The price of abortion in Bosnia and Herzegovina (BiH) is two times lower than in Croatia and steadily more women from neighbouring Croatia decide to have an abortion in BiH. Even though doctors can use “conscientious objection” in both countries the situation in Croatia and BiH differ in this regard as the public pressure to refrain from abortion is on a higher level in Croatia.
“I meet female patients from Croatia who complain about this issue, especially if they come from a smaller town/ village. Simply, the patient finds herself in the situation that no one would perform abortion and then she comes to our clinic in Sarajevo. Just recently, one of the patients confided in me that the doctor from the previous clinic she visited attacked her and said “no abortion, you should give birth to that child” – said Emina Sarajlija Pavlović, gynecology and perinatology specialist.
“The decision about this step belongs to the woman only” said Sarajlija Pavlović, who counsels every patient, and talks to them before the decision. “If I feel that the woman has some dilemmas I suggest her to take some more time to reach a final decision. No one can force her to anything, nor pressure her into doing it, and yes – it did happen that the patients do not return”.
The BiH Law on Abortion one of the most liberal
Even though abortion is still a taboo topic in BiH, the current law that has been in place in since 1977 is one of the most liberal laws on this matter in Europe. Every woman has the right to choose to end pregnancy until the tenth week of pregnancy. She only needs to file a written request to the healthcare institution. Abortion due to medical reasons is free of cost and is done in the public healthcare institutions. Termination of pregnancy at the request of the woman is performed in public as well as private healthcare institutions/clinics.
According to Delila Hasanbegović, Programme Coordinator in Sarajevo Open Centre, despite abortion being legal and accessible on paper the reality is different as free and safe abortion services are not equally available across the country.
“The situation is similar to that of many countries of the world and Europe. Reasons for this are multiple, from inadequate equipment in the public healthcare institutions, via nonexistence of healthcare institutions or insufficient number of institutions/clinics that would perform abortions in smaller towns/villages, to inadequate methods of performing abortion and incomplete procedure of informing patients on the course of abortion” she emphasised.
Also, Ms. Hasanbegović identifies the pricing of abortion services as a disadvantages of the existing Law. Currently there are different prices for abortion on request in different public healthcare institutions and different prices in public and private clinics. There is also the lack of unification in this field in the cantons of the Federation BiH, and between Federation BiH and Republika Srpska.
“Sarajevo Open Center acquired data that the healthcare institutions in certain cantons do not cover the costs of the medical abortion, even though they are obliged to do that, and that some clinics perform only medically induced abortions, while they do not perform abortions on request” – she explained.
Croatia to get a new law on abortion
Even though the new law on abortion in Croatia (that is being drafted) does not differ much from the currently existing law, one of the novelties would be the provision on the right of gynecologists to conscientious objection, that in itself presents a serious barrier to abortion care, especially when there is no referral procedure that would oblige another doctor or hospital to perform the procedure.
Currently clinics are required to come to an agreement with some other hospital where they direct patients who have been denied abortion care due to conscientious objection. Activists and experts estimate that more than half of the Croatian medical staff uses their right to deny care based on their personal views.
This right is being used by doctors in BiH as well, although not as widely as in Croatia. One of them is the gynecologists Salko Mašić, who said that he does not perform abortions, and is the happiest if he manages to talk women out of their decision. “I do not understand that there are people who find money more important than ethics, I am performing only spontaneous abortions, and other cases I forward to my colleagues” Mašić explained.
“Lately in BiH, we see more and more requests for tightening the criteria for abortion, and observe serious threats to reproductive women’s rights – the right to decide and the right to bodily autonomy” said Delila Hasanbegović. “Conscientious objection, that gives the right to deny healthcare limits the availability of services related to reproductive health to many women, like information on contraception, prenatal tests and legal termination of pregnancy.” Tightening the criteria for requested termination of pregnancy, the space for illegal abortion opens endangering the health and lives of the women.
“Medical professionals’ conscientious objection is violation of the Hippocratic Oath. Prohibition of abortion does not prevent abortions from happening, it prevents safe and legal abortions. Medical professionals in BiH and in the region do not use conscientious objection when they provide medical services to perpetrators of criminal offenses, even the most serious ones, but only in cases of sexual and reproductive women’s rights – more precisely, when it comes to the right of the woman to decide about her own body, health and life” – said Ms. Hasanbegović. She adds that in BiH there are still no serious attempts to amend the existing laws in that context, nor are there, in the public discourse, intensive discussions like the ones in the neighbouring Croatia.
