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By Samantha Singson

BANGLADESH, August 21, 2008 (C-FAM) – The World Health Organization (WHO) launched an initiative recently to boost a program for menstrual regulation in Bangladesh. WHO states that the objectives of this program are to “ensure the quality of [menstrual regulation] and to share the knowledge of safe motherhood.”

“Menstrual regulation,” also known as “menstrual extraction” (ME) is billed as a family planning method for women who missed their regular menstrual period and who strongly suspect that they are pregnant but cannot or do not want to wait for the results of a pregnancy test. Critics charge that menstrual regulation is a technique used to provide abortions in countries, like Bangladesh, where abortion is illegal.

A fund of $2.73 million, which was established with funding from the Netherlands Ministry of Development Cooperation and in partnership with the government of Bangladesh and non-governmental organizations working on menstrual regulation, will support projects over a four-year period starting this year.

Since there may not be an actual pregnancy to terminate, menstrual regulation is sometimes available in countries that prohibit abortion.  If the woman was pregnant at the time the menstrual extraction is performed, the evidence of an abortion is either destroyed during the procedure or easily disposed of.  Menstrual regulation is sometimes regarded as a cross between “foresight contraception” and “hindsight abortion.”

Bangladesh has allowed menstrual regulation since the 1970s. A memo from 1979 established menstrual regulation as an “interim method of establishing non-pregnancy” for a woman at risk of being pregnant, whether or not she is actually pregnant.

Officials touted the menstrual regulation initiative as a positive step to help Bangladesh achieve Millennium Development Goal 5 to reduce maternal mortality by three-quarters. The maternal mortality rate in Bangladesh is decreasing, but is still one of the highest in the world.  According to the UN Children’s Fund (UNICEF), of the 2.5 million women who become pregnant each year, an estimated 370,000 develop fetal complications which the health facilities in the country are neither equipped nor able to handle.

Proponents of the WHO initiative assert that the decreasing maternal mortality rate can be primarily attributed to increased family planning services, including menstrual regulation. They argue that making menstrual regulation more widely available reduces the maternal deaths, decreasing the likelihood that a woman would recourse to an unsafe abortion. 

UNICEF cites lack of access to emergency obstetric care, lack of skilled birth attendants, and maternal malnutrition as the primary causes of maternal death in Bangladesh, not unsafe abortion.  According to UNICEF statistics, half of Bangladeshi women of reproductive age are underweight and in 2001, only 11.8 percent of deliveries were assisted by qualified medical personnel.

Critics of the WHO initiative charge that the menstrual regulation program may lead to fewer deliveries, and thus lower the maternal mortality rate, but it will not make women’s deliveries any safer.

The WHO is currently reviewing project proposals from interested organizations and research institutes working on menstrual regulation.

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