SPOTLIGHT ON ISSUES
by Gitanjali Singh
July 3, 1999
On May 4, 1995, abortion in Guyana was decriminalised after six hours of fiery debate in parliament and two years of intense public discourse.
The historic passage of the Medical Termination of Pregnancy Bill brought to a successful end, 37 years of efforts to decriminalise abortion in Guyana and repealed the 1861 legislation which made the act illegal.
The passage itself was momentous as it was by a conscience vote which allowed parliamentarians from both sides of the house to support or oppose the bill.
Minutes after the Bill was passed, Gail Teixeira, the then health minister who had pushed relentlessly for the law reform, with strong support from PNC frontbencher, Dr Faith Harding, social scientist, Fred Nunes and two city gynaecologists among other persons, said: "...There is much work to be done now and I hope that everyone will cooperate; all the non-governmental agencies, churches and all the health staff, will work as one to ensure that our aim to reduce abortions and save lives will come to pass. In two to three years time, we can do a revision to see if it is working. If not, it can be discussed again in parliament and be removed...."
Four years after its passage, Spotlight on Issues focuses on the successes and failures of the Medical Termination of Pregnancy Act, 1995. It features interviews with key players, including Teixeira, Nunes and Harding.
Some 30,000 abortions reported per year
An estimated 30,000 abortions are done in Guyana each year, most of which are repeat abortions as a result of the serious lack of family planning and counselling services.
Of this estimated sum, however, less than 8,000 abortions are being reported each year an indictment on the Abortion Advisory Board, which was to have ensured that doctors complied with the regulations of the Medical Termination of Pregnancy Act of 1995.
The number of doctors reporting moved from 15 in 1996 to 16 in 1997 but fell to 11 in 1998. This erratic reporting does not allow for a trend to be discerned as to whether there is an increase or decrease in the number of abortions performed since the historic law reform in 1995. But it is not believed that there has been any explosion in abortions in Guyana over the last three years.
From March to December 1996, 15 doctors reported 7,711 abortions, which dropped to 6,614 abortions by 16 doctors in 1997 and by June 1998, 11 doctors reported 3,127 abortions. (See tables and accompanying breakdowns.)
It is not clear why only 11 doctors were reporting in 1998; whether there were insufficient forms or whether they found no reason to fill these forms out because of the lack of enforcement of the law by the Abortion Advisory Board. Repeated efforts to get an interview with Chairman of the Board, Frederick Cox, have been futile.
Two city gynaecologists, Dr M.Y. Bacchus and Dr Neville Gobind, both of whom reported the number of abortions they had done, said they have never heard from the Advisory Board. Nor have they ever seen a copy of any of the board's reports.
However, comparing the data available at the end of June with the first four months of reporting in 1996 (see table 1), suggests that many abortions have gone unreported. While eight doctors reported 2,610 abortions for the first four months of 1996, 11 doctors reported 3,127 abortions for the first six months of 1998.
The bulk of the abortions reported, according to data compiled, related to women in their 20s. Their ethnic and religious composition fit with the respective proportions in society. Almost all of the abortions reported are in Region Four which also suggests non-reporting and under-reporting from other regions.
The data available shows a high incidence of abortions, not by teenagers but by young women between 20-29, who account for more than half of all the terminations. The largest single block of women continuing to seek abortions are single females, accounting for almost half of the abortions. And just over 60% of the women seeking abortions have a secondary education. Almost all of the abortions are by Guyanese, dispelling fears that Guyana would become a tourist attraction for abortions.
More than 60% of the abortions are repeat abortions with almost half of the women having had a previous abortion within 24 months. There is a clear trend that repeat abortions are on the increase; confirming concerns that abortion is being used as a form of birth control and that counselling is not readily available.
What the data also shows is that more than 80% of all women seeking abortions have three or fewer children, a clear indication of the wish for small families, with terminations a means to that end.
Additionally, almost all of the abortions reported were started and completed by the same doctor with very few complications arising.
However, there is a high and growing reliance on dilation and curettage (D&C) as a method of termination. This emphasises the need for the Ministry of Health and the Medical Council of Guyana to actively train doctors in vacuum aspiration.
Also of concern, as seen in the data, is the decline in the use of antibiotics as a preventive measure against sepsis. This has dropped from 99% in March of 1996 to 31% in June of 1998 and may result in an increase in admissions for sepsis at public hospitals.
