Eleven years have passed since Spain passed the Abortion Law, but despite being a recognized right, obstacles persist that hinder access. Although in all this time there has been no public evaluation of its application, testimonies have come to light that illustrate the failures of the system. It is the case spread by Cadena SER from the public hospital Clínico San Carlos in Madrid, which refused to perform an abortion on a woman despite the unfeasibility of the fetus. The center alleged conscientious objection from the entire service and referred her to a private clinic. It is not an isolated case: the vast majority of voluntary interruptions of pregnancy do not occur in centers of the public health network, but in specialized clinics with which the Administration arranges the service and the woman does not pay for it. According to Health data, in 2019 85% of the total were made this way.
“The public health delayed my abortion to seven months because it denied me information about the fetus”
The question comes from afar. It was the clinics that more than 30 years ago took on the task of performing abortions at a time of enormous institutional neglect and stigma. They were professionals who believed in the right to abortion and came to train abroad to learn how to do it. “Many of us began to do it in public health, but it became impossible because they did not bet on it, there were complaints, legal insecurity and pressure. We decided to get out of there and a whole parallel network of committed doctors was created,” explains Francisca García, President of the Association of Accredited Clinics for the Termination of Pregnancy (ACAI).
Once the 2010 law came into force, which stipulates that abortions be carried out in the public network and considers it “exceptional” to do it in accredited centers, the communities chose to continue to maintain the concert route, instead of creating circuits specific within the public health. Even in those cases in which there are no private centers with which to arrange the service.
This situation forces thousands of women a year to travel to other provinces to have abortions because even in these situations the public does not assume them. It occurs in more than a dozen provinces, including Jaén, Huesca, Teruel, Cáceres, Cuenca or several in Castilla y León such as Zamora, Palencia or Salamanca. This despite the fact that the law recognizes “equal access to the benefit for all women, regardless of where they reside.”
In them, no abortion is performed, but there are also territories in which what is derived are medical interventions beyond the 14th week, which is the limit of free abortion. From then on, it is only legal if there is a risk to the life or health of the pregnant woman or “serious abnormalities in the fetus”. It was the situation of the woman who has reported her case to Cadena SER and who thanked her for the treatment they gave her at the Isadora clinic in Madrid, but it has happened on other occasions: in 2016 a woman was forced to travel 500 kilometers to have an abortion, a trip in which she lost her uterus and for which the Servizo Galego de Saúde (Sergas) was condemned. A year later another woman denounced the Murcian Health Service for denying her information about the fetus and also being referred to a clinic in the capital.
What’s behind conscientious objection
In all cases, the reasons given by the hospital services pointed to conscientious objection. Nor is it something exceptional: when the counseling departments are asked why the public centers do not assume abortions, they usually give this among other reasons. This was specified by the Castilian-Manchego Government last May, when it alluded to the fact that “there is conscientious objection in all the services involved” and also the Andalusian Ministry of Health: “The Board cannot ask a priori to a doctor if he is for or against performing abortions to organize hospital services. ”
In response to a letter sent by the Salamanca Feminist Movement, the Junta de Castilla y León recognizes that “in the field of public health, they are not currently being carried out nor have they been carried out in the province because the professionals directly involved take advantage of the conscientious objection “. The cases are referred to Valladolid.
But what are we talking about when we talk about conscientious objection? “It is not just an ideological question, which has also existed and has been around for a long time,” believes Silvia Aldavert, coordinator of L ‘Associació drets sexuals i reproductius de Catalunya, but also adds to other reasons. There are professionals who directly oppose it for moral reasons, but the experts also point to a lack of training and interest and stigma: “Many times there is a professional objection rather than an ethical one. It continues to be a stigmatized and non-standard practice about which there is no he speaks and does not train future gynecologists, which does not give prestige or value in the professional career “, explains García, from ACAI.
This causes specialized clinics to be seen “without generational change” of professionals and denounce the breach of article 8 of the Abortion Law, which requires training professionals “in sexual health and reproductive health, including the practice of interruption pregnancy “and on an ongoing basis. ACAI professionals offered themselves in 2010, when the standard was created, to implement this type of training without success, they recall.
Class objection is illegal
However, the law recognizes the right of physicians to conscientious objection, but also establishes that it must “be manifested in advance and in writing” precisely so that “access and the quality of care of the provision cannot be impaired” by its exercise . In other words, it is an individual right, recalls Aintzane Márquez, a lawyer for Women’s Link, an organization that handles the case of Murcian women: “In many cases, an institutional conscientious objection is being made, which is actually illegal. There are addresses of hospitals and heads of gynecology services who demand that abortions not be performed, which is a bad exercise of this right, “he explains.
There is also no public data on how many objectors there are, nor do Administrations usually collect the information to see what degree of objection there is and what number of professionals can be counted on. Aldavert denounces an “evident lack of political will” to reorganize the services, and in part he believes it has to do with how conscientious objection is embodied in the law. “It is not well articulated, it was established that an entire center could not object, but there is no registry, it is not possible to follow up and there is no knowledge of the data in a transparent way,” he points out.
The Minister of Health, Carolina Darias, has referred to this matter in a press conference this Wednesday. “Access to quality care cannot be undermined by the right to object. It does not look like this is good practice,” she said when asked about the case of the San Carlos Clinical Hospital.
The Ministry of Equality, which is immersed in the process of reforming the regulation, has among its priorities the regulation of this recognized right, and among the possibilities it is considering doing so in the style of the recently approved Euthanasia Law, which obliges administrations to create a registry of professional objectors so that “adequate management of the provision can be guaranteed,” that is, for the purposes of health organization.
A comprehensive reform
The updating of the law that the department headed by Irene Montero intends to complete aspires to be comprehensive and to touch on different points, an “ideal” moment, Aldavert believes, “for fine spinning”: “When we talk about abortion, I don’t think we can talk about “They have to be done here or there” and all in the same way. We have the picture painted because we have one of the most progressive laws in the world, and although many things would have to be changed and there are many obstacles, we have abortions of proven quality, as well Now we have to stop in detail to see what is not working. Nor can doctors be forced to do things that they do not want to do, because that is what women are going to suffer. ”
From ACAI they insist that training is key for abortion to be articulated in the public health network and they fear that, as the Ministry of Health proposed in a decree that was put out for public consultation a few months ago and later withdrew after the controversy, it will impose only one type of method, the pharmacological one, “because it requires less involvement of the doctor,” says García. The president of the association, with more than 30 years of experience in the Ginegranada clinic, demands a comprehensive “quality” training for professionals that covers both techniques – pharmacological and instrumental – with the aim that women “can decide.”
In what all the experts agree is that there are still obstacles that cause “that abortion is not a 100% guaranteed right in our country,” adds Márquez, due to the “lack of involvement of the administrations.” And among the first barriers is the lack of clear information. In fact, due to institutional opacity, it is almost impossible to make an exact X-ray of what is happening: “The system is a complex network because there is a very strong neglect at the institutional level and because abortion is hidden and invisible. If these were operations of heart we would be appearing every day in the newspapers “, concludes Aldavert.
Do you know any case of women who have not been allowed to interrupt their pregnancy in public health? Do you have any testimony to share? You can tell us by sending an email to [email protected]