"Having another child would be a life or death situation for her": Understanding pregnancy termination among couples in rural Bangladesh

Objectives. We conducted a mixed-method study in rural southwestern Bangladesh, a country in which an estimated 730000 elective pregnancy terminations occur each year, to explore women's and couples' motivations to terminate pregnancies. Methods. Quantitative data derived from a 1998 cross-sectional survey and a longitudinal demographic surveillance system (1998-2003) were combined with qualitative data gathered through 84 in-depth interviews conducted with 19 couples during 2004-2005. Results. Quantitative results indicated that 11% of couples reported a pregnancy termination in the study period; the rate was highest among couples who reported in 1998 that they wanted no more children (29%). Both wives' and husbands' fertility preferences independently and significantly predicted pregnancy termination. Qualitative findings showed that more than half of the participants had attempted to terminate a pregnancy at least once in their lifetime. Conclusions. Our results highlight the importance of collecting data from both partners and the influence of husbands' fertility preferences on reproductive decisionmaking. The prevalence of reported pregnancy terminations in our population, along with the use of informal methods in termination attempts, highlights the need for continued provision of contraceptives and access to safe and affordable pregnancy termination services in this setting.