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‘What kind of life will they have?’ Russian doctors on what the country’s anti-abortion shift means for their work and the pregnant women in their care

Source: Meduza

Although Russia doesn’t currently have a federal law banning abortions, an increasing number of private clinics now refuse to perform the procedure. In March, 19 private clinics in Russia’s Republic of Tatarstan “voluntarily” stopped performing abortions. And Tatarstan isn’t an isolated case: over the past year, access to abortion in private clinics has been restricted in at least 15 Russian regions. Doctors fear this signals a possible imminent curtailment of women’s reproductive rights at the national level. The independent journalists’ cooperative Bereg asked doctors at clinics that previously performed abortions for their perspectives on the situation. With Bereg’s permission, Meduza shares their answers, translated into English.

The following responses have been lightly edited for clarity.

Elena (name changed)

In our clinic, we see about two or three patients a week who want to terminate their pregnancies. The consultants at state healthcare facilities actively promote anti-abortion policies and encourage women to give birth, so women are forced to turn to private clinics. It used to be that a woman could go to a consultation at a government-run clinic and easily schedule an abortion. Now, state institutions actively pressure them: “No, we won’t give you an abortion — have the baby.” So, the woman goes to a private clinic.

I believe that women should be given the right to choose because having a child is a huge responsibility. After all, the child not only needs to be born but also raised. Children should be wanted. Restricting the right to abortion shows complete disregard for a woman’s opinion. I know that they’ve banned abortions in Crimea, but if they ban them in all regions, what will we do? Women will be giving birth to unwanted children, and there will be more children in orphanages. It’s bad. I’m active on social media, and I conducted a survey: the majority of my followers said that women should have the right to choose.

There were about 30 clinics licensed to perform abortions in Tatarstan; 19 is more than half. But again, there are abortion pills, and then there’s vacuum aspiration. Pills aren’t suitable for everyone because of certain deadlines. And vacuum aspiration is a surgical procedure; the clinic has to be equipped for it. We have very few clinics in the republic that can perform it.

Of course, if there’s a total ban, there will be more underground abortions. I’m certain of that. In the 1990s, it was very common; there were midwives who performed abortions at home. Many women died of sepsis. If they completely ban abortion now, women will look for ways to do it illegally. If a woman wants to, she’ll find a way.

I perform abortions, but mostly for medical reasons, when the pregnancy isn’t viable. If a woman has an unwanted pregnancy, I always ask her what the reason is. For example, sometimes she already has three or four children. Or she has a very young child and isn’t ready to have another. Or she says her husband was called up to the front, and she found out she was pregnant, and what can she do? I don’t know how I feel about it; it all depends on the situation.

You understand where a woman is coming from, basically — that her pregnancy’s unwanted, that there are certain circumstances, that she needs help. But there’s pressure from the state. If abortions are banned, there will be a huge uproar and revolt. There will definitely be protest movements. I think everything is slowly heading in that direction.

Anonymous 

It all started a few years ago when Russian Health Minister Mikhail Murashko began talking about the need to ban abortions in private clinics because of abortion’s supposed detrimental effect on demographics. Shortly after, ministers in a lot of regions started considering the matter. Not just in Tatarstan but in the Nizhny Novgorod and Kaliningrad regions as well, I think.

They gave various justifications for it. Some argued that there are a lot of medical complications in private clinics; others said there’s no statistical record, meaning the state doesn’t know how many abortions are performed there. They also claimed private clinics might violate regulations when performing abortions since they’re not subject to the same oversight as state-run clinics.

If, let’s say, private clinics are doing something poorly, they should probably be better regulated, right? Here, their perspective was: “We’re looking for grounds to justify banning abortion.” In exchange for pulling abortion services, they offered the private clinics state contracts and the opportunity to provide some other services covered under Russia’s Obligatory Medical Insurance: licenses for other procedures. That’s how the conversation unfolded.

Many did surrender their licenses to avoid souring relations with the ministry. It’s strange. I think it would have been enough to establish some kind of regulatory framework. Abortions don’t have any impact on demographics. There are studies showing this — not only in Russia but in other countries as well. Banning abortions doesn’t lead to increased birth rates; there are other reasons behind the declining birth rate.

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If Russia completely bans abortion, it’s quite possible that the number of illegal abortions will increase. We already had experience in the Soviet Union with home abortions. You can physically do the procedure at home. It goes without saying that the timeframes [within which it’s safe to have an abortion] and hygiene guidelines probably won’t be observed, and there are complication and infection risks after these types of procedures.

Maybe banning abortions will slightly increase the number of births. But what kind of life will these children and their mothers have? This is completely wrong for society.

I have no particular feelings toward the local authorities because I know that it isn’t our Health Ministry that’s setting the policy. But at this stage, putting pressure on clinics is largely illegal: there’s no law that prohibits performing abortions in private clinics.

The government typically tests the water in such cases. A certain lawmaker says something and then watches to see how the population and activists react. Then, they’ll try to put some restrictions in place. Let’s say they ban private clinics from performing abortions and then watch to see if it works, if people accept it or not. Afterward, it’s entirely possible that they’ll introduce a complete abortion ban.

Lela

As far as I know, the Republic of Tatarstan’s Health Ministry convened a meeting with the heads of private clinics in 2023. There, they discussed a potential ban on abortions in private clinics and the voluntary surrender of licenses. Several clinics immediately gave up their licenses. And those that didn’t restricted access to the procedure. In January 2024, Russia’s first crisis pregnancy center opened in Tatarstan.

Private clinics are provided with detailed guidelines outlining each step of the process. Even down to what language should be used when talking to women, how to dissuade them from terminating the pregnancy. There are discussions at every stage, even when the doctor and patient are going into the operating room or when the patient is being given the first pill.

I don’t think Russia’s Health Ministry is pursuing a complete abortion ban. The ministry has to acknowledge that each woman’s situation is unique. But they’re definitely trying to reduce the number of abortions as much as possible.

Alexandra (name changed)

Many clinics in Kazan have stopped performing abortions altogether, while some will only do them up to the fifth or sixth week of pregnancy. This will likely lead people to look for other options. Where there’s a ban, there will always be workarounds — and those looking to profit from them. I’ve been asked to perform abortions even in late stages of pregnancy. While I refused, someone else will say yes.

As for a complete ban, no, the Russian authorities aren’t aiming for that. But they are trying to reduce the number of abortions; I think they do have that objective. Everything points to it: some clinics aren’t performing abortions anymore, and now you have to fill out so many forms, register these patients on [Russia’s government services portal] Gosuslugi, and make mandatory referrals to a psychologist.

Personally, I’m strongly opposed to what’s happening. Women should be able to decide whether or not they want to give birth, whether or not they’re able to support a child. The government doesn’t take on the full responsibility of providing for these children —just look at single mothers. So, I’m very against it. It’s a huge problem. This will lead to an increase in illegal abortions, which could lead to an increase in maternal mortality rates. And also, an increase in the number of abandoned children.