Academic journal article Journal of Health Population and Nutrition

Desire for Children and Subsequent Abortions in Matlab, Bangladesh

Academic journal article Journal of Health Population and Nutrition

Desire for Children and Subsequent Abortions in Matlab, Bangladesh

Article excerpt

INTRODUCTION

Abortion--legal or illegal--has been practised in most countries of the world. The variation in the level of abortion across countries depends not only on legality of the procedure but also on religious restrictions and cultural acceptance. According to the Penal Code of 1860, induced abortion is illegal in Bangladesh except to save the life of the mother (1). Since the late 1970s, the law allows menstrual regulation in the early stages before pregnancy status is clinically confirmed (2,3). Such interpretation of the law, along with the decline in desired family size and availability of menstrual regulation services, has contributed to the increased incidence of induced abortions (4).

In the past, when the law was strict, abortions were usually performed either by self or untrained indigenous practitioners. Since liberalization of the law, menstrual regulation services are available in both public and private sectors. The government health facilities providing abortion services include: Family Welfare Centres, Upazila Health Complexes, and District Hospitals, while the non-government facilities include clinics located mainly in cities and towns. Despite the availability of these facilities, most abortions are still being performed either by the client herself or with the help of indigenous practitioners (5,6), and many who sought modern abortion services had initially experienced traditional methods (7,8).

Although the availability of abortion services has contributed to a substantial increase in the number of abortions in many countries, little increase has been observed in many others. This is mainly because of social stigma and religious prohibition against abortion. An unsafe abortion may lead to untold physical and mental distress or death. A survey in 1978 estimated that about 21,600 pregnancy-related deaths occurred during the year in Bangladesh. Of these deaths, 25.8% were due to induced abortion-related complications (9). Another study reported that a considerable proportion of hospital resources, in terms of time, bed occupancy, transfusions given, and antibiotics, was used or consumed for the management of abortion-related cases (10).

Studies based on Matlab data documented a higher number of abortions in the comparison area than in the treatment area (5,11). Rahman and colleagues reported that abortion of unintended pregnancies is similar in both treatment and comparison areas, but higher levels of contraceptive use have led to lower incidence of unintended pregnancy and abortion (11). Another study in Matlab documented that lack of use or lack of use-effectiveness of the family-planning methods resulted in unwanted pregnancies and, thus, abortion (7).

This study proposes that the desire for children is a predictor of abortion, and the predictive power gets stronger as intensity to limit family size increases. The objective of the study was to examine the relationship between desire for children and subsequent abortions (once and repeated) and also whether such abortions vary by socioeconomic characteristics.

MATERIALS AND METHODS

Study area

Data for the present study came from Matlab upazila where ICDDR,B: Centre for Health and Population Research has been maintaining a Demographic Surveillance System (DSS) since 1966. The DSS is currently known as Health and Demographic Surveillance System (HDSS). Matlab is a rural area located about 70 km southeast of Dhaka, the capital of Bangladesh. The area is low-lying, and the economy is largely based on agriculture (12).

To overcome the deficiencies of the simple household contraceptive distribution programme, major modifications in the field structure and programme activities were introduced in October 1977. An experimental maternal and child health and family-planning (MCH-FP) programme was introduced in half of the DSS villages (treatment area), while the other half (comparison area) continued to receive limited services provided by the government programme (13). …

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