Regarding the timing of abortions, the data shows that some 66% of the women have terminations by the eighth week and another 30% by the 12th week. This is found to be very desirable.
On pre and post termination counselling, doctors are recorded as having provided over 90% of this, which is alarming given that doctors are usually pressed for time to see other patients. The increasing incidence of repeat abortion bears this out.
Refusal of contraceptives rose from 18.2% in March of 1996 to 31.4% in June last year.
The data also reflects that almost all terminations are done in hospitals which is difficult to accept given that most doctors do terminations in their clinics.
FPAG trains counsellors, field workers
In the wake of the abortion law reform, two non-governmental organisations opened their doors to the poor and vulnerable to provide pre- and post- abortion counselling services and also to look at alternatives to abortion.
These were the Early Pregnancy Advisory Service (EPAS) of East Street and Family Planning Association of Guyana (FPAG) of New Market Street.
FPAG is initially funded by Family Planning International Assistance (FPIA) and has to date trained 46 counsellors and 15 field workers with youths included in the latter category.
FPAG, launched in 1998, provides family planning education, gynaecological examination, contraceptives, emergency contraception, counselling before and after safe terminations. It also provides access for abortions up to eight weeks and FPAG's work is targeted at poor communities.
In its first grant period, the pace of work by the organisation was slow but the response, according to head, Melissa Humphrey, has been positive. The targets set by the funding agency were surpassed by 106% and 120% respectively.
"It is heartening to know that the demand for medical termination of pregnancy was far below what was expected, as it was found that more clients are accepting the contraceptive method," Humphrey stated in a report to mark the end of 'Grant A' period. By the end of that period, two training sessions had been conducted in pre- and post-termination counselling, with participants being selected from the Ministry of Health and other organisations.
During its first year, FPAG also got help from the Canadian International Development Agency (CIDA) to conduct a training of trainers workshop in MTP counselling.
This, Humphrey said, was quite successful and the reference manual produced as a result is now being tested.
Last week, FPAG trained another batch of persons and Christopher Price, regional director of FPIA was at hand to congratulate them.
Cindy Briggs, executive director of a Planned Parenthood Association of Ohio, USA, was also present and has began to assist FPAG in institutional development and marketing strategy. The latter includes targeting private sector organisations to be members of FPAG, thus spreading the use of contraceptives in Guyana.
"I am still optimistic that the Advisory Board would be instrumental in seeking support from the Ministry of Health to register counsellors who have been trained in pre- and post-medical termination of pregnancy counselling as stipulated in the regulations governing the Act," Humphrey told participants at that ceremony.
She was also pleased that many youths have been trained as field workers in the community based distribution programme and hoped for their success in promoting family life education, the use of contraceptives and referral services.
FPAG began its work in Sophia to target that depressed area with family planning services. It is now developing with Briggs a mechanism by which its services can be taken across the country.
Repeal of abortion law successful -- Dr Nunes
Social scientist, Dr Fred Nunes, feels abortion law reform in Guyana has been a success as it has resulted in fewer cases of abortion complications; a huge plus for women's reproductive health.
"There are far fewer cases of complications of abortion being admitted to public hospitals, a reduction of at least 70% in just four years. Few countries could claim a more dramatic result. So from a point of view of safety, the law has been a resounding success," Dr Nunes told Stabroek News in an interview from Washington. He said that those who think the law reform has made no difference should speak to the nurses of Ward 'E' at the Georgetown Hospital.
In 1992, incomplete abortions was the eighth highest cause of admissions to public hospitals, with Ward 'E' earning the pseudonym 'slip and fell ward'. It was this finding which spurred the then health minister, Gail Teixeira to embark on reforming the law which made abortions illegal.
Dr Nunes contends that the new law has given women a certain basic dignity as they now have lawful access to a medical service and the law reform has placed new responsibilities on doctors.
"Doctors can no longer abuse women who, in distress, seek their services," says Dr Nunes, pointing out that since the new law, two doctors have been charged with improper conduct. He feels law reform has changed the balance of power between doctors and women.
But one of the explicit goals of the new law is to reduce the number of abortions over time and Nunes says this can only be accomplished through a reduction in the number of unwanted pregnancies. He posits that this would require more responsible sexual behaviour such as abstention, less extra-marital sex, effective use of reliable contraceptives and a significant change in male attitudes.
