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Story and Perspective

Stickers, Planning Prompts, and a Hotline

Mahbub Alam

Responding to the Reproductive Health Needs of Ready-Made Garment Workers in Bangladesh

Approximately 3 million women in Bangladesh work in the ready-made garment industry. They are an economic force in their country, communities, and families—and they have imminent reproductive health needs that must be addressed.

Pathfinder International works with the Government of Bangladesh to address reproductive health needs, particularly the unmet need for contraception. As part of this effort, our (re)solve project developed tailored solutions to ensure female garment workers can prevent unintended pregnancies through voluntary use of contraception. Pathfinder International is now working with the government to scale up these solutions across the country.

According to the 2017 Bangladesh Demographic and Health Survey, more than 50 percent of women using contraception in Bangladesh prefer using oral contraceptive pills, and this is true among garment workers as well. Despite their intention to use pills, around 40 percent of women discontinue use for myriad reasons, putting them at risk of conceiving when they are not ready.

(re)solve found that garment workers have extensive workdays and typically continue housework when arriving home. Their lack of leisure time makes it easy for them to miss taking the pill every day. Side-effects and lack of time to visit health facilities for refills were also challenges.

(re)solve developed a set of solutions to address these specific challenges:

  • Planning prompt for pill users: Allows health providers to help pill users create a plan for using and continuing oral contraceptives. This comes in the form of a card that identifies when she plans to take the pill every day, who she assigns to remind her, and what she will do if she experiences side effects.
  • Enhanced pill pack and supportive communication for side-effect management: Available at clinics and neighboring pharmacies, this includes reminder stickers; a visual instruction sheet to help women remember to take the pill; and a phone number for a government hotline, run by the Directorate General of Family Planning, to enroll in free supportive communication services using integrated voice response. The hotline allows women to receive a reminder to take the pill or information on how to correctly adhere to the pill and strategies to manage side effects.

The solutions are unique because they are based on a comprehensive study determining the reasons why women were dropping out of their pill regimens and their patterns of behavior. They also come at a time when the government has been heavily focused on transitioning women to long-acting reversible contraceptives (LARCs). In addition to this focus on LARCs, we looked at women’s real needs, desires, and contraceptive choices and devised solutions to allow them to exercise their contraceptive choice, while making those choices as effective as possible.

We shared the solutions with the national family planning program, and the government was very excited about our solutions. Although work under our (re)solve program ended in November, we have been able to work with the government on scaling up the solutions through Shukhi Jibon, our national USAID-funded family planning program. Shukhi Jibon provides support to the Ministry of Health and Family Welfare to strengthen health systems for increased accessibility of family planning. So far, the government has supported family planning initiatives in 400 factories, and we have a scale-up plan in place to reach an additional 50 factories with (re)solve solutions.

These 50 urban factories will provide a test case for further expanding the solutions across the country. Through a six- to nine-month testing phase, we will reach approximately 50,000 workers with the (re)solve solutions, 20,000 who currently use oral contraceptive pills, and evaluate the effect on discontinuation. The government has already incorporated the (re)solve solutions into training curricula used at factory health clinics and will apply evidence from the testing phase to develop a national scale-up plan that includes factories in rural areas.

Healthy workers are productive workers, and reproductive health is the most significant area of ready-made garment factory health we need to take care of. If someone stops taking pills because of side effects or for other reasons, that heightens the chance of unintended pregnancies, poor health, and job loss. If these solutions are effective in reducing the drop-out rate and helping women to continue using oral pills, there will be ripple effects on health and well-being in Bangladesh.

Learn more about (re)solve’s work in Bangladesh.

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