Faithful Providers
ON THE FRONTLINES OF ABORTION CARE, there exists a network of healthcare workers whose deep religious faith compels them to provide abortion care because they know it is morally and ethically necessary to fulfill both their professional oath and their spiritual calling, especially in areas where abortion provision is culturally unacceptable or illegal. Their pledge to follow their own conscience and respect women’s right to do the same is a profound testimony that neither God nor faith can be domesticated by a vocal minority of religious and political extremists.
Conscience showcases five such people whose faith journeys have enabled them to transcend political turmoil and break taboos in service to others, undeterred by threats of legal sanction, social reproach, religious censure or personal attacks. For these women and men, devotion to their patients is the fruit of their devotion to God.
Laura Gil, MD
Program Director
Fundación Oriéntame
Colombia
Photo by Ana Vallejo
I had just been admitted to medical school when I discovered I was pregnant. I was only 16 years old. I knew I needed to have an abortion, and it was not a hard decision for me to make. I was raised in a Presbyterian family—a minority in predominantly Catholic Colombia. My parents, who were both chemists, supported birth control but never talked about abortion. We also never discussed abortion in church, but we did learn about loving behavior and what it means to make good decisions. I realized that it was about self-determination. I was free to decide if I wanted to terminate my pregnancy, and no one—not my church or my parents—could tell me what to do. I was the only one who knew what would be the best decision for me and my future, and I made this decision based on my own conscience and personal relationship with God.
Abortion was completely illegal in Colombia, so I needed to get a backstreet one. It actually was not that hard to find. I saw an ad in the newspaper and went. I am not going to tell you that the doctor’s office was dark or dirty—it was just a typical, if undercover, medical office—but I was scared. It felt dangerous. No one counseled me before the procedure, and no one educated me about contraception. The doctors and staff were there just to provide the service. Although the procedure itself was medically safe, the whole thing was legally unsafe. It is not common here in Colombia to prosecute girls and women who have illegal abortions. But I have met girls who were jailed for it, so I realized much later that arrest had been a possibility. So many terrible things could have happened to me.
Yet, during the procedure, I only felt thankful that God had led me to these doctors and nurses. Afterwards, I was so relieved that I wanted to send them flowers or chocolate or cookies—anything to express my gratitude. Now that I am an abortion provider, I better understand that feeling. I also understand that, as an abortion provider, I am not expecting flowers or chocolates or anything from my patients. I am happy to do my job, and I believe the doctors and nurses who helped me were satisfied that they were able to bring abortion services to women.
I always wanted to be a gynecologist, but I never expected to work in abortion care. It just happened. I was offended by the way my colleagues would mistreat women who had abortions. I started thinking, “That could be me; that was me.” I know so many women who had abortions who just look the other way and do not support the right to choose, even as they became doctors. I never thought that was right. I could never just turn the other way.
When abortion was still illegal, I provided information on how to safely terminate pregnancy to whoever needed help. A lot of people knew I was in favor of legal abortion and that I did not believe in penalizing women, so my patients felt that they could ask me questions without judgment. I told them how to take misoprostol—I could not provide the drug itself, but I would give my patients safe guidelines.
I realized there were so many women with late pregnancies in dire situations and that these patients were being turned away because doctors were uncomfortable with providing third-trimester abortions. I believed it was consistent with my Christian faith to provide them.
In 2006, Colombia partially decriminalized abortion, allowing the procedure for various reasons, including fetal abnormalities and a woman’s health. At the time, I was working as a gynecologist at a private hospital. Our first legal abortion requests were from pregnant patients whose fetuses had severe abnormalities. Despite the needs of our patients, no one at the hospital wanted to perform abortions. My colleagues were very well-known doctors and, even if they secretly supported abortion, they were afraid of the stigma attached to it. So I performed all of the abortions myself. I figured that if I was taking care of women who were miscarrying or women who had other pregnancy complications, I also had to treat women who wanted to terminate a pregnancy. As a doctor, there is nothing different to learn about abortion than what you learn from treating a miscarriage. I started getting more and more cases, and eventually, the reproductive health organization Fundación Oriéntame invited me to start formal abortion training with the organization.
