Menstrual Regulation and Postabortion Care in Bangladesh: Factors Associated with Access to and Quality of Services


Michael Vlassoff
Altaf Hossain
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Hadayeat Ullah Bhuiyan
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Key Points

Key Points

• 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.

1. United Nations, Abortion Policies: A Global Review, New York: United Nations, 2002. 2. Government of the People’s Republic of Bangladesh, Population Control and Family Planning Division, Memo No. 5-14/MCH-FP/Trg.79, Dhaka, Bangladesh: Government of the People’s Republic of Bangladesh, Population Control and Family Planning Division, 1979. 3. Akhter H, Current status and access to abortion: the Bangladesh experience, in: Klugman B and Budlender D, eds., Advocating for Abortion Access: Eleven Country Studies, Johannesburg, South Africa: Women’s Health Project, School of Public Health, University of the Witwatersrand, 2001. 4. Oliveras E et al., Situation Analysis of Unsafe Abortion and Menstrual Regulation in Bangladesh, Dhaka, Bangladesh: International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), 2008. 5. Akhter H, Midlevel provider in menstrual regulation, Bangladesh experience, paper presented at the conference Expanding Access: Advancing the Roles of Midlevel Providers in Menstrual Regulation and Elective Abortion Care, South Africa, Dec. 2–6, 2001. 6. Chowdhury SN and Moni D, A situation analysis of the menstrual regulation programme in Bangladesh, Reproductive Health Matters, 2004, 12(24 Suppl):95–104. 7. Johnston H et al., Scaled up and marginalized: a review of Bangladesh’s menstrual regulation programme and its impact, in: Blas E, Sommerfeld J and Karup A, eds., Social Determinants Approaches to Public Health: From Concept to Practice, Geneva: World Health Organization, 2011, pp. 9–24. 8. Akhter H, Abortion in Bangladesh, in: Sachdev P, ed., International Handbook on Abortion, New York: Greenwood Press, 1988. 9. Hossain A, Kamal H and Akhter R, Septic Abortion: Results From an Anthropological Study, Dhaka, Bangladesh: Bangladesh Association for Prevention of Septic Abortion (BAPSA), 1997. 10. Singh S et al., The incidence of menstrual regulation procedures and abortion in Bangladesh, International Perspectives on Sexual and Reproductive Health, 2012 (forthcoming). 11. Hossain A, Performance statistics, Health and Rights, 2011, 4(4):4. 12. Fauveau V and Blanchet T, Deaths from injuries, and induced abortion among rural Bangladeshi women, Social Science and Medicine, 1989, 29(9):1121–1127. 13. Akhter H et al., A Study to Assess the Determinants and Consequences of Abortion in Bangladesh, Dhaka, Bangladesh: Bangladesh Institute of Research for Promotion of Essential & Reproductive Health & Technologies (BIRPERHT), 1998. 14. Fauveau V et al., Causes of maternal mortality in rural Bangladesh, 1976-85, Bulletin of the World Health Organization, 1988, 66(5):643–651. 15. National Institute of Population Research and Training (NIPORT) et al., Bangladesh Maternal Health Services and Mortality Survey 2001, Dhaka, Bangladesh: NIPORT; and Calverton, MD, USA: ORC Macro, 2003. 16. NIPORT, Bangladesh Maternal Mortality and Health Care Survey 2010, Summary of Key Findings and Implications, Dhaka, Bangladesh: NIPORT, 2011. 17. Rashid S, Akram O and Standing H, The sexual and reproductive health care market in Bangladesh: where do poor women go? Reproductive Health Matters, 2011, 19(37):21–31. 18. Rashid S, Quality of care and pregnancy terminations for adolescent women in urban slums, in: Abortion in Asia: Local Dilemmas, Global Politics, New York: Bergahn Books, 2010. 19. Piet-Pelon N, Menstrual Regulation Impact on Reproductive Health in Bangladesh: A Literature Review. Final Report, Dhaka, Bangladesh: Population Council, 1998. Guttmacher Institute 31 31. BBS, Population & Housing Census 2010: Preliminary Results, Dhaka, Bangladesh: BBS, 2010. 32. Guttmacher Institute, unpublished data from the Health Facilities Survey, Bangladesh, 2010. 33. Das TR, Deputy Director (Maternal and Child Health), Directorate General of Family Planning, Bangladesh, Dhaka, personal communication, Aug. 31, 2012. 34. ICDDR,B and Maternal Health Task Force, Menstrual Regulation Using Medication Is Acceptable and Feasible in NGO Settings in Bangladesh, Dhaka, Bangladesh: Center for Reproductive Health, 2011.