Academic journal article International Perspectives on Sexual and Reproductive Health

The Incidence of Menstrual Regulation Procedures and Abortion in Bangladesh, 2010

Academic journal article International Perspectives on Sexual and Reproductive Health

The Incidence of Menstrual Regulation Procedures and Abortion in Bangladesh, 2010

Article excerpt

CONTEXT: Bangladesh is unique in including menstrual regulation (MR) services as part of the government family planning program, despite having a highly restrictive abortion law. The only national estimates of MR and abortion incidence are from a 1995 study, and updated information is needed to inform policies and programs regarding the 1 provision of MR and related reproductive health services.

METHODS: Surveys of a nationally representative sample of 670 health facilities that provide MR and postabortion care services and of 151 knowledgeable professionals were conducted in 2010, and MR service statistics of nongovernmental organizations were compiled. Indirect estimation techniques were applied to calculate the incidence and rates of MR and induced abortion.

RESULTS: In 2010, an estimated 647,000 induced abortions were performed in Bangladesh, and 231,400 women were treated for complications of such abortions. Furthermore, an estimated 653,000 MR procedures were performed at facilities nationwide. However, an estimated 26% of all women seeking an MR at facilities were turned away, and about one in 10 of those who had an MR were treated for complications. Nationally, the annual abortion rate was 18.2 per 1,000 women aged 15-44, and the MR rate was 18.3 per 1,000 women.

CONCLUSIONS: The incidence of induced abortion is the same as that of MR, which suggests considerable unsatisfied demand for the latter service. Furthermore, the high rates of complications from MRs highlight the need to improve the quality of clinical services. Increased access to contraceptives and MR services would help reduce rates of unplanned pregnancy and unsafe abortion.

International Perspectives on Sexual and Reproductive Health, 2012, 38(3): 122-132, doi: 10.1363/3812212

Among the many developing countries where abortion is highly legally restricted, Bangladesh is unique in permitting the provision of menstrual regulation (MR) services as part of the government family planning program. MR procedures are generally performed using manual vacuum aspiration, with a maximum limit of 10 weeks after a woman's last menstrual period, and without a test to confirm pregnancy.* The MR program is considered to contribute significantly to protecting women's health; (1) manual vacuum aspiration, which is recommended by the World Health Organization, (2), (3) has a very low rate of complications and mortality when performed by trained staff in hygienic conditions. (4-6) However, unsafe induced abortions are still widely performed in Bangladesh.

The national rate of MRs and induced abortions combined was 28 per 1,000 women aged 15-44 in 1995 (based on indirect estimation techniques), (7) the same rate as in South-central Asia in that year. (8) According to another study using a model-based approach, the combined MR and abortion rate in Bangladesh was in the range of 26-30 per 1,000 in the mid-1990s. (9)

No national study on the incidence of MR and abortion has been conducted since the 1995 analysis. (7) Yet in the past 15 years, notable changes have occurred in Bangladesh that may have affected access to MR services and women's and couples' motivation to resort to MR or abortion. Unmet need for contraception remained substantial at 12% in 2011, after declining from 17% in 2007. (10), (11) In addition, contraceptive use increased relatively slowly from the mid-1990s until 2011: The percentage of currently married women aged 15-49 using any method increased from 49% to 61%--an average annual increase of 0.8 percentage points. Although a majority of Bangladeshi coupies who use contraceptives relied on modern methods in the past and continued to do so in 2011 (52% of married women), most used the pill, the injectable or condoms (44%), and only a small proportion used methods with very low failure rates, such as sterilization, the IUD and the implant (8%). (11) Clearly, unmet need for contraception, use of traditional methods (9% in 2011), and reliance on short-term, reversible methods with relatively high risks of contraceptive failure and discontinuation are important factors contributing to unintended pregnancy. …

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