This is the abstract presentation by Maria Persson, which took place as part of 8th session of 10th Asia Pacific Conference on Reproductive and Sexual Health and Rights (APCRSHR10) Virtual, on 28th September 2020, on the theme of "Safe abortion and sexual and reproductive health and rights (SRHR) in Asia and the Pacific". 28 September is also observed as International Safe Abortion Day.
C H A I R
Amy Williamson, Country Director, Marie Stopes International, Cambodia
P L E N A R Y S P E A K E R S
* Dr Suchitra Dalvie, coordinator, Asia Safe Abortion Partnership (ASAP) | "Abortion and Reproductive Justice: The Unfinished Revolution"
* Sivananthi Thanenthiran, Executive Director, ARROW | "Right to Safe Abortion: putting women at the centre of the discourse and practice"
A B S T R A C T P R E S E N T E R S
* Katherine Gambir | Is Self-Administered Medical Abortion as Effective as Provider-Administered Medical Abortion? A Systematic Review and Meta-Analysis
* Aryanty Riznawaty Imma | Challenges in Recording Abortion Related Complications at Health Facilities in Setting Where Abortion is Highly Restricted
* Dr Yaghoob Foroutan | Abortion’s Patterns and Determinants in Iran: Attitudinal Dynamics
* Maria Persson | A Qualitative Study on Healthcare Providers’ Experiences of Providing Comprehensive Abortion Care in the Humanitarian Setting in Cox’s Bazar, Bangladesh
For more information on this session go to www.bit.ly/apcrshr10virtual8
#SRHR #sexualhealth #reproductiverights #familyplanning #womenshealth #genderequality #SDGs #abortion #MyAbortionMyHealth #28Sept #InternationalSafeAbortionDay #SafeAbortion #BodilyAutonomy
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APCRSHR10 Virtual abstract presentation by Maria Persson
1. A Qualitative Study on Healthcare Providers’
Experiences of Providing Comprehensive
Abortion Care in the Humanitarian Setting in
Cox’s Bazar, Bangladesh
APCRSHR10 VIRTUAL-8 28 SEPTEMBER
SAFE ABORTION AND SRHR IN ASIA AND THE PACIFIC
MARIA PERSSON, MMSC IN GLOBAL HEALTH
2. Key Concepts
Comprehensive abortion care (CAC)
Abortion
Post-abortion care (PAC)
Contraceptive provision and counselling
CAC : MR, PAC, contraceptive provision and counselling
Menstrual Regulation (MR)
MR is a procedure to regulate the
menstrual cycle to ensure a non-
pregnancy
• MRM (mifepristone & misoprostol)
• MVA
3. Background
Unsafe abortion contributes to maternal mortality and morbidity
In humanitarian settings women and girls face increased risk of unsafe abortion
Barriers to comprehensive SRH care
Lack of prioritisation
Lack of training
Lack of equipment and supplies
Lack of knowledge on the abortion law
Stigma and negative attitudes affecting service provision
4. Cox’s Bazar, Bangladesh
Over 900 000 Rohingya refugees from Myanmar
Large-scale incidences of rape and SV by the
Myanmar military
Following displacement, Rohingya women and
girls continue to face different forms of SGBV
GoB leads the humanitarian response
In March 2019
142 basic healthcare facilities and 8 hospitals, managed
by the GoB or NGOs
MR, PAC and contraceptive services were provided free
of charge at 29 facilities
5. Aim
To explore healthcare providers’ perception and experience of
providing comprehensive abortion care in the humanitarian setting
in Cox’s Bazar, Bangladesh and to identify barriers and facilitators in
service provision.
