurement of additional contraceptives and supplies, more
efficient management of services (e.g., management of side-effects). Identification of intenders
should be based on an understanding of the general and spatial characteristics of the intenders.
Segmentation analyses of the intenders who intend to use fertility intention are the two best
predictors. Intensive field-worker visits to intenders can accelerate the process of transforming
intenders into effective users.
3.4
Shifting Traditional Method toward Modern Methods
The scenario II increased use of modern methods--has demonstrative effect on the
achievement of replacement fertility. This is due to the fact that CYP for modern method user is
much higher than traditional methods including injectable methods. Increased use of LAPM also
36
means that contraceptive requirements for pill and condom will be lower and, therefore, will
reduce cost of burden. The trend analysis of BDHS data indicates that long-acting method use
in family planning program has been declining, partly because of side-effect and partly because
that it does not allow for privacy, and suffers from shortage of supplies, equipment and
physicians. If the programs fail to motivate users to LAPM, contraceptive requirements, under
this scenario, will be much higher and it will not be cost-effective.
3.5
Achieve TFR= 1.7 per woman
Bangladesh has achieved a considerable decline in fertility from high 6.3 births per woman in
the 1970s to 2.3 births per woman in 2011. Several researchers argued that this fertility decline
in Bangladesh was achieved primarily owing to a successful family planning program. There are
substantial variations in the level of fertility among the six Divisions. Khulna (South-West)
Division achieved replacement level fertility in 2011. But differential is larger across Divisions,
with the Eastern part (Chittagong and Sylhet Divisions) representing higher fertility than the
Western part (Khulna and Rajshahi Divisions) of the country. The women in Sylhet Division had
on the average 1.2 more children than women in Khulna Division, and also the women in
Chittagong Division had 1.0 more children than that of Khulna Division. Khulna and Rajshahi
Divisions have achieved replacement level of fertility and high levels of contraceptive
prevalence rates. This suggests that if replacement fertility in Chittagong Division and Sylhet
Division is achieved, then country will have fertility below replacement levels. The spectrum
policy model indicates that if TFR=1.7 is achieved by 2021, CPR will attain 73%. This will also
fulfil the demographic goal (below replacement fertility) and targeted CPR for the country as a
whole.
3.6
Formulating the Quality Strategy
Given the vision for the Bangladesh family planning program over the next 8 years, quality
strategy could be an important determinant for the fulfillment of the family planning and
population goals. There are two major components of the quality strategy. The first focuses on
making family planning services accessible to current non-users who intend to use in future.
This means that regular visit of field workers should be ensured. One concern is that over the
last few years (BDHSs) visit of field workers at the household level has been declining despite
the fact that contraceptive prevalence rate has been increasing.
The second component emphasizes substantially improving the quality of family planning
services for all users. The quality strategy stipulates that the family planning program should
find ways to reach these women intenders (or women who have unplanned pregnancies,
mistimed births and unwanted pregnancies) and help them to get their expressed desires
fulfilled. The Information, Education and Communication (IEC) program in place may need to
be reviewed, redesigned and made multi-faceted to have effective and measureable impact on
the point of reaching the non-users. The program strategy should be to reduce the incidences of
the above mentioned events and it would help to achieve demographic objectives.
In addition to converting the intenders into users, this strategy requires gradual improvement in
contraceptive continuation and effectiveness as well as gradual shift in method mix toward longterm method acceptance, and method mix. This information suggests that encouraging for
LAPM use will not only have demonstrative effect on the achievement of replacement level
fertility, but also will lower requirement of contraceptive commodities. New strategy is required
to be so designed as to help increase LAMP acceptors, because current use of LAPM is
significantly low.
37
3.7
Policy Implications
The commodity projection is performed for four scenarios. The findings indicate that first
scenario provides projected contraceptive commodities that are very close to actual figures from
MIS data. This also fulfills the expected demographic goal. If programmatic inputs are provided
to increase the number of acceptors of LAPM users, then projected requirement need to be
modified based on MIS and service statistics data. However, current situation does not indicate
that any major deviation from projected requirements is likely to take place during next few
years.
