title: 'How shall we survive': a qualitative study of women's experiences following denial of menstrual regulation (MR) services in Bangladesh.
abstract: BACKGROUND
  About one quarter of women in Bangladesh are denied menstrual regulation (MR) due to advanced gestation [J Fam Plann Reprod Health Care 41(3):161-163, 2015, Issues Brief (Alan Guttmacher Inst) (3):1-8, 2012]. Little is known about barriers to MR services, and whether women denied MR seek abortion elsewhere, self-induce, or continue the pregnancy.
  
  
  METHODS
  After obtaining authorization from four health facilities in Bangladesh, we recruited eligible and interested women in to the study and requested informed consent for study participation. We conducted in-depth interviews with 20 women denied MR from four facilities in four districts in Bangladesh. Interviews were translated and transcribed, and the transcripts were analyzed by two researchers through an iterative process using a qualitative content analysis approach.
  
  
  RESULTS
  Of those interviewed, 12 women sought abortion elsewhere and eight of these women were successful; four women who sought subsequent services were denied again. Two of the eight women who subsequently terminated their pregnancies suffered from complications. None of the participants were aware of the legal gestational limit for government-approved MR services. Given that all participants were initially denied services because they were beyond the legal gestational limit for MR and there were no reported risks to any of the mothers' health, we presume that the eight terminations performed subsequently were done illegally.
  
  
  CONCLUSIONS
  Barriers to seeking safe MR services need to be addressed to reduce utilization of potentially unsafe alternative abortion services and to improve women's health and well being in Bangladesh. Findings from this study indicate a need to raise awareness about legal MR services; provide information to women on where, how and when they can access these services; train more MR providers; improve the quality and safety of second trimester services; and strengthen campaigns to educate women about contraception and pregnancy risk throughout the reproductive lifespan to prevent unintended pregnancies.
authors.affiliation: Association for Prevention of Septic Abortion, Bangladesh (BAPSA), Dhaka, Bangladesh.
authors.forename: Altaf
authors.initials: A
authors.lastname: Hossain
authors.affiliation: Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
authors.forename: Heidi
authors.initials: H
authors.lastname: Moseson
authors.affiliation: Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, Oakland, CA, USA. Sarah.Raifman@ucsf.edu.
authors.forename: Sarah
authors.initials: S
authors.lastname: Raifman
authors.affiliation: Ibis Reproductive Health, Oakland, CA, USA.
authors.forename: Caitlin
authors.initials: C
authors.lastname: Gerdts
authors.affiliation: Ipas Bangladesh, Dhaka, Bangladesh.
authors.forename: Kamal Kanti
authors.initials: KK
authors.lastname: Biswas
authors.affiliation: Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, Oakland, CA, USA.
authors.forename: Diana Greene
authors.initials: DG
authors.lastname: Foster
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000627:therapeutic use; D000028:Abortion, Induced / Q000009:adverse effects / Q000331:legislation & jurisprudence*; D000328:Adult; D001459:Bangladesh / Q000453:epidemiology; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D016595:Misoprostol / Q000627:therapeutic use; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D036301:Qualitative Research; D016387:Women's Health
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol
keywords: Abortion; Bangladesh; Denial of abortion; Menstrual regulation; Second trimester