EIGHTEEN years ago, in the context of a health crisis in which septic and incomplete abortions accounted for the third and eighth largest causes respectively of admission to public hospitals in Guyana, a network of women’s groups, health professionals and human rights activists engaged in a wide-ranging debate advocating for legislation to address unsafe and unregulated abortions. The end result was the enactment of the Medical Termination of Pregnancy Act (MTPA) in 1995.

The reasons and purpose for the enactment of the MTPA are as relevant and current today as they were in 1995. They are three-fold: to enhance the dignity and sanctity of life by reducing the incidence of induced abortions; to enhance the attainment of safe motherhood by eliminating deaths and complications due to unsafe abortions; and to prescribe the circumstances in which any woman who voluntarily and in good faith wishes to terminate her pregnancy may lawfully do so.
The death of Karen Badal, a mother of two, on December 31, 2011, at the Georgetown Public Hospital (GPH) from a perforated uterus and acute peritonitis following a botched abortion performed by an uncertified doctor at his private office on the lower East Coast, tragically exposed the ineffective implementation of the MTPA. This maternal death could and should have been avoided.
We may never know how many other women in Guyana have died as a result of backstreet abortions. What we do know is that, according to the Ministry of Health’s Assessment of Emergency Obstetric and Newborn Care in Maternity Facilities 2010 (the EmONC report), released in 2012, severe abortion complications are the fourth leading cause of maternal deaths in Guyana and that approximately a third of all terminations of pregnancy are incomplete (botched), in some cases with severe complications, and all requiring post-abortion medical care. There was also one recorded maternal death from severe abortion complications during the survey period of the report
The EmONC report also confirms that even though 99.6% of terminations are done at private hospitals, treatment for 70% of incomplete abortions takes place at public hospitals. These data need some explanation as they do not coincide with or track the large number of terminations performed at private doctors’ offices and clinics throughout Guyana. The data also seem to suggest that the private hospitals are responsible for the remaining 30% of incomplete abortions requiring further medical care, even though the same report cites only one recorded termination of pregnancy for the East Berbice/Corentyne area, but 130 terminations required post-abortion care.  The report also indicates that, in 83% of all cases, there was no record kept of the trimester in which the termination occurred. In spite of the MTPA, the report identifies termination of pregnancy in the second trimester as the least available individual medical service in all public health facilities.
We welcome the statements made last month by Minister of Health, Dr. Bheri Ramsaran, and Chief Medical Officer, Dr. Shamdeo Persaud, that the Ministry of Health:
(1) Plans to make terminations available in the public health system;
(2) Is currently embarked on a mission to raise awareness among women about the medical termination of pregnancies, targeting in particular young girls;
(3) Will be making efforts to improve current methodologies from dilation and curettage (D&C) to much safer manual vacuum evacuation, and
(4) Will conduct training, certification and gazetting of the doctors certified to perform medical termination of pregnancies.

We call for these statements to be put into effect without delay and for the relevant authorities to expeditiously take all necessary action to:

1.      Conduct a full and expeditious investigation into the death of Karen Badal.

2. Ensure that in future full investigations of all septic or other complications from uncertified abortions are conducted and that appropriate disciplinary action is taken against unauthorised medical practitioners.

3. Reduce the number of incomplete abortions that lead to increased maternal morbidity and mortality by ensuring access to reproductive health services, including the right to safe and affordable terminations within both the public and private health sectors.

4. Monitor the application and efficacy of regulations made under the MTPA in relation to:
a. The conditions for authorisation of registered medical practitioners to perform terminations.
b. The conditions for approval of institutions to perform terminations.
c. The maintenance and submission of records of terminations.
d. Pre-and post-termination counselling services.

5.     Conduct and publish an assessment of currently available reproductive health services, including:
a. The current number of doctors working in the public and private health sectors who are qualified to perform terminations.
b. The names and addresses of MTPA-authorised medical practitioners and MTPA-approved institutions.
c. The annual numbers of incomplete abortions since 2003 and the types of complications.

6.    Review the composition and work done by the Medical Termination of Pregnancy Board, with a view to improving its capacity to effectively monitor implementation of the MTPA.

7.      Ensure the availability of mandatory emergency contraception for all female victims of rape and incest of all ages at all hospitals so that they are not burdened with an unwanted pregnancy.

8.     Ensure that emergency contraception is also made available at all health centres and hospitals so as to reduce the number of unwanted pregnancies leading to terminations.

9.    Conduct investigations into the hundreds of cases of other women who, after the enactment of the MTPA in 1995, ended up at the GPHC or other regional hospitals with septic or other complications from uncertified, backstreet abortions, and where the doctors performing these abortions were named, investigate and take necessary action against them as outlined in the Medical Practitioners Act.

DANUTA RADZIK
ANDAIYE
LEILA JAGDEO
REVEREND PAT SHEERATTAN-BISNAUTH
JOY MARCUS
KRYSTA BISNAUTH
SHERLINA NAGEER
JANICE JACKSON
KAREN DE SOUZA
VANDA RADZIK
JOSEPHINE WHITEHEAD
DENISE DIAS
SIMONE MANGAL
RAQUEL THOMAS CAESAR
JOCELYN DOW
VIDYARATHA KISSOON
STELLA RAMSAROOP
JOEL SIMPSON
LAUREL JAMES
SIMONE MORRIS-RAMLALL
WANDA FORTUNE
ONEKA ARCHER-CAULDER
PAMELA NAUTH
PARBATTIE RANGLALL
MARVA THOMAS
SALIMA BACCHUS-HINDS
GAITRIE SHIVSANKAR
NATASHA YHAP
SHARON OUSMAN
ARETHA CORREIA GRASSI
SHERRI PRABHU DAS
MARCIA FOWLER
COLETTE MCDERMOTT
PHILIPPA WEEKES-BROWNE
JUNE GRIFFITH
NICOLA RAMCHURJEE
SHAZIE RAHAT
JANICK DAI ARJOON
Yonell Hernandez
Natasha Rhodius
Amena Humphrey
STACY PERSAUD CHUNG
GLADYS WILSON
STACEY GOOLSARRAN
NADIA SAGAR
AMANDA KING
JACKIE DEGOIS VIEIRA
UANDA HARRIA
CHRISTINE RAMBARRAN
SHALINI ANGELA PERSAUD
GARETH MILES
MARK JACOBS
DEVON GABOUREL
OLUATOYIN SAMANTHA ALLEYNE-WILLIAMS
RAQUEL TROTMAN
LYDIA INDIRA BADAL
TISHIKA DE COSTA-FRANCE
VIJAYA JAGNANDAN
RENUKA ANANDJIT
NATASSIA ROMANOVA
ANOUSKA CHEDDIE
NAVINA NATASHA PAUL
SHARILYN JENELLE PHILIPS