Five years after the passage of the law to legalise abortion and safeguard women's reproductive health in Guyana, the Ministry of Health still grappling with implementation issues, has instructed the Georgetown Public Hospital to provide abortion services.

Health Minister, Dr Leslie Ramsammy, in a statement last week said he had asked the Georgetown Hospital to develop a programme to provide terminations as part of the public health service it provides on behalf of the Ministry of Health.

"Similarly, the service will be duplicated at the West Demerara, Suddie, Linden and New Amsterdam hospitals during 2002," Ramsammy said.

Dr Ramsammy said that while the public sector was yet to provide terminations under the act as a health service, it was burdened by the terminations done elsewhere, which sometimes resulted in complications. He said the public hospitals across the country were forced to deal with terminations due to failed contraception, uterine evacuation secondary to incomplete abortion and uterine evacuation secondary to spontaneous abortion.

Ramsammy promised full implementation of the Medical Termination of Pregnancy Act next year.

"As minister, I see the issue as a public health problem and thus, a public health approach is appropriate," Ramsammy said to the media.

Abortion continues to be used as a form of contraceptive in Guyana with little or no regard by the medical profession to honour the reporting requirements of the law. This results in many abortions going unreported each year. And as such, the statistics available do not allow for the discernment of the true trend or for any worthy analysis to be made on the impact of the law on the incidence of abortion in Guyana.

An advisory board named since 1996 to supervise the implementation of the law has not achieved that objective despite it being revamped and Ramsammy is reportedly looking to revamp the board once more. He said in the statement that while the board has been functioning, its functions needed to be reviewed and this would be done as part of the consultations that the ministry was to pursue.

"...The board will need to be reconstituted so that some changes can be made in order to transform the board into a more active one," Ramsammy stated.

Ramsammy acknowledged that full implementation was critical if the problems of teenage pregnancy, poor family planning, the frequency of unwanted pregnancies and illegal terminations as well as the complications resulting from terminations were to be dealt with.

The ministry, he said, would focus on several areas of non-compliance with the 1995 Act to ensure more complete and effective implementation, including the crucial pre and post termination counselling.

Ramsammy said that the issue of making abortions available in the public sector would be looked at in the next few months, as well as the mandatory reporting by medical practitioners of terminations done both at private and public institutions.

The reporting of complications resulting from terminations; the training of doctors in manual vacuum aspiration, possible revision of the Act and ensuring the effective functioning of the MTP advisory board were all issues, which Ramsammy said would be dealt with in the coming months.

Ramsammy said that an attempt would be made by the ministry to build capacity and introduce pre and post termination counselling at health centres and hospitals and the counselling requirements of the act would be enforced.

"We believe that the efforts to build capacity and to provide counselling have been meek [and] we are seeking to correct this situation. We will begin a new round of consultations to determine if adjustment in the mechanism for counselling may be necessary," Ramsammy stated.

The current provision allows for persons seeking terminations to be counselled 48 hours before a decision is taken to terminate. Many practitioners find this impractical, especially in cases where persons live in outlying areas. But Ramsammy said that despite this, all providers of medical termination were to adhere to the regulations governing counselling.

The minister noted the usage of dilation & curettage as the method of termination and said the ministry would promote the use of manual vacuum aspiration as the preferred method.

Ramsammy said that the recommendations made to revamp the act would be considered over the next few months.