The family planning commodity projection will be successful if FP program implements
according to strategic plan, timely procure and supply. To minimize any risk of a future stockout, the projected requirements for contraceptive commodities need to adjust for current
consumption data. In addition, the projected number of condoms needs to adjust for increased
demand for condoms for future STD, HIV/AIDS prevention program.
The FP commodity projection presented in this paper provides guideline for policymakers to
understand the probable scenario likely to prevail during the projected period. However, the
expected scenario can be changed through additional program input or change in population
characteristic. The future commodity requirement can also change/modify based on input data
from future survey.
3.8
Limitations
 Due to lack of information on ECP, the projection for this commodity is not done
 There are rules for distributing DDS kits at the clinics level. Therefore, projection for DDS
kits remains a challenge.
 Projected number of condoms may not meet the demand because it depends on future
STD, HIV/AIDS prevention program.
3.9
Recommendation
To reduce the cumulative pressure of contraceptive commodity of short-acting methods the
country need to shift contraceptive use patterns towards more effective longer-acting and
permanent methods. Multi-sectoral efforts for raising female age at marriage and delaying age
at first birth through promoting female education (including female school/college stipend
program) and creating employment opportunities, and more effective enforcement of the legal
age of marriage could help achieve the demographic goal.
Intensifying public information and motivation campaigns to bring about overall changes in
attitude and awareness creation among all stakeholders on: longer acting and permanent
methods, delayed marriage, popularizing two-child family norm, minimizing drop-out and
unwanted pregnancy, male involvement in NSV, availability of FP services, female education
etc will produce definable results on a longer term.
Finally, if we want to achieve replacement fertility by 2016 and population stabilization, several
factors should be taken into consideration. These include:
 High population momentum effects;
 Low age at marriage;
 High adolescent fertility;
 Shifting of child bearing towards younger ages;
 Decline in birth interval from marriage to first birth interval;
38


Continuous decline in permanent methods and long acting methods such as sterilization
and IUD; and
Decline in the visit of households by family planning workers.
To deal with all the above-mentioned factors an all-out multi-sectoral approach would be
required to reduce the population momentum and to reach population stabilization even we
achieve demographic goal by 2016.
39
BIBLIOGRAPHY
Bangladesh Bureau of Statistics. 2012. Bangladesh Population Census, 2011. Preliminary
Report. Dhaka: Bangladesh Bureau of Statistics, Planning Division, Ministry of Planning.
www.bbs.gov.bd
Bangladesh Bureau of Statistics. 2010. Sample Vital Registration System; Planning Division,
Ministry of Planning.
Bongaarts, J. and G. R. Potter. 1983. Fertility, Biology, and Behavior: An Analysis of the
Proximate Determinants. Academic Press, New York.
Government of Bangladesh. 1998. Statistical Yearbook of Bangladesh 1997, Dhaka:
Bangladesh Bureau of Statistics.
Government of Bangladesh. 2012. Prospective Plan of Bangladesh 2010-2021, Dhaka: General
Economic Division, Planning commission.
DGFP Monthly Logistics and Family Planning, Maternal and Child Health and RH Services
Reports, 2011, MIS unit, Dhaka: DGFP, Ministry of Health and Family Welfare.
www.dgfp.gov.bd
DemProj. Spectrum System of Policy Models. 2008. A Computer Program for Making
Population Projections. USAID | Health Policy Initiative.
FamPlan. Spectrum System of Policy Models. 2008. A Computer Program for Projecting Family
Planning Requirements. USAID | Health Policy Initiative.
Ministry of Health and Family Welfare (Bangladesh). 2011. Strategic Plan for Bangladesh
National Family Planning Programme 2012-2016. www.mohfw.gov.bd
BDHS 1996. NIPORT, Mitra and Associates, and ORC Macro. 1996-1997. Bangladesh
Demographic and Health Survey,1996-1997. Dhaka, Bangladesh, and Calverton, Maryland,
USA.
