Abortion in Bangladesh

History

Bangladesh originated in the area centering South Asia, surrounded by India, Burma, Nepal and other countries. Bangladesh is also one of the world’s eighth most populous countries. There are many ways Bangladesh deals with and used to deal with the topic of abortion.^[1] Bangladesh is still under the penal code from 1860, where induced abortion, which is a procedure done to end a pregnancy, is still illegal unless if the woman in danger, then it is legal.^[1] However, Bangladesh does offer a substitute for induced abortion, and that is Menstrual Regulation. In the history of Bangladesh, abortion has been prevalent especially during the years after the liberation war. For example, in 1972, the law allowed for abortion for those women who has been raped during the war.^[1] Then in 1976, Bangladesh National Population Policy tried to make abortion legal in the first trimester, however that ended up in failure, and the existing condition remains where abortion is only legal when the woman’s life is in danger.^[2] In 1979, Menstrual Regulation was introduced to the citizens of Bangladesh. Menstrual Regulation has been the main practice since then and that is what the Bangladeshi government allows over the use abortion .^[2]

Menstrual regulation

Been in the family planning program in Bangladesh since 1979, Menstrual Regulation consists of a procedure that uses the manual vacuum aspiration to basically controlling fertility so it is not possible to be pregnant after missing a period.^[1]

Basically, menstrual regulation is the induction of the uterine lining and one of the most common ways one can have a menstrual regulation is by mini-vacuum aspiration. It is a very simple and can be done with inexpensive equipment. Its procedure also goes without the use of anaesthesia.^[3]

A study about Menstrual Regulation in 2013 consisted of 651 consenting women from 10 different facilities in Bangladesh. These were seeking menstrual regulation and were about 63 days or less late of their menstrual cycle. They were given about 200 mg of mifepristone then later, they received about 800 mg of misoprostol. Then data was collected where it recounted of their experience and the satisfactions with the procedure. The result of this data showed that majority of the women, which is about 93%, had evacuated the uterus without the use of the surgical intervention. Then about 92% of the women were satisfied with the pills and the rest of the treatment.^[4]

One thing that is very prominent is the lack of access to Menstrual Regulation. According to Anadil Alam, and his research above, he stated that even though menstrual regulation are centralized and free of charge, many women still lack access to it. And the main reason that the many of the Bangladeshi women stated was the socioeconomic barriers.^[4] There is also the fact that even though it was free, there would be additional charges if it was beyond the 10 weeks that was allowed. Another issue was many of the women was not aware of menstrual regulation and the lack of education that some women in Bangladesh faced. And as Anadil Alam states that such barriers to Menstrual Regulation could be why many women turn to illegal ways to abort their pregnancy. Then there is also the fact that men have a great effect since the women needs their husband's permission to get one, where it truly depends, some men are supportive and there is the other underlying factor of money.^[5]

Abortion

Menstrual Regulation allows one to terminate within 10 weeks from the last period, but there is still a rising epidemic of high numbers of people using unsafe methods to terminate their pregnancies. Therefore, to solve this problem, there was a hotline created where more and more women can get more information about the type of fertility control that Bangladesh offers, and that is menstrual regulation, which is perfectly much more safe and administrated in more official places.^[6]

In an article by the Guttmacher Institute, it talks about the rise of the illegal abortion when there is safer methods of fertility control is available in Bangladesh. It refers to the a new study in Matlab, which is a rural district in Bangladesh, and is a good representation of rural areas in Bangladesh.^[7]

In the study by Mizanur Rahman, and Julie DaVanzo, it showed that in the time period of 2000 to 2008, a woman was more likely to die from the complications of unsafe abortion than from childbirth itself, and that death rates of childbirth was similar of the death rates for the complications of menstrual regulation.^[8]

There is also another study done in Matlab, but this refers to the trends that is related to the abortion among adolescent girls around the time period of 1982 to 1998. According to their research, abortion was more prevalent about 35 times more among unmarried than married adolescents, and it was much higher among who were less than 18 years of age and those who passed or had more than primary education.^[9]

Statistics

The statistics help further the understanding of what is happening in Bangladesh. The national rate that women participate in Menstrual Regulation as a post-contraceptive way to control their fertility was 18.3 per 1,000, based on women from the ages of 15 to 44. The national rate for induced abortion was 18.2 per 1,000 for women in the same age interval.^[1]

Only 57% of the Menstrual Regulation facilities provided the necessary procedures for this fertility control in 2010. Then there is also the case, of how the service of this facilities differ in many parts throughout Bangladesh, for example, according to Guttmacher Institute stated that “In Barisal, 76% of facilities provided services, while in Khulna, only 37% did.” And Barisal and Khulna are different divisions or parts of Bangladesh. Then there is also the topic of this services in rural places. In rural places, where the population is most concentrated, where two-thirds of Union Health and Family Welfare Centres provided these services.^[1] According to Guttmacher, about 26% women, which is about 166,000, are turned away annually.^[1] Another thing that was very important and prevalent was that in 2007, about one-fifth of married Bangladeshi women did not hear about menstrual regulation.

Organizations involved

Bangladesh is one of the five countries that is being researched by the Federation of Gynecology and Obstetrics (FIGO) Initiative for the Prevention of Unsafe Abortion and its Consequences since 2008. They estimated that about 523,808 to about 769,269 abortions occurred in Bangladesh.^[10] Also according to Shahida Zaidi and from her work with the "Achievements of the FIGO Initiative for the Prevention of Unsafe Abortion and its Consequences in South-Southeast Asia, they recorded that there was a significant decrease in abortion-related deaths in Bangladesh. It went from 13% in 2001 to less than 1% in 2010.^[10] The FIGO would send delegates and build a foundation in each of the countries, where they would use statistical date to plan an action path to solve the problem. For example, for Bangladesh, the 2012 plan was to increase the use of MVA and that misoprotol should be introduced for post-abortion care. Also in 2012, the Drug Administration for Bangladesh legalised the combination of mifepristone and misoprotol in the reason of medical abortion.^[10]

References