Doctor, heal thyself

Denying women anaesthesia during abortions is a legacy of the Soviet Union's obsessive pronatalism

There was widespread anger and revulsion this week when several women in the western Siberian city of Surgut went public about being denied anaesthesia or painkillers when having an abortion at the city’s main hospital. According to Mediazona, the hospital’s chief physician Mikhail Kurnosikov performed the procedures in question, and while the regional Health Ministry has said it is currently looking into the allegations, Kurnosikov himself has dismissed the allegations as “harassment” by “foreign agents”.

Such acts of sadism sadly aren’t particularly rare in Russia, however, and are in fact a legacy of the Soviet healthcare system, which expected doctors to help drive up the national birth rate, even if that meant resorting to medical torture as a deterrent.

Even Joseph Stalin’s signature on an order banning abortions in the Soviet Union in 1936 was insufficient to deter women from seeking the procedure when they needed it, though. Indeed, many were forced to resort to back-street abortions, carried out by quacks and charlatans, risking their health and even their lives as they did so.

The Soviet prosecutors tasked with investigating such “crimes” did so only reluctantly, earning them frequent rebukes from the People’s Commissariat for Health, as well as certain ideologically charged doctors themselves. For instance, gynaecology professor Agrippina Bliznyanskaya demanded that she be allowed to question women suspected of having back street abortions herself. At a 1949 meeting of the Moscow Commission on Combating Abortion, Bliznyanskaya cited one case in which a patient had come to her practice in serious condition, bleeding and suffering from a high fever.

Doctors were under constant pressure to increase the birth rate, and were instructed to do whatever they deemed necessary to dissuade their patients from terminating pregnancies.

As the patient writhed in agony on the gynaecological chair, Bliznyanskaya asked her whether she had had an abortion, where she had had it, who had helped her and how much she had paid. In unbearable pain, the woman confessed to going to see a certain Ms Kuznetsova but said that she had eventually asked for her money back, realising that the abortion hadn’t even worked.

By the time Soviet leader Nikita Khrushchev decriminalised abortion in 1955, public opinion had been well and truly hardened against the procedure by Stalin’s ban, with many people seeing abortion as a crime. Furthermore, doctors were under constant pressure to increase the birth rate, and were instructed to do whatever they deemed necessary to dissuade their patients from terminating pregnancies. In many cases this led doctors to punish women they were unable to talk into keeping their unborn babies by torturing them in the gynaecological chair.

Sadism against women who sought abortions was a fact of life until the dying days of the Soviet Union. Journalists began to cover the issue in the perestroika era, while foreign correspondents reported on the phenomenon with equal measures of frankness and horror. In 1989 a New York Times correspondent noted that unlike the abortion debate in the West, which was focused on the rights of the unborn child and a woman’s right to choose, “the Soviet debate is on women’s healthcare — the right to adequate supplies of reliable contraceptives, to sanitary conditions, anaesthetics and the respect of medical workers.”

Soviet women had to pay bribes to obtain the last two items on that list — painkillers and a modicum of respect from medical workers. A woman could get a sufficient dose of anaesthesia if she was willing to pay for it.

“Our medicine is very cruel — it has a stone heart and Stone Age equipment,” a Moscow woman told the New York Times after describing her own experience of having an abortion, which she said had been performed by rude medics with insufficient supplies of painkillers.

Neither the enduring stigma of abortion nor the Soviet government’s determination to stimulate population growth alone can sufficiently explain away such terrible levels of cruelty.

In the same article, another woman by the name of Yekaterina Nikolaeva described her experience at another clinic: “When she entered the operating room, a doctor yelled at her for staring at his blood-stained rubber gloves. ‘Hurry up, you,’ he said. ‘I’m sick and tired of your stupidity.’” Nikolaeva quoted another doctor who told a frightened patient: “You should have had second thoughts beforehand. You’re all fond of sweets, but you’re not willing to pay the price.”

“First, the woman has to endure the humiliation of going to the clinic to collect reams of paperwork for her upcoming ordeal. She will be treated with a blatant lack of interest and even contempt.” But the worst part must have been how the terminations were carried out. One woman I spoke to told me that once they reached the operating theatre, the abortions were "carried out simultaneously on anywhere between two and six women in the same room, with the operating tables arranged so that each woman can see what is happening opposite her.”

Neither the enduring stigma of abortion nor the Soviet government’s determination to stimulate population growth alone can sufficiently explain away such terrible levels of cruelty, so it’s perhaps likely that the daily frustration doctors experienced due to their poor working conditions and heavy workload may also have played an important role.

While Soviet healthcare was free, it was far from the highest quality available, and both a lack of supplies and an abundance of red tape were constant headaches for healthcare professionals. It was difficult to find the time to both treat and be humane to each patient, leading some to take out their pent-up anger at the system on its helpless patients.

Throughout the Soviet era, painkillers were in short supply, a fact that by the time the glasnost era began, the authorities no longer attempted to conceal. In 1988, Zdorovye magazine quoted a Health Ministry official who said that painkillers were administered in only 5% to 20% of abortions. There was always the option of patients providing the anaesthesia themselves, but that would involve having the requisite contacts and know-how to acquire it.

The authorities’ tacit encouragement of medical torture during such procedures, however repugnant, may well be its chosen alternative for dissuading women from terminating pregnancies.

In today’s Russia, where there is neither a ban on abortion nor a shortage of anaesthetic, the authorities are looking for other ways to control women’s reproductive behaviour. Much as it did during the Soviet era, the state exerts pressure on gynaecologists, much to the irritation of the medical professionals themselves, who then take their anger out on the “cause” of all their troubles — their female patients.

While its fear of social unrest seems likely to prevent the Kremlin introducing a total abortion ban in Russia, the authorities’ tacit encouragement of medical torture during such procedures, however repugnant, may well be its chosen alternative for dissuading women from terminating pregnancies.