Over 30 percent of hospitals in Romania are refusing legal abortions

Romanian medical student Bianca was in South Korea in March this year when she discovered she was pregnant.

At the time she was taking part in a short work placement in Daegu in the south-east of the country, and was soon to return to Germany to resume her Erasmus programme.

“The news freaked me out,” she told The Black Sea. “I knew a baby would complicate my career and I was not ready for it.”

The next few weeks and months were crucial. She’d not only her Erasmus responsibilities in Germany to consider, but Bianca was also due to sit a series of final-year medical exams at her university in Romania before beginning a hospital residency.

Bianca took the decision to end her pregnancy quickly, and from her temporary home in Daegu she considered the least complicated way to do this.

A termination in South Korea was out of the question, she learned. The country had a decades-old ban on abortion in all but the cases of crime, serious impairment, or threats to the health of the mother. It was a law that would be ruled unconstitutional by the highest court within weeks.

She thought of Germany, but dismissed the idea; she knew the procedure was not only expensive, but required a mandatory consultation and a four-day waiting period that would cause unnecessary delays.

Romania, Bianca decided, was her best option.

A week later, she landed at the airport in her home city of Iași, in north-east Romania, and travelled to the Cuza Vodă Hospital, the largest public gynaecology institution in the region, where she consulted with a doctor.

“The doctor who received me made an ultrasound and said the pregnancy was okay,” Bianca told The Black Sea. “I asked if they could do an medical abortion there. [The doctor] said, ‘We cannot perform abortions’.”

The doctor informed her that the entire hospital refuses to carry out terminations, including medical abortions – an effective non-surgical procedure that requires two pills be taken within 48 hours of each other – because they seem not to be safe. It was a questionable medical opinion. The doctor recommended Bianca to visit a private clinic.

“It didn’t seem normal that the largest regional hospital for gynaecology didn’t perform abortions,” Bianca said, and so she persisted in asking about the pills, which are permitted until the ninth week of pregnancy in Romania. Again, the doctor’s advice was ethically problematic.

“I asked the doctor how to take the pills and she told me, ‘You are a student of medicine, you will work it out. I feel bad, but this is the situation. If you are in the seventh week, you are at the limit, and I don’t know whether they will work.’ ”

With only a few days before she had to return to Germany, Bianca was forced to ask a friend to help obtain the abortion pills, which she took without any medical supervision.

“I would have preferred a doctor who could tell me exactly how I was supposed to take these pills because there are risks,” she said.

Robert Dâncă, the manager of Cuza Vodă hospital, told The Black Sea that all of the doctors there have refused to perform abortions on both religious and moral grounds since 2014, a position that he supports.

“The law does not oblige us to do this, as it is a service on request, and we can accept or not," he said.

By law, women in Romania can access an abortion at a state hospital up to 14 weeks of pregnancy, without any counselling or waiting period. But Bianca’s situation is likely not unique.

According to an investigation by The Black Sea, a significant proportion of public hospitals are now refusing the procedure. Between March and July this year, female reporters at The Black Sea contacted all the hospitals in Romania they identified as being publicly owned with gynaecology departments to inquire about a termination.

The results were striking. We found that 60 – more than 30 percent – of the 190 hospitals contacted refuse to grant abortions to women.

Human rights lawyers told The Black Sea that while individual doctors may decline to perform the service, the hospitals they work for cannot – meaning the 60 institutions are likely violating their legal obligations to patients.

The findings appear at a time of hardening abortion attitudes. Interviews conducted by The Black Sea, as well as examination of financial records, suggest that an influx of support and tactics from abroad over recent years has played a role in intensifying opposition to abortion throughout Romania.

The 2016 professional code for medics outlines that any doctor can decline to provide services if it affects their professional independence or moral values, or contravenes their professional principles.

These ‘conscience-based refusal’ laws are common in most European countries, but when every doctor in a hospital invokes them, it can cause problems for women like Bianca.

Human rights lawyer Iustina Ionescu argues that any woman refused an abortion by her local hospital could sue, drawing a distinction between individual doctors and the healthcare provided.

“The doctor might not be held responsible,” she told The Black Sea, “but the unit is a service provider covered by the healthcare law, and does not have such an explicit provision. I would say it is illegal for the healthcare unit to refuse, but we would need a case.”

