"There is no such thing in civilized countries"

Samara private clinics refuse to carry out abortion under pressure from the local Ministry of Health. What do the doctors say about this?

On November 20, the head of the Ministry of Health of the Samara Region, Mikhail Ratmanov, said that his department asked the region’s private clinics to refuse abortion. According to the official, out of 31, which licensed to carry out the procedure, ten responded to the call. They already managed to “voluntarily pass” permission. In 2020, private Samara clinics will not be abortion at all, the Samara minister hopes. The authorities promise that the termination of pregnancy can still be carried out in state medical institutions-however, there they will convince women not to do it there. Prior to this, in the Samara region - as in a number of other regions - already held shares of refusing abortion for one or several days. The new initiative in the Samara Ministry of Health was explained by the fact that many private clinics, due to “commercial interest”, do not comply with laws and are not always able to qualitatively carry out the procedure. A online pattern was created against the initiative of the authorities, and the regional prosecutor's office began checking the legality of the clinic refusal to carry out abortion. Medusa talked with gynecologists and obstetricians from Samara’s private clinics on how they relate to the new policy of the Samara authorities.

Vladimir Dupilov

obstetrician-gynecologist, experience 31 years

I am not a specialist in abortion, although I was in charge of the gynecological department for 25 years and carried out operations every day. The doctor should provide assistance to sick women and give them life, but he should not take his life. According to my moral concepts, I believe that the doctor should not do abortion. Thank God I was able to refuse because there were doctors who performed these operations.

I consider this recommendation correct. Operations should not be carried out on every corner. Private clinics, as a rule, keep incomplete records of abortion, may not observe the terms of “silence” when a woman give time to think about this serious step and consult a psychologist. I do not think that all private clinics - especially small ones - have in the staff of a psychologist who would conduct these conversations. In many cases, the procedure is performed formally, and many women will refuse abortion if a competent specialist will talk to them.

Any abortion leads to complications , and I saw formidable consequences. More than thirty years ago, when I was a student, I watched a fatal outcome. Then, after an abortion, a man died. Perhaps it shocked me for a lifetime. Breeding pregnancy cripples the psyche of both doctors and patients, so the smaller there are, the better.

There should be abortion clinics - three on the city, no more. If there are doctors who, according to their moral beliefs, consider the fulfillment of abortions to be acceptable - for the sake of God, let them do it, but do this only. Let this be done in large centers, where there is an opportunity to correct complications that may occur in the process.

Women in our city [Due to the refusal of ten clinics, carried out the procedure] were not injured, because no one forbids abortion in state medical institutions. For this, there are enough conditions and equipment. Moreover, over the past 10 years, the number of abortion in Samara has decreased significantly. As the head of the department, I felt this because women became more aware of in matters of contraception.

I support the new Minister of Health - a surgeon by education. I do not think that this is a populist decision and a desire to score points. This is a fundamental position, and he consistently runs it to life. Now, even in state clinics, it is allowed to have abortion not every day, but only on certain ones. There is a tough regulation for these procedures.

The recommendations given by the Ministry of Health should be executed because no one will go against them. No one wants to quarrel with them.

Anastasia Sinitsyna

Reproductologist in a private clinic, experience nine years

As a doctor and woman, I am against abortion. But they do not need to prohibit them. We and the whole world have already passed. When interruption was prohibited both in the States and in the Soviet Union, this led to criminal consequences and to a high share of mortality in women. Operations were done without anesthesia and without pain relief in some incomprehensible apartments. The world overcame this step. This is not the path that we should follow.

The fight against abortion for me is an increase in sexual literacy of the population: working with adolescents and young people, training contraception. This tactic works, and this has been proven in European countries. Results can be achieved using sexual education, but it is necessary that people get away from the taboo topic of sex. I'm not sure that schools are ready for this. But so that the children have accessible information and they do not just watch porn, you need to conduct these conversations in families.

Some women perceive drug abortion as a pill for pregnancy. They do not understand harm, although if you choose between ordinary surgical and medication, the second, of course, is better - fewer consequences. But prohibiting abortion is a bad way to deal with them, this will lead to an increase in complications and criminal abortions. I specialize in the pipe factor of infertility . Abortion is in one of the first places among the reasons for this.

This will complicate the life of women who have decided to abortion. Any good doctor that in the state, in a private clinic, will talk to the patient, will warn about risks, will give time for thought. But the decision remains with the woman, as well as the choice of a place of assistance.

First, to obtain a license [to conduct abortion of power] introduced more stringent requirements for abortion. On the one hand, it is safer for customers, on the other hand, higher requirements are presented to clinics in terms of equipment. Now, for the most part, the interruption is in table. In most cases, this is not needed for this. Accordingly, the complication of licensing reduces the number of clinics that can not only engage in drug interruption.

All this is covered with good goals and sounds good. But the very position of the Ministry of Health, that private clinics do not comply with the law, is not true and belittles the level of private medicine. If women start contacting hospitals, most likely the service will suffer.

