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- W3122496486 abstract "Abstract Background: In Bangladesh, abortion is illegal except to save a woman’s life, though menstrual regulation (MR) is permitted. MR involves the use of manual uterine aspiration or Misoprostol (with or without Mifepristone) to induce menstruation up to 10-12 weeks from the last menstrual period. Despite the availability of safe and legal MR services, abortions occur outside of the legal system and are associated with high complication rates. Methods : Qualitative semi-structured interviews (SSIs) were conducted with 25 trained MR providers from urban tertiary care facilities in six different cities in Bangladesh. SSIs explored providers’ attitudes about the practice of unsanctioned MR/abortion providers and self-managed MR/abortion, their experiences treating patients who sought abortion services out-of-clinic, barriers/facilitators to safe MR/abortion, and MR/abortion definitions. Results : There were three predominant yet overlapping themes: (i) logistics of obtaining MR/PAC/abortion, (ii) provider attitudes, and (iii) overcoming barriers to safe MR. Lack of consensus among trained providers revealed challenges for defining MR/abortion and gestational age cutoffs. Increasing post-abortion care (PAC) services may be due to patients purchasing Mifepristone/Misoprostol from pharmacists who do not provide adequate instruction, or patients may be directed to untrained providers by brokers, who intercept patients entering the hospitals/clinics and receive a commission from unsanctioned clinics for bringing patients. Perceived barriers to accessing in-clinic MR include distance, family influence, brokers, lack of knowledge, and provider attitudes toward MR. Conclusions : Providers in urban tertiary care facilities in Bangladesh see primarily the complicated MR/PAC cases, and the safety of out-of-clinic/self-managed abortion is unknown. Lack of standardization among providers of MR definition/gestational age cutoffs may affect patient care and MR access. MR safety may be improved by eliminating brokers. A harm reduction approach to improve MR/abortion care provided by pharmacies may improve safety and access. Policy makers should consider increasing training of frontline health workers, such as Family Welfare Visitors (FWVs) to provide evidence-based information about Mifepristone/Misoprostol." @default.
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- W3122496486 date "2020-08-20" @default.
- W3122496486 modified "2023-10-16" @default.
- W3122496486 title "Out-of-clinic and self-managed abortion in Bangladesh: a qualitative study of menstrual regulation providers" @default.
- W3122496486 doi "https://doi.org/10.21203/rs.3.rs-44841/v1" @default.
- W3122496486 hasPublicationYear "2020" @default.
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