Framing menstrual regulation as a pathway to advancing reproductive autonomy in restrictive legal contexts

While 60 countries have expanded legal abortion access over the past three decades, implementation gaps persist, necessitating innovative approaches beyond conventional law reform. This paper examines the concept of menstrual regulation, which refers to actions taken to bring back a late period for an individual who may or may not be pregnant. Although only formally institutionalized in Bangladesh, the practice of menstrual regulation has resonance to how women in diverse contexts perceive delayed menses and possible early pregnancy. In this paper, we trace the evolution of the menstrual regulation program in Bangladesh, from an emergency post-war intervention to its integration in the national family planning program, through periods of service expansion and decline, and explore the substantial impacts and persistent challenges faced in its implementation. We then examine the global evidence beyond Bangladesh, which reveals related practices taking place across Asia, Africa, Latin America, and Europe, demonstrating widespread cultural resonance and policy applicability. We argue that by working within the ambiguity of early pregnancy status and using linguistic ambiguity and strategic policy framing to navigate legal restrictions, menstrual regulation offers a pragmatic, contextually responsive pathway to reproductive autonomy when conventional abortion law reform is untenable. However, advocates must ensure that menstrual regulation serves as a step toward, not a substitute for, comprehensive abortion law reform and full realization of reproductive rights.