Population Council Research that makes a difference

Even with increased use of family planning methods in Bangladesh, menstrual regulation (MR) also is increasing. Roughly one-third of Bangladesh's four million pregnancies each year are unplanned or unwanted (NIPORT, Mitra and Associates, and Macro International 2009). The Ministry of Health and Family Welfare, through its nationwide infrastructure and NGO clinics, provides manual vacuum aspiration (MVA) for MR. Even the lowest-level government facilities (e.g., Union Health and Family Welfare Centers) are well equipped to offer MVA.

Current use of MVA for MR can lead to infection, including perforation of the uterus, and can result in incomplete MR. Service statistics from Marie Stopes Bangladesh, Bangladesh Association for Prevention of Septic Abortion, and Reproductive Health Services Training and Education Program (RHSTEP) reveal that 25 percent, 48 percent, and 29 percent of their respective clients report complications related to MR and require  post-MR care (personal communication). Between 30 and 50 percent of MR clients nationwide experience post-MR complications as the result of the services being performed by untrained providers in unhygienic conditions, which increases the risk of maternal morbidity and mortality (NIPORT, Mitra and Associates, and Macro International 2009).

The use of a combination regimen (mifepristone and misoprostol) for MR (menstrual regulation with medication, or MRM) is safer and more effective than MVA (WHO 2006).  A study using mifepristone and misoprostol for MR suggests that 94 percent of women in the clinic setting and 91 percent in the community setting had complete MR with no serious complications (Alam et al. 2009).

In collaboration with the Bangladesh Directorate General of Family Planning and Marie Stopes Bangladesh (MSB) and with funding from the World Health Organization, Council researchers are undertaking an operations research study to test the feasibility of introducing and the acceptability of a combined regimen of mifepristone and misoprostol for MR in government and NGO health facilities.

Twelve government and two MSB health facilities from eight districts (4 urban and 4 rural) in Dhaka division are participating. The government and MSB health facilities are providing MRM. In addition, the MSB facilities are providing clinical support through a round-the-clock call service, as they already have experience in providing MRM using a different regimen (misoprostol only).  

All women presenting for MR will be offered a choice between MVA or MRM. The study will establish links between policymakers, researchers, and program implementers to assess the challenges faced in the introduction of MRM, the acceptability of MRM to providers and users compared with MVA. Evidence generated will be used to make informed decisions for national policy and programmatic change.