The Black Sea followed up on the journalists’ calls with a official written request for information on state hospitals’ abortion polices, including whether services were accessible year-round and interrupted by staff holidays, as well as details on the number of doctors performing – and refusing – abortions.

When we asked for the reasons doctors give for denying care, the most common two replies were personal and religious convictions. The professional code states that any doctor refusing to provide abortions must first give their reasons and then direct the patient to another colleague or medical unit. But many hospitals appear in breach of this requirement.

Of the hospitals that we called by phone, ten failed to make any referral at all, and a further 16 gave no specific referral, instead suggesting that our reporter go to another city or a private clinic.

“The referral process is not working,” said Florin Buhuceanu, president of human rights NGO Accept, and executive president of Euroregional Center for Public Initiatives (ECPI), which researched abortion access earlier this year, with another NGO, Centrul Filia.

“If there are two physicians and both are refusing to perform abortions, it is clear that the state medical unit will not do it, which is a clear violation of the current healthcare law.”

In hospitals that do provide abortions, the situation is not straightforward. The Black Sea found eight hospitals that had only one doctor on staff willing to perform the procedure. Daniela Chiriac is a doctor in the Municipal Clinical Emergency Hospital in the western city of Timisoara, where only seven of the 44 doctors undertake abortions.

“It was the choice of each person,” she said, from an office inside her clinic. “No one can force a doctor to do this if he is not obliged.”

Chiriac stopped carrying out abortions seven years ago because of what she said was a general fatigue at having done so many, a reason also cited by some other senior doctors.

“In the 1990s, when abortion was legalised in Romania, there were very many,” she said. “We had around 50 a day. On this corridor [of our hospital], all the rooms were ambulances for curettage [surgical abortion]. And then everyone was doing it, of course, and I did it. There were very many; now there are very few. I believe that we have four to five per day.”

But doctors are also increasingly exposed to pressure from anti-abortion groups and the church, which encourage them to invoke the conscience clause. In Timisoara, in 2014, the head of the Orthodox Church granted diplomas to eighteen doctors who refused to grant abortions.

In 2015, Pro Vita, a Romanian anti-abortion group close to the Orthodox Church, along with the Association of Catholic Doctors in Bucharest, published a guide that claimed no doctor can be sanctioned for refusing to perform abortions, and that abortion is “not a right protected by European and International legislation”.

The paper encouraged “the whole medical corps, especially gynaecologists, to renounce the barbaric practice of abortion, using their right to moral objection.” Pro Vita Bucharest offers legal support to any doctors or pharmacists who face sanctions for invoking the clause.

Efforts to restrict abortion access is not limited to convincing doctors not to perform them. The Black Sea found anti-abortion advice distributed in state clinics and institutions. One leaflet discovered at the Alexandru Ioan Cuza University read: “Pregnant? Worried? We are the support for which you have the need!” The flyer supplied a phone number offering pregnancy advice. The number is run by Romanian anti-abortion groups Glasul Vieții and Pro Vita Iași, as well as Heartbeat International, the American pioneers of pregnancy crisis centres. Heartbeat International controls a worldwide network of more than 2,600 organisations whose shared vision is to “make abortion unwanted today and unthinkable for future generations”.

On the grounds of the state-run Cuza Vodă Hospital in Iași is a church with its entrance covered by a poster of an anti-choice organisation, Glasul Vieții. It announces: ‘With God together for a new life! Together we can make great people!’ Underneath it, pinned to the church, are pages decrying abortion as a “great sin” and the “killing” of life.

Dan Damaschin is a priest and president of Glasul Vieții. Before Cuza Vodă effectively banned abortion, his organisation enlisted volunteers to stand outside the hospital with placards and leaflets containing anti-abortion messages.

Damaschin told The Black Sea that the hospital used to perform up to ten abortions a day, calling the place a “mini-abattoir”.

When asked about the influence of outside groups, Robert Dâncă, the Cuza Vodă Hospital manager, told The Black Sea, “We have a very special relationship with the church. In the hospital's yard, we have the church led by the priest Damaschin, who is involved in many social programs and activities and together we support everything related to family.”

