Abstract
BackgroundAbout one quarter of women in Bangladesh are denied menstrual regulation (MR) due to advanced gestation [J Fam Plann Reprod Health Care 41(3):161-163, 2015, Issues Brief (Alan Guttmacher Inst) (3):1-8, 2012]. Little is known about barriers to MR services, and whether women denied MR seek abortion elsewhere, self-induce, or continue the pregnancy.MethodsAfter obtaining authorization from four health facilities in Bangladesh, we recruited eligible and interested women in to the study and requested informed consent for study participation. We conducted in-depth interviews with 20 women denied MR from four facilities in four districts in Bangladesh. Interviews were translated and transcribed, and the transcripts were analyzed by two researchers through an iterative process using a qualitative content analysis approach.ResultsOf those interviewed, 12 women sought abortion elsewhere and eight of these women were successful; four women who sought subsequent services were denied again. Two of the eight women who subsequently terminated their pregnancies suffered from complications. None of the participants were aware of the legal gestational limit for government-approved MR services. Given that all participants were initially denied services because they were beyond the legal gestational limit for MR and there were no reported risks to any of the mothers’ health, we presume that the eight terminations performed subsequently were done illegally.ConclusionsBarriers to seeking safe MR services need to be addressed to reduce utilization of potentially unsafe alternative abortion services and to improve women’s health and well being in Bangladesh. Findings from this study indicate a need to raise awareness about legal MR services; provide information to women on where, how and when they can access these services; train more MR providers; improve the quality and safety of second trimester services; and strengthen campaigns to educate women about contraception and pregnancy risk throughout the reproductive lifespan to prevent unintended pregnancies.Electronic supplementary materialThe online version of this article (doi:10.1186/s12978-016-0199-8) contains supplementary material, which is available to authorized users.
Highlights
About one quarter of women in Bangladesh are denied menstrual regulation (MR) due to advanced gestation [J Fam Plann Reprod Health Care 41(3):161-163, 2015, Issues Brief (Alan Guttmacher Inst) (3):1-8, 2012]
The participants in this study were denied MR services because they presented past the government sanctioned gestational age limit, yet not a single participant was aware of the gestational limit for government approved MR, or that MR was regulated at all
Overall, results from this study provide new insight into women’s experiences seeking abortion in Bangladesh: from factors associated with later presentation for MR, actions upon denial of services, safety of abortion procedures, and women’s awareness of and ability to exercise their rights to terminate a pregnancy
Summary
About one quarter of women in Bangladesh are denied menstrual regulation (MR) due to advanced gestation [J Fam Plann Reprod Health Care 41(3):161-163, 2015, Issues Brief (Alan Guttmacher Inst) (3):1-8, 2012]. The majority of all abortions in developing countries are performed in unsafe or illegal conditions and the consequences can be severe [2]. This is despite the fact that in the vast majority of countries abortion is legal for one or more indications [3]. Factors such as poverty, stigma, lack of awareness of the law and distance from a provider prevent women from accessing safe abortion services within government authorization [4, 5]. Many attribute Bangladesh’s significant reduction of maternal mortality in recent decades [14] to sustained declines in abortionrelated deaths and increased availability of MR [13, 15, 16]
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