Currently, I am one of a handful of doctors in Colombia who provide late-term abortions. Our abortion law has no gestational age limit because you cannot limit the right to choose at any gestational age. However, many doctors do not know what to do with patients who are beyond 20 weeks gestation. As I trained doctors through Fundación Oriéntame, I realized there were so many women with late pregnancies in dire situations and that these patients were being turned away because doctors were uncomfortable with providing third-trimester abortions. I believed it was consistent with my Christian faith to provide them. During the Zika virus epidemic, we saw a lot of pregnant women with severe fetal abnormalities who were not detected until 28, 29 or 30 weeks. Besides me and maybe five or six other doctors, no one else would provide abortions for these women.
Sadly, it remains common here for doctors to be conscientious objectors when it comes to abortion. The Catholic hierarchy, of course, plays a big part in that, influencing the way health professionals act: If being a Catholic means not supporting abortion, then doctors will refuse to perform abortions because they want to avoid looking like bad Catholics in front of their patients and colleagues. I once did a survey among gynecologists, asking the question: “How much does your religion influence your professional decisions?” About 60 percent of respondents said it highly influences their decisions. That is worrisome to me. As a health provider, you are allowed to have a religious affiliation, but you cannot allow your religion to dictate the type of care you provide to your patients, especially if it is telling you to limit women’s rights and women’s bodily autonomy.
Most, if not all, of my patients identify as Catholic. They have exercised their conscience. I see a lot of women who are in an extreme situation and believe that it is justified by God. They don’t feel guilty. None of my patients has ever changed her mind because of being a Catholic. I have never had a patient tell me that she will not have an abortion anymore because a priest or bishop convinced her not to.
Still, some of my Catholic patients struggle with very deep internal conflict, because they know they need an abortion, but feel guilty and judged. They feel like they will not be able to go to church anymore or that they will be automatically excommunicated and unable to receive communion. I often think about my patients and what they must feel inside when they go to Mass and hear a priest preach about the evilness of women who have had abortions. There is so little I can do to counter that—to address the power and rhetoric of the Catholic hierarchy. The fact that they are going to go to Mass for the rest of their lives and hear that they are murderers is hurtful and wrong. I want my patients to remember why they made their decision. I tell them, “Don’t let people make you forget why you are doing this. You are doing this because you love your family and because you love yourself.”
As a Protestant in a Catholic country, there is actually a higher moral expectation for me. People ask me all the time, “You’re a Christian—why are you in favor of a woman’s right to choose? Why do you perform abortions?” I tell them I perform abortions because, to be a true Christian, I must support women who have abortions. For me, it has always been spiritual. The decision to terminate a pregnancy does not have to go against your religion. I know mine did not. I had an abortion because of my Presbyterian faith. I knew I had the freedom to make my own decision; I made a loving decision, and so have my patients.
The decision to terminate a pregnancy comes from the heart. People believe women have abortions outside their relationship with God and then go and ask for forgiveness, but that is not the case. It is a decision you make with your Christian conscience, so you should always feel supported in your relationship with God.
Carol Portmann, MD
OB-GYN and Maternal-Fetal Medicine Specialist
Queensland Ultrasound for Women
Australia
As a teenager, I tried out many different religions—Catholicism, Buddhism, Bahá’í. I even went to an Evangelical church for a bit. Nothing really stuck until my boyfriend and I decided to get married. We popped into a little Uniting church here in Brisbane, thinking it would be a lovely place for our wedding. The minister said, “Why don’t you also come one Sunday and join us?” We thought, “Why not?” We followed the minister’s suggestion and, more than 20 years later, we have been everything from elders to council treasurer and secretary.
Our Uniting church has always been supportive of me and my work in abortion care. Because I’ve held roles on the church council, I made sure our congregation and ministers were aware that I perform abortions. The last thing I wanted was for something about me to turn up in the papers and shock my church. I didn’t want my ministers saying, “We never knew you did that kind of thing!” We’ve cultivated a certain level of trust; they believe that if I choose to perform abortions, then I must feel it is right.
As a young medical-school graduate, I spent about six months at a clinic in New South Wales. The clinic provided public-funded abortions—something you won’t find in many parts of Australia. I was 25 years old at the time, and had never before encountered abortion. The procedure wasn’t talked about in medical school, and many of the hospitals in Queensland, where I did my training, were run by a Catholic health system. I hadn’t heard much about abortion while growing up in Queensland, either. Admittedly, I had led a pretty sheltered life until then, and had never really thought about why someone would need an abortion. I told my colleagues that I was happy to sit in on consultations and the procedure, but that I wasn’t comfortable performing abortions myself.
