Bangladeshi activists help sustain access to family planning services.

A family planning counselor awaits her clients at Popular Medical College Hospital, Dhaka.

District advocacy working groups made up of local reproductive health champions urged policymakers to purchase personal protective equipment (PPE) so health workers can continue to provide family planning and other services.

COVID-19 severely threatens reproductive health services around the world. Supply chains moving contraceptive commodities are stalled. Health facilities have been repurposed and staff redirected to COVID-19. People are told not to travel, even for family planning services, and many are afraid to visit clinics anyway for fear of infection. Moreover, inadequate supplies of PPE are typically reserved for those on the front lines of the COVID response. The Guttmacher Institute estimates that global disruptions to reproductive health services could result in 15 million unintended pregnancies over the course of just a year.

A March 2020 travel lockdown saw aspects of this global picture mirrored in Bangladesh, stirring fears that hard-won gains in reproductive health would be lost and unintended pregnancies would spike. Health centers across the country scrambled to respond to the virus, allocating their limited supplies of PPE to essential workers. Tied to an annual budget cycle and lengthy procurement process, the national government could not quickly fill supply gaps to expand PPE to those providing family planning services.

But local governments could. Since 2017, civil society has been building relationships with Bangladesh’s union councils, the most local layer of government administration, around reproductive health. Supported by a partnership among Bangladeshi NGOs, Marie Stopes Bangladesh and Shushilan through the Advance Family Planning initiative, district advocacy working groups made up of grassroots reproductive health champions have pushed for the use of council resources to improve access to family planning.

Union council budgets are relatively modest: the total allocated to family planning in 2020 came to around US$500,000, compared with more than US$100 million committed annually by Bangladesh at the national level. But because the councils – with the help of the advocacy working groups – are intimately familiar with specific local needs, their expenditures can have a disproportionately large impact. For example, the purchase of a table can allow a trained health worker to begin offering IUD insertions. Purchase of an ambulance helps clients reach the Family Welfare Centers for care. And, as COVID-19 surged, advocates advised the union councils that purchasing PPE would allow health workers to get back to work.

The councils took action, increasing their PPE supplies to cover 400 health workers in 28 communities in three of Bangladesh’s 64 districts. The investment allowed community clinics to immediately resume providing family planning and other critical health services.

“Because we laid the groundwork with the union councils, communities had an avenue to press their political leaders to adapt when COVID struck,” explains Mr. Gautam Narayan Chowdhury, a lawyer and member of the Pirojpur district advocacy working group. “The power to influence small decisions at the local level can add up to big change.”

The local councils can’t reverse the impact of COVID-19 on their own – strong national leadership remains essential, and advocates continue to pressure the government to honor their commitments to improve access to family planning services, prioritizing postpartum family planning, reducing social and geographic disparities, and addressing unmet need among adolescents and youth.

But small-scale focused demands, flexible financing mechanisms, and strong relationships between local government and civil society can make a real difference. Bangladesh’s experience shows how important it is to be able to respond quickly to changing community needs when a crisis like COVID-19 strikes.

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A family planning counselor awaits her clients at Popular Medical College Hospital, Dhaka.

Health workers discuss commodity register maintenance and reporting at Anwer Khan Modern Medical College Hospital, Dhaka.

A Family Welfare Visitor provides family planning services to a fishing company worker in Bagerhat district, Bangladesh.

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