"I am not aware of any data that clearly indicate any trend in a drop in the number of abortions in Guyana. Nor would I expect this in the short term of four years. This is a hard goal to achieve and will require a good deal more than the law; for example, a strong programme of sex education in schools," Dr Nunes says.
While the promotion of the law reform was based on the need to protect poor and young women who are particularly vulnerable and were most likely to end up butchered by 'backstreet' abortionists, the law reform has not resulted in the promised safety net for them. This is so because terminations of pregnancy (TOPs) are not offered at the public hospitals.
"Until the government makes TOP services readily available through its public hospitals, these vulnerable groups will not realise the full benefits of the law," states Nunes. He finds the government's reluctance to provide such a service "a sad abandonment" of the group in whose name much of the campaign was conducted.
Dr Nunes, who played a major role in research and in lobbying support for abortion law reform in Guyana, argues that the improvements which have taken place so far as a result of the law reform did so in spite of the lack of implementation of the law by the Ministry of Health. He stresses that the successes were as a result of the repeal of the old law, rather than the implementation of the new one.
"The old law which prevented women from having legal access to medical treatment was the cause of the clandestine, bottom-house abortions and the sloppy, sub-standard practices of some doctors. Once that law was repealed and market forces were allowed to operate, those doctors simply had to put an end to their wretched practice of initiating abortions and leaving women to go to PHG when they started to abort," Nunes says.
On the issue of the non-implementation of the new law, Dr Nunes points to the lack of inspection of facilities for abortions; the non-arrest of non-medical providers; the lack of training for doctors who do abortions after eight weeks; and the registration of just about any doctor who applied to the Medical Council of Guyana to be an Authorised Medical Practitioner.
The social scientist also points out that no pressure has been mounted for all doctors to comply with the reporting requirements of the law, which does not lend to an accurate picture being painted on the number of abortions being done in Guyana.
Dr Nunes feels there has been a pitiful disregard of the campaign commitment to ensure the provision of high quality, comprehensive, pre- and post-abortion counselling. He also finds that the promised transparency of the implementation and impact of the law through the Advisory Board has not materialised.
Dr Nunes notes that most abortions in Guyana are as a result of women having repeat abortions. "If counselling was in place and was effective, we should by now have begun to see a decline in the incidence of repeat abortions. To the best of my knowledge, only the Family Planning Association of Guyana (FPAG) has made any serious effort at training counsellors," said Dr Nunes.
But what needs to be done now?
Dr Nunes says: "For me, there are two major disappointments. First is the reluctance to be scientific about the intervention of law reform in this controversial and sensitive area--the reluctance to create a vibrant civil body of persons of divergent values and interests, to monitor the implementation of the law."
However, he does not believe it is too late to gather baseline data and learn how the law is working. "If there is hope to engage civil society in its own governance, this is an essential step," Dr Nunes argues. "The Advisory Board needs to be energized. This means providing it with secretarial support and such technical assistance as it needs to interpret its data and do its work. An Advisory Board that was alive and well could address most of the other matters."
Dr Nunes said his second disappointment has been the lack of response from the Ministry of Health.
"I fear that the political leadership is simply poorly advised that this matter is not a priority. Sexual behaviour is at the core of the HIV/AIDS problem in Guyana. That is already at crisis levels. We cannot so neatly compartmentalize issues by imagining that we can treat with the transmission of sexual diseases and ignore another major consequence of unprotected sexual involvement," Dr Nunes says.
He believes that the ministry should be a model of the standards it demands of the private sector. It should be the source of "best practices" in counselling, termination techniques, post-abortion contraceptive acceptance and top class reporting.
"Instead, in clear breach of the law, it is not even reporting on those complications of abortion which are treated every day in its public hospitals. This is inexcusable," Dr Nunes contends.
He says there can be no informed assessment of the law without reliable data but finds Guyana's record on reporting better than Barbados's experience where there has been no government compiled report since its law reform in 1983.
Dr Nunes believes that the Advisory Board is a most important indicator of the willingness of Guyanese society to work together constructively in spite of patently divergent interests. "The inability of this body to function is a sad signal of deeper fissures in the social system. There is an unwillingness to work through differences to serve broader common interests. There is a refusal to be open-minded and big-hearted about differences. There is a fear of expressing any respect for another's perspective. Such intolerance makes community impossible. It is most unfortunate that some religious leaders who have so much to contribute in this realm, have been most adamant in their refusal to serve on this body. If persons can't work on this small board, one wonders how they can expect to agree on a Constitution," Dr Nunes says.