BDHS 1999. NIPORT, Mitra and Associates, and ORC Macro. 1999-2000. Bangladesh
Demographic and Health Survey,1999-2000. Dhaka, Bangladesh, and Calverton, Maryland,
USA.
BDHS 2004. NIPORT, Mitra and Associates, and ORC Macro. 2005. Bangladesh Demographic
and Health Survey 2004. Dhaka, Bangladesh, and Calverton, Maryland, USA.
BDHS 2007. NIPORT, Mitra and Associates, and Macro International. 2009. Bangladesh
Demographic and Health Survey 2007. Dhaka, Bangladesh, and Calverton, Maryland, USA.
BDHS 2011. NIPORT, Mitra and Associates, and ICF international. 2011. Bangladesh
Demographic and Health Survey 2011 Preliminary Report. Dhaka, Bangladesh, and
Calverton, Maryland, USA.
Mridha, M. K., I. Anwar, and M. Koblinsky. 2009. Public-Sector Maternal Health Programmes
and Services for Rural Bangladesh. Journal of Health and Population Nutrition. Apr. 27(2);
124-138.
40
USAID | DELIVER PROJECT, Task Order 1. 2011. The Logistics Handbook: A Practical Guide
for the Supply Chain Management of Health Commodities. Arlington, Va.: USAID |
DELIVER PROJECT, Task Order 1.
41
APPENDIX-A
Table 1: Projected Demographic goals under scenario-I
Demographic
Characteristics
TFR (Per woman)
CPR (Percent)
All method
Condom
Female
sterilization
Injectables
IUD
Male sterilization
Implant
Oral Pill
Traditional
2014
2015
2016
2017
2018
2019
2020
2021
2.09
2.02
1.95
1.87
1.8
1.73
1.66
1.59
65.25
5.87
66.6
5.99
67.95
6.12
69.3
6.24
70.65
6.36
72
6.48
73.35
6.6
74.7
6.72
5.35
11.88
0.78
1.3
1.17
29.1
9.79
5.46
12.12
0.8
1.33
1.2
29.7
9.99
5.57
12.37
0.82
1.36
1.22
30.31
10.19
5.68
12.61
0.83
1.39
1.25
30.91
10.39
5.79
12.86
0.85
1.41
1.27
31.51
10.6
5.9
13.1
0.86
1.44
1.3
32.11
10.8
6.01
13.35
0.88
1.47
1.32
32.71
11
6.13
13.6
0.9
1.49
1.34
33.32
11.21
Table 2: Source Mix by method in percent
Source Mix
2014
2015
Condom
Public
30
30
Private
70
70
Female
sterilization
Public
80
80
Private
20
20
Injectable
Public
75
75
Private
25
25
IUD
Public
96
96
Private
4
4
Male sterilization
Public
96
96
Private
4
4
Implant
Public
99
99
Private
1
1
Pill
Public
60
60
2016
2017
2018
2019
30
70
30
70
30
70
30
70
30
70
30
70
80
20
80
20
80
20
80
20
80
20
80
20
75
25
75
25
75
25
75
25
75
25
75
25
96
4
96
4
96
4
96
4
96
4
96
4
96
4
96
4
96
4
96
4
96
4
96
4
99
1
99
1
99
1
99
1
99
1
99
1
60
60
60
60
60
60
42
2020 2021
Private
40
40
40
40
40
40
40
40
Source: BDHS 2011
Table 3: Projected commodities by source under scenario-I
Commodity
2014
2015
2016
2017
2018
2019
2020
Condom
Public
72405704
75733920
79131992
82569672
86032808
89508016
92976136
Private 168946640 176712480 184641296 192662560 200743216 208852032 216944320
Injectable
Public
12201702
12762570
13335206
13914519
14498122
15083758
15668202
Private
4067234
4254190
4445069
4638173
4832708
5027920
5222734
IUD
Public
85418
89048
92641
96225
99786
103292
106666
Private
3559
3710
3860
4009
4158
