Romania: abortion, mission (almost) impossible

In Romania, having an abortion has become increasingly difficult. Under the pressure of the Church and pro-life NGOs – and with the complicity of the state – women are losing this fundamental right. A reportage

Kai, 22, tells her story sitting at the desk in her small student room on the outskirts of Bucharest. After growing up in South Africa, she returned to her homeland in 2017 to study veterinary medicine. Last summer she found herself in a young man's apartment after a night in which she and her friends had been drinking. She had passed out. When she regained consciousness, she was naked on the bed of the guy who had invited her, in pain. "His room-mates started clapping when they saw me. I left in a hurry". A few days later Kai realised she was pregnant. A friend then advised her to go to the police. But first she went to the guy who raped her and told him she was pregnant and she needed money to have an abortion". He replied: 'I'll give you the money if you blow me'. I slapped him, went home, and called the police”.

Her rapist eventually offered to give her the money if she dropped the complaint. Kai refused. To find a medical facility, the young woman googled "abortion clinic Bucharest" and called the first number. The person at the other end of the line asked her if this was her first pregnancy and her first abortion, adding: "Unfortunately we can't, because we did it once and the girl died. But I can send you videos to help you on your journey to motherhood”. Kai refused and hung up, but that did not stop her from receiving spam emails with anti-abortion videos.

Then, on the recommendation of a friend, she met Andrada Cilibiu of the Centrul Filia association. Andrada pointed her to the private clinics and public hospitals where abortion was practised. But every time something got in the way. As time went by, Kai became increasingly concerned, knowing full well that the legal deadline for an abortion in Romania is fourteen weeks. At the third clinic she visited, they even gave her an ultrasound and the doctor turned the screen to show her the embryo. Then he put a picture from the ultrasound in her hand. Then he conclude: "Unfortunately we will not be able to perform your abortion, we are afraid you will bleed too much. You must go to the hospital".

Eventually Kai went to a public hospital recommended by Centrul Filia. She told the doctor that she was raped and needed to have an abortion as soon as possible. She did not want a drug abortion, fearing it would not work 100% and she asked for a curettage under anaesthesia. Since it was Sunday, the gynaecologist suggested that she come back the next day. On Monday she was told: "Unfortunately we cannot do it today, because it is a religious holiday in Romania". On Tuesday, Kai arrived at 8 am. At noon, she was still waiting. At 17.00, the same. She ended up talking to the nurses, who knew nothing, she then called the doctor, who did not answer. It was already past 20.00 when finally an intern informed her that the doctor had had an emergency and would not be able to operate until the next day.

Kai spent the night in the hospital. During the operation, despite the anaesthetic, she experienced severe pain. "It's the worst pain I have ever felt", she would say. But the nurses would just tell her to stop moving and the doctor would not talk to her... They just paused as she vomited from the pain. "It was interminable, the doctor kept saying 'one more minute'...". Kai counted the seconds in her head before passing out. When she woke up, a nurse told her the abortion was over. “The doctor left the room without speaking to me.” Kai stood up and started crying, still in pain.

"Was it really that painful?", a nurse asked. "Yeah, it was awful", Kai replied. "Well, maybe next time you'll be more careful", the nurse lectured her. "I was raped", Kai replied. The nurses apologised and finally started paying attention to her. Meanwhile, her rapist had moved to Germany. The police told Kai that the rape was "a personal matter between them" and left it at that.

As terrifying as it is, Kai's story is not the only one. It illustrates what all Romanians know very well: it is better not to need treatment... And the situation in Bucharest is better than in rural areas.

