According to the Ministry of Health, on average over the past seven years, Russian women have performed more than 760 illegal (in official statistics, they are called criminal) abortions annually - the numbers vary from 154 in 2014 to 3,489 in 2016. Journalist Anastasia Platonova studied who and how performs criminal abortions in Russia and why their number may grow if abortion is removed from the compulsory medical insurance system.
In July 2017, a local resident approached Elena *, a nurse at a rural outpatient clinic in the Stavropol Territory. The patient was 12-13 weeks pregnant and wanted to terminate her - there was no money for raising a child.
According to the investigation, Elena agreed to help the patient for 5,000 rubles. First, she offered her to drink the drug "Cytotec" (used for medical abortion. - Approx. TD). She agreed, but the drug did not work, and two days later Elena gave the woman a "massage of the uterus" and an injection, and later introduced the patient to a Foley catheter (urological, sometimes used as a method of inducing labor. - Approx. TD). Soon after that, the woman's temperature rose to 38.9, her legs began to swell. The woman's sister called an ambulance, Elena came to the call and removed the catheter, assuring her that the pregnancy was terminated.
A few days later, the patient began to lose consciousness, she felt sick, and suffered from pain. An ambulance took the woman to the hospital, where doctors determined that the pregnancy was ongoing. Soon after that, the woman still had a miscarriage, a criminal case was opened against the nurse, she was sentenced to a suspended sentence and banned from holding positions in health care institutions for two years. Elena now works as a pharmacist.
Barriers
Women are forced to have an abortion without going to a doctor for many reasons, says Rebecca Gomperts, a gynecologist in Amsterdam and founder of Women on Waves. In Russia, this is often due to a difficult financial situation, deficiencies in the healthcare system (when there are no clinics available nearby where abortion can be performed), domestic violence, problems with documents, stigmatization, in which women are afraid of condemnation.
In May 2014, a nurse Irina * was on duty at a hospital in a Khakass urban-type settlement. On duty, her friend approached Irina, who explained to her that she was pregnant, the term was about eight weeks. She already had one child, and the woman wanted to have an abortion. Then Irina simply took her friend to a free ward, and at ten in the evening she went up with her to the surgical department and made her an abortion with a curette (a medical instrument used in surgery to remove (curettage). - Approx. TD). During the operation, the cervix was perforated, bleeding began, Irina had to call a car, and her friend was taken to the regional hospital, and a case was opened against the nurse under article 123 of the Criminal Code (illegal termination of pregnancy). Now Irina works as a nurse in the same hospital.
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“Barriers on the way to receiving medical care can be called a“week of silence”(the obligatory waiting period between going to the doctor and the immediate termination of pregnancy. - Approx. TD) and the obligatory consultation of a psychologist,” says WHO temporary adviser on the prevention of STIs and unwanted pregnancies, Dr. Medical Sciences Galina Dikke. - What is the purpose of compulsory psychological counseling? In an attempt by the state to dissuade a woman from abandoning pregnancy termination in favor of having a child."
According to her, such measures affect both the health of women - each week of waiting doubles the risks of complications, and the financial situation: due to psychological counseling, women lose at least one working day and 2,080 rubles, respectively, according to Dikke's article from 2014.
The effectiveness of such measures is low: according to the Minister of Health Veronika Skvortsova, voiced at a government meeting on December 30, 2017, thanks to counseling, abortion is refused in only 5% of cases (of the total number of abortions) or in 7% of cases, if spontaneous abortions are not taken into account (miscarriages).
She didn't say anything to mom
In 2013, a 15-year-old schoolgirl Ulyana * from a village near Moscow learned that she was pregnant: “I took a test, [there] are two strips. Naturally, I didn't say anything to my mother, I went to our hospital, to the gynecologist. The doctor looked at me in the chair, said approximately that the period is three months, nothing can be done."
According to Nikolai *, the child's father, together they began to look for a way to terminate the pregnancy and found a private gynecological clinic in Moscow through an advertisement in a newspaper, where they agreed to have an abortion and gave Ulyana pills. The clinic's services cost about 15,000 rubles. On February 14, when the pregnancy was about 16 weeks, Ulyana had a miscarriage caused by abortion pills. Due to severe bleeding, the girl lost consciousness, she was taken to intensive care. A case was initiated, Nikolai was given a recognizance not to leave, and the taxi driver who drove Nikolai, Ulyana and her mother to Moscow was also interrogated, but the investigation was soon terminated.
In the culture of our country, a woman giving birth is a vessel from which it is necessary to get the contents. The vessel, of course, needs to be saved for future use, but thinking about its feelings and well-being is not the most important task.
Sexuality education can help reduce unsafe abortions, as adolescents gain knowledge of contraceptive methods and physiology, as well as the availability of medical abortion, says Rebecca Gomperts: “Sexuality education is just the foundation, teens need to be taught how to have a sex life that pleasure, while avoiding unplanned pregnancy or illness."
Galina Dicke agrees with her: “WHO initiated research on medical abortion precisely in order to reduce the severity of criminal abortions in developing countries. In order for medical abortion to appear in the compulsory medical insurance system, in 2011-2012 we did a great job. As a result, the regions have adopted a tariff agreement with the compulsory medical insurance, and now medical abortion can be done free of charge."