4304
4444
Implant
Public
132132
137746
143304
148847
154357
159779
164999
Private
1335
1391
1448
1504
1559
1614
1667
Pill
Public
89702608
93825912
98035736 102294648 106585096 110890488 115187104
Private
59801740
62550612
65357152
68196432
71056728
73926992
76791408
Table 4: Projected Demographic goals under scenario-II
Demographic
Characteristics
TFR (Per woman)
CPR (percent)
All method
Condom
Female
sterilization
Injectables
IUD
Male sterilization
Implant
Oral Pill
Traditional
2014
2015
2016
2017
2018
2019
2020
2021
2.13
2.07
2.01
1.95
1.89
1.84
1.78
1.72
64.4
6.11
65.5
6.31
66.6
6.52
67.6
6.74
68.7
6.96
69.8
7.18
70.9
7.4
72
7.62
5.56
12.35
0.81
1.36
1.22
30.26
6.77
5.75
12.77
0.84
1.4
1.26
31.29
5.89
5.94
13.19
0.87
1.45
1.3
32.33
4.98
6.14
13.63
0.9
1.5
1.35
33.39
4.04
6.34
14.06
0.93
1.55
1.39
34.47
3.07
6.54
14.51
0.96
1.59
1.44
35.56
2.07
6.74
14.96
0.99
1.64
1.48
36.66
1.05
6.95
15.42
1.02
1.69
1.52
37.78
0
Table 5: Projected commodities by source under scenario-II
Commodities
2014
2015
2016
2017
2018
2019
202
Condom
Public
75290128
79770720
84418880
89202952
94106560
99112736 10419700
Private 175676976 186131664 196977392 208140224 219581968 231263040 24312635
Injectable
Public
12687788
13442834
14226141
15032350
15858694
16702340
1755911
Private
4229263
4480945
4742047
5010784
5286232
5567447
585304
IUD
Public
92445
97596
102801
108087
113437
118797
12408
Private
3852
4066
4283
4504
4727
4950
517
Implant
Public
143002
150970
159020
167197
175468
183767
19194
43
Pill
Private
Public
Private
1444
93276192
62184132
1525
1606
1689
1772
1856
193
98827008 104585608 110512584 116587576 122789712 12908849
65884664
69723736
73675056
77725048
81859816
8605900
Table 6: Projected demographic goals under scenario-III
Demographic
Characteristics
TFR (Per Woman)
CPR (Percent)
All method
Condom
Female
sterilization
Injectables
IUD
Male sterilization
Implant
Oral Pill
Traditional
2014
2015
2016
2017
2018
2019
2020
2021
2.0
1.9
1.8
1.7
1.6
1.5
1.4
1.3
66.84
6.02
68.72
6.19
70.6
6.36
72.48
6.54
74.36
6.71
76.24
6.88
78.12
7.05
80.0
7.22
5.49
12.17
0.8
1.34
1.2
29.83
9.98
5.64
12.52
0.83
1.38
1.24
30.68
10.24
5.8
12.87
0.85
1.41
1.27
31.53
10.5
5.95
13.22
0.87
1.45
1.31
32.39
10.76
6.11
13.56
0.89
1.49
1.34
33.24
11.01
6.27
13.91
0.92
1.53
1.38
34.09
11.27
6.43
14.26
0.94
1.57
1.41
34.95
11.52
6.58
14.61
0.96
1.61
1.44
35.8
11.77
Table 7: Projected commodities by source under scenario-III
ommodities
2014
2015
2016
2017
2018
2019
2020
2021
ondom
Public
74225696
78232728
82341592
86520768
90754864
95028536
99320400 1035919
Private 173193280 182543024 192130384 201881776 211761328 221733248 231747600 2417145
ectable
Public
12508410
13183650
13876084
14580363
15293874
16014062
16737334
174571
Private
4169470
4394550
4625362
4860121
5097958
5338021
5579112
58190
D
Public
89681
94115
98539
102980
107423
111832
