Menstrual regulation unsafe abortion and maternal health in Bangladesh.

Maternal mortality has declined considerably in Bangladesh over the past few decades. Some of that decline--though precisely how much cannot be quantified--is likely attributable to the countrys menstrual regulation programwhich allows women to establish nonpregnancy safely after a missed period and thus avoid recourse to unsafe abortion. Key Points. (1) Unsafe clandestine abortion persists in Bangladesh. In 2010 some 231000 led to complications that were treated at health facilities but another 341000 cases were not. In all 572000 unsafe procedures led to complications that year. (2) Recourse to unsafe abortion can be avoided by use of the safe government sanctioned service of menstrual regulation (MR)--establishing nonpregnancy after a missed period most often using manual vacuum aspiration. In 2010 an estimated 653000 women obtained MRs a rate of 18 per 1000 women of reproductive age. (3) The rate at which MRs result in complications that are treated in facilities is one-third that of the complications of induced abortions--120 per 1000 MRs vs. 357 per 1000 induced abortions. (4) There is room for improvement in MR service provision however. In 2010 43% of the facilities that could potentially offer it did not. Moreover one-third of rural primary health care facilities did not provide the service. These are staffed by Family Welfare Visitors recognized to be the backbone of the MR program. In addition one-quarter of all MR clients were denied the procedure. (5) To assure that trends toward lower abortion-related morbidity and mortality continue women need expanded access to the means of averting unsafe abortion. To that end the government needs to address barriers to widespread safe MR services including womens limited knowledge of their availability the reasons why facilities do not provide MRs or reject women who seek one and the often poor quality of care.