Plans being refined to offer abortion service at public hospitals – CMO

Jun 02, 2014 News

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Although there is currently limited access to elective termination of pregnancy services within the public health system, moves are apace to not only ensure that such services are readily available, but also to ensure that they are delivered safely.
At least this is according to Chief Medical Officer (CMO), Dr Shamdeo Persaud, who disclosed that Guyana has in place an abortion legislation which provides for women to seek safe abortions.

Despite the fact that the legislation has been in place for close to two decades, the issue of abortion is yet seen as rather sensitive and controversial and is therefore not often discussed. Moreover, aside from the instances when abortion is seen as crucial to save the life of a pregnant woman, or in the case of unintended (or unwanted) pregnancy among young girls, the service is one that is mainly accessed at privately operated health facilities at a cost. “There are approved private places that have been offering this service since the passing of the 1995 (Abortion) Act and women who so desire can go there still to access the service,” said Dr Persaud.
But this service being primarily offered privately is likely to become a thing of the past as according to Dr Persaud, “at this point in time we are working in the public sector to provide this service more.” Already there is limited capacity at the Suddie Regional Hospital and moves are being made to build capacity at the Georgetown Public Hospital Corporation and other public health facilities as well, Dr Persaud said.
This, according to the CMO, will see public health facilities being able to cater, on a wider scale, to women who may opt for voluntary termination of pregnancy. “The system that we are setting up now will entail providing pregnant women with counselling and options because the law says that options should be described to the pregnant woman one of which would be to go through with the pregnancy and maybe adoption options and so on and then of course detailing the termination process itself which can have consequences,” outlined Dr Persaud.
He noted however that there may be instances when some women may not opt to voluntarily have an abortion but are instead forced to do so for various reasons which could range from migration to marital issues.  As such the importance of counselling cannot be understated as part of the process, said Dr Persaud, as he stressed that “counselling gives enough room for people to consider all the factors and make informed decisions in the end.”
Following the actual abortion process patients will also be subjected to another bout of counselling. “So the nurses are the main persons we are training to make sure that this is provided…,” said Dr Persaud.
Another main aspect of capacity building to offer this service is that of ensuring that trained professionals are available to perform the procedure.  As such, at the GPHC alone, a total of eight doctors have been so trained and are now skilled to undertake abortions, Dr Persaud said. Additionally, he noted that most of the equipment for this purpose have been acquired which embraces the safest form of pregnancy termination – vacuum extraction. “This doesn’t involve any scraping or sharp objects that can cause damage – perforation of the uterus, destroying the endometrium, damaging the cervix or any such thing…The one we are recommending is approved globally as safest,” said Dr Persaud.
Although the service is not officially on the list of offerings at the GPHC, the CMO did disclose that “we have started to do practices…it is not opened to the public as yet because they are now finishing up the counselling training,” even as he added that “medical procedures like these need practice.”
Once training and sufficient practice sessions are completed, it is expected that the service will be expanded to hospitals at Diamond, New Amsterdam and Linden.
In order to conduct an abortion, practitioners must be so certified, which means that merely having a licence to practice as a doctor is not sufficient certification. “There is a separate certification procedure where the practitioner has to be trained and certified to perform termination of pregnancies,” Dr Persaud asserted.
Currently there are 17 doctors who are certified to conduct abortions and there are a few more who are undergoing training, Dr Persaud said.
The safest period within which an abortion should be conducted at health facilities with limited resources is between eight and 12 weeks after the time of conception. However, the CMO noted that any such procedure between 12 and 18 weeks after the time of conception should be done in a hospital setting since there may be need for anaesthetic input.  “We have all this detailed in the Act and the Regulations and we will observe all of these once we start (offering this service full-scale) in the public sector,” assured Dr Persaud.
Meanwhile, he disclosed that the Ministry is continuously looking at the issue of self-medicated abortions whereby women opt to utilise the labour-inducing Cytotec, which according to Dr Persaud is a prescription medication. “My desire is that women would seek the involvement of their medical practitioners; you can use that option but it must be under the directive of a medical practitioner.”
“We have had instances where women buy this tablet and they ingest it or insert it to their detriment.” And according to Dr Persaud, the Ministry recorded one such case in the recent past whereby the woman developed severe complications even bleeding in the brain.

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