In another autonomous community, with almost no information about the process and after more than two months of travel. This is how María (not her real name) faced the voluntary termination of pregnancy that she underwent last November due to the “extremely serious and incurable” disease suffered by the fetus. The “most difficult” process of his life, he explains in conversation with elDiario.es, marked by misinformation in public health and a trip by his own means of more than 200 kilometers to exercise his right. The woman dares a year later to tell her experience, which is not an isolated case in Spain, but agrees to do so without revealing her name or the community in which she lives or to which she was transferred. She fears retaliation because there are few cases like hers since she is pregnant again.
Thousands of women are forced each year to travel to other provinces for abortions
At the time the pregnancy was aborted, it was very advanced — it was 36 weeks — but not a single public hospital in her community performs this type of intervention. In 2020 they were Castilla-La Mancha, Extremadura, Madrid and Murcia. To these we must add those, such as Castilla y León, that do not perform those that exceed week 22 of gestation. In these cases, the health ministries arrange the service with private clinics, in which the woman does not pay for the benefit. However, there are medical interventions that clinics in some territories do not undertake and in some provinces these centers do not even exist. This implies that thousands of women a year are forced to travel to have an abortion, and in some cases, such as María’s, to change their autonomous community.
The concerts are not exceptional, it is the prevailing model in Spain since the clinics assumed the interventions in the 80s due to the stigma that it entailed. Decades later, the situation has barely changed and the number of abortions handled by the public does not reach 16%, according to data managed by the Ministry of Health.
Just a year ago now, María was immersed in the process that she qualifies as the hardest of her life. A series of “comings and goings” traversed by “an enormous information gap” that led her to contact the Association for Sexual and Reproductive Rights of Catalonia, which has accompanied her throughout the process. Silvia Aldavert, its coordinator, considers that it is a “paradigmatic” case of “almost all the barriers that women face in relation to abortion”, among them, that of territorial inequity, which forces thousands of women a year to leave their provinces to exercise their right.
Already in the 20th week of gestation, the gynecologists at the hospital where they treated María began to see that something was not right in her pregnancy, but the conclusive opinion came later. “At that moment you start to worry and tests and more tests follow each other, but the weeks go by. It is a very desperate feeling of uncertainty,” explains the woman in conversation with elDiario.es.
The abortion to which she underwent, beyond the 22nd week of gestation, requires confirmation by a clinical committee, a group of specialists constituted in each community. In his case, he requested it on three occasions; In the first, even the doctors were not able to name the anomaly suffered by the fetus, so the committee rejected it. It was also denied by the Catalan committee to which he went on the recommendation of the association.
“Several abnormal things” were seen, among them, genital hypoplasia, hepatomegaly, delayed intrauterine growth or long bones in very low percentiles, according to gynecological reports to which elDiario.es has had access. “They told us about a huge risk of hospitalizations and illnesses,” explains María. She continued to undergo further tests and finally, after consulting with two specialists in prenatal diagnosis and fetal malformations, they confirmed that she had hypoplasia of the corpus callosum with suspected Smith-Lemli-Opitz syndrome.
The wait on the November bridge
“They told me that he could have a life expectancy of between two and three years, and in the best of cases many congenital malformations, constant interventions or basic needs that he was not going to be able to do himself,” he says. The second consultation with the clinical committee led to the admission of the case, but it was several days without information waiting for the decision. “They didn’t tell me anything about the hospital, until they called me on Friday to tell me that two members had voted, but as the following Monday was a holiday, a third was missing who had left the bridge. They told me to have things ready on Tuesday for if they called me to go to the clinic. ”
That’s how it went. Two months had passed since the tests saw the first anomalies, but the days of waiting for the conclusion of the committee were “of real anguish”. It was a highly desired pregnancy, which ending it was “the hardest decision I have ever made and will ever make”, but no one gave her reasons why the hospital where she had been tested and followed up. The whole process could not, at this moment, interrupt it.
According to the latest data available, from 2020, which was the year in which María had an abortion, 21,576 voluntary interruptions of pregnancy were performed in Castilla-La Mancha, Extremadura, Murcia and Madrid, only four in public centers. 40 of them, due to fetal anomalies incompatible with life or due to an extremely serious and incurable fetal disease, as happened to her. In the hospital they told him that fetolysis [nombre técnico con el que se designa la finalización de la gestación] They would do it in a clinic in another province, 200 kilometers from her home, but they did not explain anything else, says the woman, who denounces a “huge lack of information” during the process.
She made the trip in her own car, driven by her husband, hardly knowing what the intervention she was going to undergo consisted of. Nor did he ask. “It’s a time when you just want it all to end,” he says. He also did not know what he would have to do next. At the clinic, where he assures that the professionals gave him a “fantastic” treatment at all times, they were surprised that he did not already have an appointment at the hospital to enter and that the expulsion of the fetus took place. It is something that happens in several public hospitals: they do not perform fetolysis in their facilities, but they do assume the deliveries later in the event that the clinics do not do so.
Maria had to call the hospital to ask when and how she had to undergo it. “An hour later they contacted me and told me to go home and the next day to enter for the scheduled labor induction,” he recalls. At that time, she was grateful that she did not go directly to the hospital to be at home with her young son, but it is difficult to imagine that after an intervention of these characteristics something like this would happen with another healthcare service. “That night I cried a lot and it has taken me all this time to be able to talk about it like this. Guilt is added to the whole process, because you feel guilty. You are the mother of that child …”, reflects María.
“Lack of political will”
Among the “barriers” that the Association of Sexual and Reproductive Rights of Catalonia identifies in the case, Aldavert highlights three: on the one hand, the obligation that the woman had to move, even leave her autonomous community, in order to have an abortion, a “breach” of the current law, which recognizes “equal access to the benefit to all women, regardless of where they reside”; also the “lack of information and support” during the process and the power that the norm grants to clinical committees, in situations in which “the woman does not decide” and that on occasions, says Aldavert, “they make ambiguous decisions.”
“That there is no accompaniment or any professional team from the public network that covers the entire process is a violation of rights that in the end ends up causing what is known as institutional violence. There is a neglect and lack of political will to implement abortion in the center “, believes the coordinator of the association. To try to tackle this and other obstacles that continue to hinder access to abortion, the Ministry of Equality is working on a reform of Organic Law 2/2010 on sexual and reproductive health and the voluntary interruption of pregnancy, which, among other things, provides for regulate conscientious objection so that hospitals assume the interventions and prevent cases like María’s from occurring.
“I do not know if all the gynecologists in all the hospitals in my community are objectors, but it is heard that there are people who occupy certain positions that are,” sums up the woman when asked if this may be a reason why the public centers refer their case to a clinic in another autonomy. “At that time we were immersed in uncertainty and despair and you don’t think about it, but if they did the obstetric check-up, why not interrupt it when I needed it?” He asks a year later.