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News 10 Dec 14

Macedonia Abortion Rulebook 'Traumatises Women'

A new Health Ministry rulebook for counselling during termination could traumatise women by emotionally blackmailing them to continue their pregnancies, gynaecologists warned.

Meri Jordanovska and Sinisa Jakov Marusic

 Gynaecology clinic in Skopje | Photo by: build.mk

The new rulebook produced by the Health Ministry that instructs doctors how they should counsel those who are seeking an abortion looks more like a guide for applying psychological pressure on women to change their minds, medical professionals told BIRN.

“I do not understand the goal of this rulebook. Until now, we asked women who wanted a termination whether they would like to hear the heartbeat of the offspring. In most cases they declined. From now on I will be obligated to do it,” a gynaecologist from a Skopje clinic told BIRN under condition of anonymity.

“Obviously our medical knowledge and ethics differs from those of the [health] minister,” the gynaecologist added.

The document, written in line with the government’s socially conservative policies that aim to portray abortion as a murder, is signed by Health Minister Nikola Todorov, and will soon be distributed to medical facilities and become obligatory for doctors.

Medical professionals said that the most disturbing part of the text specifies that “during counselling… dynamic ultrasound images are shown [to the pregnant woman] along with description of the offspring, and she is played the heartbeat of the offspring”.

The text further instructs that “the doctor should inform the woman of all the anatomical and physiological characteristics of the offspring at that gestational age”.

Another gynaecologist from a private clinic in Skopje told BIRN, under condition of anonymity, that women will not be given a choice whether to listen to the new text or not.

“I will now have to explain to the woman, where the offspring’s eyes are and where the heart is. I don’t see the point of it, unless the goal is to persuade her to keep it,” he said.

He said that women who seek termination, whether it is for personal or health reasons, usually avoid such potentially emotional confrontations.

He explained that the foetus’s eye blink and heartbeat can be seen after six weeks of pregnancy. After ten weeks, individual organs can be recognised.

The problematic text further states that the pregnant woman will be counselled “about the possible benefits from the continuation of her pregnancy, as well as about the possible risks from undergoing or avoiding of the intervention”.

The Association for Health Education and Research, HERA, an NGO, said that the rulebook should be withdrawn and revised because it goes against local legislative and international health conventions.

It said that according to the Macedonian Law on Patient’s Protection and the recommendations of the World Health Organisation, a patient has the right to refuse information linked to his or her health and recommended medical interventions.

“The showing of dynamic ultrasound images of the foetus, listening the heartbeat, being informed about its gestational age and explanations of the effects of the intervention are in no way linked to the health condition of the woman, and are irrelevant for the intervention itself,” HERA told BIRN in a written statement.

“They have a biased goal, to make the woman feel guilty and possibly change her mind, which can further reflect badly on her health,” it said.

In June 2013, the government adopted new abortion legislation that critics said curbs women's rights. The changes were adopted amid protests by activists and in the absence from parliament of opposition parties.

The old law, dating from 1976, left key decisions on terminations to women and doctors.

But under the adopted changes, women were obligated to file requests for abortions and now have to confirm that they attended counselling, informed the 'spouse” of their intention to abort and meet a gynaecologist. The law now also prohibits women from having a second abortion within a year of the first one.

Last year Health Minister Nikola Todorov insisted the changes were “liberal”.

“There will always be opposing opinions over which right is greater, the right of the woman to decide on her own or the right to life of the child in her womb,” Todorov then said.

The government has also backed an anti-abortion media campaign that described terminations as murder.

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