Menstrual regulation outside health facilities in Bangladesh: a qualitative study

Abstract

Abortions are restricted in Bangladesh, and menstrual regulation (MR) exists as an approved alternative. MR is available from health facilities, yet more than twice as many procedures were performed outside health facilities in 2014, often performed under unsafe conditions and little is known about the reasons women seek informal providers. I conducted 43 interviews with women who had undergone MR outside health facilities to understand the lived experiences of women. I also conducted observations services, and had conversations about MR provision and services with community members, pharmacists, health staff, and official MR providers to contextualize women’s experiences. I used frameworks on trajectories to seeking abortion-related care and ecological models to examine women’s experiences. Participants spoke about restrictions of movement, how relationships with families, communities, and informal providers could facilitate or hinder seeking services, and how they themselves defined their pregnancies and MR procedures. Their experiences varied and they sought MR from informal providers for a multitude of interrelated reasons. Women did not attempt to seek MR at approved facilities before seeking informal providers, citing structural barriers such as finding clinicians at health facilities difficult to access. While more than two thirds of women sought follow up care, only 9 women ultimately sought follow up care at formal health facilities, and described additional difficulties accessing this care. A subset of women who used methods that can be safe, such as allopathic medication from pharmacies, had negative experiences and judged their procedures not to have been effective. Women spoke about significant barriers to seeking MR in health facilities, and in many cases struggle with essentially all aspects of care seeking. Experiences with formal providers led women to not consider these as options, and they found female information providers easiest to access. For MR to be more accessible at the community level, the wider cultural context of women’s domestic and social lives needs to be taken into account.