The Incidence of Menstrual Regulation Procedures and Abortion in Bangladesh, 2010

Singh, Susheela; Hossain, Altaf; Maddow‐Zimet, Isaac; Vlassoff, Michael; Bhuiyan, Hadayeat Ullah; Ingerick, Meghan

doi:10.1363/3812212

Cited by 47 publications

(51 citation statements)

References 14 publications

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“…Even with a more liberal legal framework in place however, persistent value systems and the continued stigmatization of induced abortion may result in large proportions of abortions taking place clandestinely and under unsafe conditions. In Bangladesh, for example, even after more than three decades of national coverage by the government-supported menstrual regulation 12 program, about half of all pregnancy terminations are still via the procurement of (illegal) induced abortion rather than through legal menstrual regulation (Singh et al 2012). …”

Section: Discussionmentioning

confidence: 99%

The cost of post-abortion care in developing countries: a comparative analysis of four studies

Vlassoff

Singh

Onda

2016

Health Policy Plan.

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Over the last five years, comprehensive national surveys of the cost of post-abortion care (PAC) to national health systems have been undertaken in Ethiopia, Uganda, Rwanda and Colombia using a specially developed costing methodology—the Post-abortion Care Costing Methodology (PACCM). The objective of this study is to expand the research findings of these four studies, making use of their extensive datasets. These studies offer the most complete and consistent estimates of the cost of PAC to date, and comparing their findings not only provides generalizable implications for health policies and programs, but also allows an assessment of the PACCM methodology. We find that the labor cost component varies widely: in Ethiopia and Colombia doctors spend about 30–60% more time with PAC patients than do nurses; in Uganda and Rwanda an opposite pattern is found. Labor costs range from I$42.80 in Uganda to I$301.30 in Colombia. The cost of drugs and supplies does not vary greatly, ranging from I$79 in Colombia to I$115 in Rwanda. Capital and overhead costs are substantial amounting to 52–68% of total PAC costs. Total costs per PAC case vary from I$334 in Rwanda to I$972 in Colombia. The financial burden of PAC is considerable: the expense of treating each PAC case is equivalent to around 35% of annual per capita income in Uganda, 29% in Rwanda and 11% in Colombia. Providing modern methods of contraception to women with an unmet need would cost just a fraction of the average expenditure on PAC: one year of modern contraceptive services and supplies cost only 3–12% of the average cost of treating a PAC patient.

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Section: Discussionmentioning

confidence: 99%

The cost of post-abortion care in developing countries: a comparative analysis of four studies

Vlassoff

Singh

Onda

2016

Health Policy Plan.

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“…Abortion is common in Bangladesh, where there is an estimated abortion rate of 37 per 1000 women of reproductive age, compared to an average of only 26 per 1000 in South Asia [15, 16]. The Bangladesh penal code restricts abortion except to save the life of a woman, but since 1979, the Government of Bangladesh allows a procedure known as MR to induce menstruation and establish non-pregnancy [8].…”

Section: Introductionmentioning

confidence: 99%

“…The Bangladesh penal code restricts abortion except to save the life of a woman, but since 1979, the Government of Bangladesh allows a procedure known as MR to induce menstruation and establish non-pregnancy [8]. An estimated 653,000 MR procedures were performed in health facilities nationwide in 2010 [15]. An additional 647,000 induced abortions were performed in the same year, the majority of which were unsafe [15], carried out by untrained providers or under unhygienic conditions.…”

Section: Introductionmentioning

confidence: 99%

“…An estimated 653,000 MR procedures were performed in health facilities nationwide in 2010 [15]. An additional 647,000 induced abortions were performed in the same year, the majority of which were unsafe [15], carried out by untrained providers or under unhygienic conditions. It is estimated that 231,400 women suffered from complications following induced abortion in 2010 [15].…”

Section: Introductionmentioning

confidence: 99%

“…An additional 647,000 induced abortions were performed in the same year, the majority of which were unsafe [15], carried out by untrained providers or under unhygienic conditions. It is estimated that 231,400 women suffered from complications following induced abortion in 2010 [15]. Postabortion care (PAC) is provided to women with incomplete abortion due to unsafe abortion, incomplete MR or miscarriage.…”

Section: Introductionmentioning

confidence: 99%

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Integrating postabortion care, menstrual regulation and family planning services in Bangladesh: a pre-post evaluation

Biswas¹,

Pearson

Shahidullah³

et al. 2017

Reprod Health

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BackgroundIn Bangladesh, abortion is restricted except to save the life of a woman, but menstrual regulation is allowed to induce menstruation and return to non-pregnancy after a missed period. MR services are typically provided through the Directorate General of Family Planning, while postabortion care services for incomplete abortion are provided by facilities under the Directorate General of Health Services. The bifurcated health system results in reduced quality of care, particularly for postabortion care patients whose procedures are often performed using sub-optimal uterine evacuation technology and typically do not receive postabortion contraceptive services. This study evaluated the success of a pilot project that aimed to integrate menstrual regulation, postabortion care and family planning services across six Directorate General of Health Services and Directorate General of Family Planning facilities by training providers on woman-centered abortion care and adding family planning services at sites offering postabortion care.MethodsA pre-post evaluation was conducted in the six large intervention facilities. Structured client exit interviews were administered to all uterine evacuation clients presenting in the 2-week data collection period for each facility at baseline (n = 105; December 2011–January 2012) and endline (n = 107; February–March 2013). Primary outcomes included service integration indicators such as provision of menstrual regulation, postabortion care and family planning services in both facility types, and quality of care indicators such as provision of pain management, provider communication and women’s satisfaction with the services received. Outcomes were compared between baseline and endline for Directorate General of Family Planning and Directorate General of Health Services facilities, and chi-square tests and t-tests were used to test for differences between baseline and endline.ResultsAt the end of the project there was an increase in menstrual regulation service provision in Directorate General of Health Services facilities, from none at baseline to 44.1% of uterine evacuation services at endline (p < 0.001). The proportion of women accepting a postabortion contraceptive method increased from 14.3% at baseline to 69.2% at endline in Directorate General of Health Services facilities (p = 0.006). Provider communication and women’s rating of the care they received increased significantly in both Directorate General of Health Services and Directorate General of Family Planning facilities.ConclusionsIntegration of menstrual regulation, postabortion care and family planning services is feasible in Bangladesh over a relatively short period of time. The intervention’s focus on woman-centered abortion care also improved quality of care. This model can be scaled up through the public health system to ensure women’s access to safe uterine evacuation services across all facility types in Bangladesh.

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Mifepristone–misoprostol for menstrual regulation in public sector facilities in Bangladesh

Alam

Lotarevich

Das³

et al. 2017

Intl J Gynecology & Obste

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The Incidence of Menstrual Regulation Procedures and Abortion in Bangladesh, 2010

Abstract: CONTEXT: Bangladesh is unique in including menstrual regulation (MR)

Cited by 47 publications

References 14 publications

The cost of post-abortion care in developing countries: a comparative analysis of four studies

The cost of post-abortion care in developing countries: a comparative analysis of four studies

Integrating postabortion care, menstrual regulation and family planning services in Bangladesh: a pre-post evaluation

Mifepristone–misoprostol for menstrual regulation in public sector facilities in Bangladesh

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