Hangers for the Health Ministry

chelyab“#Hangers for the Health Ministry,” “Give us a choice,” “Without state-funded abortions there will be backroom abortions,” “The Health Ministry violates human rights,” “Banning abortions is no solution”: a protest installation set up by feminists outside of Hospital No. 1 in Chelyabinsk. Photo by Anastasia Zelentsova. Courtesy of Novaya Gazeta

“Go Find a Place That Will Give You an Abortion When You Have a Cough like That”: The Challenges Women Face During the Pandemic
Alla Konstantinova
Mediazona
June 4, 2020

Since early April, most hospitals in Russia have been focused on battling the coronavirus pandemic, and the Russian Health Ministry has recommended postponing routine surgeries. Under this pretext some medical facilities have begun refusing to perform abortions and other gynecological operations. Consequently, unemployed women have been forced to take out loans for abortions at private clinics or give birth to children they may not be able to feed.

In April 29-year-old Tatyana Shapovalova, from the village of Solomenny, which is part of Petrozavodsk but is physically separated from the city, found out that she was eight weeks’ pregnant. Shapovalova already has four children, but only the youngest lives with her and her common-law spouse. Her parental rights have been restricted, so one child is being raised by Shapovalova’s sister, and the other two by foster parents.

“Our living conditions are very bad,” Shapovalova says, explaining the decision.

She and her husband decided to end the pregnancy: the village obstetrician-gynecologist sent Shapovalova off for tests, an ultrasound, and a consultation with a psychologist. The trips to the psychologist and doctors and waiting for the test results took a month.

“It took a week for the blood panels to arrive, and a week for everything else,” she says.

The fact that she would have to pass a Covid-19 test before the surgery was something Shapovalova learned from the village gynecologist one week before her appointment at the perinatal center in Petrozavodsk—ending a pregnancy as covered by compulsory health insurance is currently done only at this facility. One building at the Gutkin Municipal Maternity Hospital has been turned into a coronavirus observation ward, while the other has been converted into a coronavirus treatment facility. Tatyana caught a cold and had a strong cough, but she had the Covid-19 test smear.

“Six days later, I got a negative result for the coronavirus. The next day, I traveled to Petrozavodsk to the perinatal center,” Shapovalova continues. “I was already at twelve weeks. But in the reception area they heard my cough and went to consult with the head physician. I sat there for about forty minutes. Then the nurse came out and said, ‘You’re denied hospitalization.’ I said, ‘I have a negative test result for the coronavirus.’ And she replied, ‘Go find a place that will give you an abortion when you have a cough like that.’”

Petrozavodsk residents have at times had to wait even longer—sometimes two weeks—for the results of Covid-19 tests, says Irina Koroleva, the director of Women’s Clinic No. 1.

“For example, on June 1 we received the test results only for May 14. All of the labs in the city have had problems with the reactive agents for the swabs. If check-up results are not provided in time, the perinatal center has the right to refuse a woman service. It is the same with childbirth: if a woman is in labor, she’s sent to the maternity hospital, which has been converted into a coronavirus observation ward. Or the baby will be delivered in a single-bed ward in the perinatal center’s emergency room.”

The head doctor of the perinatal center, Yevgeny Tuchin, explained that Shapovalova had been denied treatment on the basis of a Health Ministry order.

“An artificial termination of pregnancy is not performed when acute infectious diseases and acute inflammatory processes are present in any location, including a woman’s reproductive organs,” he wrote in response to a query from Mediazona. “The abortion is performed after the patient recovers from these illnesses.”

Shapovalova insists that they did not even examine her at the perinatal center, and the only person with whom she spoke was the nurse, who merely heard her cough.

In Russia, an abortion is performed at a woman’s request only within the first twelve weeks of pregnancy; abortions are provided to rape victims “according to social indicators” for up to twenty-two weeks. Because of the delays with tests and the unexpected refusal at the perinatal center, Shapovalova missed this deadline.

Now Shapovalova, who is currently unemployed, lives in an unfinished wooden house, and was already restricted in her parental rights, has to give birth to a fifth child.

[In early April, the Health Ministry recommended that the heads of Russian hospitals “consider postponing” routine surgeries, citing as a reason for the decision the complicated epidemiological conditions in the country. At the same time, the ministry recommended not reducing routine treatment for patients with renal, cardiovascular, or endocrine diseases, or cancer. The Ministry of Health did not mention gynecological diseases or abortions, thereby creating additional problems for Russian women.]

Not Only Karelia
Shapovalova did not demand a written refusal of an abortion from the doctors. Medical lawyer Anna Kryukova says that now it will not be easy to prove the illegality of the doctors’ actions.

“A written refusal is provided after a written inquiry,” says Kryukova. “She didn’t insist on it, and the powers that be took advantage of it.”

In April, a female employee at the No to Violence Center (nasiliu.net) telephoned forty-four Moscow hospitals: only three of them agreed to schedule her for an abortion as paid for by compulsory health insurance. The Moscow Department of Public Health told us that, during the pandemic, many hospitals had classified elective abortions as routine or non-urgent surgeries. Later, the Department of Public Health reported that hospitals that had not been repurposed for treating Covid-19 are performing abortions, as before.

In an interview with Mediazona, Karina Denisova, a spokesperson for Hospital No. 1 in Chelyabinsk, called a social media announcement that they would no longer be performing abortions in their outpatient clinic a “misprint.” After protests by Chelyabinsk feminists, who set up an installation featuring clothes hangers next to the hospital entrance (in Soviet times, some women performed abortions on themselves using hooks made out of hangers) the hospital admitted that the published information had been “incorrect.”