I was well aware that abortion clinics in Queensland had a poor reputation. Queensland is arguably the most conservative Australian state when it comes to medical and political attitudes towards abortion. Abortion is still a criminal offense—for the patient seeking an abortion, the doctor who performs it and anyone who assists the doctor. Abortions are only permissible for fetal abnormalities and to prevent “significant” risk to maternal life, which includes psychosocial factors, as well as medical complications. Public hospitals provide maybe one percent of all abortions in Queensland, and private clinics openly provide abortions under these provisions. These clinics and doctors are shunted to the fringes of medical society. You know how it is: People talk about how you “go to one of those clinics.” And when something happens, it’s always, “Oh, those doctors at that clinic.”
The farther into the country areas of Queensland, the worse this social stigma is. There may only be one or two general practitioners in a town—and these are towns where the receptionists and the nurses are everyone’s friend. If you go to your general practitioner for postabortion care, the gossip can really spread; once someone identifies you as having had an abortion, you could be ostracized.
When I returned to Queensland after my time in New South Wales, I began working at a public hospital as a maternal-fetal medicine specialist. Even though abortion is rarely discussed in public hospitals, because of the patients I treated, I eventually learned to view abortion as part of my everyday job. If I have to diagnose a fetus with a serious medical issue, such as having no kidneys or brain, then I must be able to give my patients options. If I can’t provide options, then I can’t successfully diagnose. I always make sure that I can give my patients a full spectrum of choices, so they can make the best decision for them and their families.
Soon after I started to practice, I connected with the local group Children by Choice, which introduced me to the social side of abortion—the women whose circumstances are often ignored and neglected. More and more, I realized that I was acting very similarly to other doctors, drawing lines for what I would let a woman do. That’s not the way it’s meant to work if you’re working with pregnant women. So, I advocated for abortions—not just for patients with fetal abnormalities and other medical issues, but also for victims of sexual assault and domestic violence and women living in poverty.
Over time, I tried harder to get public hospitals to be more open to seeing women in desperate psychosocial circumstances who wanted an abortion. We’re talking about hospitals that wouldn’t even let these women past the front door. The common refrain was, “We don’t do that here.”
I reached a brick wall in the public system. I couldn’t fully change the attitude that assumed: “We can tell a mother when she’s allowed to have an abortion.” I was appalled by that concept—that my patients needed my permission to terminate a pregnancy. It felt very paternalistic—a Victorian attitude persisting in the 21st century.
Many people in my congregation knew abortions occurred in Queensland—and some were against it—but they had never thought about why people may choose to terminate a pregnancy and how difficult the decision might be. By providing examples and telling the stories of my patients, I was able to humanize abortion.
Australia isn’t a very Christian country. Christianity is not part of the average Australian’s everyday life. Yet, somehow, the idea that abortion is shameful was adopted in Australian society. It might be hard to comprehend, because we’re a liberal and relaxed country. When people envision Australia, they imagine people enjoying themselves in the sun and partying away. Underneath all of that, however, are these bizarre, oppressive leftovers of our colonial culture. It’s like we’re sticking our heads in the sand to stop us from being dragged into the present.
It’s not all about religion, though; you can have faith and be modern and open-minded, like my Uniting church. About a decade ago, my church invited me to lead a Sunday night session on why I provide abortions. Many people in my congregation knew abortions occurred in Queensland—and some were against it—but they had never thought about why people may choose to terminate a pregnancy and how difficult the decision might be. By providing examples and telling the stories of my patients, I was able to humanize abortion. At the time, most of my patients were terminating pregnancies because of fetal abnormalities, but I was also able to address psychosocial issues. There’s this idea that when a woman becomes pregnant with an unintended pregnancy, she is happy and joyful and jumping up and down, exclaiming, “Yeah, I can have an abortion now!” It’s not like that. No one wants to be pregnant just to have an abortion.
For many of my patients, there’s no choice at all. As a provider of later abortions, I am on the journey with the mother, because I’m the person who’s doing the physical deed. I’m the one performing a procedure that causes the baby to pass away. For these patients, not one of them would choose it. I made my fellow churchgoers recognize that you can’t separate the issue from the people who need help.