If obstetrician-gynecologists say that abortion is evil, and they will not do this, then all the “right” and “good” doctors will begin to carry out quietly. It is definitely bad, but you need to fight not with the number of abortions, but so that there is no unscheduled pregnancy.

Marat Tugushev

Gynecologist-surgeon, chief physician of a private clinic, 27 years of experience

We initially developed as a clinic of reproductive medicine, that is, contributed to the birth of a new life. Therefore, the implementation of medical abortions would be unethical in relation to those women who come to us for a child, for help. But we still need a license, because it is common and is required when we have to terminate the pregnancy according to medical reasons and with developmental malformations: for example, if the fruit is without a head. Then you need to evacuate the contents of the uterine cavity.

It is simply impossible to prohibit or select a license. Therefore, the minister carries out the work aimed at ensuring that clinics voluntarily do this. We all perfectly understand that medical abortion carries a lot of complications that do not appear immediately after surgery. Rough intervention in a woman’s body can lead to infertility.

In the first place should not be a ban, but work with a woman who decided to abortion. This is in all our standards when it is necessary to conduct a pre -analysis of counseling. During the consultation, a doctor must definitely talk to a woman and talk about the negative consequences of abortion. This is right. And the minister has ideas that limit the woman’s decision on abortion in time - when a woman has a “day of silence”, she might think, weigh everything and abandon a hasty decision, preserving the baby.

Women's rights are not violated. After all, abortions do not prohibit. The woman still has the right to choose, and she can contact the state clinic, which will continue to perform these procedures. In my opinion, it is impossible to prohibit abortion. Otherwise, the swing will swing in the other direction when criminal abortions begin, which is much worse than the implementation of this procedure in normal medical conditions. We already encountered this in 1936 [when an abortion was introduced in the USSR]. Then there were criminal abortions made outside medical institutions, and against their background - the death of women. It doesn’t matter who performed it: a doctor, not a doctor or a midwife. If this is not in the walls of a medical institution - this is a criminal abortion. As a rule, they end deplorable.

Svetlana Belova

obstetrician-gynecologist in a private clinic and a state hospital, 24 years of experience; The name of the interlocutor was changed at her request

It became known about this [recommendations for abandoning abortion] for a long time, as soon as the new minister appeared. The Ministry of Health sent letters with recommendations in the summer of 2019. Then, state hospitals were offered to interrupt only on Tuesdays and Thursdays, so that women do not mix in the corridors: those who abortion, with those in the operating room.

This is normal in the Arab emirates or other countries of the Eastern abroad, where abortion is prohibited. This cannot be done in Russia, because in civilized countries there is no such thing. A person must make a choice himself so that no one forces him by forcibly.

Many clinics [in Samara] really have already abandoned abortion. Maybe everyone will refuse, but the fact is that there will not be less abortion. If a person needs to have an abortion, then he will do it anyway. There are many regions around us - the Ulyanovsk, Saratov and Orenburg regions - where it is easy for a woman to get, and she will be done there.

Since the state wants no abortion, you need to do something for this. Not only the clergy to call and increase the staff of psychologists. Prevention should be carried out before an unwanted pregnancy. Explain, starting from school, how and what is arranged, so that in childhood they understand what they can come to. First of all, engage in sexual education. From state hospitals we go to schools and lyceums, give lectures on morality and protection. In 2017, we came to the registry office and talked to those who just filed a statement about safe sex, and how to avoid an unwanted pregnancy, how to prepare for this.

In the late 1990s and early 2000s, we were given free spirals , contraceptives for women and condoms for men. Because there is a layer of the population that simply cannot buy a spiral even for a thousand rubles. Then we wrote in the patient’s card to be given condoms or pills. I had five female dormitories on the site, and I put a spiral for girls. Many were handed out [contraceptives] pills, they drank them, brought empty packaging and took a new one. It worked. Now there is nothing of that support.

I understand that this [termination of pregnancy] is bad, and I explain to every woman that on the moral side she commits murder. All the conversations that there is no heart in the fetal egg - only conversations. He has everything, just very small. But there are different situations, sometimes I want to say: "No, you better do it." Because such beggarly conditions in which some women live and will raise a child there is terrible. Better she will kill him in the womb, than half his life will mock him. Nevertheless, you always need to talk about two people. Therefore, men who are abortion with women also explain that this is their murder. Do not think that she kills alone.

Only 30–40% of women regrets the deed. It seems to me that only those who have a low IQ level do not regret. But abortion is a personal business of every woman, because it is not for me to raise a child, not to the state, not to a psychologist, not to the church, but to her. She will be with him all her life.

It seems to me that no doctor has one hundred percent faith, that abortion is bad. Unless, of course, he is not some kind of radical believer. We always communicate a lot with doctors on this topic. From my encirclement, 80% of women gynecologists interrupted their pregnancy. And what, we are the same people with the same families. For example, I have a girlfriend who has always been categorically against abortion, but when the question arose about the unwanted fourth child, she went to it.

Alexey Yurtaev

With the participation of Daniil Brezhnev