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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. 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, Bangladesh. “Before this training we used to sometimes advise people on such services and provided menstrual regulation (MR) services but after the training I’ve have become and confident and efficient in providing MR services,” she says. “Earlier there could possibly have been mistake but now I can provide MR services efficiently and perfectly. I can now provide MR services in more organized manner.” But while Yasmin, who has worked in family planning for 16 years, says that the recent training has increased her confidence in properly doing MR procedures, the health complex still lacks basic supplies. “There were difficulties due to limited equipment,” she says. “We sometimes have to use personal equipment.” But, she says, the presence of Kit 8 has made life easier. “Prior to this kit, many clients did not complete the full course of medical as advices due to financial issues… during floods there are many hardships including financial difficulty,” she says. “However with this kit, most of the medicines are provided and clients are easily managing on their own.”

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. When Shana Khatun, a mother of three, became pregnant again she says she began to feel very weak and had issues with massive bleeding.Citing her age and the possibility of further medical complications, Khatun decided to undergo a menstrual regulation procedure. “But if the hospital and services weren’t there then I would have had to have continued with my pregnancy, even when (I do) not want another child” she says. Khatun says that the procedure went well, but that without the presence of medicine found in Kit 8 she would have lacked post-operation medicine. “After the menstrual regulations services I was prescribed a few medicines which I could not buy due to poor financial condition,” she says. “But the hospital gave me a number of medicines that I could take.” And while Khatun 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. “I feared they would treat me poorly (the hospital),” she says. But Kahtun says she found the hospital trustworthy and helpful, even when she was suffering complications such as mass bleeding. “I will be very cautious that I should not get pregnant again however in event if I get pregnant again then I will come to this hospital only,” she says.

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.”  

Julie was a midwife with the Ministry of Health for 20 years before she joined the Vanuatu Family Health Association (VFHA) as nurse and project manager for IPPF's SPRINT Initiative response in Vanuatu. When Cyclone Pam hit Vanuatu, the SPRINT Initiative and VHFA started providing life-saving services to the Island, Tanna, which was the population worst affected by the typhoon. Many communities there live remotely, in grass huts, with no immediate access to medical care.  Julie was there with the VFHA team. “When I first came here we used the kitchen to operate from. On my second trip, we created a clinic in our youth centre, and used the nearby health post for clinical procedures. Soon we saw more patients pouring in, which created a huge demand for space." Health conditions are very low. Even before the cyclone hit the island, it was reported that the average mother loses two pregnancies each, in her lifetime. Every person in the village knows at least one mother who has died during child birth. Access and knowledge to family planning is overlooked as traditional practices are used first. As Julie explains, advocating about family planning is a challenge in the area, also for language barriers. “Talking about birth-spacing and talking in the regional dialect of Tanna is a problem. Most of us in Vanuatu speak Bislama, but people here in Tanna aren’t well versed with it. However, we try our level best with all possible methods including sign language and demos to impart knowledge about family planning.” Family planning services are just a part of the IPPF-SPRINT Cyclone Pam response, that also included general health check-up, counselling and awareness about Sexual and Gender Based Violence, maternal care and awareness and prevention of HIV and Sexually Transmitted Infections (STI).