Susana is a doctor at one of the large public hospitals in Madrid, but in addition to going to work at the center every day, she is also his patient. Therefore, when she became pregnant in January of this year, it was her own colleagues who followed her evolution. Until things started to go wrong. At week 14, a very serious anomaly was detected in the fetus and she felt that aborting was the only option. But I couldn’t do it there. Although the professionals who treated her acknowledged that they would be willing to perform the intervention, they could not do so “due to hospital policy.” “They told me that abortions of any kind were not performed,” she says.
The woman prefers not to reveal the name of the health center and her name is not Susana either. She has chosen to remain anonymous to talk about “one of the worst experiences” of her life, that of having an abortion late in the pregnancy of a desired child. And having to do it, furthermore, outside the circuit of the public health network: “At the hospital I asked what the next step was and they told me that we had to go to the offices on Sagasta Street to make an appointment with one of the three possible clinics that do it. I asked them why they would choose one or the other and they told me that I could see opinions on the Internet,” Susana laments.
Her case is no exception: in Spain the vast majority of voluntary terminations of pregnancy (81.45% in 2023) are carried out in private clinics with which the service is arranged and women do not pay for it. This continues to be the case despite the fact that the reform of the abortion law has been in force for a year and eight months, which gave priority to public centers and ordered administrations to establish the necessary measures so that abortion was, once and for all. , assumed mostly by them. However, the recent dates of the cases collected by this means show that this is not yet the case.
“We do not understand how it can be that women are taken out of their reference health centers to have an abortion. It is a right, it should be guaranteed in all hospitals, but despite the new law the situation is practically the same,” she says.
Christina Romero
— Founder of the association A Contracor
“We do not understand how it is possible that women are taken out of their reference health centers to have an abortion. It is a right, it should be guaranteed in all hospitals, but despite the new law the situation is practically the same,” says Cristina Romero, one of the founders of the A Contracor association, which brings together women who have terminated their pregnancies due to medical issues. Romero emphasizes that referrals “stigmatize” women and can sometimes contribute to “generating a feeling of guilt” when seeing how “the doors are closed to them for something that is important to them.”
It is a feeling that Susana had: “The gynecologists at the hospital treated me very well, they had a lot of empathy, but the way the process is makes you feel like you are doing something horrible and you feel judged. It seems as if by not doing it at the hospital they wanted to hide it. At that moment you are so devastated by the situation itself that they tell you that it can’t be here and you don’t even fight, but you feel hopeless,” says the woman, who, however, was treated at her health center days later because she had pain that In the end they came to nothing. That is to say, she was welcomed back into the hospital after being expelled, but, of course, after having terminated her pregnancy.
Neither in your hospital nor in your city
Although it is a general situation, some communities stand out above others: Extremadura, Ceuta and Melilla did not carry out a single public abortion in 2023, while in Madrid, Andalusia, Murcia and Castilla-La Mancha the figure does not even reach 1 %. When asked by the Ministry of Health of the Community of Madrid about the shortage of abortions provided by public centers and about Susana’s case in particular, a spokesperson argued that “assistance is guaranteed” and that “the issue” is that “logically we cannot ‘force’ the professionals involved in the procedure to perform it,” he states, slipping that the refusal of some hospitals to perform abortions would be due to a matter of conscientious objection.
However, the law establishes that this is an individual right and its exercise cannot affect “the access or quality of care provided,” so public services “must be organized” to guarantee that personnel are available. To this end, the law requires regulating conscientious objection through the creation of registers of objectors so that it can be known in advance which professionals can or cannot be counted on and to prevent there from being a generalized objection such as that which exists in hospitals such as Susana’s. However, only a few communities have created these records and Madrid is not among them.
But what happens there is not unusual. Rocío Medina Rodríguez has also experienced it on her own skin, who terminated her pregnancy last April at week 22 because the fetus had a malformation that, although at first she and her husband wanted to think that it might not be so serious. , ended up being confirmed as practically incompatible with life. Most likely, the pregnancy had not even come to term, the doctors explained. So even though “we didn’t even want to consider it,” in the end they ended up requesting the interruption as they were advised by “up to five different gynecologists,” says the woman, who lives in Córdoba.
