Selina lives in Shewrapara, Mirpur with her husband and two-year-old son. After the birth of her first child, her menstruation became irregular. The next time she conceived, she was unaware of her pregnancy. When Selina went for a pregnancy test to a nearby Surjer Hasi clinic, it was already too late. The pathologist said she was positive and suggested she go for an abortion. He gave her a visiting card of a woman who performed late-term abortions. But Selina was not ready for it.
Just like Selina, Rita (not her real name) also received the visiting card from the pathologist at the same clinic. The unmarried 32-year-old only realised her pregnancy after four months due to irregular menstruation, even though she had experienced this since adolescence.
She took the visiting card from the pathologist and went to the prescribed woman. The person she found was by no means a professional physician; locals said the nurse had worked at a clinic and then started the abortion business around seven years ago.
Rita went through a two hour-long abortion process, but her problems did not end with it. Her menstruation did not stop for next three months and when she consulted a doctor, Rita was told that due to the unsafe abortion, she would not be able to conceive again in her life.
Another spine-shivering example of the condition of the maternal health sector has been found in the country. An unwanted pregnancy took Meena, around 17 years old, to a traditional birth attendant recently. As a treatment, the attendant inserted a herbal tree into her uterus which resulted into severe pain and heavy bleeding. Later Meena was cured by consulting a doctor who treated all her complications which resulted from that unsafe abortion.
Unsafe menstruation regulation (MR) and abortion are accelerating the maternal mortality rate in the country. Statistics show an estimated 572,000 women suffer from complications arising from unsafe abortion every year. Health experts say couples should be aware of family planning methods to avoid unwanted pregnancy. Such awareness can help decrease the rates of MR and abortion in the society.
The actual number of abortion-related deaths remains under a cloud as the statistics exclude the number of the fatalities resulting from a lack of proper medical and technological facilities, experts say.
In Dhaka, there are at least 2,000 unregistered places where late abortions are performed and in many cases, these procedures are undertaken by traditional birth attendants or nurses. Abortion is legal in Bangladesh only when it is essential to save the mother’s life. Yet, a procedure the government terms “menstrual regulation,” which involves vacuum aspiration to bring on menstruation and thereby establish non-pregnancy is legal in the first trimester (three months).
Despite the legal provision, unsafe abortion continues to take place, especially in cases where girls become pregnant before marriage. Many girls turning pregnant before 18 lack knowledge of reproductive health and how to access medical services, so they try to escape the situation by opting for unsafe procedures, despite the risks to their chances of conceiving in future.
Investigations have found that pathologists who provide expectant mothers with contact details of the unprofessional abortionists often belong to reputed clinics like Surjer hashi, Mother Care etc, and that these clinicians receive commissions from the abortionists in addition to the clients.
In Shyamoli, there are over 20 places where the illegal procedures are carried out. Usually, the owners of the business rent a house portraying themselves as a family. It has been found that they have connections with many government and private clinics that provide them with clients. Usually they charge Tk500 to Tk10,000 per abortion; the rate varies depending on the financial ability and social status of the client. The clinic officials who refer the cases receive at least 20% commission from each.
Wishing not to be named, a senior officer of Marie Stopes Society, said: “Every day many girls come to us for late abortions but we do not do it. We facilitate safe MR within 10 weeks from conception. So people go to unsafe places as our law does not permit abortion after 10 weeks of conception. There is an exception only if the mother is suffering from some kind of physical complications. So the whole system is responsible for the establishment of these illegal abortion centres as well.”
Syed Mohammad Sarif, director of Child and Mother Care under the Department of Family Planning, said: “We have assigned responsible people at every post who are accountable for their acts, but they never monitor the overall situation.”
“We know that our nurses help to do abortions, many staffs including pathologists provide the addresses where one can go for abortion. But we do nothing. If we can penalise them through transparent trials the situation may improve,” he added.
Director General of Health Service Dr Khandhakar Md Shefayatullah said: “We are continuing our campaign to make couples aware of reproductive health and procedure and providing them with safe MR services if they want to avail that. But when it is matter of abortion, we do not operate that.”
“Abortion is a very sensitive procedure whether you do it within the time or after that,” he added.