Providing Menstrual Regulation and Post-abortion Care in an Acute Crisis

Location:

Introduction:

An eruption of violence triggered an exodus of refugees to Bangladesh. There were nearly 626,000 newly arrived refugees to Bangladesh in the 3 months since August 2017, joining about 400,000 that had arrived before that escalation. It is known that in crisis settings women face significant hardships when trying to prevent unintended pregnancy due to loss of livelihoods, assets, and family and social structures; disrupted access to contraception and other SRHSexual and reproductive health services; and increased risk of exploitation, sexual violence, and transactional sex. In February 2017, a report from the United Nations stated that more than half of the 101 refugee women interviewed by UNUnited Nations investigators across the border in Bangladesh said they had suffered rape or other forms of sexual violence at the hands of security forces.

Project Description:

Ipas-Bangladesh responded to a request from UNFPAUnited Nations Population Fund to establish menstrual regulation (MR)* and post-abortion care (PAC) services in 8 strategically located facilities serving refugees. The implementation rapidly included the following components: baseline assessment; partner and key stakeholder engagement; approval of the Bangladesh government; supply of medication and vacuum aspiration commodities available in the Ministry of Health (MOH) and MISPMinimum Initial Service Package procurement systems; supply of equipment for facility readiness; strengthening the capacity of health care providers; and strengthening of referral sites for severe complications of unsafe abortions. Capacity building and training strategies were developed to cause minimal disruption, if any to service provision. The duration of the formal trainings was adjusted and time was prioritized for practicum sessions on pelvic models and women seeking care to ensure adequate uptake of skill and knowledge of the procedures. The approaches to training and site strengthening addressed stigma, values and attitudes about MRMenstrual regulation through values clarification and attitude transformation (VCAT) exercises. Following the training, clinical trainers and project staff provided support to ensure sufficient logistic supply and support to newly trained providers to assess for competency and confidence with providing MRMenstrual regulation and PACPost-abortion care services.

Results:

A total of 51 service providers representing many cadres participated in initial trainings. Service providers were from the 8 initial sites as well as from other stakeholders offering service provision in and around the camps. In the first 3 months of service provision, 283 women and girls sought services, 75% MRMenstrual regulation and 25% PACPost-abortion care. The majority (60%) were managed with medications while 38% were managed with MVAManual vacuum aspiration. Fifty-seven percent received post-abortion contraception.

Lessons Learned:

Menstrual regulation and PACPost-abortion care were imperative during this crisis. When services were made available, women sought assistance, saving them from complications of unsafe abortions and potentially nonexistent or poor-quality PACPost-abortion care. This project shows that demand for these services existed among these refugees but could have been easily overlooked in this complex environment of competing priorities. Introducing these services as early as possible opens the door for women to begin to heal and discuss exposure to violence, contraception, and other SRHSexual and reproductive health issues important to them at a time when they face great challenges.

*MRMenstrual regulation 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.”