MR service in Bangladesh: Challenges and Solutions
Since abortion is illegal in Bangladesh except in emergency case of saving the mother’s life, menstrual regulation is securing the reproductive rights of the women in Bangladesh. Menstrual regulation (MR) is a service to reestablish the absent menstrual cycle of the women for short span. According to the Guttmacher Institute, an estimated 646,600 induced abortions were performed in Bangladesh in 2010, the majority of which were unsafe. In such case, menstrual regulation is playing vital role to save women’s life and reduce maternal death. On the observation of Global Day for Safe abortion on 28th September, Share-Net Bangladesh team has discussed about the starting of MR service in Bangladesh, major challenges and possible solutions with Quazi Suraiya Sultana, Executive Director, RHSTEP.
According to Guttmacher Institution, there has been decline in 47% of public and 80% of private facilities in 2014 in providing MR services since 2010. One group has dropped doing MR because they have reached the retirement age and others have made this choice for religious belief.
After the liberation war in 1971, many women went through physical and mental turmoil because of rape incidents. Many of them committed suicide, became lunatic, gave away their children or killed the babies. Considering this pathetic situation, the Health Ministry of Bangladesh took initiative to stop this. Some government bodies and doctors decided to end this horrific situation and help the women. Before that, no trained services were available. Since abortion is illegal, they decided to provide a unique service so that the women and the whole nation gets benefitted from it.
Decision was made to start MR service to save the mother’s life from the critical condition but very few trained doctors were available at government medical colleges. Immediately, the service system became popular because of the crying need. Everyday there used to be long queue of women. The service was free and the hospital environment was also favorable. For the increasing demand, the government decided to spread the training to the family welfare visitors and family welfare clinics. But in 1983, the donor stopped donating. In the same year, MTSP (Menstrual Regulation and Services Program) was started with many other health related services like RTI, STI, cervical cancer etc. After the decision of the government, MTSP was divided and RHSTEP emerged as the NGO working on reproductive health service for women.
Before introducing the MR service, people used to go the quack and they were not concerned about their health problems. After the availability of the service, many self-motivated clients used to visit the clinics. The clinics were clean, stuffs were well-behaved and doctors were well trained. But sometimes, the doctors used to deny doing MR for exceeding 10 weeks of pregnancy.
Being unable to get government service, many women go to untrained doctors and quacks which create the MR complications. Sometimes, money is fixed with the dealers for over-gestation period and since the women do it privately, the death is not recorded exactly.
Counselling is an integral part of performing MR. Three counsellors are available for providing pre and post counselling on MR service. Pre counselling is based on the process of MR and the consequences of this. Post counselling is also important since the women are asked to take one course of contraceptives and also to mitigate psychological reactions after the MR. Providing counselling service is mandatory for every organization. Sometimes doctors provide counselling while giving the service. They also empathize with the patients and make them to calm down.
Unintended pregnancy is related to the child marriage. Many parents marry their daughters off for various social reasons. The have the traditional believe that the spending after a girl is useless since she will leave the parent’s house and only the son will look after them in their old age. They also believe that the girl will face problem if she conceives late. Sometimes there are lots of financial reasons associated with early marriage. Reasons like sexual assault, eve teasing, abduction and other social demoralization work as catalyst for early marriage. Another major reason is, the boys like to marry the young girls so that they can dominate.
‘Early married girls conceive babies soon to secure the position in the in-law’s house. It is difficult to break the shackle of these in-depth reasons of child marriage’, says Miss Suraiya.
Another fact is that women are not the part of income generation. For this, they do not have any voice in the family. Sharing personal opinion, Miss Suraiya says, ‘Few days ago, we asked the parents to engage daughter in managing local grocery shop along with the son. Since everyone knows the girl in the community, it will be safe for her. At the same time, this will also empower the girls’. She extends her logic with the example of garments workers. Economic empowerment is reflected among the female garments workers. Though it is illegal, many girls below 18 join in the garments with poor salary. These girls establish status in their village home by sending money on each month. This also create a voice for them. This means, economic solvency can reduce most of the problems. It enables the girl to take active part in the family planning and other decision making also.
To get the expected outcome from the available MR services, men also needs to be engaged in the advocacy campaign since they play major role in the decision making in the family. If they are well informed about the MR services, they can give well instructions in the families. Training the service providers in the pharmacies is equally important. ‘When there will be equity and understanding between husband and wife, most of the problems on reproductive health along with MR can be easily solvable’ Miss Suraiya affirms.
Miss Suraiya firmly believes that maternal mortality is decreased because of the immense support of the government and NGOs also have lots of contribution in this.