While he agrees that there is need to reform the law, this for him is not a priority given that the existing law is not being implemented. Issues which he thinks deserve attention are: the imprudent restriction to non-surgical methods of TOP in the first eight weeks; whether all doctors doing TOPs should be trained; whether minimum standards should be specified for all facilities in which TOPs are performed; and the value of the 48-hour waiting period.
Abortion reform was the right thing to do --Teixeira
Law reform on abortion in Guyana has worked, former health minister, Gail Teixeira, says.
"What was the law all about in the first place? It was to decriminalise the whole issue of abortion, allow women to have choices and reduce the level of morbidity and sometimes mortality from unsafe abortions. In general, the law has done that. It has provided the framework for that because it provides women with a choice of not having to do things illegally and it has allowed women to have access to safer abortions," Teixeira argued last month.
Minister of Youth, Sports and Culture since 1998, Teixeira said the law reform has seen a trend of reduction in admissions to the Georgetown Hospital for botched abortions.
"I would love to see the figures which have come out now. I made a promise then --and though it was my promise, it should be kept--of reporting to parliament [on the successes or failures of the law reform]. Now that you have a database for 1996, 1997, 1998, it would be useful some time in 1999 to table a report in parliament to say if we have achieved some of the things we set ourselves," Teixeira stated.
Teixeira said it was not her expectation in 1995, that the law reform would bring immediate and radical change.
"I really wanted to provide a choice for women and to reduce what I was seeing in the public hospital of maternal mortality and morbidity. What we were talking about in health was the number of women who had botched abortions, who became dysfunctional after they had such an abortion. These women were suffering from chronic gynaecological and obstetric problems, constant miscarriages, infertility and so on and did not realise it was due to a badly done abortion," the minister said.
She noted that if these women had had recourse to safe abortions, guaranteed by the law, maybe their whole lives as women would not have been disrupted. But for her, that was only the tip of the iceberg.
Not in a position to speak on current abortion figures, Teixeira said she certainly would like to see a strengthening of the reporting mechanism of abortions done in Guyana and for persons operating outside the law to be dealt with. She does not believe that the Medical Council of Guyana has shown the strength and willingness to deal with the recalcitrant.
She also believes that steps have to be taken to strengthen pre- and post-abortion counselling and to ensure that what the doctors say on the reporting forms was actually done.
The minister feels that the time is also ripe for a survey to be done on whether women are now making a conscious effort to use birth control.
"Now that we are dealing with safe abortions, we have to move to reduce the number of abortions being done," said Teixeira.
And she disagrees with Deryck Bernard that a lot of feminist and western arguments pushed the law reform and that it has to date not addressed the issue of the poor and vulnerable. She asserted that it was the poor and vulnerable who cannot afford a specialist and end up having botched abortions and are those admitted to the public hospital. She also pointed out that the whole debate arose out of the discovery that the third highest cause of admission to public and private hospitals was botched abortions.
"I would have loved to have thought that as a feminist, this was on my agenda and this is what I was going to do as minister of health. But I did not have it on my agenda. It grew out of the debate on maternal mortality and recognising that the other causes of maternal mortality were going to be much more long term in reducing," said Teixeira.
She contends that decriminalising abortions would bring a faster solution to one of the many causes of maternal deaths. She noted that there were 29 maternal deaths at the Georgetown Hospital in 1992 and this was reduced to around 13 in 1997 and were mainly due to high risk mothers not monitored properly, not attending clinics or mistakes made in the delivery. There has been no known documented death as a result of abortion in the past four years.
As to why Georgetown Hospital is not providing the service for the poor, Teixeira said initially, this was because the hospital was not equipped with the clinical skills to offer this service. However, she said a process had begun before she left the Ministry of Health to have abortions done there and she is certain this service is being provided. Dr Mohamed Raheem of the Georgetown Hospital Maternity Unit said such services are not provided.
"If I had to do it again, would I do it the same way?" Teixeira, answers. "There should be an advisory board but we were not definitive enough in terms of what the board's role was and what powers the board has. So If I had to do it again, I would give the board more powers and allow it to be proactive. I think there is a vagueness and certain tentativeness of how one handles this thing," Teixeira stated.
