Consistent with new approaches advocated by both donors and the government, NGOs in Bangladesh have dramatically reoriented their reproductive health service delivery strategies to improve both quality and cost recovery. Door-to-door family planning distribution has been discontinued, and increased service charges have been introduced. By requiring women to leave the house to access services and incur additional financial, social, and logistic costs, the new program tests both the level of familial support for family planning and women's reproductive health, and the extent to which women today are able obtain services without it. We have undertaken a three-year qualitative study in two urban and three rural sites to assess community adaptations to the new NGO service delivery model. The findings indicate that despite now strong normative commitment to fertility control among men, there is often a disconnect between their interest or implicit endorsement and their willingness to spend money on women's health. Due to increased mobility, labor force participation, and male migration, among other things, women are increasingly willing and able to access reproductive health services in the absence of familial support, however the persistence of gender inequalities means their ability to pay up front for these services is variable. This paper demonstrates the salience of gender issues to efforts aimed at increasing the sustainability of reproductive health services. Specifically, it highlights the need for attention to cost dimensions in the promotion of male involvement and for flexibility in cost-recovery strategies to account for gender-specific constraints in access to cash.
Learning Objectives: By the conclusion of the session, participants will be able to: 1) recognize the salience of gender to the viability of user fees for reproductive health services; 2) understand why and how attention is needed to cost dimensions in the promotion of male involvement; and 3) articulate the need for flexibility in cost-recovery strategies to account for gender-specific constraints in access to cash.
Keywords: Reproductive Health, Gender
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: JSI Research and Training Institute
Pathfinder International
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: I am employed as a consultant with JSI Research and Training Institute. However, I am not affiliated with the project operated by JSI in Bangladesh that is discussed in this paper.