Alternate strategies for beginning contraceptive use: the case of Bangladesh.

A modeling procedure was used to evaluate strategies of family planning acceptance in the Bangladesh context. Several different recommendations can be made as to when couples ought to begin using contraception: 1) fixed date strategies suggest that women begin use exactly a certain number of months (designated T) after birth; 2) the postamenorrheic strategy requires women to begin use after their 1st menstrual cycle; and 3) a mixed strategy recommends beginning use either after 1st menstruation or after T months postpartum, whichever comes 1st. The model requires estimates of 5 parameters: natural fecundability; effectiveness of the contraceptive; the mean length of postpartum amenorrhea for specification of the probability distribution of anovulation; an estimate of the proportion of 1st menstrual cycles that are ovulatory; and the monthly risk of discontinuing contraception during an anovulatory month. The results of the analysis using the values believed to be most characteristic of Bangladesh suggest that the long T, mixed or postamenorrheic models are the most appropriate strategies of acceptance, given the current situation in Bangladesh. Due to low natural fecundability and long amenorrhea, the long T strategies remain the most advantageous irrespective of the level of discontinuation. Even when natural fecundability is increased to reflect the characteristics of young women, the long T approaches continue to be the best. In selecting between the long T, mixed and postamenorrheic strategies, there may be some administrative advantage to the mixed T approaches.