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  • Title: Innovations in reproductive health care: menstrual regulation policies and programs in Bangladesh.
    Author: Dixon-Mueller R.
    Journal: Stud Fam Plann; 1988; 19(3):129-40. PubMed ID: 3406963.
    Abstract:
    Although abortion is legally restricted in Bangladesh, early menstrual regulation (MR) as a means of reducing female morbidity and mortality associated with indigenous abortion has been part of the government's health and family planning efforts since 1975. Approximately 3,000 doctors and 2,600 female family planning workers (Family Welfare Visitors) have been trained in techniques of MR in a program intended ultimately to serve rural populations in all areas of the country. This paper assesses MR training and service programs in Bangladesh for their capacity to provide high quality reproductive health care for very poor women who are trying to control their fertility. Among other advantages, MR programs serve as an entry point for many women to contraceptive services and to maternal health care. The place of menstrual regulation in Bangladesh is reviewed, beginning with a survey of the procedure's history, legal basis, traditional background, then an account of training and service delivery in Bangladesh. Menstrual regulation (MR) can have a place in societies that have the concept of bringing on the delayed period with traditional treatment, as in the Bengali term "washing out the uterus." Similarly, MR may be legal where abortion is only forbidden after pregnancy is confirmed. 3 programs of MR training and service have been introduced in Bangladesh: the Menstrual Regulation Training and Service Program begun by the Pathfinder Fund in 1978, now a quasi-governmental institution based in hospitals; the Mohammedpur Fertility Service and Training Center or Model Clinic, a comprehensive family planning agency; and the Bangladesh Women's Health Coalition, a nongovernmental feminist organization training only female family welfare visitors. Approximately 3000 physicians and 2600 female welfare visitors have been trained since 1976. 70,000 procedures are reported yearly, or 400,000 MRs since July 1975. The number of informally trained operators is unknown, and the actual number of MRs is estimated to be about 240,000 annually. Most clients are married, uneducated, kept in seclusion. Unmarried, widowed, divorced or abandoned women, called "social cases" are treated with special sympathy since abortion is illegal and pregnancy for them is severely stigmatized. The complication rate for the hand-held suction MR is extremely low, especially considering the field conditions that often exist. Complications are minimized by rejecting about 30% of candidates, usually for advanced pregnancy. As a postcoital method, MR has the advantage of providing an excellent entry into family planning and other health care services.
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