It was Saima (pseudonym) and her husband’s first visit to a gynaecologist in Mohammadpur following an unwanted pregnancy of eight weeks.
The couple – both service holders – visited the chamber of an associate professor at a top-class hospital to seek service just ahead of Eid-ul-Fitr.
“You may opt for a surgical menstrual regulation which will cost around Tk25,000 at my hospital. But this hospital is closing in a day for Eid. So, if you prefer it somewhere else now, I can manage to get it done within Tk15,000,” the woman said, quoting the doctor.
The couple took the service, secretly, as a package at a hospital in Moghbazar under the supervision of the same doctor. It took only 10 minutes for the MR, and the patient had to wait for another 40 minutes for rest.
Usually, this hospital performs eight to ten MRs per month, alongside offering other gynaecological solutions, said a staff member of the hospital.
Abortion is illegal in Bangladesh, but menstrual regulation through surgery and medication gives women an option to terminate an unplanned pregnancy. A number of non-governmental organizations like Marie Stopes and RHSteps provide these services to terminate unplanned pregnancies.
The minimum cost for a surgical menstrual regulation (MR) service can be more than Tk2,000, but through medicines (MRM), it costs less than Tk300. An MR treatment can be advised for women up to 12 weeks after their last menstruation.
MR is a procedure that uses manual vacuum aspiration or a combination of mifepristone and misoprostol to “regulate the menstrual cycle when menstruation is absent for a short duration".
Md Shawkat Hossain, project manager of Marie Stopes Bangladesh, said that the number of MR and MRM provided to women was strictly confidential and his organization would not reveal data or information about the service recipients.
“From my experience, I can say that people in Bangladesh have less conservative views on abortion. Apart from Dhaka, most MR and MRM service takers are from Sylhet, Noakhali, and Chittagong,” he told Dhaka Tribune.
The highest cost of an MR can be up to Tk10,000 depending on the service providers, he said. On the other hand, the medicines for an MRM usually cost only Tk250-300.
Under the Penal Code of 1860, induced abortion in Bangladesh is permissible only to save a woman’s life. In all other circumstances, it is a criminal offence, punishable by imprisonment or fines.
Also Read - Age-old law restricts women’s right to abortion in Bangladesh
Menstrual regulation, defined as the procedure of regulating the menstrual cycle when menstruation is absent for a short duration, has been available free of charge under the government’s family planning program since 1979.
The Bangladesh National MR Service Guidelines specify that the written consent of the woman undergoing MR needs to be taken before the procedure. But before that, the woman has to go through a screening process.
According to Shawkat Hossain, around 20 companies produce medicines needed for MRM in Bangladesh, and a woman should go through the process under the guidance of a doctor or trained healthcare provider.
Khaleda Yasmin, national coordinator of Family Planning-Field Services Delivery (FP- FSD) at the Directorate General of Family Planning (DGFP), told Dhaka Tribune: "People in Bangladesh do not really have dogmatic views on abortion. However, a section of people opposes it due to religious reasons.
“The government provides support for terminating unplanned pregnancies through MR and MRM. The real problem is not conservative views on abortion, but a shortage of trained healthcare providers who can carry out MR and MRM."
The government medical college hospitals provide these services free of cost. The procedures are not very complicated and the recovery time is also fast.
DGFP has no data on abortions
There is no official statistics on abortions in Bangladesh as the DGFP does not keep a record of it.
According to The Guttmacher Institute, a pro-choice research organization in Germany, in 2014, an estimated 430,000 MR procedures were performed in health facilities across Bangladesh, representing a sharp 34% decline since 2010.
In 2014, 57% of MR procedures were performed in public facilities, down from 63% in 2010. The NGOs provided 35%, and private clinics provided 8% of the MR services.
Apart from Marie Stopes, several other NGOs and healthcare providers including RHSTEP, Ghashfool, Momota, and the Family Planning Association of Bangladesh provide MR and MRM services.