Menstrual Regulation and Postabortion Care in Bangladesh: Factors Associated with Access to and Quality of Services
• In 2010, an estimated 653,000 menstrual regulation (MR) procedures were performed in Bangladesh. In addition, there were 647,000 induced abortions, the large majority unsafe.
• About 12% of MR clients—or 78,000 women—were treated for complications, a rate many times higher than expected if manual vacuum aspiration procedures are done under hygienic conditions by trained providers. Complications may arise, for example, from inadequate training and failure to properly sterilize equipment.
• Approximately 231,000 women were treated in facilities for complications of induced abortion in 2010. In addition, health professionals estimated that 60% of all women with complications did not get medical care.
• The public sector accounted for about two-thirds of all MRs performed; nongovernmental organizations provided about one-quarter, and private clinics, about one-tenth. The public and private sectors each accounted for about half of postabortion care patients.
• Only 57% of public and private facilities that would be expected to provide MR services actually did so, with a wide range across divisions (37–76%). Shortages of trained providers, lack of equipment and religious and cultural reasons are key reasons for not providing MR.
• Only two-thirds of Union Health and Family Welfare Centres provided MR in 2010, yet these facilities are especially important because they are located in rural areas where most women live.
• An estimated 26% of women seeking MR services were rejected. The most common reason was exceeding the official limit of weeks since the last menstrual period. However, respondents gave several additional reasons for rejection that went beyond government criteria.
• This report’s findings call for policy and programmatic actions to increase availability of and access to MR and PAC services; to improve the quality of MR services, including decreasing rejections; and to reduce disparities in access between urban and rural and between poor and better-off women.
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