I am in a rare position here in Brisbane. I receive more respect than my fellow abortion providers because of my background in maternal-fetal medicine. Most doctors who provide abortions here are general-practitioner surgeons, so gynecologists or obstetricians at public hospitals look down on them. They see abortion providers as not being “specialized” enough—even though there’s no abortion training program in Queensland. Even when I started as a maternal-fetal health specialist, I had no formal training in abortion.
The private clinic I work at now provides roughly 4,000 abortions each year, and we do so without feeling overly threatened. There’s always that small chance that our clinic might get raided, but it doesn’t stop us from providing abortion services. There’s not enough scrutiny, I think, to shut us down. Doctors in the public system are not suspicious of us, but they do give us a snide, sideways kind of look. It’s almost as if they’re saying, “What do you expect? They’re just abortion providers.”
We’re still trying to change the general attitude that if you have an abortion, you must have done something wrong to begin with. I do have patients who are struggling not only with this social stigma, but also with a moral or spiritual conflict. I always remind them: “You need to look after yourself, but God is here for you.”
I have nothing but overwhelming love and support for the woman standing in front of me. I believe God does, too. He would want me to do everything I could to care for this person—and that doesn’t exclude abortion. Every patient is a person with a life who needs to be supported.
Albert G. Thomas, MD
OB-GYN & Associate Professor of Obstetrics, Gynecology and Reproductive Science
Mount Sinai Medical Center
New York, United States of America
Photo by Babita Patel
I was already performing abortions when I converted to Catholicism. My wife’s family was Catholic—her father almost entered the priesthood—and we wanted to keep the faith and raise the kids Catholic. We got married in a Catholic church in Yonkers. No one at the parish knew I performed abortions. I never felt like I had to keep it secret, though. Catholicism encourages discussion, debate and openness. My father-in-law taught me that.
My family is from Jamaica, and I was born here in New York City. First generation. My parents were Episcopalian, but they weren’t that religious. I served as an altar boy in the Episcopal church, but my parents didn’t attend Mass with me.
Growing up on the Lower East Side, I had terrible asthma as a kid. I was hospitalized a lot, and my parents even sent me to stay with family in Jamaica for six months, hoping the clean air would cure my condition. Not long after I returned, my father, who worked as a customs inspector at Idlewild Airport (now known as JFK), moved us to Westchester County.
Maybe it was my numerous experiences with hospitals and physicians, but I knew early on that I wanted to be a doctor. I’ve always been compelled to take care of others. My father died young from leukemia, so I thought I would be a cancer doctor. That’s usually how it happens; it’s something personal that leads you one way and then another.
As a medical student at Mount Sinai, I made several mission trips to Sierra Leone and Ghana. The first time I traveled to Ghana, I saw a patient who had performed an abortion on herself. This was 1985. The young woman developed clostridium; she had lockjaw. She was dying. There were no medicines or vaccines there to treat her. This was not the way anybody’s life should end.
I already knew that I wanted to work in gynecology and obstetrics, but from that point on, my advocacy for women’s healthcare really solidified. It just wasn’t right—this young woman shouldn’t have died from a botched abortion. And I could see how much generalists were needed in healthcare. I’ve been given opportunities over the years to specialize in maternal-fetal medicine, but I turned them down. I wanted to do everything for everybody. I wanted to take care of others, just like the selfless physicians who took care of me as a child.
For 20 years, I ran the abortion clinic at Mount Sinai Medical Center in New York City. When I started in 1987, I ran the whole thing myself. There would sometimes be private physicians performing terminations of pregnancies for their own patients, but I did all terminations otherwise. We provided abortions up until the 24th week. We have considerable abortion access in New York, but we also served other populations. I would frequently see patients who had traveled from areas that didn’t have any providers. Some of these patients traveled 100 miles, maybe more. Back in the 1980s and early 1990s, I had five or six patients each week traveling from Pennsylvania.
I like to think that if I were told it is wrong to do certain things in medicine because of some religious objection, I would rise above that and be the person I am now, advocating for everyone to receive the same standard of healthcare.
While running the Mount Sinai clinic, I treated many Catholic patients—many of whom were burdened spiritually. As a physician, I’m there to provide patient-centered care, not to shine a light on myself. We work in the background. We have our faith, but it’s a private matter; we do what’s best for others. But when it helps to let my patients know that I’m a person of faith, I share my Catholic background with them. I will minister to them right then and there.
