Abstract
BackgroundAbortion related deaths as a proportion of maternal mortality appears to have fallen dramatically in Bangladesh from 5 % in 2001 to 1 % in 2010. Yet complications from menstrual regulation (MR) and unsafe abortion continue to cause deleterious health, economic and social consequences for women in the country.MethodsThis quasi experimental design study with a baseline (January to December 2008) and an endline survey (August to October 2009) was conducted in 69 public, private, and NGO sector health facilities in Jessore district of Bangladesh with the objective of adapting and implementing a set of process indicators, specifically to supplement the indicators for monitoring emergency obstetric care interventions. At the baseline, we collected retrospective data from all 69 health facilities that provided MR, legal abortion or post-abortion care (PAC), by reviewing their last one year’s records. Three months after introducing the safe menstrual regulation and abortion care (SMRAC) model, endline data was collected. Signal function (critical services that facilities must perform in order to prevent and treat abortion complications) analysis was used to characterize facilities as providing basic care, comprehensive care, or neither. Facility mapping, and records on services provided and complications treated were used to further characterize service availability and to describe service use and quality.ResultsNo facilities fulfilled criteria for ‘comprehensive’ care at either the baseline or end line while only one met the ‘basic’ criteria during the endline of the project. Recommended uterine evacuation technology, manual vacuum aspiration (MVA) was used for 100.0 % of MR clients but only for 8.0 % or fewer PAC patients. MR clients were 37.5 times more likely than PAC patients to leave facilities with a contraceptive method (75.0 % vs. 2.0 %).ConclusionPersistent use of older uterine evacuation technologies was observed when recommended techniques were widely available in the facilities. Notable gaps were identified in providing post-abortion contraceptive services for women treated for PAC. By systematic implementation of the SMRAC model, health systems can track and measure progress and gaps in their implementation and identify strategies for further reduction of abortion-related morbidity and mortality in Bangladesh.
Highlights
Abortion related deaths as a proportion of maternal mortality appears to have fallen dramatically in Bangladesh from 5 % in 2001 to 1 % in 2010
Owners of the four private facilities felt that participation in the project was time-consuming and not beneficial to their business and the non-governmental organization (NGO) clinic had closed due to lack of funds
Data suggest that Bangladesh has made progress in reducing maternal mortality due to unsafe abortion and increased access to menstrual regulation (MR) along with emergency obstetric care has been shown to contribute to this reduction [20]
Summary
Abortion related deaths as a proportion of maternal mortality appears to have fallen dramatically in Bangladesh from 5 % in 2001 to 1 % in 2010. Slow progress has been made toward Millennium Development Goal 5 (MDG 5) of reducing maternal mortality ratio by 75.0 % between 1990 and 2015 Many countries, those with low resources, have not met the necessary 5.5 % annual decline necessary to be on track for the 2015 deadline [1]. Women who do not want to become pregnant and do not have access to contraception are at risk of unplanned pregnancy and unsafe abortion [5] This result in complications arising from MR procedures and unsafe abortion continue to cause deleterious health, economic and social consequences for the women and for the society as a whole, both in the short term and in the long run [6]
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