Health system costs of menstrual regulation and care for abortion complications in Bangladesh.
BACKGROUND
Treatment of complications of unsafe abortion can be a significant financial drain on health system resources, particularly in developing countries. In Bangladesh, menstrual regulation is provided by the government as a backup to contraception. The comparison of economic costs of providing menstrual regulation care with those of providing treatment of abortion complications has implications for policy in Bangladesh and internationally.


METHODS
Data on incremental costs of providing menstrual regulation and care for abortion complications were collected through surveys of providers at 21 public-sector facilities in Bangladesh. These data were entered into an abortion-oriented costing spreadsheet to estimate the health system costs of providing such services.


RESULTS
The incremental costs per case of providing menstrual regulation care in 2008 were 8-13% of those associated with treating severe abortion complications, depending on the level of care. An estimated 263,688 menstrual regulation procedures were provided at public-sector facilities in 2008, with incremental costs estimated at US$2.2 million, and 70,098 women were treated for abortion-related complications in such facilities, with incremental costs estimated at US$1.6 million.


CONCLUSIONS
The provision of menstrual regulation averts unsafe abortion and associated maternal morbidity and mortality, and on a per case basis, saves scarce health system resources. Increasing access to menstrual regulation would enable more women to obtain much-needed care and health system resources to be utilized more efficiently.
International Centre for Diarrhoeal Disease Research-Bangladesh, Dhaka, Bangladesh. heidibartjohnston@gmail.com
Heidi Bart
HB
Johnston
Elizabeth
E
Oliveras
Shamima
S
Akhter
Damian G
DG
Walker
D000028:Abortion, Induced / Q000009:adverse effects* / Q000191:economics; D001459:Bangladesh; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D008597:Menstrual Cycle / Q000502:physiology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000191:economics / Q000517:prevention & control