A few patients even asked me to bless the baby afterwards. That’s really one of the most honored things I can do for somebody. These particular individuals were really torn about undergoing the procedure, but they either had a medical reason or a very strong social reason for why they needed an abortion. They didn’t need me to be pompous or to judge them. They needed someone who could hold their hand and tell them it was going to be okay.
Maybe if I had grown up Catholic, rather than Episcopal, I would have been more conflicted about abortion. I didn’t grow up thinking abortion was the worst thing; I didn’t believe that it was evil. But who knows? Maybe I still would have thought, “You know, letting women have the choice to terminate a pregnancy is best for everybody.” I didn’t see any problem with practicing evidence-based medicine and being a Catholic. I like to think that if I were told it is wrong to do certain things in medicine because of some religious objection, I would rise above that and be the person I am now, advocating for everyone to receive the same standard of healthcare.
I don’t call myself an abortion provider; I’m a comprehensive health provider. And as a comprehensive health provider, I serve all patients—those who want to terminate a pregnancy and those who want to continue their pregnancies. My job is not to convince patients to have a termination. My job is to help them make a decision that’s well informed. I think that’s what God would want us to do—to practice the best medicine. Not to consider ourselves in terms of what’s best for our patients, but to consider what our patients’ needs are. If I’m so concerned about my own salvation, then how can I help others?
I always say to patients, regardless of whether it’s for a termination of pregnancy or a hysterectomy: “How are you going to feel about this later? Are you going to hate your decision a year from now?” There will be patients who feel better. Patients will tell me, “I came to you because I was told this was something I should consider, and you’ve convinced me that this is a decision I’m making based on information that’s current and updated.” And some patients are going to say, “I’m not going to do this, but I needed to hear this from you, because I needed to know this information.”
By not having doctors who provide everything from contraception to terminations to deliveries and hysterectomies, the American healthcare system is putting women at risk. We have patients who have healthcare paid for by a company, but they don’t have any providers in the area. This delays them from getting prenatal or abortion care. A lot of things can happen in just a few weeks to someone who wants to keep their baby. And if a woman wants an abortion but can’t get one in the first trimester, either because there are no providers in her area or because her doctor refuses to provide abortion, then she’s forced to carry the pregnancy to term or have a second-trimester abortion, which is more costly and carries more health risks.
The Catholic church understands how important it is to have universal healthcare for everybody. But when you pick and choose what counts as healthcare and what doesn’t, you get inconsistencies and poor outcomes. Anything that prevents mortality is healthcare. Birth control pills prevent cancer, specifically, ovarian cancer and endometrial cancer, so they can be used off-label for these diseases. Unintended pregnancies have a higher morbidity and mortality rate, but long-acting reversible contraception, which is being used in countries that are stalwarts in universal healthcare, has significantly decreased maternal mortality. A lot of people think carrying a pregnancy to term is all fun and games, but it’s not.
Just a few days ago, I had a patient suffer a postpartum hemorrhage after I delivered her fifth baby. We had to perform a hysterectomy. She had one foot in the grave. What if she’d had a tubal ligation after her fourth pregnancy, or better access to contraception? She wouldn’t have been in this near-death situation in which she needed three units of blood and a hysterectomy.
We really are trying to save lives. We’re not glossing over women. We’re saying, “No, you have to be able to give free birth control pills because they’re life-saving.” We’re not saying that because we are anti-religion. We are people of faith. We’re truly prolife. We’re pro-women’s life. We’re pro-children’s life. You can’t take that moniker away from us.
Cassing Hammond, MD
OB-GYN & Associate Professor of Obstetrics and Gynecology
Northwestern University Feinberg School of Medicine
Illinois, United States
One thing that unites us in the Unitarian Universalist church is the notion that religion is an awakening. It is a process, rather than a set of fixed beliefs. That’s how I would describe my journey to providing abortions: a process of my faith and work evolving together. Life experience converts you. There’s no more spiritual component of my life than practicing medicine, and that includes providing safe abortions to those in need.