She said her own criticism of herself is that she was not certain how much the board could do and in terms of its composition, came to a compromise with the religious communities. She said it was a judgement call and she may have made the "wrong" call. Two persons from the churches were named to the board, Sheila George, and Rev Wilfred Ledra.
"Is there a different type of combination [for the board members]? Yes, probably. That will have to be experimented with. I really wanted, because of the sensitivity of the law, to include as many of the religious people as possible as I felt they had a stake in this issue and would be a closer watchdog," said the minister.
She said she could have put on the board a number of feminists who "may have done a better job" and feels the religious community lost a good opportunity to come on board and have access to the data to see what kind of interventions it needed to make to reduce the number of abortions.
She feels the persons on the current board are committed to the law reform and seeing it work but believes that a nexus was not created between the board from a statutory point for it to work along with the MCG and the Nursing Council to implement the law reform.
"I think ours was the only piece of legislation which provided for such a board and we had no idea how to go about doing it. So in all fairness to the individuals on the board who are deeply committed, we should not castigate them." She said what is needed now is to get some advice and sit and talk about the issue.
As to the 48-hour waiting period of the law which is not being adhered to as well as the non-surgical methods under eight weeks, the minister indicated that if there is a strong body of opinion to change these, a lobby should be made. She noted that the 48 hours was to appease the churches and for women to seek counselling from their pundit, imam or preacher. As to the non-surgical method, not available in Guyana, this issue can be re-examined.
The minister said she would not like to see the Medical Termination of Pregnancy Act, 1995 repealed and is satisfied that in the first three years of its enactment, it has had an impact.
She said what was achieved in Guyana, which has one of the most modern pieces of abortion legislation, is an example for other countries as the maturity exhibited in Guyana in the process up to and after the law has not been seen in many other countries including the US and Europe.
"Looking back at the whole issue I am glad that we did it. I think it was the right thing to do. I have no doubt in my mind that it was the correct thing to do in our society at that time..." For her, it was a lesson not only in law reform but also in dealing with a highly charged, highly controversial issue which brought many forces together especially women across the political divide. And it is a lesson, she feels, which needs to be replicated in other aspects of Guyanese life. She said she is proud to have worked with so many people to make this happen.
What is needed now, she believes, is the softer issues such as societal intervention, professional and educational interventions. That is, introducing family life education in schools as soon as possible and overcoming reservations in this area, and having the professional intervention to ensure that women's reproductive health is improved.
She also feels that there is need for nurses at health centres not to sit in moral judgement of youths approaching the centres for contraceptives, noting that encouraging the use of contraceptives is one of the ways to curb the incidence of abortion. She said that there has been increased use of contraceptives but agreed that there is need for wider use.
Impact of the Abortion Act
Stabroek News canvassed the opinion of a wide-cross section of persons to determine the impact of the Medical Termination of Pregnancy Act of 1995. Five key players did not make themselves available. Frederick Cox, chairman of the Abortion Advisory Board; Health Minister, Dr Henry Jeffrey; the Guyana Council of Churches; the Guyana Hindu Dharmic Sabha; and Chief Justice, Desiree Bernard. Justice Bernard said she has not been following the issue and the Dharmic Sabha said it did not have a position on the issue and would need data to make an objective assessment.
Below are the views shared:
Dr Mohamed Raheem; head of gynaecological unit, PHG: "None of the consultants at the Georgetown Hospital provide abortion services and I do not personally do so because I am a Muslim. The hospital does not offer abortion services but if complications develop as a result of abortions elsewhere we sort them out. "Since I have been there (October 1997), we have admitted between one and three patients per day on average as a result of incomplete abortions. What we have been seeing is very serious. Not only are there cases of sepsis, but there are cases of perforated uteruses and damage to other vital structures such as women's intestines. I am told that the admissions we are seeing now are fewer than what obtained before. "I was told that the ministry has a plan to establish a counselling centre [family planning] at the Georgetown Hospital but I am not aware of the details. I don't know of any plan to provide abortion services at the hospital. "What is of concern to me is the tremendous disinterest among women in using contraceptives. This applies to women visiting private and public hospitals. There are all kinds of myths about the usage of contraceptives. However, persons ought to make a conscious decision to prevent pregnancies rather than resorting to abortions as a means of contraceptives. "I have seen a number of horror cases first hand. Recently there was one woman from the East Coast who had aborted a 16-week-old foetus. Her uterus was perforated and a foot of her intestines damaged. "Another case that comes to mind is a 23-year-old from West Demerara whose tubes were damaged as a result of the abortion. Her uterus was perforated and by the time she got to the Georgetown Hospital I had to drain two litres of pus from her. "There is also a new trend being seen involving the unscrupulous practice of drug stores selling cytotec over the counter to women to induce abortions. In the last six months we have been dealing with a tremendous amount of cases where a lot of doctors are telling patients to buy cytotec as a means to have an abortion. A month later the women are still bleeding and they then come to the Georgetown Hospital with their complications. This is cause for alarm in both the public and private health sector. If a family cannot afford an abortion, family planning services are available.The result of the use of cytotec is that users may not be able to conceive, and if they do there is a high risk of an incomplete pregnancy. "No, the new maternity theatre at the Georgetown Hospital is not functioning. It does not have the appropriate lights, compatible gas outlets or enough anaesthetists. There is also a problem to get D&Cs done because of the lack of instruments, theatre time and inadequate amount of theatre beds. We often have a pile up of patients. Another problem is if a woman needs a transfusion, she may have to wait weeks for this."
