Menstrual Regulation as Biographical Disruption: Experiences of Bangladeshi Urban Women in Dhaka

Abstract

Menstrual Regulation (MR) has been part of Bangladesh’s national family planning program since 1979. In Bangladesh, abortion is legal but highly restricted. The current abortion law in Bangladesh is based on highly restrictive British Colonial law, written in 1860, that permits abortion only if the mother’s life is in danger (Council of the Governor General of India 1860). Abortion is not permitted: to preserve physical health, to preserve mental health, because of rape or incest, fetal impairment, or more broadly economic or social reasons. However, there is a medical procedure which the government terms as Menstrual Regulation (henceforth MR) which involves vacuum aspiration to bring on menstruation (and end any pregnancy) which is legal in the first trimester. Doctors can perform the intervention up to ten weeks and paramedics are allowed to provide service up to eight weeks after the woman’s last menstrual period. The policy in place legalizes MR but criminalizes abortion. The different nuanced meanings of MR in the past four decades, its service provision, limitations and strategic usage require a comprehensive study that brings in women's perspectives. On the surface, the problem seems one dimensional- the legality and illegality of abortion. However, the complexity encompasses more than just the issue of legality. Like abortion in any other context, MR is a traumatic experience and this is particularly true in this space of legality and illegality. In a highly conservative and religion society like Bangladesh, MR is a social taboo. But the fact remains unexplored, how those women, who has undergone MR, negotiate and cope in post-MR periods.

This research explores post-MR biographical disrutions across different generations of women in urban Bangladesh belonging to different socioeconomic class, marital status and religious identity. In this study, we report multidimensional post-MR biographical disruptions and coping mechanisms across generations and socio-economic classes. The approaches focus on the insider perspective rather than relying on the outsider narrative. Lay experiences are given privileges and legitimacy. By focusing on women's narratives, this research provides an evidence based critical understanding of urban Bangladeshi women's subjectivities and their experience in coping post-MR disruptions as they navigate the difficulties around having to undertake MR. I draw from the idea of ‘biographical disruption’ and combine with the politics of place to get a robust picture of the mundane experiences and also politics behind the experiences. I also emphasize upon the role of different types of capitals, and, how the individual mobilizes these resources to repair their biography. I find, perhaps surprisingly, younger women from lower socio-economic class are in better position to cope with the post-MR disruptions and they are able to generate resources more competently to rebuild their biographies. Married women from middle and upper socio-economic classes are in more vulnerable position. They are more likely to be stigmatized from their family members, rather than colleagues and neighbours, which is the case for the women belonging to the lower strata. Within household decision making power is a good predictor of successful coping and women from lower socio-economic classes are better positioned as their economic power correlates with within household decision making power. MR changes many pre-MR behaviour, most notably sexual behaviour. Religious norms plays crucial role and older women and married women from middle and upper socio economic classes are more likely to suffer from regressive religious norms. By contrast, younger unmarried women challenge the existing norms and quite often they are successful in rebuilding their biographies even if they are not out of adverse stigmatization.

Based on the narratives of the women in this study, we see an important generational shift in women’s situation in terms of exercising sexual autonomy and enjoying overall independence. We also find divergence by socio-economic locations. Looking beyond the quantitative figures of MR discourse, and delving deeper into women's lived experiences, this study shows that younger generation of women on average do not see MR solely as post marriage family planning method, rather the new generation of young people whose lives are directly influenced by globalised culture codes, who are economically solvent and experience less mobility restrictions, the notion of romance is stronger among them than that of marriage and child bearing. We also see large variation by socio-economic locations, particularly married women in middle and higher socio-economic classes are in more vulnerable position.

I add to the literature by providing an individually perceived socio-economic location based analysis of post-MR biographical disruptions and also how individual at different locations and of different generations cope and generate resources to rebuild their biographies. One strong finding of the research is that the absolute absence of post MR mental health counselling affects the psychological wellbeing of the respondents on different levels. Irrespective of the age, class, marital and religious identity, women interviewed talked about tackling their post MR psychological trauma in their own personal ways (''shutting it out'', ''locking it away'') which most often left a long term damaging impact on their mental wellbeing and their ability to have relationships. Since the state policy does not recognize MR as a pregnancy terminating procedure, the provision of psychological counselling post MR is not considered. None of the clinics/doctors the women went to for MR services prescribed psychological counselling. As a policy measurement, we strongly argue for the integration of mental health programmes with the MR related services.