FACT SHEET

Menstrual Regulation and Unsafe in Bangladesh

■■ Under Bangladesh’s penal code of 1860, were likely done in unsafe conditions or providers who were recruited to replace induced abortion is illegal except to save by untrained providers. a large cohort of providers reaching re- a woman’s life. tirement age. At UH&FWCs that did not ■■ The annual rate of MR in 2014 was 10 offer MR services in 2014, 92% of pro- ■■ Menstrual regulation (MR), however, per 1,000 women aged 15–49, down viders aged 20–29 said they did not pro- has been part of Bangladesh’s nation- from 17 in 2010. vide MR because they lacked training in al family planning program since 1979. the procedure. MR is a procedure that uses manual ■■ The annual abortion rate in 2014 was or a combination of 29 per 1,000 women aged 15–49. ■■ In 2014, 57% of MR procedures were and to “regu- Because of changes to the methodol- performed in public facilities, down late the menstrual cycle when menstru- ogy for estimating abortion incidence, from 63% in 2010. NGOs provided ation is absent for a short duration.” MR this rate is not comparable to the rate 35%, and private clinics provided 8%, performed using medication is referred estimated for 2010. The rate was of MR services. to as MRM. highest in Khulna (39) and lowest in Chittagong (18). ■■ Facilities reported that almost all MR ■■ Government regulations allow for MR patients received contraceptive coun- procedures up to 10–12 weeks after Provision of and trends in MR seling (99%), but much smaller propor- a woman’s last menstrual period (de- services tions were given a contraceptive meth- pending on the type of provider), and ■■ Nationally, only 53% of public-sector od: 77% of those receiving MRs at MRM is allowed up to nine weeks after facilities permitted to provide MR public facilities and only 7% of those a woman’s last menstrual period. services actually did so in 2014 (down attending private facilities. from 66% in 2010). At 20%, this propor- ■■ Despite the availability of MR servic- tion was much lower among private- Treatment for complications of es, many women resort to clandestine sector facilities (down from 36% in , some of which are unsafe. 2010). ■■ An estimated 384,000 women suffered complications from clandestine abor- ■■ In 2014, some 2.8 million pregnancies— ■■ Only about half of all union health and tion in 2014. One-third of those requir- 48% of all pregnancies—were family welfare centres (UH&FWCs) ca- ing facility-based treatment did not re- unintended. Abortion and MR proce- pable of providing MR procedures did ceive the postabortion care (PAC) they dures accounted for close to three- so in 2014, a significant decline from needed. fifths of unintended pregnancies.* two-thirds in 2010. These facilities are the primary health providers in rural ar- ■■ In 2014, 91% of public and private Incidence of MR and abortion eas, where the majority of the popula- health facilities considered able to pro- ■■ In 2014, an estimated 430,000 MR pro- tion lives. vide PAC did so, an increase from 84% cedures were performed in health facil- in 2010. The most common complica- ities nationwide, representing a sharp ■■ The number of MRs provided by tions treated were hemorrhage and in- 34% decline since 2010. UH&FWCs also dropped precipitous- complete abortion; more serious com- ly, from 302,000 in 2010 (close to half plications, such as shock, sepsis and ■■ In addition, an estimated 1,194,000 in- of all MR procedures in the country) uterine perforation, were also reported. duced abortions were performed in to 138,000 in 2014. The decline in pro- Bangladesh in 2014, and many of these cedures at UH&FWCs accounted for ■■ Between 2010 and 2014, there was a close to three-quarters of the total na- marked increase in the proportion of tionwide decline. PAC patients diagnosed with hemor- *The study estimated total pregnancies based on existing rhage, from 27% to 48%.† It is pos- data on births, the study's new estimates of abortions and ■■ MRs, and model-based estimates of miscarriages. The decline in the proportion of sible that this rise is related to an in- †These percentages include complications from MR, in UH&FWCs providing MR services may crease in the incorrect clandestine use addition to those from miscarriage and abortion. have been due, in part, to a lack of train- of misoprostol. ing among a recently recruited cohort of