Gynaecologist Dr Mohamed Y. Bacchus: "Yes, the law reform has worked in that it has led to doctors cleaning up their act. We now have fewer cases of sepsis and more doctors completing the termination of pregnancies. "However, it has failed in that the incidence of abortions have remained the same and in the last three months we have been seeing a doubling of the figures for some reason. I can't say why but high on the list of reasons continues to be the socio economic conditions of families. There has been a failure to promote wide contraceptive use and as such abortion continues to be used as a means of contraceptive. "Counselling is also another problem as most doctors are not trained to do counselling. The Family Planning Association of Guyana has trained two batches of counsellors and a few hospitals provide counselling services, but a majority of patients are not offered counselling. "This entire problem stems from the lack of sex education in schools. And to compound this, personnel at health centres who do not have a clue often give wrong advice. Until this situation is corrected, we will continue to have a high rate of abortion. I would estimate that in Georgetown alone, in both private hospitals and clinics, some 500 to 600 abortions are done each week. "As to the Medical Termination of Pregnancy Act itself, we continue to break the law as those who wrote the law had no background in gynaecology. The 48 hours waiting period to allow patients to make up their minds whether they will proceed with an abortion or not is impractical given the logistics of a woman travelling from outlying regions. "The non-surgical method of termination before eight weeks is also broken as no non-surgical methods are available in Guyana. The RU486 (Mifepristone) abortion pill is only available in some first world countries. As a result, doctors use the methods available to them locally which are surgical. "Another problem is although abortion is now legal in Guyana, it is not available at the government facilities. What is the point of the abortion law reform if poor people cannot have a free access to the service? They will still end up at backstreet doctors and pay money for such services and may suffer complications. "The sad thing about the law reform is that its implementation is not being monitored. The sepsis rate at the gynaecological ward at the Georgetown Hospital is a good indication of what is going on in Guyana regarding abortions."
Dr Neville Gobind, practicing gynaecologist: "I find that definitely there has been less incidence of septic abortion. Women under the new law are exercising their rights to safe abortion. So in this regard the law has worked. "Before the new law, even here, at Woodlands Hospital, I would have seen septic cases but I don't hear these horror stories anymore. Abortions now have become safer in Guyana. I don't think there have been any abortion deaths since the law has been passed and I feel that is as a result of the legal parameter. "In terms of what the bill had hoped to achieve--a reduction in the incidence of abortion--we are not able to say as we do not have the figures necessary and we do not have a past database to compare it with. But in the last three months, we have been seeing an increase in the number of abortions. In March, the figures doubled at Woodlands and I feel people are more and more using abortions as a means of contraception. "Woodlands Hospital offers professional counselling services but the 48-hour waiting period is difficult to adhere to. Many women, sometimes from distant areas, barely scrape up enough money to come and are prepared to have the abortion then, not later. As such I do not adhere to the waiting period but I insist that everyone having a termination make a commitment to use some form of contraceptive. But it is difficulty to get people to accept that they need to use contraceptives and they provide many excuses about possible side effects of the various contraceptives. "A failing of the law is that its provisions have not been effective and the Advisory Board has failed to oversee the implementation of the new law. I have never heard from the Board. "Nevertheless, I feel the passing of the Bill was a good move and it is still not too late to start implementing the measures of the Bill and for the Advisory Board to get its act together. But to achieve the objectives of the Bill, I feel strongly that sex education has to be introduced in schools. There also needs to be more public programmes on the use of contraceptives. "As to the training of doctors, the Guyana Medical Council contacted me two years ago on this issue but nothing came out of it. There is also need for broad-based criteria of counselling so that there will be uniformity in the kind of services women are receiving. "Though the Act has its weaknesses and there are many flaws in its implementation, I believe we have to thank Minister Gail Teixeira for having the courage and dedication to move ahead with it. I admire her for that as her courage, which I believe had personal and political ramifications for her."
