Dear Editor,
On January 15, 2026, the Government of Guyana will celebrate its tenth anniversary of ignoring an unequivocal High Court ruling regarding the legal right of mid-level healthcare professionals to provide non-surgical abortion services in early pregnancy.
In 1995, Guyana distinguished itself by becoming the first country on the South American continent to pass legislation making abortion legal. Now the Government embarrasses itself by its sustained avoidance of any positive action to implement a central facet of that law regarding mid-level healthcare professionals. One of the major innovations in the MTOP Act was a provision at section 5(1) for mid-level healthcare professionals to provide non-surgical abortion care in early pregnancies under the supervision of a doctor.
The term “or supervised by a medical practitioner” did not mean physical presence; all that was required was for the doctor to be “on call”, accessible by phone. This is what we now proudly call telemedicine.
The legal history of this provision is instructive of the power struggle between doctors and all other health care workers, in this case, nurses.
The UK’s 1967 Abortion Act only contemplated abortions being performed by “registered medical practitioners” but by the late 70s termination by medical induction using extra-amniotic fluid was in practice. And this procedure involved nurses.
The process was slow and took 18-30 hours. So, this tedious service was left to nurses. The Royal College of Nursing was concerned about the vulnerability of its members, since nurses were not mentioned in the Abortion Act.
The case reached the House of Lords, where it was decided that so long as the nurse was acting under the direction of a medical practitioner, her/his actions were lawful. There was no need for the doctor to remain at the patient’s bedside; s/he just had to be accessible by phone. (Royal College of Nursing v DHSS [1981] 2 WLR 279)
So, the primary consideration was the convenience of doctors rather than any empowerment of nurses.
In our case, the driver for this provision was the hinterland – vast areas, sparsely populated very difficult terrain, poor and expensive transportation, and few medical practitioners. If access was to be meaningful and safety was to be secured, mid-level healthcare professionals had to be empowered to provide abortion care.
But the Ministry of Health, our doctor-centered culture, and the Attorney General, all objected to this provision. In 2013 we appealed to the High Court for an interpretation of section 5(1).
The declaration was unambiguous: Justice Roxanne George ruled that within the constraints established by the Act “medexes, midwives, nurses, pharmacists and any other appropriately trained and registered mid-level member of the health profession” could lawfully provide non-surgical abortion care.
The Government never appealed this ruling. Instead, for ten years, it has simply ignored it. This is not benign neglect; it’s malignant indifference. The consequences are real for poor women.
Thirty years after the law and ten years after a court ruling, 84% of mid-level health care workers remain unaware of their legal authority to provide early, non-surgical terminations.
Even more startling, although the technology of abortion has shifted from surgery to medication, 91% of pharmacists are unaware that they can lawfully administer medication abortion. The Government has chosen not to inform them.
Unfortunately, mid-level professional associations, like Midwives’, Nurses’, and Pharmacists’ have apparently chosen not to challenge the doctor-dominated culture and assert their legal rights within the MTOPA. But there is no need for a fight.
All they need to do is (i) contact the Telemedicine Centre for a cooperating supervisory doctor; (ii) ask the Centre to make Form F available so they can report any services, and here is the kicker, (iii) ask that Misoprostol (Cytotec) be made available in District Hospitals and Public Health Clinics as the World Health Organization recommended in its Abortion Care Guideline, 2022.
Mid-level healthcare workers do not need a separate registration to provide abortions in the first eight weeks. Similarly, there is no need for approval of facilities for abortions in the first eight weeks.
The legal path is clear for mid-level health personnel to respond to clients seeking early abortions. But the Ministry will almost certainly continue to frustrate this service by restricting Mifepristone and Misoprostol to GPHC and Regional Hospitals alone.