MARCH 2017 Trends in MR Provision Recommendations SOURCES ■■ Increase the training of pro- The data in this fact sheet are Measure 2010 2014 % change viders in the provision of MR the most current available and and MRM, with a particular are drawn from Hossain A et al., Access to and Quality of Total no. of MR 653,078 430,183 -34% focus on UH&FWCs. Menstrual Regulation Services procedures and Postabortion Care in ■■ Ensure facilities have the Bangladesh, 2014, New York: % of facilities 57 42 -26% necessary equipment, med- Guttmacher Institute, 2017; and providing MR ication and trained staff to Singh S et al., The incidence of services provide MR. menstrual regulation procedures and abortion in Bangladesh, 2014, International Perspectives ■■ Increase providers’ aware- on Sexual and Reproductive ■■ Poor women and rural 2014. In addition, many fa- ness of the national MR Health, 2017, 43(1). women are the groups cilities that had trained staff guidelines, including infor- considered most like- and the equipment to pro- mation on the appropriate ACKNOWLEDGMENTS ly to be at risk for compli- vide MR procedures did not reasons for refusing to pro- The study on which this fact cations from unsafe abor- do so. This was especially vide MR. sheet is based was made tion. Respondents to the common in the private sec- possible by grants from the Dutch Ministry of Foreign 2014 Health Professionals tor: Although 63% of pri- ■■ Educate women about MR Affairs, the Norwegian Agency Survey estimated 85% of vate facilities reported hav- services. Ensure they know for Development Cooperation, nonpoor urban women in ing both the equipment and about this free, legal alterna- and the UK Government. The need of facility-based care trained staff, only about one- tive to illegal abortion; where views expressed are those for complications from clan- third of these facilities actu- to obtain services; and the of the authors and do not destine abortion would re- ally provided MR. window of time since their necessarily reflect the official ceive it, compared with only last menstrual period during policies of the donors. 47% among their poor rural ■■ Public and private facilities which MR is permitted. counterparts. reported refusing to pro- vide MR services to an es- ■■ To reduce complications as- ■■ Nearly all public and private timated 105,000 women in sociated with the use of facilities that provided PAC 2014. This figure represents misoprostol and mifepris- in 2014 (99%) offered fami- about one-quarter (27%) of tone, increase awareness ly planning counseling to the all women seeking MR at among drug sellers and their vast majority of their PAC these facility types. clients of the correct use patients. However, only 18% and dosage of these drugs of these facilities provided ■■ Most facilities reported hav- through informational leaf- Association for their patients with contra- ing turned away women lets or posters and clear, ac- Prevention of Septic ceptive methods. seeking MR because they curate drug labeling. Abortion, Bangladesh had exceeded the permit- House No: 6/3, Block: D, ■■ Barriers to MR services ted number of weeks after To reduce high rates of Section: 2, Borobag, ■■ Even though the MR pro- their last menstrual period unintended pregnancy, in- Mirpur, Dhaka-1216 gram has been support- or because of medical rea- crease the provision of 880-9002325 ed by the government of sons. However, some pro- high-quality contraceptive [email protected] Bangladesh since 1979, viders also cited social or care by providing a wide www.ibiblio.org/bapsa many women are unaware cultural reasons not reflec- range of methods (includ- of its services. National tive of government guide- ing long-acting reversible Demographic and Health lines: 27% reported turning methods), offering counsel- surveys show that, in away women because they ing on consistent and cor- 2014, more than half of were childless, 6% because rect use, and facilitating ever-married women in women were unmarried, 7% method switching. Bangladesh had never because they considered the heard of MR, a marked in- woman too young and 8% crease from only one-fifth because the woman’s hus- of married women in 2007. band had not consented. Good reproductive ■■ On average, among facilities health policy starts with in the public and private sec- credible research tor that could potentially pro- vide MR services, three in 125 Maiden Lane 10 lacked basic MR equip- New York, NY 10038 ment, trained staff or both in 212.248.1111 [email protected]

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