An intervention that could not be carried out at the Reina Sofía University Hospital, which diagnosed the anomaly. And not even in his own city. His case is one of the thousands that each year not only stop being taken care of in public centers, but are also referred to other provinces because in some of them there are not even private clinics to arrange the service. This despite the ruling of the Constitutional Court that ruled a year ago that forcing women to travel violates their rights. “They told me I had to go to Seville but they didn’t explain why. I understand that there may be some gynecologist who is not a supporter, but in an entire hospital there are no possibilities? It is inconceivable with any other type of benefit,” denounces Rocío.
Despite her insistence, the woman did not know what would happen once she arrived at the clinic in the Andalusian capital, where she and her husband went by train “thinking that everything was going to end that day.” However, there they informed him that he had to return a week later because the process required taking a pill the day before and those interventions were only done there on Wednesdays. “It was very hard because it was one of the worst moments of my life and no one had warned me that I was going to leave there with my daughter inside,” she remembers. Finally, he asked the clinic to only perform fetolysis [finalización de la gestación] and immediately returned to Córdoba and entered the hospital to have “a humanized birth,” since she wanted “to be able to say goodbye to my baby” and this was something that the clinic did not offer her.
That is, the hospital refused to perform the abortion as such, but it did accept the woman for the subsequent step. “If that is where they have told me that the girl is ill, why can’t they finish the process? It’s like you’re doing something clandestine, which adds to the uncertainty and discomfort you already feel. In the end, once I returned from Seville, they treated me in the hospital as if it had been a spontaneous abortion and they applied the same measures to me. Why so much difference? It seems that there are cases that are acceptable to the system and others that are not,” Rocío laments.
From one hospital to another
From the Association of Voluntary Pregnancy Termination Clinics (ACAI) they explain that there are requests from women in these situations, who abort due to medical pathologies, “which we will not be able to do from the centers” because “we perform abortions, not births,” explains its spokesperson Sonia Lamas, for whom it is important as a first step to guarantee that the benefit is assumed normally by public centers that “there is training for professional teams” and specialized units “in which women can choose the method and type of benefit regardless of the situation in which they find themselves.”
The vast majority of voluntary terminations of pregnancy (IVE) are carried out at the woman’s request (94% in 2023) and at less than 14 weeks of gestation. Only 6% decide due to fetal anomalies or risk to life and health, but in both cases referral to private, subsidized centers is common (82% and 75% respectively). “It is important not to understand that there are some first-class abortions and others second-class because it generates more stigma. “They are all legal and voluntary,” reasons Silvia Aldavert, president of the Association of Sexual and Reproductive Rights, who regrets that despite the reform of the law “there is no monitoring and sanction in case of non-compliance, both for the communities and for the specific centers.”
For their part, the autonomies in which this continues to occur respond along the same lines, appealing that the benefit “is guaranteed” and avoiding answering questions about the specific cases reported in this report. Thus, a spokesperson for the Ministry of Health of the Government of Andalusia points out that the model of referral to concerted clinics aims to “guarantee access to the right above the right to conscientious objection” while the Department of Health of the Generalitat Catalan answers that the benefit “is guaranteed through the appropriate devices in each case.”
The latter does not comment on the case of Valentina Aragón, a 36-year-old woman who a year ago decided to abort after the fetal malformation that doctors detected at 17 weeks of gestation. It is another case of a hospital, in this case the Sant Pau in Barcelona, which refers voluntary terminations of pregnancy to other centers, in this case, however, not to a concerted clinic, but to another public hospital in the city, the Clinic. “The gynecologist who carried out my pregnancy literally told me that they couldn’t do it there because the hospital is managed by the Church,” says Valentina.
At the Clínic “everything went very well”, both “the treatment given to me by those who treated me” and “the intervention itself”. “If I have to complain about something, it is that they did not explain to me how everything was going to be until the day before because it would have helped me to know beforehand, but I was treated with great tact and care. They even gave me the option of seeing the baby, but I said I didn’t want to, I was clear about it,” the woman recalls.
However, she and all the others do not understand why if the IVE is a public benefit developed in a state law since 2010 – recently reformed – they should leave their reference hospitals to exercise the right. Sant Pau, in fact, is a subsidized hospital center that stopped performing abortions in 2012 without, according to the staff, giving explanations. However, today there are still professionals who demand to recover the activity. “I never thought that the hospital where I belong, where I have never had any problems, could not do this to me not because they did not have the means, for example, but because of the decision of some people even though it receives public money and we are within the limits.” the law,” Valentina summarizes.
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