Menstrual Regulation and Post Abortion Care Challenges during Flood: Evidence from Belkuchi, Bangladesh

Background: Menstrual regulation and post abortion care services are family planning methods used in Bangladesh. There are a plethora of studies that have addressed the challenges related to the quality of and access to menstrual regulation and post abortion care services in Bangladesh. Nevertheless, there is no research that specifically seeks to redress quality and access issues in flood-prone locales of Bangladesh by integrating the views of women (clients/potential clients) and service providers. This research aims to fill this gap. Methods: After the 2016 floods in Belkuchi Upazila, 370 surveys were conducted with women from January to February of 2017. All the respondents had received menstrual regulation and post abortion care services during the floods in 2016. Six designated menstrual regulation and post abortion care public facilities were also assessed using structured assessment tool, prior to the floods of 2016. The facilities included five Union Health and Family Welfare Centers and Belkuchi Upazila Health Complex. One Resident Medical Officer, five Sub-Assistant Community Medical Officers and four Family Welfare Visitors were also consulted for the assessment. Results: It was found that the outcome of their most recent pregnancy was 53% selfdiagnosed 'spontaneous abortion' and 47% menstrual regulation. Only 66 respondents (18%) shared their health-related information. 23% experienced complications for which the majority received health care. It was found the Belkuchi Upazila Health Complex is well equipped for menstrual regulation and post abortion care services. All the five Union Health and Family Welfare Centers were under-equipped and understaffed for menstrual regulation services before, during and after floods. As such, the utilisation rates of these facilities were low. Conclusions: More ethnographic research is required to address the low response rates of women sharing information on menstrual regulation and post abortion care experiences. A number of measures are also suggested as how to improve policy and practise in Belkuchi and beyond in order to build the capacity of reproductive health facilities in disaster or vulnerability contexts.