Twentieth-century Romania offers a test case in what happens when an entire country imposes very heavy restrictions on abortion. In 1966, the Communist dictator Nicolae Ceaușescu, concerned about the country’s falling birth rate, passed Decree 770, making abortion on request illegal in Romania. While the birth rate spiked initially, it soon fell every year, until 1983, when women turned to the black market to terminate pregnancies.

“In the 1970s, young people were afraid to have sex,” says Daniela Drăghici, a 65 year-old abortion rights activist. “We never talked about pleasure. It was difficult because every single month we were thinking about getting our period. If we got our period we were very happy. If we didn’t, we were very worried, and started looking for ways out.”

When she fell pregnant in the 1970s, Drăghici contacted a network that carried out illegal abortions and underwent surgery on a kitchen table in an apartment in Bucharest.

“There were not many providers because every single person involved in the network was unsafe,” she said. “Someone took me to a doctor in an apartment in Bucharest which belonged to some woman. Everything was hush-hush: when to go, where to go, what to do, what not to do. And to come with this amount of money. It was like in the action movies; I had to leave the money in a certain place.”

Drăghici was lucky by comparison. During Communism, illegal abortions and maternal deaths were commonplace. The Romanian government estimates that between 1966 and 1989 around 10,000 women died from botched abortions, or subsequent medical complications.
Immediately after Ceaușescu's death, in 1989, the provisional government legalised abortion and during the first years of the 1990s, the abortion rate rose dramatically before it dropped again. Eurostat figures show that between 2013 and 2017, the abortion rate in Romania went down by one-third, from 14.9 in a thousand, to 10.1.
Many defenders of women’s reproductive rights believe the lessons of the ban and the toll it took on Romania’s women are being forgotten.

“Romania didn’t internalise the history of the 10,000 women who died,” said Florin Buhuceanu, from NGO Accept. “There is nothing in remembrance of their deaths. Do we learn it in school? Do we learn how women were terrorised? The stigma over abortion is growing rather than diminishing.”

The anti-abortion movement has been active in Romania since the early 1990s, almost immediately after the ban was lifted. Supported and financed with the help of several international organisations, one of its early aims was to establish a network of pregnancy crisis centres that could persuade women to keep their babies.
The most prominent group in Romania, Pro Vita, set out a strategy to push for women in Bucharest hospitals to receive counselling before and after their abortions, conducted with the help of American activists.

By 1998, Pro Vita had joined America’s Pregnancy Resource Center International and Global Partners in setting up the ‘Fundația Clinica Pro Vita’ (Foundation Clinic Pro Vita) in Cluj Napoca, which provided abortion counselling. Meanwhile, other organisations created similar pregnancy centres in the cities of Timișoara, Iași and Oradea.

Records examined by The Black Sea show that the Romanian anti-abortion movement has extensive links with a wider international network of groups. According to the UK Charity Commission, the British charity Society for the Protection of the Unborn Child Research and Education Trust (SPUC) donated £90,000 over six years to anti-abortion association Provita Media. This is the only non-UK charitable expenditure by the SPUC, which claims that its donations were for "programmes in Romania intended to protect the lives of unborn children."

Asked about their policy goals for Romania, Tom Hamilton, a SPUC spokesperson, said that the “SPUC Education and Research Trust has no active presence in Romania. Our goals there are the same as they are everywhere with regard to abortion which we believe to be harmful to women and contrary to the rights of the unborn child as recognised in the UN Charter on the Rights of the Child.”

US anti-abortion and anti-contraception group Human Life International has its own Romanian branch, which is managed by Darul Vieții (The Gift of Life), an organisation known for setting up prayer vigils outside an abortion clinic in Timisoara. Both HLI Romania and Darul Vietii list Gerda Chișărău as a director. The financial records show that Chisarau and HLI Romania received $27,759 from HLI between 2003 and 2007 to “support of pro-life activities.” Between 2007 and 2016, there are no public records detailing HLI‘s financial activities, but when they reappear, in 2016, they show that the group provided a grant of $4,590 to its Romania branch, along with an accompanying $3,023 for an unnamed individual. In 2017, this increased to $10,693 – and $4,003 for “Church-related mass stipends.”

Darul Vietii’s crisis centre to help mothers and babies, Mater Misericordiae, near Timișoara, was funded by international groups like Switzerland’s pro-life ‘Ja zum Leben’ (Yes for Life).

