Abstract
BackgroundDespite the remarkable reduction of maternal mortality, unsafe and untimely menstrual regulation (MR) remains a major maternal health problem in Bangladesh. This study aimed to determine the prevalence and identify determinants of MR among ever-married women in Bangladesh.MethodsData for this study have been extracted from Bangladesh Demographic and Health Survey (BDHS) 2014. The survey followed a two-stage stratified sampling procedure and the study used a sub-sample of 8084 ever-married women aged 15 to 49 years extracted from survey sample of 17,863. Univariate and multivariate mixed-effect logistic regression analyses were used to identify risk factors for MR accounting for potential between-clusters variations.ResultsThe weighted prevalence of MR was 12.3% (95% CI: 11.1–13.4%) among (991/8084) ever-married women. Women were less likely to have MR if they were from Chittagong (AOR 0.74, 95% CI: 0.57–0.96; p = 0.026) and Sylhet (AOR 0.53, 95% CI: 0.36–0.77; p = 0.001) divisions. Women were more likely to have MR if they were from high (AOR 1.47, 95% CI: 1.18–1.83; p = 0.001) and the highest (AOR 1.62, 95% CI: 1.27–2.05; p < 0.001) socioeconomic status (SES) group; being employed (AOR 1.35, 95% CI: 1.16–1.56; p < 0.001), having one or two children (AOR 1.73, 95% CI: 1.24–2.40: p = 0.001) and ≥ 3 children (AOR 2.56, 95% CI: 1.82–3.58; p < 0.001), and having membership of non-government organization (NGO) (AOR 1.18, 95% CI: 1.02–1.38; p = 0.030).ConclusionMR is prevalent among Bangladeshi women and independently associated with geographic location, SES, parity, employment and NGO membership status. Health policy should prioritize in reducing spatial and socioeconomic inequalities in relation to MR services by ensuring accessibility and availability of MR services, especially in suburban divisions. Furthermore, abortion should be legalized in Bangladesh that will ultimately reduce the morbidity and mortality associated with unsafe abortion.
Highlights
Despite the remarkable reduction of maternal mortality, unsafe and untimely menstrual regulation (MR) remains a major maternal health problem in Bangladesh
Among the administrative divisions of Bangladesh, the highest and lowest prevalence rates of MR were in Dhaka (15.1%, 95% Confidence Interval (CI): 12.5–17.7%) and Sylhet (7.2%, 95% confidence interval (95% CI): 4.5–9.8%), respectively while other divisions except Rangpur had approximately same prevalence rates
The proportion of MR was higher in employed women (13.9%, 95% CI: 12.2– 15.5%) compared to unemployed women (11.4%, 95% CI: 10.1–12.7%)
Summary
Despite the remarkable reduction of maternal mortality, unsafe and untimely menstrual regulation (MR) remains a major maternal health problem in Bangladesh. Abortion is a significant cause of maternal morbidity and mortality, and often unsafe [1]. The risk of unsafe clandestine abortion, related complications and deaths are usually high in the countries where the law prohibits abortion or abortion is only permitted to save the life of a woman [2, 4, 5]. Abortion-related deaths and complications remain a major maternal health problem in Bangladesh though the overall maternal mortality has declined considerably in the last two decades [5]. The incidence of abortion and proportion of abortion-related maternal deaths has increased from 2010 to 2016 in Bangladesh [2, 7,8,9]. In 2014, about 1,194,000 induced abortions occurred in Bangladesh, and most of them were not attended by skilled personnel and were conducted in unsafe conditions, which causes severe medical complications including incomplete abortion, hemorrhage, cervical lacerations, sepsis, uterine perforation, bladder injury and shock [10, 11]
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