Romania has around 220 public hospitals with a gynaecology section where women can in principle have abortions. In fact, however, every year fewer and fewer hospitals offer this service. The evolution of numbers is brutal. In 2019, an investigation by The Black Sea revealed that 60 of the 190 public hospitals contacted said they did not do abortions – almost one in three. With the Covid-19 pandemic, the situation became "very concerning", stresses Andrada Cilibiu of Centrul Filia. Of the 112 public hospitals contacted, only twelve practised abortions in April 2020, and none in Bucharest. In November 2020, the Ministry of Health collected data from 134 public hospitals and sixteen private clinics: 58% of them denied abortions. In September 2021, out of 128 public hospitals contacted by Centrul Filia, 69 did not offer abortions, or 54%. Over three years, there has therefore been a rise from 32% to 54% of public hospitals that do not practise abortions. At this rate, what will the situation be in 2025?

In 2013, Romania had one of the highest abortion rates in the EU (14.9 per 100 births). Five years later, the percentage had dropped to 8.6. The fall was even steeper after the first wave of Covid-19. According to data from the National Institute of Public Health, between 2019 and 2020 the number of abortions fell by 40%, from 26,862 to 15,595. In the first nine months of 2021, 10,429 abortions were performed, with an average even lower than in 2020. However, this decline is not the result of public policies that promote contraception or sex education. In fact, in 2011 the Romanian government stopped funding contraception subsidies, making access to birth control much more difficult, and stopped teaching birth control in public schools.

This sharp decline is due instead to the fact that in Romania it is increasingly difficult to have an abortion. The same statistics show that more and more hospitals report zero abortions on their balance sheets. A striking example of this development is the Polizu, the largest maternal hospital in Bucharest, which no longer practises abortions... More and more gynaecologists and obstetricians are using the "conscience clause" to refuse this operation. Of 802 gynaecologists called by Centrul Filia, only 275 said they agreed to perform abortions. "Most of those who refuse put forward religious and moral reasons", reports Andrada Cilibiu. “But sometimes it's a hospital directive, which is illegal”. It should be noted that doctors have insurance that covers any negligence, but abortion is not covered.

The trend does not seem to be reversing: more and more young gynaecologists are exercising their conscience clause. "Pro-life NGOs are also lobbying in medical schools", says Andrada Cilibiu. And professional bodies seem to get in line with their positions. In 2019, Gheorge Borcean, president of the College of Physicians, publicly congratulated all healthcare workers who refused to practise abortions. "Abortion at the request of the patient is not a medical act", he said. "If anyone asked me what actions I would take against doctors who refuse to perform abortion, I would say that I congratulate them! Nowadays, abortion on demand has become such a monstrously trivial thing that no one thinks of what it really means, that is, the end of a life".

Should we think that in Romania the rights of doctors now take precedence over the rights of women? The fact remains that the legislator does nothing to guarantee access to abortion to all those who need one. "Actions that restrict access to abortion are a form of violence against women", says Andrada Cilibiu. "We have young women who give birth against their will. The state forces us to become mothers without our consent". According to Andrada Cilibiu, the state would have the power to oblige any public hospital to provide this service, under penalty of revocation of accreditation for gynaecology.

Andrada Cilibiu started working for Centrul Filia in 2019. At the time, the association was looking for volunteers to call and report public hospitals that practise abortion in order to better orient the women who reached out. Official figures on the issue are scarce, because the Romanian state does not actually collect them. "I was shocked by the answers that were given to me", recalls the young activist. "Some hospitals justified themselves by citing the Bible, others told me they wanted to 'raise the birth rate'. This is unacceptable". The worst thing, she adds, "is that no one really knows what is going on".

Andrada Cilibiu never had an abortion, but abortion traumatised several generations of women in her family. "My grandmother, who is 100 years old, told me that her mother died of a clandestine abortion in 1938. My mother then told me that she had to have an abortion in the early 2000s and that it was very complicated to do so". In 1957, Communist Romania was one of the first countries in the world to legalise abortion. But in 1966, due to the stagnation of the population, which went against the regime's development plans, Nicolae Ceausescu issued decree 770. His pro-natalist goal worked perfectly: within a decade, the number of children per woman doubled, from 1.9 to 3.7. But at the same time, some 10,000 women lost their lives and 100,000 were maimed due to clandestine abortions. Not to mention the extremely high infant mortality and orphanage scandals that made international headlines after the fall of the regime.

