ABORTION AMONG COUPLES IN RURAL BANGLADESH

Abstract

Gipson and Hindin1 provide a valuable insight into understanding pregnancy terminations in rural Bangladesh. We recognize the necessity of addressing the context of abortion in order to develop services to tackle the significant morbidity and mortality associated with unsafe practices. The use of quantitative analysis supported by interviews gives a much-needed depth to the understanding of these issues, particularly in regards to the significant impact of male partners’ fertility preferences on pregnancy outcomes. The ghost bike for Amelia Geocos was recently dedicated at 1st Avenue and E 49th Street in Manhattan by loving family and friends. Photograph by Philipp Rassmann. Printed with permission. However, some aspects of the methodology prompt further discussion. We question the validity of the approach used to ascertain pregnancy (1 missed period, fertile, and not lactating). It would also have been helpful to have had more information about the participants who were lost to follow-up, and separately about those who missed a period but were not pregnant. We also query the use of walking distance to the nearest health center as a proxy for access to health services and we question whether the difference between walking for 5 minutes and 10 minutes can define access appropriately, especially when recognizing access is such a multidependent issue influenced by many factors, including partners’ preference, health care preferences, and economic status. In addition, although the interviews provide added insight, we have reservations regarding the reliability of the apparent use of only 1 researcher to identify key themes from the transcripts. Gipson and Hindin consider the implications for life in rural Bangladesh but we question the extent to which the results of such research—on a rural area in the southwest of the country—can be representative of other rural areas of Bangladesh. For example, Gipson and Hindin1 found 11% of pregnancies were terminated compared with 18% nationally. Further research seeking to provide insights into approaches to abortion in other areas of Bangladesh would be useful. We welcome the authors’ comments on these points and concur with their valuable recognition of the impact of male partners on termination-seeking behavior and of its significant public health implications. Targeting men in these populations with education programs regarding family planning would appear to be beneficial in reducing the frequency of pregnancy terminations. Also, continuing to support the training of health care professionals in the delivery of safe, hygienic menstrual regulation services would be beneficial in reducing the use of informal methods in abortion attempts.