Determinants of Induced Abortion and Reproductive Health in Some Selected Areas of Rajshahi

Abstract

In Bangladesh, advancement of medical science and easy access to modern medical facilities, the death rates especially child mortality have declined significantly during the last few decades. On the other hand women's ability to control their fertility is limited. Though family planning methods are available everywhere in the country, a woman may not use them because of financial constraints, personal beliefs, opposition family members or concern about the perceived adverse effects on health or future fertility. Fertility and mortality is not accompanied with each other. As a result population growth is becoming unmanageable and have resulted serious challenges to the achievement of national objectives and targets with regard to socio-economic development. Human reproductive processes are mainly influenced by contraception and sometimes by induced abortion where contraceptive practice is less use effective. Common sense and an elementary understanding of the biological determinants of human reproduction indicate that contraception and induced abortion represent alternative means of achieving the same aggregate level of fertility in a particular population. But induced abortion is harmful and sometimes dangerous to maternal health. So the levels of contraceptive use and the incidence of induced abortion continue to provoke heated discussion. An induced abortion is the deliberate termination of pregnancy by artificially inducing the loss before the viability of the fetus. Pregnancy is a critical phase in women's life and for obvious reason it cannot be avoided. However, for smooth management of health, sometimes pregnancy is required to be avoided by contraceptive use or terminating pregnancy to save the life of mother from the unwanted pregnancy in the initial stage of pregnancy. Generally, when family planning measures fail, the outcome of the ultimate baby make the family size larger otherwise induced abortion is done to keep the family size unchanged. In Bangladesh, a study reveals that among the unintended pregnancies that are due to contraceptive failure 31 percent undergo menstrual regulation (MR), 4.9 percent seek for induced abortion and remaining 55 percent gives unintended birth (Akhter, 1997). Abortion, legal or illegal, is being practiced in all most all countries of the world. However, variation in the level of abortion across countries depends not only on legality of the procedure but also on religious restrictions, cultural acceptance and also awareness about the odd consequences of abortion effect. According to the Penal Code of 1860, induced abortion is illegal in Bangladesh except to save life of the mother (Bhiwandiwala et al. 1982). Since the late 1970s, the law allows menstrual regulation in the early stages before pregnancy status is clinically confirmed (Akhter and Rider, 1983; Ali et al. 1978). Such interpretation of the law, along with the decline in the desired family size and availability of menstrual regulation services has contributed to an increase in the incidence of abortion (Dixon-Muller 1988). Before the introduction of MR practice in 1970s in Bangladesh, when the law was strict, induced abortions were usually performed either by self or untrained indigenous practitioners which was very serious for maternal health. For this reason the MR practice was allowed legally and consequently menstrual regulation service has become available both in the public and the private sectors. The government managed health facilities providing abortion services are: Family Welfare Centre, Upazila Health Complex and District Hospital while non-government facilities are private clinics located mainly in cities and towns. Despites all these facilities, huge number of abortions are still being performed either by the client herself or with the help of indigenous practitioners (Ahmed et al. 1998; Ahmed et al. 1996), and many of those who sought modern abortion facilities had experienced traditional method initially (Bhuiya et al. 1999; Caldwell et al. 1999)……………………………