Dr Faith Harding - PNC member on Abortion Advisory Board: "I think some work has been done since the new law but enough has certainly not been done. The government seems not to have any programme to give effect to the objectives of the Act. There is no education programme to promote safe sex. And I do not think women are being counselled or young women are being given a choice. "Some teenagers are not au fait with reproductive health care and the way their bodies work and there needs to be an education campaign to counter this. So as far as the objective on promoting women's reproductive health is concerned, that has not been met. "Reduction in the number of abortions: I do have the data so I do not know what the records are showing on trends and on the number of botched abortions. "I have not gone to many of the meetings of the Advisory Board as we do not seem to be able to get as much movement as I would expect. The board is bogged down in triviality. No, the terms of reference of the board does not limit its scope of work but I think the problem lies in its interpretation. "And not having a chairman since the death of Pearlene Roach has not done the board any good. [Cox is now the acting chairman.] The board has also been affected by the manipulation of Gail Teixeira as she was saying who should be the chairman and what the board should do and not do. I have made myself scarce since then on the board but I have not resigned. "I do not regret throwing my support behind Teixeira for this law reform in 1995. What I regret is that women's reproductive health has not benefited as it should. I do not regret taking the opportunity to support a law which can promote safe women's reproductive health as I value that. The intense debate brought out the need to safeguard women's reproductive health and that women can have choices. But the government has failed to provide abortion services for poor women, so they do not have an option under the law."
Manzoor Nadir: leader, The United Force: "We know that before the law change, the Abortion Act had been honoured more in the breach. But now, it is difficult to see if the objectives of the law reform have been met as there is only some element of reporting. "However, there will be those who will say the impact of the law has been positive but I do not believe the law has had any major impact. I still feel the same way as I did in 1995 that the law reform would facilitate abortion on demand. "And we have not studied the whole psychology and sociology of abortion in Guyana and young girls getting pregnant out of wedlock. Abortions deals with persons not pregnant for their husbands and is used to keep them 'clean'. There is a larger problem than the abortion issue and that is the moral issue and the behaviour in society. "There has been no attempt to set up counselling services throughout the country to implement the spirit of the law. The law is being used as cosmetology to facilitate abortion on demand. And there has been no attempt to put into effect all those wonderful things promised in the act [reduction in the number of abortions; widespread use of contraceptives etc..]." (Nadir voted against the bill the 1995.)
Rupert Roopnarine, leader, Working People's Alliance: "It is fair to say that those of us who supported the Act for lives have not seen that happening. The Abortion Board established has barely functioned and if it did function, it was in secret as no one knows what is happening. "Since in this and other areas of Guyana we are operating in statistical darkness, I am not in a position to say whether or not there has been a decline in bottom house abortions or whether we have succeeded in making that much of a difference in women's reproductive health. "I am astonished to learn that the procedure [terminations] is still not available at the Georgetown Hospital and that women must have recourse to private hospitals and doctors, thereby imposing an additional hardship on women who may well have been driven to the decision by their own harsh economic conditions. "The Act places great emphasis on counselling and as far as I am aware there is virtually little counselling available and certainly the hard-pressed doctors have little time or inclination to carry out this area of activity. "I am also concerned that while the Act stipulates that termination under eight weeks be non-surgical, no such facility appears to be available in Guyana. "I would be interested to know whether there has been an increase or decrease in the number of abortions being performed; a statistic from which one might be able to draw certain conclusions. "I have to conclude that in this area as in other areas of legislation, the government is ready enough to bring bills to the assembly but seems incapable of following through with the necessary institutions and arrangements for their implementation. "What we need and may have to demand in parliament is a full report from the Ministry of Health on the process which has followed the passage of the legislation. The minister must tell us what steps have been taken to make the provisions of the Act meaningful. "When I supported the legislation--which I did without hesitation--I did so because I was convinced that it would have made a difference to the reproductive health of women in this country and in particular the vulnerable. That this has not happened is a matter of regret and real concern. "The time has come perhaps for reassembling of the special select committee to open public hearings on the Act and what has proven to be its shortcomings.