The first law passed after the revolution of December 1989 was the one that legalised abortion. A true symbol. "In the 1990s, sex education courses and family planning programmes were booming in Romania", recalls Daniela Draghici. This historic Romanian women's rights activist aborted "on the kitchen table" during the Ceausescu era. "Until the mid-2000s, things changed for the better in Romania", continues the activist, referring to women's reproductive rights. But then the country started taking big steps backwards, and is now accelerating in that direction.

"We have no official figures, but we do know that women have abortions at home. Their number has increased during the pandemic", says Andrada Cilibiu, who travels regularly to Romania holding awareness and education seminars for women. "When I work in the fields in the villages, I meet women who sometimes already have ten children. I ask them, 'Do you want to have more?', they answer: 'It does not depend on me, but on the will of God and my husband'... ". Many men do not allow their wives to use contraception, nor do they want to wear condoms during sexual intercourse. "I know women who refuse to say they have a spiral because the Church has told them it is a sin".

"Doctors tell us that many women die from abortions at home, but then their death certificate shows another cause. If they are hospitalised, it is passed as a miscarriage that went wrong", adds Andrada Cilibiu. "Women who die are the most vulnerable and the poorest. In 2020, for example, a 45-year-old woman died of haemorrhage in Ploiesti, a medium-sized city near Bucharest, after a poorly performed curettage by a doctor of a small private practice. The nearby hospitals had all refused to practise abortion and the private clinics had made it prohibitively expensive for her: around 400-500 Euros. "We do not encourage abortions. (...) We encourage births", declared the spokesperson for the Ministry of Health at the time.

In Romania there is no law that allows women to get justice from hospitals or the Romanian state if their right to abortion is violated. In any case, the topic is taboo and most women prefer to move on as quickly as possible, as activists from Centrul Filia point out. The EU does not seem to have the means to tackle the problem either. The association has sent numerous reports to the European Commission and the EU Parliament, "but no reaction". EU health legislative initiatives are not binding on member states. These are only indications "to which the Romanian government responds in a hypocritical way, without taking any action", regrets Andrada Cilibiu.

Andrada Cilibiu has her own list of abortion facilities and gynaecologists, but she does not make it public to protect them from harassment by pro-life organisations. Because the problem is not only medical: anti-abortion activists, often members of orthodox fundamentalist movements such as the Pro-Vita association, born in Iasi in eastern Romania, are increasingly organised. They have substantial financial resources, thanks to the money sent by their partners based in the United States, Russia, and Western Europe. In addition to aggressively lobbying doctors, authorities, and political parties, these pro-life organisations are also very present in the public arena. In Romania "Birth crisis centres" have been set up on the model of the American "Pregnancy crisis centres". Until recently, when you googled abort (abortion in Romanian), the first result was "abort.ro". A one-page site with a few sentences: "Do you want to have an abortion? Need help or information? We are here for you", followed by a phone number. It was this number that Ekaterina called when she got pregnant in 2019, when she was 19.

"The people I called made me two appointments with a gynaecologist, but to change my mind", she says. At the time Ekaterina was living in Bucharest, studying industrial management and working in the call centre of a multinational, which was about to promote her to team leader. "I couldn't finish my studies and my promotion vanished when my superiors found out I was pregnant”. Meanwhile, abortion activists promised her food for the baby, a stroller, clothes... "They brainwashed me", she sees in retrospect. "They told me that the abortion was a painful operation, that there was a high probability of becoming sterile, that I would be traumatised for the rest of my life, that I would regret it. They also promised me that they would help me raise my son, that they would send me everything I needed... After a while it was too late to make another choice...". At that point they stopped calling her. "They disappeared and they never helped me".

