A situation analysis of the menstrual regulation programme in Bangladesh

Menstrual regulation (MR) using vacuum aspiration is widely available in Bangladesh through public, NGO and private sector facilities, even though abortion is illegal except to save a woman's life. For more than two decades the MR programme was run as a vertical programme. In 1998 the Government of Bangladesh introduced the Health and Population Sector Programme (HPSP) incorporating menstrual regulation into the essential services package. This paper reports a situation analysis of the MR Programme under the HPSP, using the World Health Organization rapid evaluation methodology. In spite of wide availability, barriers such as distance to health facilities and transportation costs, unofficial fees, lack of privacy, confidentiality and cleanliness in public health facilities, and in some cases attitudes of service providers, are limiting access to MR services. Quality of care is compromised by inadequacies in infection control and in provider training and counselling. Health system weaknesses include gross under-reporting of cases by providers who do not wish to share unofficial fees, which affects monitoring and adequate provision of supplies. The HPSP has caused uncertainty regarding supervision in public sector facilities, and adversely affected training by NGOs and government-NGO coordination. Services in part of the NGO sector have also been affected by funding changes. To make the programme as a whole more effective, all these issues have to be addressed.