A Qualitative Study on Health Care Providers’ Experiences of Providing Comprehensive Abortion Care in Cox’s Bazar, Bangladesh

Background:Humanitarian settings are often characterised by limited access to comprehensive abortion care. At the same time, humanitarian settings can increase the vulnerability of women and girls to unintended pregnancies and unsafe abortions. Humanitarian actors and health care providers can play important roles in ensuring the availability and accessibility of abortion-related care. This study explores health care providers’ perceptions and experiences of providing comprehensive abortion care in a humanitarian setting in Cox’s Bazar, Bangladesh and identifies barriers and facilitators in service provision. Method: In-depth interviews (n=24) were conducted with health care providers (n=19) administering comprehensive abortion care to Rohingya refugee women and with key informants (n=5), who were employed by an organisation involved in the humanitarian response. Data were analysed using an inductive content analysis approach. Results: The national menstrual regulation policy provided a favourable legal environment and facilitated the provision of comprehensive abortion care, while the Mexico City policy created organisational barriers since it made organisations unable or unwilling to provide the full comprehensive abortion care package. Supplies and equipment were available, but a lack of space created barriers to service provision. Although training from organisations had made the health care providers confident and competentand had facilitated the provision of services, their knowledge of the national abortion law and menstrual regulation policy was limitedand created a barrier.The health care providerswere willing to provide comprehensive abortion care, motivated by the vulnerability of Rohingya women. Although they acquired skills and applied strategies to communicate and provide care, the health care providers’ personal beliefs and perceptions of Rohingya women influenced their provision of care. Conclusion: The availability and accessibility of comprehensive abortion care was limited by unfavourable abortion policies, a lack of privacy, a lack of knowledge of abortion laws and policies, health care providers’ personal beliefs and a lack of cultural safety. To ensure the accessibility and availability of quality services, a comprehensive approach to sexual and reproductive health and rights is needed. Organisations must ensure that health care providers have knowledge of abortion policies and the ability to provide quality care that is woman-centred and non-judgmental. [.1] Are both underlining and green font necessary to indicate changes? [.2] A barrier to what specifically