The effect of husband counselling on Norplant acceptability in Bangladesh.

During 1988-92 in Bangladesh family planning workers at the Mohammedpur Fertility Services and Training Center in Dhaka the Family Planning Association of Bangladesh (FPAB) clinics in Dhaka and Rangpur and the BAVS clinic in Khulna counseled 408 husbands on the contraceptive implant Norplant. Researchers compared the rate for wives of the counseled husbands (cases) with that of the 209 women whose husbands received no counseling on Norplant (controls). At 36 months follow-up the total life-table discontinuation rate was lower among Norplant acceptors whose husbands received counseling than among those whose husbands were not counseled (32.1% vs. 42.4%; p = 0.07). The reduction in Norplant discontinuation was by about 25%. The difference in the rates was greatest at FPAB Dhaka (34.3% vs. 47.4%) and lowest at FPAB Rangpur (25.4% vs. 25%). Discontinuation rates were lowest at FPAB Rangpur perhaps because it discouraged early removal and had the greatest proportion of women not wanting any more children. Menstrual problems were the major reason for discontinuation for both groups. Cases had a lower discontinuation rate for other personal reasons than controls. When the researchers controlled for sociodemographic variables and clinics cases were 0.81 times the hazard for discontinuation compared controls. The hazard for discontinuation among acceptors wanting more children stood at 1.52 times that for those not wanting more children. Cases were more likely than controls to report at least one complication or complaint during the first 36 months of Norplant use (73% vs. 63%) suggesting that they and their husbands were more sensitized to physical complaints. Duration of use was the most liked feature of Norplant. The least liked feature was changes in the menstrual pattern for cases while there was no least liked feature for controls. 97% of all women would recommend Norplant to others. These findings suggest that husband counseling has some effect on Norplant discontinuation rates but more research is needed.