Every year, around 2400 women die from clandestine unsafe abortion, and thousands of women suffer disastrous consequences, including sepsis and sterility. Still, the cases of menstrual regulations (MR) done across the country are not properly reported, let alone abortion.

According to official statistics, 8000 doctors and 6500 Family Welfare Visitors (FWVs) trained on MR are posted in government clinics at national, district, thana and union levels at present, but accurate estimates of the annual number of procedures are not available due to weak reporting system and the tendency of MR performers to under-report the performance.

In Bangladesh, women take informal means of abortion, including inserting twigs, sharp objects into uterus, ingestion of herbs, washing powder, chemicals/ herbs, vigorous massaging and pressure on the abdomen.

Though the existing law prohibits termination of pregnancy, except to save the life of the mother, hundreds of clinics only in the capital are performing abortions, ignoring the government regulation.

Analyses of available data from ICDDR, B show that the total abortion rate is minimised by high quality family planning programmes of the government, but unsafe abortion remains a leading cause of maternal mortality in the country.

In 1978, one year before the legalisation of MR, deaths from abortion accounted for an estimated 26 percent of all pregnancy-related deaths in Bangladesh. To reduce the mortality rate, the government trained health workers to perform menstrual regulation (MR) up to ten weeks' gestation.

Stigma associated with MR came as the first reason for tarnishing the image of the successful programme aimed at reducing the maternal mortality rate, specialists said.

Besides, the rigidity of the system like obtaining permission from guardian or husband and availability of alternative sources such as homeopathy and Kabiraji makes women go for life-threatening options.

While legalising the MR, the government clearly defined that MR services will be provided by medical college hospitals, maternal and child welfare centre (MCWC), district hospital at the district level, the Thana Health complex at the Thana level and the Family Welfare Centres (FWC) a the Union level.

However, a study conducted by Bangladesh Association for Prevention of Septic Abortion (BAPSA) in 80 upazilas in 2003-04 showed that 69 percent of abortion cases are performed by traditional birth attendants such as Aya, Kabiraj, Ojha and sweeper.

While visiting several clinics in the city's Azimpur, Chankharpool and Mohammadpur areas, this correspondent found evidence of illegal abortion.

A doctor even claimed her success in aborting foetuses of seven or eight months' gestation, while her assistant said it is also possible in the 10th month. There are also brokers who lure women to these clinics.

According to official statistics, 15,000 MRs are performed a year, but the actual figure is not less than 30,000, an official at the Maternal and Child Health Training Institute said, preferring anonymity.

"More often than not, these cases remain unrecorded. And there are also back street abortions."

It has been observed that due to lack of monitoring at Upazila level, trained Female Welfare Visitors (FWVs) often take patients to their homes and perform the MR in unhygienic condition. Sometimes, the lure of a fast buck drives nurses, Aya and other hospital staffs to perform the MR.

A patient with 'incomplete abortion' at Dhaka Medical College Hospital said she inserted a root of a plant into her uterus as per the advice of a Kabiraj. The foetus of six months' gestation came out of the womb within 24 hours, but the placenta remained inside. She is now fighting for life as she suffers from perforated uterus.

Dr Kazi Golam Rasul, general manager, programme resource development, Marie Stopes, said, "Though women in urban areas have access to proper healthcare services, there are a lot of illegal practitioners in this sector. Medicines causing abortion are also available in pharmacies, but such drugs cannot terminate pregnancy. Rather, they are harmful to maternal health."

Acording to a recent study of ICDDR,B, conducted by Dr Elizabeth Oliverus and Dr Heidi Johnson, "The MR programme in Bangladesh is lauded around the world for its decentralisation and stand as an example of smooth collaboration of GO-NGO, but still Bangladesh has miles to go."

Dr Elizabeth Oliverus and Dr Heidi Johnson told The Daily Star, "The continuing presence of unsafe abortion in Bangladesh suggests that MR services are not accessible to all woman. While factors limiting access to services have not been well studied, the data suggest that almost 10 percent of women seeking MR come to health facility too long after their last menstrual period to be eligible for MR".

Another reason to restrictive accessibility, according to them, is that unofficial fees are often charged for MR services.

The number of MR and abortion in some areas is increasing, but unsafe abortion remains a major cause of maternal mortality. The country needs a strong intra-ministerial monitoring system that would make people aware of the harmful effects of unsafe abortion, experts said.

Unsafe abortion could also lead to breast cancer or permanent sterility, they said, adding that since abortion is not legal, the government has no programme to make the people aware of the fatal consequences of unsafe abortion.

To achieve the Millennium Development Goal (MDG) of reducing 75 percent of maternal mortality, interventions to stop unsafe abortion should be taken right now, they suggested.