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Int J Gynaecol Obstet. 1988 Oct;27(2):265-71.

Menstrual regulation in Bangladesh: an evaluation of training and service programs.

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  • 1Institute for Urban Research, Morgan State University, Baltimore, Maryland.

Abstract

This article evaluates the performance of three urban menstrual regulation (MR) training and service programs in Bangladesh. Virtually all of the MR providers including physicians and paramedics in the three centers received training in various MR procedures by means of demonstration or class lectures. However, a significant proportion of the trained MR providers were unable to render proper MR services due to the lack of clinical facilities and lack of equipment. Analysis of follow-up data for MR clients revealed that those women who utilized MR procedures offered through the centers had an average of about three live births. Physician providers were more likely to serve clients from a higher socioeconomic strata, while paramedical providers were more likely to serve MR clients from lower socioeconomic strata or agricultural background. Most of the clients receiving MR services were ever and current users of contraceptives and developed fewer complications from MR procedures than those served by untrained traditional herbalists, healers or birth attendants.

PIP:

Although induced abortion is illegal in Bangladesh, the Government has made menstrual regulation available since 1975 for the prevention of unwanted pregnancies. By 1985, a total of 2399 physicians and 7093 family planning paramedical workers had been trained to provide menstrual regulation in selected clinics throughout the country. Between 1975 and 1985, 286,500 menstrual regulation procedures had been performed in Bangladesh. This study evaluated the performance of 3 urban menstrual regulation training and service programs through interviews with both service providers and clients. Nearly all the service providers has been trained in pre and post-menstrual regulation counseling, contraindications, and treatment of complications and learned about the various menstrual regulation procedures through class lectures or demonstration. While 64% of the physician providers interviewed indicated they felt fully confident about performing menstrual regulation at the conclusion of their training, only 28% of the paramedical providers expressed this confidence. Moreover, a significant proportion of trained providers were unable to render services due to a lack of clinical facilities, lack of sterilization, or the absence of equipment such as syringes. In terms of clients, those who received the menstrual regulation procedure from a physician were more likely to be of higher socioeconomic status and to have the procedure performed in a hospital. Paramedical providers were more likely to serve clients from an agricultural background. Complications occurred in 173 of the 1365 clients interviewed (especially bleeding and abdominal pain), but there were no significant differences in complication rates between the 2 categories of providers. 82% of menstrual regulation clients were found to be using contraception at a follow-up interview. More widespread use of menstrual regulation could reduce the maternal deaths resulting from clandestine abortions; however, this study indicates a need for improvements in clinical facilities and equipment.

PMID:
2903095
[PubMed - indexed for MEDLINE]
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