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22 Aug 2019

Combi-packs and contact centres: supporting safe menstrual regulation in Bangladesh

Marie Stopes International


Pathways to care, Client experience, Pharmacy provision, New technologies, Converting unsafe services, Self-administration, Medical Abortion (MA), Commodities, Product Quality, Non-judgmental services, Counselling, Menstrual Regulation (MR)

In Bangladesh, abortion is only legal to save a woman’s life. However, in the 1970s, menstrual regulation was introduced as a method to establish non-pregnancy and a strategy to reduce the impact of unsafe abortion.

Unlike abortion, in menstrual regulation services, pregnancy is not confirmed before a procedure or medications are administered. If women are self-administering the medication, it’s important that they have access to accurate medical advice on the correct regimen, as well as follow-up care, for example, if experiencing unexpected side effects.

To understand how to best support women accessing menstrual regulation medications, Marie Stopes Bangladesh analysed data from their contact centre, which receives tens of thousands of calls every year, mostly from menstrual regulation users.

The subsequent study, recently published in the Journal of Medical Internet Research, highlights the important role of contact centres (more widely known as call centres) and hotlines in safe self-administration of mifepristone and misoprostol - the drugs used for menstrual regulation (MR) in Bangladesh, and for medical abortion in other settings. It also shows how combi-pack availability, with packaging that includes clear instructions and a contact centre phone number, can support safe access to care.

Analysing over 280k calls - who called the contact centre and why?

Between 2012 and 2016, the study analysed over 287,000 calls made to the Marie Stopes Bangladesh contact centre. This analysis included who was calling, the reason for their call and whether use of the contact centre shifted as new products were introduced to the market.

Over four years, use of the contact centre steadily increased, most commonly among menstrual regulation users, their husbands, pharmacy workers and village doctors. Most menstrual regulation calls were related to the use of misoprostol. However, after the more effective combi-pack was introduced to the market in 2014, a growing proportion of calls were about the combi-pack regimen instead.  The most common reasons for calling were to obtain information about the correct regimen, to find information about side effects, or to report side effects experienced.

What this means - enabling safe care with combi-pack, clear packaging and onward support

Firstly, the study highlighted the role that the combi-pack can play in expanding access to safe services. After the combi-pack entered the market, fewer people called to find out the correct dosages, which could reflect the fact that the combi-pack is easier to use and has clearer instructions.

In addition, the analysis highlighted the value of printing a contact centre number or hotline number on medical abortion or menstrual regulation packaging, for onward information or support.

When Marie Stopes Bangladesh started printing their contact centre number on their own product packaging, there was a substantial increase in calls about the product. There was a similar increase when Marie Stopes Bangladesh started printing their contact centre number on another company’s product, too. By maximising visibility of the contact centre to women using menstrual regulation products, Marie Stopes Bangladesh could increase women's access to information about how to use the medications and support throughout the process.

Finally, the study showed the value that contact centres and hotlines can have for people using or prescribing menstrual regulation products, or medical abortion products in other settings.

The Marie Stopes Bangladesh contact centre received high and increasing volumes of calls over the study period, with a high proportion of callers having previously used the contact centre. This suggests the contact centres are meeting an unmet demand for information about menstrual regulation medications from both menstrual regulation users and health care providers, and that contact centres can provide an accessible way to deliver this information and support.

In summary – delivering a continuum of care for menstrual regulation and medical abortion

In short, the findings support the importance of combi-pack availability, with clear, user-centred instructions included in the packaging. The findings also highlight the value of ensuring that there is onward support for combi-pack users, in the form of a contact centre or hotline, to provide the information and support needed for safe menstrual regulation and safe medical abortion care.

By raising awareness of contact centres and hotlines through combi-pack product packaging, we can support women in accessing the safe and informed care they need and deserve.

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