Mayer Hashi II (MH-II)
According to FP2020, the modern contraceptive prevalence rate was 44.3% for all women in Bangladesh in 2013 when the Mayer Hashi II (MH-II) program began. The most popular contraceptive method were oral contraceptives (48.9%), followed by injectable contraceptives (20.6%) and external condoms (13.9%)—and only a fraction of women chose LARCs and PMs.
As a follow-on program to our Mayer Hashi program, EngenderHealth partnered with Avenir Health, Meridian Group International, and Population Council as well as the government of Bangladesh’s Directorate General of Family Planning and Directorate General of Health Services and other local nongovernmental organizations (NGOs) and private sector firms to implement MH-II. MH-II built on the success of its predecessor’s work increasing uptake of FP and SRH services, but with a particular emphasis on reaching marginalized urban areas and expanding private-sector provision of LARCs, postpartum FP, and FP for young married couples to delay first births. MH-II worked across the entire country, with a focus in the latter years in high-priority districts and hard-to-reach areas to facilitate access to services, particularly for underserved communities.
Drawing on EngenderHealth’s SEED Model, MH-II used an integrated approach to address barriers to FP uptake associated with supply, demand, and the enabling environment. We worked with healthcare providers, facility managers, and compliance officers—providing clinical and client-centered counseling training and coaching assistance, quality assurance improvement support, and equipment and supplies—to strengthen high-quality FP service delivery (particularly for LARCs and PMs) in public, private, and NGO facilities. We facilitated community mobilization activities (including providing limited assistance for mobile teams conducting FP special days), supported workplace-based initiatives, and facilitated funds to reimburse clients for costs associated with services (such as travel expenses and provider fees) to address demand-side barriers. To foster a sustainable enabling environment, MH-II advocated for updates in national policies, guidelines, and regulations related to the provision FP methods, particularly LARCs and PMs—including through task shifting, integration of FP with maternal and child health services, and increased funding for government facilities.
MH-II contributed to multiple successes in improving FP service delivery and uptake as well as strengthening the broader enabling environment. The project supported significant annual increases in FP uptake, including increased acceptance of LARCs and PMs, in the first four years, before we narrowed the focus of the program to select priority districts. From baseline to the end of the fourth year, implant uptake increased from 8,103 clients to 150,264 clients, intrauterine device uptake increased from 1,207 clients to 15,895 clients, and female sterilization increased from 1,394 clients to 16,002 clients. Further, over the life of the program, we supported an estimated 14,785,590 couple years of protection and averted approximately 4,243,831 abortions, 2,448,988 unsafe abortions, 3,746 maternal deaths, and 26,199 child deaths. Through focused advocacy efforts, the project supported 12 changes in FP policies, regulations, and guidelines—more than doubling our own initial expectations. Furthermore, MH-II contributed to an estimated lifetime savings of $233,496,988 in direct health costs.