6. Method
Study design: descriptive exploratory qualitative study
Sampling: purposeful sampling with assistance from Ipas, an organisation
involved in the humanitarian response in Cox Bazar
Data collection: 24 in-depth interviews (IDI)
19 IDI with HCP(16 paramedics and 3 doctors). Face-to-face at or close to their work in
Cox’s Bazar (March 2019)
5 IDI with key informants (December 2018 and March 2019)
Data analysis: inductive qualitative content analysis
7. (1) Collaboration
and organisation of
CAC
The MR policy provided a favorable legal
environment for MR,PAC and FP
Good collaboration among humanitarian actors and
with the GoB
HCPs expressed having a supportive work
environment
Supply and equipment was readily available and
adequate
However, implants was not readily available and not
all facilities provided IUD
The Mexico City policy affected organisations'
willingness to provide MR services
led to territorial disputes about which organisations should
provide FP services
led to lack of space for MR providers
8. (2) Confidence,
competence, and
pride affecting
HCPs’ provision of
CAC
HCP felt confident that they provided good services
Adopting the same language (dialect) was
experienced as facilitating trust
HCP took pride in their work and created a positive
identity that generated an enabling environment
where they could provide services
“I feel happy that from a worst scenario, I helped a girl
to live a new life. I love these things with the job, to help
and protect people from danger.” (Paramedic 0–5 years’
experience)
HCP felt adequately trained in MR, PAC and FP and
had received training from NGOs before deployment
However, there was limited knowledge on the
abortion law among HCP and the knowledge on the
MR policy varied
9. (3) HCPs’
perceptions of
abortion and MR
influencing CAC
provision
HCPs defined abortion as PAC, spontaneous
abortion, or as termination of pregnancy after
week 12
MR was described as regulation of the menstrual
cycle that happened before the heartbeat
Before a certain gestational age (7-12 weeks), the
embryo was not considered a child and thus not
sinful to abort
“In my experience, I think the baby don’t have hands or
legs till 10 weeks. At that time, the baby is like an egg
yolk … And when there is a client who needs MR, we
make them understand that it is not a sin. And we tell
them, “It is now like a duck egg or a chicken egg, and
this is just like a liquid yolk inside your body.”
(Paramedic, more than 10 years’ experience)
10. (4) HCPs’
understanding of
Rohingya women’s
needs influencing
CAC provision
HCPs perceived the Rohingya community as
patriarchal and Rohingya women as religious and
conservative
Led to condescending attitudes
Affected HCPs understanding of Rohingya women’s
needs and desires
“They usually don't take implant and IUD because they
think that they will go to hell if they die after taking this in
her body” (Paramedic, 5- 10yrs experience)
“We tell them it MR is not a sin. Because it will save your
family, make you and your newborn child happy. You already
have a child. If you take another baby now, you will get a bad
impact on your health. You cannot give your children enough
care. So, take the MR and care for your family.” (Paramedic,
more than 10 years’ experience)
Adjusted counselling and used religion and
motherhood to increase acceptance
11. Conclusion
Based on the participants’ experiences, the study findings suggest CAC can be implemented,
and provision can be scaled up in a humanitarian setting, under rapidly changing
circumstances. However, access to and availability of quality CAC was limited as shown in
the result
The large number of actors involved in delivering SRHR programs in Cox’s Bazar creates an
opportunity to increase access to and availability of quality CAC
Training on MR policy and abortion law and in-service training, including value clarification,
should be secured to improve quality of care and ensure that the care provided is woman-
centred and non-judgmental.
To fully understand the trajectories to abortion-related care in the humanitarian setting in
Cox’s Bazar, more research is needed to understand women’s health-seeking behaviours and
encounters with abortion-related care from their own perspectives.
Thank you very much Amy (Chair). My name is Maria Persson, and I am here today in the capacity of my former engagement with Karolinska Institutet. And will present a study that I conducted together with former colleagues from Karolinska Instituetet 2019. The study was funded by RFSU (the Swedish Association for Sexuality Education). The study is a qualitative study on healthcare providers Experiences and Perceptions of providing Comprehensive abortion care in a humanitarian setting. And that humanitarian setting is Cox’s Bazar in Bangladesh.