{"id":10573,"date":"2011-08-16T13:28:57","date_gmt":"2011-08-16T12:28:57","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=10573"},"modified":"2011-08-16T13:28:57","modified_gmt":"2011-08-16T12:28:57","slug":"vasiliy-vlassov-russian-womens-reproductive-rights-in-grave-danger","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2011\/08\/16\/vasiliy-vlassov-russian-womens-reproductive-rights-in-grave-danger\/","title":{"rendered":"Vasiliy Vlassov: Russian women’s reproductive rights in grave danger"},"content":{"rendered":"

\"VasiliyAccording to current Russian law,\u00a0women can ask for an elective abortion up\u00a0until 12 weeks of pregnancy. Between 12 and 22 weeks, an abortion can only be made on the basis of medical or so called \u201csocial\u201d 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.\u00a0For instance they have eliminated the right to perform a second trimester abortion\u00a0if 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.<\/p>\n

This summer is different. A group of representatives has teamed up with a number of anti-abortion activists, who are\u00a0mostly from the Russian Orthodox Church. They have worked behind closed doors for a year and a half on measures to restrict women\u2019s access to abortion which would take away some of her rights and give it to her \u201clegal guardian,\u201d\u00a0her husband, and medical and government authorities.<\/p>\n

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<\/em> by the doctors to go to an appointment with a \u201cpre-abortion psychologist.\u201d Without the psychologist\u2019s signature, an abortion is not performed. Recommendations\u00a0have been\u00a0prepared by Christian organisations and church officials, and are now also fully endorsed by the Ministry of Health and Social Affairs, for such \u201cpre-abortion psychologists.\u201d 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\u00a0put it.\u00a0It is discussed at great length how the psychologist should break the woman’s resolve\u00a0in order to force her to accept the outcome desired by the authorities. The woman\u2019s interests never enter the picture. The recommendations contain phrases like \u201cagainst her will\u201d as well as citations from ideologues from the Russian Orthodox Church (which take the place of scientific references). There is a questionnaire which\u00a0must be filled in during the consultation\u00a0containing questions like \u201cDo you know that abortion\u00a0at any time is murder?\u201d and \u201cAre you ready to meet the soul of your murdered child when you die?\u201d<\/p>\n

It is extremely disturbing that such clearly unethical recommendations, written by people who actually perform such \u201ccounselling\u201d if one may call it thus,\u00a0have been\u00a0endorsed by the Ministry in charge of the nation\u2019s health. It is\u00a0equally disturbing that psychological abuse of that sort is being performed already in a lot of places all over Russia.<\/p>\n

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\u00a0implement in the whole country look like this:<\/p>\n

\u201cWe 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\u2019s health. There are no safe abortions.<\/em><\/p>\n

Abortion not only causes the strongest biological trauma, it also causes a severe psychological trauma, which leads to personal and family tragedies.<\/em><\/p>\n

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 \u2013 those are some of the complications of abortion.<\/em><\/p>\n

When you decide to perform an abortion, you do not only risk your health, but also cause irreparable harm to your soul.\u201d<\/em><\/p><\/blockquote>\n

This type of\u00a0church influenced propaganda is already endorsed by the Ministry of Health and Social Affairs, which has moved to implement the Christian groups regional practices\u00a0on\u00a0a country scale. New \u201cpre-abortion psychologists\u201d\u00a0have been\u00a0hired, with the goal of having one in every state medical institution dealing with pregnancy (in 2009, only 20% had such a \u201cspecialist\u201d), and requiring every woman seeking abortion to go through this psychological abuse.<\/p>\n

At the same time, the Russian parliament is debating\u00a0a 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\u00a0controlled 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:\u00a0a 48 hour obligatory waiting period for those who terminate their first pregnancy, and permission for doctors\u00a0to 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,\u00a0Olga 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 \u201cpsychological consultations\u201d will be obligatory. Then\u00a0last 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,\u00a0the 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\u00a0she 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\u2019s permission to obtain an abortion, will not\u00a0end up in\u00a0the law.<\/p>\n

If adopted, the proposed changes to the current law will significantly limit women\u2019s access to abortion, and will be likely to\u00a0result 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\u2019s rights to exert control over their bodies and their lives.<\/p>\n

A longer version of this text, prepared by a group of civil rights activists is posted at http:\/\/demography-ru.blogspot.com\/2011\/08\/call-for-solidarity.html<\/a>. The authors are: Vera Akulova, Boris Denisov, Galina Dikke, Lyubov Erofeeva, Igor Yanovich, and Vasiliy Vlassov.<\/p>\n

Vasiliy Vlassov<\/strong> 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.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

According to current Russian law,\u00a0women can ask for an elective abortion up\u00a0until 12 weeks of pregnancy. Between 12 and 22 weeks, an abortion can only be made on the basis […]<\/p>\n

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