– Views move as “protecting the nation”
The Ministry of Health has recently been able to make quiet but progressive strides in the area of the safe termination
of pregnancy, an undertaking that has been long in coming. Currently there are a number of selected health facilities countrywide that are able to offer this service at no cost to patients.
Although a Medical Termination of Pregnancy Act was brought into being since 1995, under the tenure of then Minister of Health, Gail Teixeira, the related issue has been one fraught with controversy, with some persons advocating for the provision of the service while others have been opposing it.
Despite this state of affairs, Chief Medical Officer (CMO), Dr Shamdeo Persaud, during an interview with this publication recently shared his conviction that “Minister (Bheri) Ramsaran has been bold enough to take on that challenge and we are happy to say that we have started…”
“We didn’t make an announcement, deliberately, because we didn’t want to stigmatise any institution or health professionals, because in some countries there are designated abortion clinics and we don’t want to go there,” said Dr Persaud.
Although recently implemented, the termination of pregnancy service has been running smoothly at several public health facilities, according to the CMO. He pointed out that this has seen the Ministry being able to “institute the full law, which means that women seeking a termination of pregnancy, not related to medical conditions, incest or rape, can by choice come to one of the clinics to access the service.”
Ahead of being afforded the service, Dr Persaud explained that women are provided with pre-termination counselling. This, he noted, is in keeping with the Act which requires that a 48-hour period be given to patients to consider whether they still desire to proceed with the procedure or not.
And according to Dr Persaud too, “if they wish or wish not to discuss with their partner that’s fine; the law does not mandate them to do that. It is fully the woman’s right; she has the time to consider based on the counselling session whether she would like to go ahead and there are also options that will be given to her.”
“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.”
Once a woman has carefully considered the possible options, she can then return to an approved health centre that is certified by the Chief Medical Officer to have the procedure done. On completion of the procedure, patients are then subjected to post-termination counselling which, according to Dr Persaud, “includes the provision of contraceptives so that they do not use termination as a form of contraceptive…this is to ensure that the next time around they would use an approved non-termination technique.”
The CMO disclosed that the Health Ministry has been working to ensure that all those tasked with conducting the procedure are properly trained and licenced and that “we are using recommended safe measures for termination.”
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.
As of earlier this year, there were 17 doctors certified to conduct medical termination of pregnancy, and there were a few more undergoing training, Dr Persaud said.
It was explained that the safest period within which a pregnancy should be terminated 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,” Dr Persaud had assured during an earlier interview with this publication.
He disclosed even then 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 him, 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,” he’d insisted.
Offering services such as the medical termination of pregnancy comes as part of the efforts of the Health Ministry to ensure that it delivers quality and much needed health care to the nation.
The CMO noted that while persons may take religion into consideration when certain health issues are discussed, the onus is on the health sector to focus on delivering health care. “People behave differently and I think the world is now at a stage where we have to modify our thinking, at least from the point of view of health. I think our main objective is to provide people with all the protection that they need, regardless of where they are.
“I don’t want to judge who is right and who is wrong, but if people are involved in sexual and reproductive activities and it can pose risks to their health, we must provide them with the education they need, and we must provide them with the service they need.”
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