If you had asked me during medical school, I couldn’t have given you a “bumper sticker” answer about my support for reproductive choice. Although I always supported a woman’s right to choose, I did not yet have real-life context related to abortion. By the end of the first week of my OB-GYN clerkship, I knew reproductive health was my calling. As an OB-GYN, you can influence an entire lifetime of health by ensuring a successful pregnancy, by preventing an unintended pregnancy or by providing other types of healthcare women require.
When I began residency training in obstetrics and gynecology at the University of Rochester, most residencies did not provide routine opportunities to perform abortions. At Rochester, we had the option to train in first- and second-trimester abortion. I couldn’t anticipate then how important this training would be.
One night during my residency, a 17-year-old girl came into the emergency room nearly bleeding to death. She was 17 weeks pregnant and hemorrhaging from a placental abruption. I didn’t know what to do. Fortunately, I was on call with an attending physician who had experience in second-trimester abortion. Together, we were able to treat her and prevent her from undergoing more-invasive surgery. We saved her life—all because the attending physician knew how to successfully perform a second-trimester abortion.
After that night, I knew I needed to have this skill, too. More importantly, I understood that reproductive rights are not abstract political principles. Patient experience made the political principle behind abortion real to me.
Direct clinical experience continues to motivate me to provide abortions. In the early 1990s, I began working in private practice and continued seeing patients with medical complications that necessitate abortion: patients carrying fetuses with abnormalities, patients enduring early rupture of membranes, patients in danger of hemorrhaging and patients with life-threatening infection. The more I treated patients and encountered these complicated issues, the more I realized that abortion was a profoundly important and personal part of patient care.
I also encountered patients expressing their spiritual beliefs. One of my first abortion patients worked for the local Catholic diocese. As I performed her procedure, she told me that she opposed abortion. I was struck by how she felt compelled to share her objection to abortion while she herself was undergoing an abortion. Over the years, I’ve learned that this is a common experience among women who identify with a religion or belief system that morally objects to abortion. Religious and moral conflicts often lead women to feel worse about terminating a pregnancy. Their religious community does not offer spiritual support. A component of their life that has always provided comfort is no longer there for them. Shouldn’t your religious faith provide you solace during a difficult time? Why does your religion instead make you feel frightened and uncomfortable about your life decisions?
There’s no more spiritual component of my life than practicing medicine, and that includes providing safe abortions to those in need.
One of the seven principles of Unitarian Universalism is respect for the inherent worth and dignity of every individual. More than 50 percent of individuals in the world are women. I can’t imagine a religion or a nation that purports to respect women’s inherent dignity, yet restricts them from making one of the most important personal decisions they can make for themselves—whether to have a child.
Abortion is the one medical circumstance in which we expect women to let other people decide what’s best for them. In an ideal world, antichoice lawmakers, religious leaders and politicians would talk to my patients. They would sit down with the families of women who undergo abortion. They would experience what my patients and their families face. Only then could they understand what happens when you expose women to the risks of continuing a pregnancy when they do not want to carry the pregnancy to term, or when it would harm their physical or mental health to do so. We downplay the risk of pregnancy, but a woman is often safer if she terminates a pregnancy than if she continues it. That does not mean that ending a pregnancy is always the right decision. However, government or spiritual leaders should never mandate these choices for women or force a woman to put her own life or well-being at risk.
My students at Northwestern University’s Feinberg School of Medicine know this. Prospective residents ask me: “Do you have abortion training in this program? I only want to go to a program that has abortion training.” Unlike my residency days, there is now a more organized approach to abortion training. Current residents learn various types of abortion procedures, unless they specifically opt out. This helps prevent what happened that night I was on call 30 years ago when, by chance, one of the few attending physicians able to provide a second-trimester abortion happened to be on call with me and helped saved a patient’s life.
Because it respects the inherent worth and dignity of women, providing abortion is a spiritual and moral act. It respects a woman’s dignity and helps her regain control of her life. I am proud to provide abortions. I am also proud that my own Unitarian Universalist congregation regularly donates its Sunday collection to Planned Parenthood and other groups that ensure reproductive rights. I hope other congregations might consider doing the same.
Joachim Osur, MD
Director of Regional Programs and Field Offices
Amref Health Africa
Kenya
Photo by Niha Wadekar
When you choose to become a medical person, there are ethics you have to live by. Medical science is different from faith. Faith is about believing; there is no evidence in faith. Sometimes, medicine and faith clash but, if you’ve chosen to be a medical person, you have to accept the scientific evidence. You have to live by these ethics. It may come down to choosing between saving a life and sticking to your faith. As a health provider, I always choose to provide a service to save a life, because even that is godly.
