High-quality family planning services stabilise abortion rate in Bangladesh

September 27, 2001

N.B. Please note that if you are outside North America the embargo for Lancet press material is 0001 hours UK time Friday 28th September 2001.

Results of a Bangladesh population study in this week's issue of THE LANCET highlight how the provision of high-quality family planning services can decrease population growth without an accompanying increase in rates of abortion.

Fertility decline is often associated with an increase in contraception and abortion, but the causal relations are difficult to examine without experimental data. Bangladesh has undergone a transformation in fertility reduction over the past two decades; the average number of births has decreased from 6.5 to 3.3 per woman. Contraceptive use among women of reproductive age has tripled, to 55%. In one typical rural area the frequency of abortion has also tripled, to about 50 per 1000 livebirths.

Mizanur Rahman from Pathfinder International, and colleagues from the USA and Bangladesh, assessed trends in overall abortion rates and rates for intended and unintended pregnancies in two areas of Matlab, a region typical of rural Bangladesh. Matlab has been the focus of extensive demographic research about pregnancy outcomes since 1966. The two areas studied differed in the provision of family planning services; the treatment area had access to the Maternal Child Health and Family Planning Project which provided better-quality family planning services than the standard government services available to the comparison area. Pregnancy outcomes between 1979 and 1998 were analysed, and were matched to survey data on fertility preferences; this enabled the identification of pregnancies as intended or unintended.

Abortion rates were substantially lower in the area with better family planning services than the comparison area, both in the early 1980s and late 1990s. The abortion rate in the area with better services remained virtually unchanged, increasing from 2.2 to 2.3 abortions a year per 1000 women; in the comparison area the rate increased from 5.2 to 6.8 abortions a year per 1000 women. Abortion of unintended pregnancies was similar in both areas, but higher contraceptive use in the treatment area resulted in lower rates of unintended pregnancy and abortion.

Mizanur Rahman comments: "Abortion may increase during the fertility transition in less-developed countries as the desire to limit family size increases unless there is widespread availability of quality family planning services."
Contact: Dr Mizanur Rahman, Pathfinder International, 9 Galen Street, Ste 217, Watertown, MA 02472, USA; T) 1-617-924-7200; F) 1-617-924-3833; E) MRahman@pathfind.org


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