“We hope that there would not be any attempts to limit this human right, and we will do all it takes to prevent any limitations to the right to abortion” – she emphasised.
Offering free contraception to reduce the number of abortions
Fast way of living, bad financial situation, not enough information on contraception possibilities and premature sexual intercourse could be named as some of the reasons that lead to increased number of unwanted pregnancies.
A very low number of doctors in BiH talk and educate their patients about contraception – as Emina Sarajlija Pavlović said, it is very important to inform them on the possibilities of preventing unplanned and unwanted pregnancies. “On the other hand, contraception is expensive, one package of pills costs 30 BAM, and many women cannot afford that. In all the countries, contraception is free, and if this were the case in our country, we would definitely have lower number of abortions” explained Sarajlija Pavlović, and wished that the state could enable women the free right to contraception in case they have health insurance.
Abortion and pregnancy are not one-dimensional topics, as are often portrayed by the opponents of abortion and those who advocate abolition or limitation of this human right. Different factors influence the decision on pregnancy/abortion.
Delila Hasanbegović said that the key term is unwanted pregnancy, that could occur for many different reasons. “ Opposed to the conservative views, usually based on arbitrary interpretations of religious beliefs, there is the human rights discourse that insists on equal accessibility of abortion to all women, and on the right of the woman to bodily integrity and personal choice” she emphasised.
The ways of talking about reducing unwanted pregnancies in the political and everyday discourse so far have been, as she said, mainly wrong and retrograde, and have not taken into account the whole situation that leads to such a decision.
“I think that unwanted pregnancies could be reduced by talking about the causes of such pregnancies – starting from education institutions, schools, via media, to public institutions; by introducing mandatory education on sexuality, sex and gender roles to schools, where students will talk about the possible causes of unwanted pregnancies and how to prevent them, as well as about the responsible sexuality education; by enabling free contraception for all couples equally, no matter which part of the country they live in, by insisting on the fact that even though abortion is not and can’t be a contraception method, it is the right of the woman to choice and bodily integrity – said Ms. Hasanbegović.
Abortion influences birth rates – yes or no?
In Republika Srpska, the anti-choice movement “For Life” that advocates that the human life should be respected and protected from the moment of conception, and that the abortion criteria be restricted, could gain momentum. Following the example of the organisation of the same name that is active in Russia, and the movement that exists in many countries in Europe and around the world, a Banja Luka foundation called “For Life” (“Za život”) was founded last summer, having the above-mentioned goals in mind.
As the founders explained, the aim and plan are to raise the awareness on what the termination of pregnancy means for birth rates, women’s health, to promote the importance of the traditional family, and to be of support to those who do not receive help while being pregnant and giving birth.
Delila Hasanbegović thinks this is one of the retrograde and neoconservative tendencies that are gaining momentum across the region. “I think this is a very dangerous issue for media to be emphasising a very delicate topic and the authorities cannot act this way. We should raise awareness on abortion and spread exclusively scientific information and knowledge. I am afraid that behind this idea and concern for the decrease in birth rates there is no objective knowledge, but selective information that aim at turning women into someone made for giving birth only and reproducing the nation, and limit women’s right to deciding on her body, and if they want – acting beyond the context of imposed motherhood” emphasised Hasanbegović.
As she said, the focus should be on creating the conditions for all the wanted children and their parent/parents to have dignified life conditions, as well as on educating the citizens on basic human rights in the reproductive and sexual spheres.
“In a country that does not adequately regulate maternity benefits, where there is no financial support for biomedically assisted fertilisation treatments, where there is a waiting list for kindergarten, and women get fired if they plan to enlarge their families, it is hypocritical to talk about supporting higher birth rates” concluded Ms. Hasanbegović.
The law is obviously not enough, professionals and institutions within the healthcare and educational system should work towards ensuring the sexual and reproductive rights of women.
Author of the interview: Belmina Milunić
Originally in BCS language, published on website interview.ba on 21 January 2019.
Translation to English: Delila Hasanbegović, Sarajevo Open Centre