A Comprehensive Look at Abortion Care Services in Trinidad and Tobago- a mixed methods approach

Abstract Background: In 2014 60% of the abortions carried out in Latin America and the Caribbean were classified as less safe and at least 10% of all maternal deaths were due to unsafe abortion. Between 2010-2014 abortion rates in the Caribbean were estimated to be 59 per 1000 women of reproductive age. There is no current country specific published data on abortion in Trinidad and Tobago and therefore a better understanding of the services and the current environment surrounding abortion-related services available in the public health systems was needed. Methods: A situational assessment, using both qualitative and quantitative methodologies, was conducted in Trinidad and Tobago. The study was done in simultaneous phases: 1) In-depth interviews with key stakeholders at institutions where abortion care is conducted 2) A review of laws, policies and programs related to abortion; and 3) Collection of information on abortion services from health facilities and women’s health advocates. Results: In Trinidad and Tobago, the English common laws provide a defence for physicians who provide a termination of pregnancy when the physical or mental health of the mother is at risk. There are no national comprehensive policy or guidelines that regulate abortion and thus the legislation and ethical code are subject to interpretation. Medical management of abortion is done using misoprostol alone regimens and surgical management is confined to dilatation and curettage. The hospitals are generally well equipped but some upgrades are necessary. WHO’s recommendations that need to be implemented mainly focus on implementation of medical abortion standard using mifepristone and misoprostol regimens, MVA and improvement in contraceptive care. A comprehensive national guide is needed to ensure consistency quality of care throughout the islands. Conclusions: Abortion in Trinidad and Tobago is still perceived differently by varying groups of persons in the health sector and by the public. In the short term, a comprehensive guide should be developed that is accessible and understood by members of the health sector for consistency and standardization of care across the islands.