Nurses, midwives still can’t offer abortion services - Supreme Court

The Supreme Court, in a case filed by Great Lakes Initiative for Human Rights and Development (GLIHD) against Government of Rwanda, upheld its restrictive policies that limit the provision of abortion care to recognised medical doctors in December last year. In the case, which was heard in October 2021, GLIHD, which does advocacy on issues of sexual and reproductive health and rights, was challenging Articles 125 paragraph two and 126 paragraph three of the Penal Code that state that an abortion must be performed by a medical doctor. The state’s take was that the procedure required an expert doctor to avoid failure to manage complications that may arise, like severe bleeding, among other issues and hence the court should not amend the policies. While the World Health Organisation says abortion can be safely and effectively performed in a range of settings and by a variety of people, including different types of health workers. However, in Rwanda, not even nurses and mid-wives are authorised. A 2019 Ministerial Order determining conditions to be satisfied for a medical doctor to perform an abortion specify one who has obtained at least a Bachelor’s Degree in Medicine, “registered and licensed by a health profession regulatory body in Rwanda and working in public or private health facility,” reads its Article 2. This, according to Tom Mulisa, the Executive Secretary of GLHID, limits access to this health service, given the little number of doctors compared to nurses. He also believes the court did not address the demands they had put to the table, which were mostly accessibility of abortion services. Mulisa said that within rural settings, there are no doctors, yet most maternal services are given at health centres, which have mostly nurses and midwives. “The issues we raised were not the ones responded to by the court. We were praying to the court that nurses and mid-wives be authorised to carry out abortions so that there is adequate access of these services to the citizens. The court spent much time arguing the ‘right to life’ instead,” Mulisa said, adding that they are going to see what to do next. Olivia Kabatesi, the founder and Country Director for Empower Rwanda - an NGO that advocates for women and girls rights told The New Times that if other healthcare professionals can assist someone to give birth in the absence of a doctor, then they can also provide abortion services, unless it requires a specialized surgeon. “Even when someone has carried out an abortion by themselves and complications arise, they are taken to the health centre. And this is when they actually are in a critical state where they would have needed a specialist in any case. Unless they need referrals, nurses and mid-wives take care of them until they recover,” she added. Kabatesi also said that these policies only favour those who can afford the involved costs such as transport fees, since one may need to go to the hospital multiple days before being given the service. Aflodis Kagaba, the Executive Director of Health Development Initiative (HDI) told The New Times that availing these services to grassroots would reduce the burden those who need it now bear. “When people can only access services from a doctor, it means they need to go to the hospital. If we are lucky enough and nurses and mid-wives are authorised to provide the same services, one can get them at the health centre,” Kagaba said. He added that although the policy said that referrals from health centres would not be required, in reality they still are. However, Kagaba says there is still hope for revision of the policies through dialogue. The World Health Organization estimates that around 45 percent of all abortions are unsafe, of which 97% take place in developing countries. A 2019 Ministry of Health report indicated that the total number of registered medical doctors in Rwanda was 1,648, with 452 of them practising in the public sector. Furthermore, 15,050 nurses and midwives were registered, with 7,593 employed in public health facilities.

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Nurses, midwives still can’t offer abortion services - Supreme Court