Access to removal of Norplant: the case of Bangladesh.

Women in Bangladesh began to use NORPLANT in 1985 when the contraceptive method was introduced to the capital city of Dhaka in a clinical trial. Two womens groups subsequently claimed that illiterate rural women were disproportionately recruited into the clinical trial and that the program was refusing to remove the implants upon request. To evaluate the quality of NORPLANT services an access to removal at the seven clinical trial centers field data were collected over the period September-November 1991 from 1151 NORPLANT users and discontinuers in interviews with eleven doctors and ten counselors focus group discussions with the counselors and through observations at the centers. NORPLANT had been inserted in 2652 women by the end of 1990. NORPLANT users were of mean age 29 years with 3.1 children. 71% of users were from rural areas even though six of the centers were in urban areas. Nonetheless the authors found poor rural women to not be more systematically recruited than other women to participate in the trials. While IUD acceptors tend to be relatively educated young and of lower parity NORPLANT acceptors are relatively less educated of middle age and of average parity. Acceptors of tubectomy in Bangladesh are comparatively illiterate of higher age and of higher parity. Access to removal is not a widespread problem for the NORPLANT program. One-third of the women had requested removal. Most of these women succeeded in having the process done and most were satisfied with services rendered. 10% of those requesting removal however had to have it performed from outside of the clinic but most of these cases were isolated at tow centers. These findings have been used to improve the training of service providers for insertion counseling and removal services.