116117
1211
Private
3737
3921
4106
4291
4476
4660
4838
50
mplant
Public
138725
145583
152432
159297
166172
172986
179620
1873
Private
1401
1471
1540
1609
1679
1747
1814
18
l
Public
91957424
96921600 102012112 107189688 112435144 117729752 123046976 1283387
Private
61304952
64614404
68008072
71459792
74956760
78486496
82031328
855591
Table 8: Projected demographic goals under scenario-IV
Demographic
Characteristics
TFR (Per
woman)
CPR (Percent)
All method
2014
2015
2016
2017
2018
2019
2020
2021
2.12
2.06
2
1.94
1.88
1.82
1.76
1.7
64.64
65.78
66.91
68.05
69.18
70.32
71.45
72.59
44
Condom
Female
sterilization
Injectables
IUD
Male
sterilization
Implant
Oral Pill
Traditional
5.82
5.92
6.02
6.12
6.23
6.33
6.43
6.53
5.3
11.77
0.78
5.39
11.97
0.79
5.49
12.18
0.8
5.58
12.38
0.82
5.67
12.59
0.83
5.77
12.8
0.84
5.86
13
0.86
5.95
13.21
0.87
1.29
1.16
28.83
9.7
1.32
1.18
29.34
9.87
1.34
1.2
29.84
10.04
1.36
1.22
30.35
10.21
1.38
1.25
30.86
10.38
1.41
1.27
31.36
10.55
1.43
1.29
31.87
10.72
1.45
1.31
32.37
10.89
Table 9: Projected commodities by source under scenario-IV
Commodities
2014
2015
2016
2017
2018
2019
202
Condom
Public
71732792
74799720
77924808
81078440
84247056
87417912
90572864
Private 167376512 174532672 181824560 189183024 196576464 203975152 21133668
Injectable
Public
12088304
12605139
13131774
13663220
14197190
14731539
15263206
Private
4029435
4201713
4377258
4554407
4732397
4910513
5087736
IUD
Public
83806
87128
90404
93662
96889
100054
103085
Private
3492
3630
3767
3903
4037
4169
4295
Implant
Public
129637
134776
139845
144883
149875
154771
159459
Private
1309
1361
1413
1463
1514
1563
1611
Pill
Public
88868952
92668536
96540176 100447184 104372728 108301088 11220972
Private 59245968
61779024
64360124
66964784
69581824
72200720
74806488
45
Appendix-B
Figure 1: Projected Total Population 2011-2021
170
165
161
165
168
160
160
In Million
163
166
158
156
154
155
150
152
150
145
140
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
Figure 2: Projected number method users under Scenario I
46
2021
Figure 3: Projected TFR under Scenario I
Figure 4: Projected number condom under Scenario I
47
Figure 5: Projected number Injectables under Scenario I
Figure 6: Projected number IUD under Scenario I
48
Figure 7: Projected number oral Pills under Scenario I
Figure 8: Projected number of WRA under Scenario I
Method: Prevalence (Condom)
49
Method: Prevalence (Pill)
50
51
Research Team
Khandaker Rashedul Haque, PhD
Team Leader
Prof Nurul Islam, PhD
Sociologist
Prof Lutfun Nahar, PhD
Demographer
Dr. Abdus Sabur
Health Specialist
Mohammad Nurul Alam, PhD
Statistician & Projection Specialist
Prof. M Sheikh Giash Uddin, PhD
Statistician & Projection Specialist
Md Shamsul Alam
Statistician & Projection Specialist
Md Khan Jahan Ali
Statistician & Projection Specialist
Iftekhar Uddin Ahmad
Team Coordination
52