Law related to Abortion :
Legal status of Abortion in Bangladesh
Under the penal code of 1860, induced abortion is permitted in Bangladesh only to save the life of the mother. In 1972 the law was waived for women raped during the war of liberation. Abortions were performed in a few district hospitals under guidance of expert teams from Bangladesh, India, UK and USA. In 1976 the Bangladesh National Population Policy attempted to legalize first trimester abortion on board medical and social grounds, but legislative action was not taken and restrictive legislation remains in effect.
Nevertheless, a memorandum from the population control and family planning Division (PCFPD) states categorically that “Menstruation Regulation” (MR) is one of the methods used in the national Family planning program. The memorandum quotes a report from the institute of law (1979) to the effect that MR does not come under the provision of penal code section 312 in regard to abortion because pregnancy can not be established.
The Bangladesh Institute of Law report (1979) also mentioned the following:
Moreover, many Family Planning clinics are carrying out the post contraceptive method of “Menstrual Regulation “as a means of birth control which does not come under the section 312 of the penal code Under stativity scheme, pregnancy is an essential element of the crime of abortion, but the use of MR makes a virtually impossible for the prosecutor to meet the required proof. In our country menstrual regulation (MR) is being carried out till the tenth week following a missed menstrual period and after that patients are referred as abortion cases. MR is now recognized as an interim method of establishing non-pregnancy for the women who is at risk of being pregnant.
The Bangladesh government’s Family Planning Division circular states that MR is included in the official policy and that a necessary support for MR service and training will be provided by the division. Another government memorandum (1980) permits that MR can be performed by an MR trained register medical practitioner and by any FWV who has specific training in MR. It also specifies that an FWV should perform MR only up to eight weeks from the last menstrual period (LMP) under supervision of a physician. Any case with a longer duration must be referred to a trained Doctor. In many government supported clinics the procedure is performed by paramedics. The second five year plan released in 1980 envisaged that MR facilities would be provided through the family planning clinics, welfare centers, all health centers and hospitals.
The common practice is to induce abortion by inserting objects in the uterus or by performing vigorous physical exercise which leads to serious complications. These complications not only ar a burden to the women’s family but also drain scare medical resources. Many advocates making legally approved abortion services by trained personnel widely available in order to save many women’s lives.
Reproductive Health Perspective :
Signatory to ICPD, CEDAW: Yes / No, any conditions
Bangladesh has signed ICPD and CEDAW
Female workers have 4 months maternity leave.
Abortion Statistics :
Maternal mortality in Bangladesh is 3.9/1000 live birth. One fourth of these deaths are due to complication of induced abortion. It has been estimated that every year 8,00,000 abortions are being performed in the country and at least 8000 women are dieing from abortion related complications each year.
A survey of pregnancy-related deaths in 1978 estimated that 7,800 women died of complications of induced abortion, which accounted for about a quarter of all maternal deaths. A more recent study of maternal mortality in a rural area found an abortion ratio of 44,2 induced abortions per 1000 live births and a death to case rate of 2.4 % by applying this finding to the whole country, it was estimated that
Public sector :
Although the existing penal code prohibits termination of pregnancy except to save the life of the mother, legal interpretation allows menstrual regulation. This scope has been conveniently utilized by gradual introduction of MR mainly through training of female paramedics and the establishment of the services in the clinic. Presently MR services is widely available in most family Planning clinics. Government efforts to further expand MR facilities are, however, seriously jeopardize by restrictive funding politics of Donors particularly USAID.
Private sector :
Abortion service available widely in private sector.
Methods used :
Single and double valve syringe (MVA), Mifepristone, Misoprostol, De&C( Dilation evacuation and curettage.
Provider level allowed for surgical and medical abortion :
- MVA providers include doctor, assistant (obstetric-Pediatrics specialist), and secondary and college level Midwife who are trained in MVA and paramedics
- MA providers include obstetric and gynecological doctors who are trained in medical abortion. Not yet introduced in the country Lobbying is going on
- D&C providers include doctors obstetric-Pediatrics ,assistant doctors who are trained in D&C
- D&E providers include obstetric and gynecology doctors, nurses who are skilled in first trimester D&C and trained in D&E
Abortion related morbidity mortality statistics :
n spite of having the availability and access of abortion / MR Service both at private and public sectors Septic abortion is still one of the common reasons for maternal death. “The death of women while pregnant or within 42 days or termination of pregnancy irrespective of the duration or site of the pregnancy or its management, but not from accidental or incidental cause is a maternal death” Every year on an average 12,000 to 15,000 maternal deaths occurs due to pregnancy and delivery related complications. Following Pie chart highlights the major causes delivery related complications.
Manufacture and/or availability through import of abortion equipment (MVA syringes, EVA equipment) :
Manufacture/ import of Mifepristone, Misoprostol :
Informal / illegal providers – if present who are they :
In Bangladesh in remote rural areas, all abortions are induced by indigenous health parishioners and the Traditional untrained provider even quacks still provide unsafe abortion services. The problem of unsafe abortion and illegal providers some time discussed on newspaper while there is a serious abortion complication reported.
Population urban/ rural – Demography of the country :
Total population 144.5 million, where male 74.0 million & female 70.5 million.
Urban population: 36.7 million
Rural population: 107.8 million
(Source Statistical Pocket Book Bangladesh 2008).
Role of government :
In 1974 the government encouraged the introduction of menstrual regulation (MR) services in a few isolated Family planning clinics. In 1978 the Pathfinder fund international initiated an MR training and services program seven medical colleges and two government district Hospitals. Training was given to government doctors and paramedics (Family Welfare Visitors, FWVs) and a few private doctors. In 1979 the government included MR in the national family planning program and encouraged doctors and paramedics to provide MR services in all government hospitals, health and Family Planning complexes (Government circular, 1979) citing a law institute paper, the government noted that MR is not regulated by the penal code, since pregnancy is difficult or impossible to prove. Rather, MR is saved to be an “interim method of establishing nonpregnancy ” for a woman at risk of being pregnant, whether or not she actually is pregnant (Bangladesh Institute of Law and International Affairs, 1979).
Role of religion/ religious leaders :
In Bangladesh Religious leader do not officially against abortion but they have limited support on abortion. From available information.
Local Ob Gyn societies :
Bangladesh Ob Gyn societies Support Abortion.
Current status and potential of research :
Acceptability and Feasibility of Mifopristone & Misoprostol for menstrual regulation in Bangladesh (MRM study Phase III) – conducted by icddr, b for introducing the Medical Abortion in national scale.
A bibliography on Menstrual Regulation and Abortion Studies in Bangladesh, Compiled by Dr. Halida Hanum Akhter and Dr. Tabassum Ferdous Khan, Promotion of essential and Reproductive Health and Technology (BIRPERHT), December 1996, BDHS 2004 and 2008, Brochure of SAAF Project and Information booklet (Tothow Konika) of BWHC consortium.