Like Shapovalova, a resident of Kovrov in the Vladimir Region will also have to give birth. Obstetrician-gynecologist Alexander Rusin says that the woman was also denied an abortion.

“At Kovrov Central Municipal Hospital,” Rusin says. “They said, ‘It’s the coronavirus: we are closed for routine surgeries.’ What did the woman do? Nothing, as far as I know. Well, deadline was nearing, she was at eleven weeks. She left. Of course, I consider [the hospital’s actions] illegal, a violation of the law.”

“I Eat Macaroni to Save Money”
Irina Drozdova of Vsevolozhsk was supposed to have her tubes tied on April 13. Twenty-five-year-old Irina decided on the operation after an exceedingly difficult childbirth.

“The anesthesia for the C-section and the post-natal stress triggered cardiomyopathy,” she says. “Now I take pills that are incompatible with pregnancy, and I’ll be taking them for the rest of my life. Plus, they put me on a defibrillator, and it is just one of the indications for sterilization under compulsory health insurance.”

Getting ready for the operation, Irina underwent dozens of tests, but it was suddenly canceled.

“They refused because of the situation with the coronavirus, but I had spent three months doing the paperwork, consulting with a cardiologist, and undergoing an ultrasound—everything was ready. In order to reschedule, I have to go through another complete workup,” Irina says.

In April, dozens of maternity hospitals across Russia were repurposed to treat the coronavirus, and the Health Ministry recommended that facilities that did not close should do consultations with pregnant women online.

Twenty-nine-year-old Muscovite Anastasia Kirsh, who gave birth to a daughter in May, connected via WhatsApp with her gynecologist in the women’s clinic at the Yeramishantsev Maternity Hospital.

“If I needed to find out test results, get a referral to the infant feeding center, renew a prescription, or had an urgent question, it was possible to resolve that online, which was very convenient. Other services—gynecological exams, measurements, ultrasounds—were performed in the clinic as usual.”

Coda Story has told the tale of a Moscow woman who had to take out a loan for an abortion, because her husband had lost his job when the quarantine started, and the family had no means of support left. At Moscow Hospital No. 40, she was denied a free abortion under compulsory health insurance.

“You should not even count on a surgical abortion under compulsory health insurance. Routine surgeries, except in emergency cases, are currently not being performed,” a doctor told the woman. “Your case is not an emergency: there is no reason to hospitalize you. […] If you want to fight for your rights, you will miss all the deadlines.”

Unemployed single mother Anna Kazakova, from the Moscow suburb of Yegoryevsk, where the maternity hospital had been turned over to battling the pandemic, was faced with a choice: schedule an abortion under compulsory health insurance in Kolomna, fifty kilometers from home, and make numerous trips back and forth, first for tests and then for the operation, or pay to terminate the pregnancy at a private Moscow clinic, which would take a single day.

“They were sending everyone off to give birth fifty kilometers away at the Kolomna perinatal center,” she explains. “But what was I supposed to do with my four-year-old daughter? Drag her back and forth with me? They would start ‘losing’ the tests and making lots of referrals to psychologists, as is usually the case. There is all this hubbub in Russia about supporting families and mothers. But in fact, you have nothing coming to you. And an existing child doesn’t count either. If I tell them I won’t be able to support a second one in such conditions, I won’t get anything but condemnation,” says Anna.

After borrowing 15,000 rubles from a friend, Anna had a medical abortion at a private clinic in Moscow. Now she thinks about how to repay the debt.

“I eat macaroni to save money on food,” she says. “I applied for social security, but they said that I was not eligible for any benefits.”

“They Were Turned Down—and They Left, Sadly Wiping Away Tears”
Medical lawyer Anna Kryukova believes that “no one has directly prohibited” abortions in Russia, but that all the instances of refusal are the consequence of fear and ignorance on the part both of doctors and patients.

“The battle against Covid-19 has been farmed out by the federal government to the regions, but they all still look to Moscow,” Kryukova argues. “Doctors are used to saluting at every turn—god forbid they do something wrong, or they will be dismissed from their posts. This is due to fear: it is easier to follow orders now than to get whacked upside the head for these violations later. The outreach work has also been done very poorly: people are already so frightened of the virus, and nobody is explaining anything to them.”

Many patients need surgical help now, but they are afraid to go to the doctor because of the coronavirus, says Ph.D. in medicine and obstetrician-gynecologist Kamil Bakhtiyarov. He works in a private clinic in Moscow where paid medical and surgical abortions are performed.

“Women are so frightened that they come in for termination of pregnancy practically wearing spacesuits,” he says. “They’re terrified, deeply terrified. The first question they ask is, ‘Are you working with Covid patients?’ For patients who need surgical treatment the problem of hospitalization comes up: in the first place, many clinics have been repurposed to threat Covid cases, and secondly, people themselves are very much afraid. A person doesn’t want to go to an ordinary hospital because there it’s six people to a room.”

Despite the pandemic, patients should insist on their right to medical care, argues Kryukova.

“People should still seek medical care and exercise their rights. The problem is that the victims [mentioned in this article] apparently did not do that,” she says. “Unfortunately, the patient community does not know its rights very well. These women were simply turned down verbally—and they left, sadly wiping away tears. Nobody chases after patients nowadays: for something to change, the person who needs the medical treatment has to take the first step.”

Translated by Mary Rees