Today Ekaterina lives with her mother in a village near Suceava in northern Romania. It was the child's father who wanted them to move there, because Ekaterina's parents lived there. At her mother's insistence, she ended up marrying him. Five months later, she divorced her husband due to his alcoholism problems. She is now a single mother and she feels like the "black sheep" of her family. "I was expected to live with an alcoholic, that's the mentality here". Did she regret keeping the baby? "It's not a decision that I have yet accepted. But I am still waiting to feel the maternal instinct to guide me and tell me what to do... I have not yet fully accepted I am mother”.

According to Eurostat, almost a quarter of all teenage mothers in Europe live in Romania. The fault lies with a deadly cocktail: no sex education in schools, no public policy for contraception, and increasingly limited access to abortion. "Pro-life activists also oppose sex education and contraception, which shows that this movement does not really care about fetal life and reducing the number of abortions, as it opposes the very measures that would reduce unwanted pregnancies", points out anthropologist Radu Umbres.

"In Romania, access to contraception is very limited", confirms Irina Popescu-Mateescu, 38. The midwife worked from February to September 2021 at the Ministry of Health, when it was headed by Vlad Voiculescu of the USR-Plus. "I tried to resurrect a programme that was interrupted several years ago. But it was blocked". Vlad Voiculescu told her he hired her in the reproductive health planning department because he knew about her activism for women's rights. But Irina Popescu-Mateescu soon realised that her job was mainly to prevent abortions. She also soon realised that many maternity wards refused to practise abortion. "Instead, they offer a family planning interview in the hospital chapel with a priest".

In Romania there is no separation between church and state. "At the Ministry of Health, in hospitals, public employees are very religious, it is a reflection of society. Their beliefs are reflected in their work". "To give you an idea, many in the Ministry of Health do not say 'penis', 'vagina' or 'vulva', because it is taboo. They prefer to use terms like 'pussy' (pasarica) for girls or 'pea' (cucu, cuculeti, puta) for boys... ". When Irna Popescu-Mateescu proposed to the new Minister of Health, Alexandru Rafila, to allow pharmacological abortion through telemedicine, as happens in France, Germany, or even in Moldova, this trained doctor simply replied: "It is a sin".

In Romania, where the Orthodox Church is very powerful, defending the right to abortion means being under severe pressure. After six months, Irina Popescu-Mateescu was fired, while USR-Plus had to abruptly leave the government. "I tried a lot of things. I had a lot of energy and tools at my disposal, but nothing helped. They are stronger".

Since then, the midwife has returned to work in a private clinic in Bucharest. "The gynaecologists on my team do not practise abortions. It is a moral choice and in any case they do not want to complicate their lives, because they earn a very good living with other tests and operations. 'Others will take care of it', is their mentality”.

These same colleagues have asked her to stop the prenatal education courses she has given pregnant women since 2008. "They prefer less educated patients who obediently follow their instructions, and midwives are seen as dangerous because they are on the side of women, not of medical power", says Popescu-Mateescu. "In the current system, the doctor wants to stay above the patient. He is the one who knows and decides, and there should be no questions. Patients' rights simply do not exist".

In her opinion, a figure illustrates the regression taking place in Romania. "Reproductive health at the Ministry of Health is now in the hands of one person. Before 2005, there were 18. For a country of 20 million people, which has many problems in this area... it is simply unacceptable. And that person does nothing except blocking all projects. I know this because I tried to do things with WHO and UNICEF, but it never came to anything".

Today Irina Popescu-Mateescu is thinking more than ever about leaving the country. "I will continue to do my best to change things. Here, I often feel suffocated and find no one to turn to... Education is needed and there is a lack of education", she says, aware of the vicious circle in which Romania has been trapped. She concludes: "Today the bodies of Romanian women belong to society, to their husbands, not to them".

 

This article was written by colleagues from Le Courrier des Balkans  with the support of Journalismfund.eu