Despite widespread poverty in Bangladesh, the country has achieved remarkable success in family planning over the past two decades, resulting in considerable reduction in fertility. The contraceptive prevalence rate (CPR) rose from 8% in mid-1970s to 49% in 1997; the total fertility rate (TFR) had decreased from 6.3 to 3.3 and the population growth rate had declined from over 2.5% to less than 2% during the past two decades (1). In spite of these achievements, Bangladesh still faces the mounting population pressure of 122 million with a density of approximately 800 people per sq km (2).
To reach the replacement level of fertility (TFR=2.2) by 2005, the pace of increase in the use of familyplanning methods will need rapid acceleration, meaning that, by 2005, family-planning services will have to be extended from 27 million families to 40 million families; contraceptive users have to be more than doubled, i.e. from 12 to 28 million and the CPR has to be raised to 70% (3-4). To achieve these goals, the average rise in annual cost of the family-planning programme is estimated to be about US$ 10 million, which means that US$ 220 million would be needed in 2005 compared to US$ 120 million in 1995 (4). The cost of contraceptive commodities alone would account for US$ 51 million in 2005 compared to US$ 22 million in 1995 (5).
Currently, the extent of external support stands at about two-thirds of the country's family-planning programme costs (6). Due to the recent shifts in funding policies of donors, the external contributions are likely to stagnate, if not decline, in the future. Besides, the Government of Bangladesh may not be able to meet the increased costs from its own sources.
In this context, the sustainability of the familyplanning programme in the country has become increasingly important, particularly for the nongovernment organizations (NGOs) that are predominantly dependent on funding from donors.
NGOs have been pursuing a number of cost-reduction and/or revenue-generation measures to attain financial sustainability. The present study focused on revenue generation of the family-planning programmes by charging user-fees for contraceptive commodities and services. The study was carried out to: (a) review the existing experience with the user-fee (pricing) strategies; (b) assess the amount of user-fees paid by urban contraceptors for specific methods obtained from various sources; and (c) examine the socioeconomic and demographic factors associated with payment of userfees for contraceptives. Since the permanent and longeracting clinical methods, such as sterilization, IUD, and Norplant, are mostly provided free of charge, the study examined only payments made for injectables, pills, and condoms which taken together account for about threefourth of all the modern contraceptive users in Bangladesh.
METHODS AND MATERIALS
The study was done by extensively reviewing the existing information on the pricing strategies of various family-planning programmes in Bangladesh and a crosssectional survey of more than 5,000 married women of reproductive age. The survey was conducted during October-December 1996 within the sample frame of the Urban Panel Survey (UPS) of ICDDR,B: Centre for Health and Population Research. UPS is a longitudinal tri-monthly data-collection system maintained by the USAID-supported former Urban MCH-FP Extension Project (now merged with the Operations Research Project) of ICDDR,B to track socioeconomic, demographic, contraceptive use, and MCH-FP serviceuse indicators in a sample population in Zone 3 of Dhaka city. Zone 3, one of the 10 administrative units of the Dhaka City Corporation, has an estimated population of 400,000; approximately one-fourth of them live in slums.
A probability-sampling procedure was followed to select households in the sample, so that each household in the sample could be chosen with known selection probability. An area-sampling technique was used for listing the households. …