title: Utilization of mobile phones for accessing menstrual regulation services among low-income women in Bangladesh: a qualitative analysis.
abstract: BACKGROUND
  As many as one-third of all pregnancies in Bangladesh are unplanned, with nearly one-half of these pregnancies ending in either menstrual regulation (MR) or illegal clandestine abortion. Although MR is provided free of charge, or at a nominal cost, through the public sector and various non-profits organizations, many women face barriers in accessing safe, affordable MR and post-MR care. Mobile health (mHealth) services present a promising platform for increasing access to MR among low-income women at risk for clandestine abortion. We sought to investigate the knowledge, attitudes and practices regarding mHealth of both MR clients and formal and informal sexual and reproductive healthcare providers in urban and rural low-income settlements in Bangladesh.
  
  
  METHODS
  A total of 58 interviews were conducted with MR clients, formal MR providers, and informal MR providers in four low-income settlements in the Dhaka and Sylhet districts of Bangladesh. Interview data was coded and qualitatively analysed for themes using standard qualitative research practices.
  
  
  RESULTS
  Our findings suggest that low-income MR clients in Bangladesh have an inadequate understanding of how to use their mobile phones to obtain health service information or counselling related to MR, and correspondingly low levels of formal or informal mHealth service utilization. Few were aware of any formal mHealth services in place in their communities, despite the fact that providers stated that hotlines were available. Overall, MR clients expressed positive opinions of mHealth services as a means of improving women's access to affordable and timely MR. Formal and informal MR providers believed that mobile phones had benefits with respect to information dissemination and making appointments, but emphasized the necessity of in-person consultations for effective sexual and reproductive healthcare.
  
  
  CONCLUSIONS
  We report low utilization yet high acceptability of mHealth services among low-income MR clients in Bangladesh. Expanding formal and informal mHealth services targeted towards MR - and increasing publicity of these services in low-income communities - may help increase timely access to accurate MR information and formal providers among women at risk for clandestine abortion. While expanding formal and informal mHealth services for SRHR in Bangladesh may be useful in disseminating information about MR and connecting women with formal providers, in-person visits remain necessary for adequate treatment.
authors.affiliation: Yale College, Yale University, New Haven, CT, USA.|James P Grant School of Public Health, BRAC University, 5th Floor, (Level-6), icddr,b Building, 68 ShahidTajudin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh.|Present Address: Harvard Medical School, Boston, MA, 02115, USA.
authors.forename: Chelsea Jordan
authors.initials: CJ
authors.lastname: Messinger
authors.affiliation: James P Grant School of Public Health, BRAC University, 5th Floor, (Level-6), icddr,b Building, 68 ShahidTajudin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh. imahmudot@gmail.com.
authors.forename: Ilias
authors.identifier: http://orcid.org/0000-0003-1330-7813
authors.initials: I
authors.lastname: Mahmud
authors.affiliation: James P Grant School of Public Health, BRAC University, 5th Floor, (Level-6), icddr,b Building, 68 ShahidTajudin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh.
authors.forename: Sushama
authors.initials: S
authors.lastname: Kanan
authors.affiliation: James P Grant School of Public Health, BRAC University, 5th Floor, (Level-6), icddr,b Building, 68 ShahidTajudin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh.
authors.forename: Yamin Tauseef
authors.initials: YT
authors.lastname: Jahangir
authors.affiliation: James P Grant School of Public Health, BRAC University, 5th Floor, (Level-6), icddr,b Building, 68 ShahidTajudin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh.
authors.forename: Malabika
authors.initials: M
authors.lastname: Sarker
authors.affiliation: James P Grant School of Public Health, BRAC University, 5th Floor, (Level-6), icddr,b Building, 68 ShahidTajudin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh.
authors.forename: Sabina Faiz
authors.initials: SF
authors.lastname: Rashid
mesh_terms: D000293:Adolescent; D000328:Adult; D001459:Bangladesh; D040421:Cell Phone / Q000706:statistics & numerical data*; D003153:Community Health Services; D003267:Contraception / Q000523:psychology*; D005193:Family Planning Services / Q000379:methods*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D008427:Maternal Health Services; D008598:Menstruation; D011203:Poverty; D011247:Pregnancy; D036301:Qualitative Research; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Abortion; Bangladesh; Community health services; Family planning; Low-income population; Maternal health; Menstrual regulation; Reproductive health; mHealth