Sustaining menstrual regulation policy: a case study of the policy process in Bangladesh

Bangladesh introduced menstrual regulation (early abortion) into its national family planning program in 1979, and for more than 20 years women with unwanted pregnancies have been able to avail themselves of a relatively safe and accessible service. Over the years, however, concern has been expressed about deficiencies in the implementation of the policy, and by the mid-1990s, the menstrual regulation (MR) policy was approaching a critical juncture. The introduction of health sector reforms and the waning of international and domestic support raised questions regarding the sustainability of the policy. This study was conducted to determine the factors that influenced the development of and support for the MR policy in Bangladesh, in order to explore how far those factors might influence future sustainability. The study used an analytic framework based on literature from the policy field to test what factors were important in the policy process in Bangladesh. Qualitative data was gathered from interviews and documents in an inductive approach to determine the development of the MR policy, which was then subjected to a retrospective analysis of the entire life cycle of the MR policy-how it came to be placed on the policy agenda, how and why it was formulated the way it was, and why it was not implemented as well as it could have been. Data gathered from interviews and document reviews were then used in a political mapping exercise undertaken in a prospective analysis for the policy, providing insights in relation to the future sustainability of the MR policy.

The research suggested that the analytic framework used was helpful in providing a systematic analysis of contextual conditions, agenda-setting circumstances, and policy characteristics that could explain much of the variability in the policy process. The role of international donors and attitudes toward religion were found to be particularly relevant to explaining the policy process. The study concluded that the MR policy would likely not be sustained in the future unless purposeful action were taken to mobilise additional bureaucratic and political resources in support of the policy.