Ensuring women and girls receive healthcare during humanitarian crises in Bangladesh

Ms. Lovely Yasmin, 51, Nurse Supervisor at Upzila Health Complex Belkuchi, Sirajgunj

In Bangladesh menstrual regulation, the method of establishing non-pregnancy for a woman at risk of unintended pregnancy, has been a part of the country’s family planning program since 1979 and is allowed up to 10 –12 weeks after a woman’s last menstrual period. There are no legal restrictions on providing post-abortion care.

Dhukuriabera Family Health & Welfare Centre is prone to flooding during rainy season in Bangladesh. The watermarks on the walls of the clinic from last year’s flood almost reach the ceiling, and serve as a reminder of the extreme circumstances staff at the centre face in providing vital healthcare during a humanitarian crisis.

“Our office was flooded. We had to stand on chairs,” says Salma Parvin, a staff member of the centre, pointing to mildew marks on the walls. “Very few patients came to access services.”

“During floods there are lots of challenges,” says Dr. Laila Arjumand Banu at the Belkuchi Upzila Health & Family Planning Complex.  “People get stuck and may forget to use the normal family planning methods.”

The inability to access medical centres during floods can have other repercussions.

“[When there are floods] clients sometimes have a procedure done by a village provider and thereafter come to us with complications,” says nursing supervisor Lovely Yasmin. “And then we have to provide services with [medical equipment] that we don’t have.”

As part of their Innovation Programme project, IPPF’s South Asia office has begun distributing UNFPA’s reproductive health kit 8 in strategic locations most prone to seasonal flooding. Kit 8 contains three months’ worth of medicine and equipment for the management of miscarriage and complications of unsafe abortion in emergency situations, essential to minimize associated morbidity and mortality.

“I find the kits very useful,” says nurse Lipara Khatun. “Patients will benefit as they can avail these services closer to home and not have to come all the way to centres.”

Small scale innovation in Bangladesh during times of crisis: ensuring reproductive care to local communities

  • IPPF’s Innovation Programme supports small scale initiatives, which test new ways to tackle the biggest challenges in sexual and reproductive health and rights. Those challenges presented themselves in the region of Beluchi in Bangladesh where heavy flooding submerged local communities and roads under water.
    IPPF’s Innovation Programme supports small scale initiatives, which test new ways to tackle the biggest challenges in sexual and reproductive health and rights. Those challenges presented themselves in the region of Beluchi in Bangladesh where heavy flooding submerged local communities and roads under water.
  • The region of Belkuchi is very rural made up of agricultural land, which is prone to flooding in the monsoon season.
    The region of Belkuchi is very rural made up of agricultural land, which is prone to flooding in the monsoon season.
  • As part of their Innovation Programme project, our South Asia office provides reproductive health kits to health centres located in areas most prone to seasonal flooding.
    As part of their Innovation Programme project, our South Asia office provides reproductive health kits to health centres located in areas most prone to seasonal flooding.
  • Dkukuriabera Health and Family Welfare Centre experienced heavy flooding during the rainy season causing water damage to the building.
    Dkukuriabera Health and Family Welfare Centre experienced heavy flooding during the rainy season causing water damage to the building.
  • Kohinoor Begum, who has worked at the Daulatpur Family Health and Welfare Center for 18 years, says the seasonal flooding often means trouble for those seeking medical services.   “During floods roads are blocked and so people have to use boats to reach the nearest usable road,” Begum says. “I have to visit homes of clients and clients, but during floods I cannot visit them and most people also cannot visit the centre. In such scenarios a miscarriage can sometimes happen.”
    Kohinoor Begum, who has worked at the Daulatpur Family Health and Welfare Center for 18 years, says the seasonal flooding often means trouble for those seeking medical services. “During floods roads are blocked and so people have to use boats to reach the nearest usable road,” Begum says. “I have to visit homes of clients and clients, but during floods I cannot visit them and most people also cannot visit the centre. In such scenarios a miscarriage can sometimes happen.”
  • Mr. Binoy Kumar Sarkar, Ms. Salma Parvin and Ms. Khadija Khatun, say that around 20 villages and 100,000 people are covered by the facility. Recent flooding had a huge impact on the services and local community.  “We had to stand on chairs. Very few patients came to access services.”
    Mr. Binoy Kumar Sarkar, Ms. Salma Parvin and Ms. Khadija Khatun, say that around 20 villages and 100,000 people are covered by the facility. Recent flooding had a huge impact on the services and local community. “We had to stand on chairs. Very few patients came to access services.”
  • When Shana, 34, a mother of three, became pregnant again felt very weak and experienced heavy bleeding. To avoid medical complications, Shana decided to undergo menstrual regulation.   “But if the hospital and services weren’t there then I would have had to have continued with my pregnancy, even when not wanting another child” she says.   Although Shana had talked with women about various family planning methods, she didn’t feel she could talk with anyone aside from her husband about getting the procedure.
    When Shana, 34, a mother of three, became pregnant again felt very weak and experienced heavy bleeding. To avoid medical complications, Shana decided to undergo menstrual regulation. “But if the hospital and services weren’t there then I would have had to have continued with my pregnancy, even when not wanting another child” she says. Although Shana had talked with women about various family planning methods, she didn’t feel she could talk with anyone aside from her husband about getting the procedure.
  • oly, 32, explains how six months ago her period stopped. Assuming she was pregnant she showed no other symptoms or physical changes.    “My husband, father, and mother-in-law thought that my pregnancy had been eaten by a bad spirit,” Khatun says. “But when I came to the hospital the [doctor] found that I was only 3 weeks pregnant.”   Concerned about health complications she decided to undergo menstrual regulation.
    oly, 32, explains how six months ago her period stopped. Assuming she was pregnant she showed no other symptoms or physical changes. “My husband, father, and mother-in-law thought that my pregnancy had been eaten by a bad spirit,” Khatun says. “But when I came to the hospital the [doctor] found that I was only 3 weeks pregnant.” Concerned about health complications she decided to undergo menstrual regulation.
  • Nurse, Lipara Khatun, has worked in Belkuchi Upzila Health and Family Planning Centre for 19 years. Recently she received training on the provision of menstrual regulation services.   “I had done the procedures before but lacked courage and confidence,” she says. “After the training I gained courage, confidence and now I feel more efficient with the procedure. Now I have lot of satisfaction that I can do the job better and can apply the knowledge received during training.”
    Nurse, Lipara Khatun, has worked in Belkuchi Upzila Health and Family Planning Centre for 19 years. Recently she received training on the provision of menstrual regulation services. “I had done the procedures before but lacked courage and confidence,” she says. “After the training I gained courage, confidence and now I feel more efficient with the procedure. Now I have lot of satisfaction that I can do the job better and can apply the knowledge received during training.”
  • Auliya, 40, has three grown up children. When Auliya found out that she was pregnant she discussed the option of undergoing menstrual regulation with her husband.   “My spouse was supportive and he gave me the freedom to come to this decision myself,” she says. “If this service was not available then I would have carried on with the pregnancy. It would have been embarrassing, though, to have another child at this age.”
    Auliya, 40, has three grown up children. When Auliya found out that she was pregnant she discussed the option of undergoing menstrual regulation with her husband. “My spouse was supportive and he gave me the freedom to come to this decision myself,” she says. “If this service was not available then I would have carried on with the pregnancy. It would have been embarrassing, though, to have another child at this age.”
  • Nursing Supervisor Ms. Lovely Yasmin is one of several staff members providing family planning, menstrual regulation, and post-procedure care services at Upzila Health Complex in Belkuchi. She has been a nurse practitioner for 16 years. “Before this training we used to sometimes advise people on such services and provided menstrual regulation but after the training I’ve become confident and efficient in providing services,” she says.
    Nursing Supervisor Ms. Lovely Yasmin is one of several staff members providing family planning, menstrual regulation, and post-procedure care services at Upzila Health Complex in Belkuchi. She has been a nurse practitioner for 16 years. “Before this training we used to sometimes advise people on such services and provided menstrual regulation but after the training I’ve become confident and efficient in providing services,” she says.

