Auliya Khatun, 40, of Village Chandangatti, Union Daulatpur, at her home

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“My spouse was supportive and he gave me the freedom to come to this decision myself”

Auliya Khatun decided to undergo menstrual regulation when she found out that she had unintentionally become pregnant again.

Menstrual regulation, the method of establishing non-pregnancy for a woman at risk of unintended pregnancy, has been a part of Bangladesh’s family planning program since 1979. It is allowed up to 10 –12 weeks after a woman’s last menstrual period.

Auliya Khatun, a mother of three children, was 40 years old when she found out that she had unintentionally become pregnant again.

Khatun says she had heard about family planning services and menstrual regulation services available at the Upzila Health Complex from other women in her small village. 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,” Khatun says.

“If this service was not available then I would have carried on with the pregnancy. It would have been embarrassing, though,” she explains. “It is embarrassing to have another child at this age.”

Khatun, who sometimes assists her husband with work in a local handloom, also cited the financial burden another child would have on her family.

“We are facing financial difficulty so it is not possible to have another child.”

Khatun says she only experienced mild gastric discomfort after the procedure but felt assured about her recovery due to being able to check-in with doctors at the local health centre. The access to the services and doctors, she says, was a major factor in a smooth and easy recovery.

“Since this service was in a government facility I could prevail [through] this and survive,” she says. “It is an important service.”

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

In times of humanitarian crises and disasters, the inability to access health care during floods can have serious repercussions on the local community.

As part of their Innovation Programme project, our South Asia office in collaboration with the University of Leicester and the Government of Bangladesh provides reproductive health kits to health centres located in areas most prone to seasonal flooding. Known as 'Kit 8' it contains three months’ worth of medicine and equipment for the management of miscarriage and complications of abortion and menstrual regulation in emergency situations, essential to minimize associated morbidity and mortality. Medical staff are trained to administer procedures and provide post-procedure care.

While abortion is considered illegal in Bangladesh, menstrual regulation, which has been a part of the country’s family planning program since 1979, is allowed up to 10–12 weeks after a woman’s last menstrual period.

Photography © IPPF/Victoria Milko

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.

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.

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.”

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.

Poly, 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.”

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.

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country

Bangladesh

Subject

Emergencies

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country

Bangladesh

Subject

Emergencies