Dicke's article from 2014 revealed a direct relationship between the availability of medical abortion and the number of criminal abortions: for example, in the Kemerovo region, medical abortion was introduced into the compulsory medical insurance scheme in 2009 and in three years (from 2009 to 2012) the number of criminal abortions decreased by 15 times (45 cases against 3).
Some boom
These conclusions are confirmed by the obstetrician-gynecologist of the Department of Operative Gynecology of the City Clinical Hospital of Blagoveshchensk Vladimir Vysochinsky. At a time when medications for medical abortion were not available in Russia, the practice of abortion using mifepristone made in China was widespread in regions bordering China, he said.
“In 2010, medical abortions were just beginning. There was a kind of boom [for medical abortion] then, someone brought these drugs here from China on purpose, [the women] advertised themselves, did it themselves. These patients came to us with severe bleeding, incomplete abortion, and infection. Some did not confess, and some spoke themselves, especially when they were in serious condition, or we found out through relatives that they were taking such pills."
In 2010, Ekaterina's friend * from a small town in the Irkutsk region, a pediatrician Anna, also got into that wave. One morning Anna called Ekaterina and asked her to come, referring to her poor health. Ekaterina arrived, but no one opened the door for her. Then she phoned the woman's husband. When he arrived and was able to open the door, Catherine saw her friend lying on the floor unconscious in a pool of blood. After Anna was discharged from the hospital, where she spent about a month, Ekaterina learned that her friend had had a medical abortion with Chinese pills: she felt bad for two days, and after that she took the child to the garden, returned home and lost consciousness.
According to Vysochinsky, there is no such "boom" now, as medical abortion is available in state clinics, but isolated cases continue to occur.
In August 2014, 20-year-old Olga * from Sochi bought drugs for medical abortion made in China. Olga was 11 weeks pregnant and was very nervous: “[I thought] it's too early for me, an unloved man, no corner of my own, my parents are far away, I'm alone, no work, nothing,” Olga wrote on the forum. The girl took pills for four days - all this time Olga had a stomach ache and she felt sick. But the pregnancy continued, and in February of the following year, she had a healthy daughter.
Now pills for medical abortion can also be bought on the Internet - both on the websites of relatively large online pharmacies and in specialized online stores, but there is often no information about the organization. Buyers are offered French, Russian and Chinese drugs, usually kits (mifepristone and misoprostol) are sold, the price of a kit starts at 2,000 rubles.
Such procedures carry certain risks, since a woman does not communicate with a doctor, and in some cases calculates the dosage herself, but in general, studies confirm that an online doctor's consultation is sufficient for medical abortion (provided that the woman does not have serious chronic diseases, she will be able to see a doctor in case of complications and is not in a situation of domestic violence). In this case, the risks of complications with medical abortion without personal consultation with a doctor may be even lower than with surgical abortion. So, in Russia, the probability of complications from surgical abortion varies and can reach 18%. WHO considers curettage to be the most unsafe and undesirable method of termination of pregnancy, including because of the risk of complications. At the same time, the risks of medical abortion for up to 11 weeks do not exceed 3%.
Statistics on abortions performed by women without an in-person consultation with a doctor are provided by Women on the Waves led by Rebecca Gomperts and a subsidiary of Women in the Network. On their website, women who want to have an abortion, but for various reasons decided not to see a doctor, can take a short questionnaire, receive detailed instructions on how to take medications for medical abortion, a personal consultation with a doctor (by email), and women from developing countries for the donation is received by mail a parcel with drugs for medical termination of pregnancy. According to a survey conducted in January 2007, only in 8% of cases women needed medical assistance due to incomplete abortion, and in another 3% of cases women had to take antibiotics on drink due to infectious complications.
In the system - outside the system
Now in the structure of Russian health care, despite a number of obstacles, a woman can exercise her right to reproductive choice. But the situation may change, although prohibitive initiatives have not yet received support in the Duma. Vsevolod Chaplin was one of the first to speak about the need to remove abortions from the compulsory medical insurance system in 2010. "It is worth raising the question of taxpayers not paying for abortions," said the head of the Synodal Department of the Russian Orthodox Church, and in 2011, Patriarch Kirill also proposed to the government "to exclude abortion at the expense of taxpayers." At the same time, a provision on mandatory waiting days ("week of silence") appeared in the legislation. MPs subsequently tried to introduce a partial ban on abortion in 2013 and 2015, but the bills were rejected.
In 2017, the movement for a complete ban on abortion announced the collection of a million signatures, but in October of that year, a bill to remove abortions from the OMS was rejected by the Duma. In January 2019, the creation of a working group to discuss the initiative was again announced, and the Levada Center survey data showed that over 20 years the number of people who consider abortion unacceptable has tripled.
Galina Dikke believes that the withdrawal of abortions from the compulsory medical insurance system is unacceptable: “This is a disaster, it should not be done in any case. What is left for women? Paid abortions. It should be understood that in Russia about 20% of the population live in the poverty zone. And these women cannot afford to spend money on termination of pregnancy, because a medical abortion procedure costs about 6,000 rubles. What exit do they have then? Curette.
Gomperts agrees with her: “Any restrictive change in legislation will negatively affect women, especially women from the most vulnerable sectors of society. Often, campaigns to limit free abortion are carried out with slogans like “Let them pay,” which also humiliates women.”
* Hero names have been changed.
Author: Anastasia Platonova