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

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.

12. Acknowledgement
 RFSU
 Participants
 Ipas
 Dalarna University

13. Thank you!
MARIA PERSSON
EMAIL: MARIA.ELIS.PERSSON@GMAIL.COM