Publication Cover
Reproductive Health Matters
An international journal on sexual and reproductive health and rights
Volume 12, 2004 - Issue sup24: Abortion law, policy and practice in transition
2,009
Views
23
CrossRef citations to date
0
Altmetric
Original Articles

A Situation Analysis of the Menstrual Regulation Programme in Bangladesh

&
Pages 95-104 | Published online: 27 Apr 2005
 

Abstract

Menstrual regulation (MR) using vacuum aspiration is widely available in Bangladesh through public, NGO and private sector facilities, even though abortion is illegal except to save a woman’s life. For more than two decades the MR programme was run as a vertical programme. In 1998 the Government of Bangladesh introduced the Health and Population Sector Programme (HPSP) incorporating menstrual regulation into the essential services package. This paper reports a situation analysis of the MR Programme under the HPSP, using the World Health Organization rapid evaluation methodology. In spite of wide availability, barriers such as distance to health facilities and transportation costs, unofficial fees, lack of privacy, confidentiality and cleanliness in public health facilities, and in some cases attitudes of service providers, are limiting access to MR services. Quality of care is compromised by inadequacies in infection control and in provider training and counselling. Health system weaknesses include gross under-reporting of cases by providers who do not wish to share unofficial fees, which affects monitoring and adequate provision of supplies. The HPSP has caused uncertainty regarding supervision in public sector facilities, and adversely affected training by NGOs and government—NGO coordination. Services in part of the NGO sector have also been affected by funding changes. To make the programme as a whole more effective, all these issues have to be addressed.

Résumé

La régulation menstruelle par aspiration est largement disponible au Bangladesh dans des centres publics, privés et gérés par des ONG, mÁme si l’avortement n’est autorisé que pour sauver la vie de la femme. Pendant deux décennies, le programme de régulation menstruelle a été administré verticalement. En 1998, le Gouvernement a introduit le Programme du secteur de la population et de la santé (HPSP) incluant la régulation menstruelle dans les services essentiels. Cet article décrit une analyse du programme de régulation menstruelle, avec la méthodologie d’évaluation rapide de l’OMS. La distance avec les centres de santé et le co t des transports, les paiements officieux, le manque de confidentialité et d’hygiène dans les centres publics et parfois l’attitude des prestataires limitent l’accèsàces services, pourtant très nombreux. La qualité des soins est compromise par l’inadéquation des mesures contre les infections, de la formation des praticiens et de l’orientation. La sous-notification flagrante des cas, imputable aux prestataires ne souhaitant pas partager les honoraires officieux, entrave le suivi et la distribution des fournitures. Le HPSP a provoqué l’incertitude quantàla supervision des centres du secteur public et contrarié la formation assurée par les ONG et la coordination Gouvernement-ONG. Certains services des ONG ont aussi été lésés par des changements financiers. Pour rendre le programme plus efficace, il faut lever tous ces obstacles.

Resumen

La regulación menstrual (RM) por medio de la aspiración endouterina se practica ampliamente en Bangladesh en establecimientos de las ONG y de los sectores público y privado, a pesar de que el aborto es ilegal excepto para salvar la vida de la mujer. En 1998, el gobierno de Bangladesh inició el Programa del Sector Salud y Población (HPSP), mediante el cual se incorporó la regulación menstrual en los servicios esenciales. En este artáculo se informan los resultados de un análisis situacional del Programa de RM bajo el HPSP, utilizando la metodologáa de evaluación rápida de la OMS. Pese a la amplia disponibilidad de los servicios de RM, su acceso se limita por barreras tales como la distancia a los establecimientos de salud y los costos de transporte, las tarifas extraoficiales, la falta de privacidad, confidencialidad y limpieza en los establecimientos de salud públicos y, en algunos casos, las actitudes de los prestadores de servicios de salud. La calidad de la atención está comprometida por las deficiencias en el control de infecciones, la capacitación de los proveedores y la consejeráa. Entre las debilidades del sistema de salud figuran un alto subreportaje de los casos por parte de los proveedores quienes no desean compartir las cuotas extraoficiales. El HPSP ha causado duda respecto a la supervisión en los establecimientos de salud del sector público y ha afectado adversamente la capacitación coordinada por las ONG y el gobierno-ONG. Para lograr que el programa en general sea más eficaz, es necesario abordar y solucionar todos los aspectos mencionados.

Acknowledgements

This paper is based on the study “The Way Forward: Resourcing the Bangladesh National Menstrual Regulation Programme in the Context of Health Sector Reform”, funded by the UK Department for International Development and Swedish International Development Cooperation Agency and undertaken by the Reproductive Health Alliance, London, UK, and Bangladesh Women’s Health Coalition, Dhaka. The authors would like to thank Peter Hall, former Chief Executive and Sandra Kabir, former Programme Advisor of Reproductive Health Alliance, all national experts, staff members of the Ministry of Health and Family Welfare, members of the senior management of the Bangladesh Women’s Health Coalition, members of the advisory committee, the study team and all the women and men who graciously consented to be interviewed, for their support and cooperation. The report was presented at the Safe Motherhood Conference in Kuala Lumpur, Malaysia, 1 October 2003. This paper is a shortened version of the report.

Reprints and Corporate Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

To request a reprint or corporate permissions for this article, please click on the relevant link below:

Academic Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

Obtain permissions instantly via Rightslink by clicking on the button below:

If you are unable to obtain permissions via Rightslink, please complete and submit this Permissions form. For more information, please visit our Permissions help page.