In addition to funding support, American groups have provided the Romanian anti-abortion movement with a model for on how to protest and campaign. In Timișoara this year, Alecsei Ghiță, director of the Estera Foundation’s pregnancy crisis centre, launched a ‘40 Days for Life’ event, part of an international pressure campaign against hospitals.

Ghiță and his volunteers organised demonstrations at hospitals where they held up posters with pictures of babies in soft-focus along with comments like, “Daddy, when you see me in your arms you will love me” and “A Nation which renounces its own children is a nation without hope”. There were similar events in Cluj-Napoca.

In March, The Black Sea found Ghiță outside the gynaecology section of Municipal Clinical Emergency Hospital of Timișoara, with a placard around his neck and serving tea to his volunteers. “We chose this place because it’s visible, because it’s in front of a hospital where they perform abortions,” he said.

In recent years, anti-abortion groups have begun to work closely with Romanian politicians to raise the profile of their movement. In March, Romanian MEP at that time Cătălin Ivan organised the first “Babies go to the European Parliament” event in Brussels, rooted in Heartbeat International’s annual event in Washington DC, known as ‘Babies go to Congress’.

On the same day there was a ‘Babies go to Parliament’ event in Bucharest, organised by Romania association, ‘Students for Life’, which was attended by Romanian MP Matei Dobrovie and Rafael Cruz, father of anti-choice American senator and former presidential candidate, Ted Cruz. A preacher by profession, the elder Cruz has made claims that a Texas law requiring women to make ultrasounds before an abortion has led many keeping their babies.

There have been others. Bucharest hosted a ‘March for Life’, inspired by the annual protest in the American capital, where tens of thousands demonstrate against women’s right to terminate a pregnancy. Present at the event was MP Matei-Adrian Dobrovie from the opposition National Liberal Party (PNL), who The Black Sea interviewed.

Dobrovie argues that Romania is in demographic decline, and there is a need “to support the pro-life movement,” since the country ranks as second highest in the EU for abortions per live births, behind only Bulgaria. In an interview with The Black Sea, Dobrovie spoke of his proposals for state-funded counselling centres for women considering a termination.

“These centres exist in other countries, such as the United States, and in Romanian legislation they are not regulated as such,” Dobrovie said. “I proposed to the Ministry of Labour that these pregnancy crisis centres should be included as social services, and that the profession of councellor of these centres be added in the national registry of professions.”

A similar law was proposed in 2012, but failed to gain a majority in parliament. Asked if there is parliamentary support for these initiatives today, Dobrovie replied that, “There is a group of people who are dedicated to pro-family measures and we are trying to find cross-party support, because these policies must have consensus.”

There is current no draft legislation under consideration in Romania that would change abortion laws in the country. But women who wish to terminate their pregnancies are nevertheless facing severe difficulties and obstructions, as scores of doctors are beginning to invoke the conscience clause.

For Daniela Drăghici, who has fought for abortion rights ever since she endured a ‘back-street’ termination in the 1970s, the current situation is shocking.

“It is so ironic,” she said, “that gynaecologists made a lot of money at the expense of women during and after communism by performing illegal and then legal abortions, only to turn religious now, and all of a sudden fear the wrath of God just because they are old…Hypocrisy rules!”

When asked about The Black Sea’s findings, the Romanian Ministry of Health responded that the country’s doctors are regulated by the Romanian Medical Association. “The refusal to provide medical services can be found in art. 34 of [its] Code of Medical Deontology.”

The ministry did not, however, respond to the question of whether public hospitals operating under its authority could effectively ban abortion by failing to hire gynaecologists who will perform them.

Back in Germany, Bianca is now interning at a local hospital until the end of summer, while working a side job as a waitress. For women like her, Romania’s renewed assault on reproductive rights – and the kind of false information given by her doctor in Iași - causes needless risks to health.

“It was a conservative and outdated attitude,” she said. “I don’t understand how these doctors refuse to do this. The situation is horrible.”

This report was made possible with support from Journalism Fund www.journalismfund.eu

Additional reporting by Liana Fermeseanu

Opening picture: The March for Life, Bucharest, 2019 (Photo: Michael Bird)