I made the decision to become a doctor at a young age. I had just started high school, where I became interested in learning the life sciences and biology. Even then, at age 14, I knew I would end up as a doctor. That is just what I wanted to be. During medical school, I developed an interest in sexual and reproductive health. As a practitioner in this field, I am either delivering babies, treating sick women who soon become well or providing family planning to women who want to better their lives. I especially work with many men and women with sexual problems.
The issue of abortion kept coming up with my patients soon after I began practicing. Many women came to us with complications from unsafe abortions. We treated women who had attempted to self-terminate and now faced medical emergencies. Then, our women patients began asking for abortions, but we were not providing them because the healthcare system did not allow it.
We had so many patients who needed abortions, and some of them ended up with severe complications. Others died. That compelled me to look more deeply at the science behind abortion. While I was in medical school, abortion was illegal, and so that was what we were taught; however, now that I was a practicing health provider, I needed to come to my own conclusion about abortion.
When I joined Family Health Options Kenya, I learned even more about reproductive health and rights. I saw that the evidence is there. If you look at countries where safe abortion is available, women don’t die. And if you look at where it is unavailable, women still obtain abortions, but they die. The abortion rates across the world are the same whether you are in Europe or the Americas or Africa; women will have abortions when they need them. So, if you refuse to give women access to safe abortion, they will turn to unsafe and dangerous options. When they do, they die. That is what we know; that is the evidence we have.
The decision to have an abortion is not for the doctor or the nurse to make—it is the patient who makes the decision. And when patients come to us for an abortion, they have gone to their churches or their mosques. They have their own values. They know what their faith is about.
When you think about it ethically, you’re supposed to be saving lives. That is what a doctor does. When you see that these women are going to die because they’re having unsafe abortions, and you as a health provider let that happen, that is unethical. That is how I decided that it is better for women to have access to safe and legal abortion care. I am convinced that God wants these women to live, not die. If anything, they can only convert to Christianity when they are alive, not after death.
I am of the Anglican faith, and the Anglican church is very strong in Kenya. The Anglican church is opposed to abortion. But, as a health provider, I don’t sit in a clinic and preach my faith to patients. Ethics do not allow that, and so, it is not what health providers do. Our main concern is providing the healthcare that our patients need. The decision to have an abortion is not for the doctor or the nurse to make—it is the patient who makes the decision. And when patients come to us for an abortion, they have gone to their churches or their mosques. They have their own values. They know what their faith is about.
Patients, though, may have moral or spiritual conflicts about having an abortion. They don’t come to us laughing about it. They cry. It is a very difficult decision they have to make. They have a lot of emotional baggage when they come for services, because there’s a lot of stigma around the issue.
If you’re providing abortions professionally—and obtaining an abortion legally—there is less stigma, but it’s still very present here in Kenya. Providers are harassed at their private clinics. Antiabortion groups in Kenya are strong and receive a lot of support from American individuals connected to the anti-abortion movement. And problems arise when the courts get involved. Recently, a nurse was arrested and convicted of murder because a patient died while he was treating her for complications from an unsafe abortion. After a lot of legal intervention, he was released. This is when the issue of abortion gets publicized, and not in a good way.
Our constitutional law strives to expand the healthcare options women have, and we have been advocating for an expansion of these choices so that we are not restricting the decisions people make. However, we still need service-delivery guidelines to enforce the law. Without guidelines, quality of services cannot be assured. We need guidelines that show doctors what to do when a patient comes in for an abortion, and to show that we are providing abortions in accordance with the constitution. We also need an approved curriculum for training health workers on abortion issues. When I worked for Ipas, we supported the University of Nairobi in reviewing the school’s curriculum for training on abortion, and afterwards the university revised its training.
If you are a person of faith, then you need to create a balance. Health workers need to consider the ethics of abortion care—to allow patients to make the decision about which services they want, and to provide these services in a lawful way.
It is not about me anymore. I believe that providing reproductive healthcare is moral, because it benefits those who have made the decision to want the service. I do not need to preach to my patients. I do not need to interfere with their faith and values either. It always goes back to their choice.
