HIGHLIGHTS

• Despite high use of contraceptives (primarily the oral contraceptive pill), many female garment workers in Bangladesh still have unwanted pregnancies.
• With our partners, we developed behaviorally-informed solutions that encourage proper adherence to the oral contraceptive pill (OCP) and provided enhanced counseling on method switching to garment workers.
• A preliminary feasibility pilot of the solution package suggests that our designs are feasible and acceptable by the community.

The Challenge

Garment workers in Bangladesh comprise a population with high pregnancy costs because many garment factories do not provide paid maternity leave. At the same time, there is a large opportunity cost to seeking quality healthcare from clinics since garment workers work long hours. Thus, many seek care from pharmacies and informal shops. In this setting, despite the high use of contraceptives, many female garment workers still have unwanted pregnancies. We worked with Pathfinder International, Marie Stopes Bangladesh, Camber Collective, and the International Center for Research on Women (ICRW), to address this challenge. This projected supported garment workers to consistently take the pill, should that be their method of choice, and if dissatisfied with that method, switch to a more suitable method for their needs.

Our Approach

To understand the drivers of unintended pregnancies among Bangladeshi garment workers, we conducted in-depth qualitative research with the support of in-country and global partners. Based on interviews with 85 individuals, including garment workers, husbands of garment workers, and health providers, we found that unintended pregnancies often result from discontinuation of OCP. We also identified the unique situational factors that lead to OCP discontinuation and prevent uptake of longer-term methods.

Our insights led us to design a solution package that helps women adhere to the pill if it is their preferred choice, and supports women with side-effects or method switching if they become dissatisfied with the pill or are ready to consider alternative methods. The final solution package includes a planning tool for pill use, enhanced pill packaging with visual instructions and reminder stickers for taking the pill, an interactive voice response (IVR) service with reminders and support with side effects or method switching, and an interactive digital training module for health providers to enhance case-base family planning counseling.

Results

A preliminary feasibility pilot of the solution package suggests that our designs are feasible and acceptable by the community. In particular, the reminder stickers for taking the OCP were positively received and garment workers could clearly articulate where they would place the stickers and why. A primary challenge for the intervention was getting women to call the Marie Stopes Bangladesh hotline, which is the means for enrollment into the IVR program. While initial results suggest that women find the IVR program useful once they enroll, call-in rates were low. Refinements to the design could improve call-in rates and a more formal evaluation of the overall solution package is needed to assess impact.

Takeaway

As more women access contraceptives outside of clinic channels, new approaches are needed to provide hassle-free support and facilitate proper and consistent use of methods. Our solution package highlights how behavioral design can generate innovative solutions to address the ever-changing challenges women, such as garment workers, face in avoiding unintended pregnancy. In growing economies where women increasingly enter the formal labor market, with its inflexible work hours, solutions such as ours point to convenient ways to provide real-time support to women with many competing demands.

Interested in our work applying behavioral science to global health? Email gh@ideas42.org or tweet at @ideas42 to join the conversation.