Difficulties in reproductive choice – Kommersant

The Ministry of Health has developed unified speech modules for obstetricians and gynecologists so that they can advise women “in a state of reproductive choice.” It is not recommended, in particular, to say that the patient is doing wrong, but it should be explained that “being a new mother is great” and that “having a child will not be an obstacle to meeting your life partner.” Speech modules are part of a project for a unified procedure for pre-abortion psychological counseling, on which the medical department is working together with the Ministry of Labor.

The Ministry of Health of the Russian Federation sent seven regions participating in the Reproductive Health pilot project – Arkhangelsk, Kaluga, Novgorod, Tula, Magadan regions, Primorsky and Kamchatka regions – methodological recommendations for counseling women in a state of “reproductive choice”. The document contains speech modules – phrases that doctors should use in a conversation with girls under 18 years old, women 18-35 years old and over 35 years old who decide to terminate a pregnancy. So, for a girl under 18 who wants to have an abortion because of her own physical and psychological immaturity (“I myself am a child” / “why do I need a child”), the obstetrician-gynecologist should answer: “Being a young mother is great!”, “Children , born to young parents, are very close to them, because they are practically from the same generation. A woman under 35 years old, if she wants to have an abortion because she is single, is invited to say that “having a child will not be an obstacle to meeting her life partner.” To a woman over 35 who is afraid to give birth to a sick child, to explain that “perinatal diagnostics, which is well developed and widespread in the Russian Federation, makes it possible to diagnose various types of disorders free of charge and in a timely manner.”

If the patient decides to keep the child, the doctor should say: “I am very happy for you. That’s the right decision”. If he doubts or is determined to terminate the pregnancy: “Think about it, do not rush. I will refer you for a consultation with a psychologist, and then I’ll wait again.” Avoid talking to a pregnant woman The Ministry of Health offers questions and statements such as “Will you keep the pregnancy?”, “Will you give birth?”, “You are doing wrong.” It is recommended to report about abortion and its consequences with the phrases: “Each termination of pregnancy is harmful to health and the risk of complications. Abortion is a common cause of infertility and miscarriage in the future.

The Ministry of Health, together with the Ministry of Labor, is working on a project of the Unified Procedure for Pre-Abortion Psychological Counseling, and speech modules are one of its components. This is stated in the report of the department on the results of 2022 and the tasks for 2023, which were quoted by the Medvestnik publication. The new procedure will also include a questionnaire for those wishing to terminate a pregnancy (designed to identify “the patient’s reproductive attitudes, including the reasons for the abortion and motivation for maintaining the pregnancy” and inform about social support measures) and recommendations for medical psychologists. The Ministry of Health told Kommersant that the program is aimed “to increase the coverage of psychological assistance for women who are in a state of reproductive choice, and motivation towards motherhood.”

Director of the Women for Life Foundation Natalia Moskvitina said that the organization’s experts participated in the development of speech modules. However, in her opinion, pre-abortion counseling is not as effective as working with women who have not yet made a decision. Therefore, the foundation launched the Hello, Mom! project, in which women who have just found out about pregnancy are given booties, a booklet with all possible support measures, and a baptismal kit from the Russian Orthodox Church. Physicians, just as with pre-abortion counseling, are taught to use the right phrases. According to Ms. Moskvitina, during the year of the project implementation in the pilot region – Mordovia – the number of abortions decreased by 40%.

The Ministry of Health of the Russian Federation reports that in 2022 the number of all abortions in Russia decreased by 3.9% (from 411 thousand in 2021 to 395 thousand), the number of medical abortions at the request of a woman decreased even more — by 5.3% (from 189 thousand in 2021 to 179 thousand). According to federal statistics for 2022, cited by the Ministry of Health, 217,836 women applied for a medical abortion, of which 91.7% underwent pre-abortion counseling, and a quarter refused artificial termination of pregnancy.

Elza Mesropyan, an obstetrician-gynecologist at the Lapino Clinical Hospital, recalls that according to the laws of the Russian Federation, voluntary termination of pregnancy is possible up to a period of 12 weeks, then only for strong medical indications. Ms. Mesropyan points out that at the moment there is a mandatory “period of silence” – the time from the first appointment with an obstetrician-gynecologist to an abortion. It can last from 48 hours to 7 days depending on the duration of pregnancy. “During this period, consultation of specialists, a unified algorithm developed, explanation of all possible complications of abortion, psychological support from the attending physician can influence the patient’s decision,” says Elza Mesropyan. She agrees that it is precisely the first correctly chosen words of the doctor that strongly influence the mood of the patient. However, he emphasizes that words of support are “equally important” if a woman still decides to have an abortion.

The duties of doctors should not include the task of convincing the patient not to have an abortion, since “even her relatives do not have the moral right to do so,” says Lyubov Yerofeeva, obstetrician-gynecologist, public health and health specialist, WHO expert. She refers to world statistics, according to which only 5-8% of women are ready to change their mind and keep the pregnancy: “But what could change the number of abortions is government programs to provide modern methods of contraception, especially for vulnerable social groups of women.” Ksenia Firsova, manager for work with victims of the You Are Not Alone project, believes that pre-abortion counseling in itself is a “failed idea”, and in the unified speech modules there is a neglectful attitude towards women. “I am sure that such measures will not help to improve the demographic situation in the country. These are ineffective methods that are humiliating for women and give rise to stigmatization, reproductive violence, and often outright harassment,” says Ms. Firsova. In her opinion, women in such a situation need “acceptance, non-judgment by society, a partner and loved ones.”

Elena Burdelova, a psychologist at the Doctis telemedicine service, supports the introduction of algorithms and special speech patterns about reproductive choice, because “there is a big problem in the level of communicative competence of some doctors.” However, she also notes that the choice is up to the woman: “And even if she decides to have an abortion, we support the woman so that she can mentally and physically recover.”

Natalya Kostarnova