Academic journal article International Perspectives on Sexual and Reproductive Health

Acceptability and Feasibility of Mifepristone-Misoprostol for Menstrual Regulation in Bangladesh

Academic journal article International Perspectives on Sexual and Reproductive Health

Acceptability and Feasibility of Mifepristone-Misoprostol for Menstrual Regulation in Bangladesh

Article excerpt

CONTEXT: Annually, more than 700,000 women turn to menstrual regulation, or uterine evacuation with vacuum aspiration; many more resort to unsafe abortion. Using pills for the evacuation of the uterus could increase women's access to safe menstrual regulation services and reduce the high levels of abortion- and menstrual regulation-related morbidity in Bangladesh.

METHODS: At 10 facilities in Bangladesh, 651 consenting women who were seeking menstrual regulation services and who were 63 days or less past their last menstrual period received 200 mg of mifepristone followed 24 hours later by 800 mcg of buccal misoprostol, administered either at home or in the clinic. Prospective data were collected to determine women's experience and satisfaction with the procedure, menstrual regulation outcome, and the human and physical resources required for providing the method. Focus group discussions were conducted with a purposively sampled group of service providers at each site to understand their attitudes about the introduction of menstrual regulation with medication.

RESULTS: The majority of women (93%) with known menstrual regulation outcomes evacuated the uterus without surgical intervention. Overall, most women (92%) were satisfied with use of pills for their menstrual regulation. Providers faced initial challenges and concerns, particularly related to the additional counseling requirements and lack of control over the final outcome, but became more confident after successful use of the medication regimen.

CONCLUSIONS: Mifepristone-misoprostol can be safely offered within existing menstrual regulation services in urban and periurban areas in Bangladesh and is highly acceptable to women. Providers' initial concerns diminish with increased experience with the method.

International Perspectives on Sexual and Reproductive Health, 2013, 39(2):79-87, doi: 10.1363/3907973

Menstrual regulation, or the evacuation of the uterus of a woman at risk of being pregnant to ensure a state of non-pregnancy, was introduced in Bangladesh in the 1970s in the context of a restrictive abortion law, in part to reduce maternal morbidity and mortality associated with unsafe abortion. (1), (2) The introduction of menstrual regulation also coincided with the Bangladesh Liberation War, during which 200,000-400,000 Bangladeshi women were the victims of rape; the new government allowed abortions for those who had become pregnant. (3) Under the Bangladesh Menstrual Regulation program, manual vacuum aspiration is provided free of cost at primary, secondary and tertiary levels of the public-sector health system. Menstrual regulation services are also provided, for a fee, in some nongovernmental organization clinics and private-sector clinics in Bangladesh. Physicians are permitted to perform menstrual regulation up to 10 weeks' amenorrhea and midlevel providers (family welfare visitors or paramedics) up to eight weeks' amenorrhea. By the end of 2011, approximately 10,600 doctors and 7,200 family welfare visitors and paramedics had been trained in the provision of menstrual regulation. (4) Government Management Information System data report 200,000 menstrual regulation cases each year, but this is generally considered to significantly underreport the actual number of cases; a recent study estimated 653,000 per year. (5)

Although menstrual regulation services have been decentralized and are officially available free of charge in the public sector, many women lack access to these services. In a recent study, Bangladeshi women described a range of socioeconomic barriers that affected their access to menstrual regulation services and contributed to delays in obtaining these services. (6) In that study, cost, social stigma and fear of the procedure were identified as the main obstacles to obtaining safe menstrual regulation services. The cost barrier is pervasive. One study found that among menstrual regulation clients, only 11% of women reported receiving free services, even though services obtained in the public sector are supposed to be free of cost. …

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