Deryck Bernard, former PNC MP: "I feel that the issue has not been solved and we are not in a position to know if reproductive health of women has improved as a result of the law reform. And we do not know whether poor teenagers are getting better attention than before. So my reservations on the Act are still strong. "I am now convinced we were too hasty and could have a taken a little bit more time with that piece of legislation. "My reservations had to do with me not being satisfied that the debate focused on Guyana's problems. Opposition to the Bill imported the North American argument and I thought the debate was lopsided. I thought a lot of the support for the bill was based on feminine arguments which were not relevant to Guyana. "Abortion for me is more a public health than a moral issue. It has to do with how we protect the vulnerable, poor women from a bad system. The public health issue has not been addressed in Guyana as there is still no access to proper health care by the poor and vulnerable who still turn to backstreet practitioners because public hospitals do not provide an abortion service. "We have not solved the public health problem and we are not trying to find out how bad it is. Now that we are talking user charges in the public health system, that issue has become more unimportant. "It is a clear case that politics got in the way of other issue with this law reform. I am convinced my reservations were well founded when I abstained from voting on the Bill."
Clarissa Riehl: PNC MP: "I do not believe it has served its purpose of reducing number of abortions and what we have ended up with is abortions on demand. "The law has led to abortion being used as a form of birth control rather than making people more responsible. I feel it has not worked." (Riehl voted against the Bill.)
Early Pregnancy Advisory Service: "Before EPAS could objectively pronounce on the impact of the MTP Act law reform on the abortion practice in Guyana, it would be necessary to resource and analyse the relevant data. This process is still ongoing. "Concerns are however, expressed with respect to: * Abortion practice by some physicians who are not registered to do so. The MTP Advisory Board needs to look into this matter.
* The emergent practice of some pharmacies/pharmacists who prescribe a prostaglandin drug to induce abortions on request from pregnant women clients or their spouses. This drug, though authorised for use in induction of labour supervised by a physician, is not authorised for use in abortion. The Guyana Pharmacy Association needs to look into this matter.
* Impartiality and level of effectiveness of pre-abortion counseling by abortionists or their team.
* Adherence to the waiting time prior to abortion as required by law.
* Accuracy of abortion reporting countrywide.
"At this the year of the fourth anniversary of the passing of the MTP Act, the nation and its leadership needs to be reminded that abortion remains and will always remain the shedding of the innocent blood of the pre-born.
"Indeed, God hates the shedding of innocent blood. He holds the nation and its people accountable. The mystery and manner of demise of the founding chairman of the ministerial committee on the abortion bill reform, also the founding chairman of the MTP advisory board, and the alarming bloodshed from time to time, by criminal elements in this nation are instructive. Are we being judged for the 10,000 to 20,000 innocent ones aborted annually in the land. "In the wake of the passage of the MTP act, EPAS, a non-governmental organisation, where both pre and post abortion counselling and other practical support are provided has been established. We are delighted to report that several women have elected to keep their babies following counselling. With support, their experienced that the anxieties associated with an unwanted pregnancy and the new birth became manageable and were not as overwhelming as their originally though. "In addition, EPAS which offers free pregnancy tests and is located in 340 East Street, provides adoption and orphanages services as needed and is in the process of developing half-way housing facilities for pregnant women, as well. It is undergirded by a team of trained mature, female counsellors who are volunteers."
(Anti-abortionist, Dr Clarence Charles, Drs R Shiwanandan, M Shiwnandan, L. Lord and R. Lewis and P. Sherit are directors of EPAS.)
Central Islamic Organisation of Guyana: - "The debate on abortion will never abate because the parties use different bases to arrive at their positions. "Muslims are not insensitive to the factors resulting in pregnancy or to the reason for the child to be deemed unwanted or the mother subjecting herself to an abortion. "But liberalisation of the abortion law is not the answer. Its existence will not eliminate the other social evils that contribute to pregnancies, especially among teenagers. The continued existence of such evils will cause the abortion figures to go up and for it to be used further as a means of birth control." (CIOG has not commented on the impact of the law but rather reissued to this newspaper, its stance on abortion, which it is against.)
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