At her home in the village of Charmokimpur, Bijli Khatun, 32, explains how flooding was just one of many challenges her unplanned pregnancy presented. “One of [my] children is disabled and so the fear of possibly another disabled child was scary,” Bijli Khatun says. “And during the pregnancy I felt a lot of pain in my stomach and decided to get menstrual regulation.”

Bijli Khatun’s husband had heard about menstrual regulation services at the local health centre. Bijli decided she would undergo the procedure, but soon realized she would face some issues.

“The area surrounding my house was submerged in water,” she explains. “With great difficulty I went to the centre and it was closed that day so I had to come back and once the water receded then I went to the centre again and got a menstrual regulation procedure done.”

Even with legal validity, social stigma is another factor women have to consider. “Women who come are hesitant and do not share their health problem easily,” says nurse Lovely Yasmin. “They expect complete confidentiality… as people are religious and [the woman] might have problems at home or in her locality.”

The programme also provides vital post-procedure care –most commonly pain relief- of which many women who undergo menstrual regulation, would be unable to afford themselves. Shana Khatun, 34 says “After the menstrual regulation services the hospital gave me a number of medicines I could take, I was also prescribed a few medicines which I could not buy due to [my] poor financial condition.”

Shubhutara Khatun is another client. She’s 32 and a mother of four, and decided to undergo menstrual regulation services after finding out she was pregnant again.

“Even though I have [undergone] menstrual regulation I would not want to tell others,” she says. “They will feel I have sinned and they will insult me.”

Several of the women feared being identified by the community, saying they would face a backlash due to conservative religious beliefs held in the region.

Shana Khatun says she found the hospital trustworthy and helpful. “I will be very cautious that I should not get pregnant again,” she says. “However in the event I get pregnant again, then I will come to this hospital only.”

IPPF’s Innovation Programme supports small scale initiatives, which test new ways to tackle the biggest challenges in sexual and reproductive health and rights. Each project is partnered with a research organization to ensure their impact is measured and learning shared to improve the efficacy and evidence-base of our programming.