Vasiliy Vlassov: Russian women’s reproductive rights in grave danger

Vasiliy VlassovAccording to current Russian law, women can ask for an elective abortion up until 12 weeks of pregnancy. Between 12 and 22 weeks, an abortion can only be made on the basis of medical or so called “social” indications laid out by the government. Over the years, the government has dramatically decreased the number of reasons that women can qualify for a late abortion. For instance they have eliminated the right to perform a second trimester abortion if the parents are both unemployed. This has been done under the pronatalist pretext, though in practice the share of abortions made for medical or social reasons has never risen much higher than 2% and 3% of all abortions respectively.

This summer is different. A group of representatives has teamed up with a number of anti-abortion activists, who are mostly from the Russian Orthodox Church. They have worked behind closed doors for a year and a half on measures to restrict women’s access to abortion which would take away some of her rights and give it to her “legal guardian,” her husband, and medical and government authorities.

Some of the proposed measures, such as psychological consultations (even obligatory ones) or informed consent forms, do not sound so bad. But the devil is in the details. A woman seeking an abortion is required by the doctors to go to an appointment with a “pre-abortion psychologist.” Without the psychologist’s signature, an abortion is not performed. Recommendations have been prepared by Christian organisations and church officials, and are now also fully endorsed by the Ministry of Health and Social Affairs, for such “pre-abortion psychologists.” The recommendations say openly from the start that the goal of the consultation is not to help the woman to figure out what is best for her, but to force her to change her mind about having an abortion, by making her feel guilty of “murder of her unborn child,” as the recommendations put it. It is discussed at great length how the psychologist should break the woman’s resolve in order to force her to accept the outcome desired by the authorities. The woman’s interests never enter the picture. The recommendations contain phrases like “against her will” as well as citations from ideologues from the Russian Orthodox Church (which take the place of scientific references). There is a questionnaire which must be filled in during the consultation containing questions like “Do you know that abortion at any time is murder?” and “Are you ready to meet the soul of your murdered child when you die?”

It is extremely disturbing that such clearly unethical recommendations, written by people who actually perform such “counselling” if one may call it thus, have been endorsed by the Ministry in charge of the nation’s health. It is equally disturbing that psychological abuse of that sort is being performed already in a lot of places all over Russia.

The story is the same for informed consent forms. The consent forms used at a local level in the regions whose practices the Ministry of Health and Social Affairs is trying to implement in the whole country look like this:

We are sorry that you are thinking about terminating your pregnancy. Medical abortion is an artificial termination of pregnancy. Abortion is the only medical procedure which is performed in absence of any disease, and harms one’s health. There are no safe abortions.

Abortion not only causes the strongest biological trauma, it also causes a severe psychological trauma, which leads to personal and family tragedies.

Abortion may result in infertility, ectopic pregnancy, spontaneous abortion, or birth of weak, ill children. All those are long term complications of abortion. Bleeding, damage to the cervix and uterus, peritonitis, sepsis, inflammatory and oncological diseases of ovaries, uterus, breasts – those are some of the complications of abortion.

When you decide to perform an abortion, you do not only risk your health, but also cause irreparable harm to your soul.”

This type of church influenced propaganda is already endorsed by the Ministry of Health and Social Affairs, which has moved to implement the Christian groups regional practices on a country scale. New “pre-abortion psychologists” have been hired, with the goal of having one in every state medical institution dealing with pregnancy (in 2009, only 20% had such a “specialist”), and requiring every woman seeking abortion to go through this psychological abuse.

At the same time, the Russian parliament is debating a new version of the main health law, to be voted on and adopted in early September. As the President has expressed his support for the law and suggested that it be adopted as soon as possible, it is highly unlikely that Parliament, which is controlled by two government parties, will vote against the law. In early July, the health committee decided not to include all but two of the proposed amendments in the law. The two amendments that they did include are: a 48 hour obligatory waiting period for those who terminate their first pregnancy, and permission for doctors to decline performing an abortion. But the church groups were furious, and together with officials from the Ministry of Health and Social Affairs forced the head of the committee, Olga Borzova, to change her position. On 22 July Borzova declared that she had been to three meetings with Russian Orthodox Church officials, and that the waiting period will be applied to all pregnancies, not just to the first, and that “psychological consultations” will be obligatory. Then last week on 5 August, Borzova said that the waiting period will be extended to one week, that the only social reason to have an abortion after 12 weeks will be a pregnancy resulting from rape (but not, say, the sudden death of the husband, or imprisonment for the woman herself), and that informed consent forms will be required to include strong language suggesting severe harm from abortions. Since she has already changed her position twice to accommodate the demands of lobbyists from the Russian Orthodox Church, there is no guarantee that the other restrictions, including the requirement to obtain the husband’s permission to obtain an abortion, will not end up in the law.

If adopted, the proposed changes to the current law will significantly limit women’s access to abortion, and will be likely to result in a rise of criminal abortions (which even under current, less restrictive laws cause up to 5% of maternal deaths). They will compromise the autonomy of women, and will be a major setback to women’s rights to exert control over their bodies and their lives.

A longer version of this text, prepared by a group of civil rights activists is posted at The authors are: Vera Akulova, Boris Denisov, Galina Dikke, Lyubov Erofeeva, Igor Yanovich, and Vasiliy Vlassov.

Vasiliy Vlassov is a Professor of medicine at the Higher School of Economics, Moscow. His research interests are in epidemiology, evaluation of diagnostic tests, public health, and especially health care delivery with scarce resources. He is the co-founder and current president of the Russian Society for Evidence Based Medicine.