Situational Analysis of Strengthening the National Menstrual Regulation (MR) Programme in Bangladesh

Abstract

Several hundred thousand women in Bangladesh terminate their pregnancy either by menstrual regulation (MR) or through abortion. Government policy does not recognise abortion; but there exists a policy for MR, permitting termination of unwanted pregnancy up to 10 weeks from the last menstrual period. But access to safe MR is limited—unskilled and untrained providers mostly conduct termination of pregnancy- making unsafe abortion one of the leading causes of maternal deaths in Bangladesh. In order to reduce maternal mortality and morbidity in the country, an initiative was launched in 2008 (with financial support from the Embassy of the Kingdom of the Netherlands).The overall aim was to improve knowledge of and access to quality MR services for the prevention of unsafe abortion and unsafe MR. The present study was undertaken to examine the impact of the MR intervention, i.e. to assess the extent to which the implementing agencies-Marie Stopes Clinic Society (MSCS) and Family Planning Association of Bangladesh (FPAB) have achieved their desired objectives. Three independent indicators have been used for the evaluation—how far the program has been successful in: (a) increasing awareness regarding timeline for safe MR, (b) enhancing access to services to get rid of unwanted pregnancy, and (c) reducing the incidence of unsafe abortions, early marriage, and violence against women. Findings suggest that,overall, the MR initiative has been successful in achieving the targets. Respondents in the intervention area are much better off in terms of awareness regarding timeline of safe MR (79 per cent of women and 88 per cent of the MR clients) compared to their control group counterparts (51 per cent and 74 per cent respectively), access to skilled provider for termination of unwanted pregnancy, and fewer incidences of unsafe abortions as a way of pregnancy termination. People belonging to different age groups (adolescents, adults, the aged) and socio-economic categories (rich/poor, educated/illiterate) get the relevant message regarding WHY, WHEN, WHERE, and by WHOM the MR procedure should be performed. The implementing agencies have played a crucial role in promoting safe MR in their respective working areas in the aspects of awareness creation, capacity development, infection prevention, standard guideline on MR, enabling environment, and rights based approach. However, there still remains scope to improve quality of care.