A newly adopted Serbian law guaranteeing free healthcare to children, pregnant women and new mothers could have unexpected detrimental consequences. Namely, Article 5 of this newly adopted law requires that terminations of pregnancies, along with the identification details of the patient, be reported to the government health insurance fund.
Article 5 has been fueling heated debates over a potential register of terminated pregnancies and abortions being compiled by the government. Doctors are concerned that penal provisions on healthcare facilities and practitioners who fail to send reports of their patients’ abortions might corner them to break confidentiality bounds and medical ethics. Meanwhile, the government is denying accusations of creating abortion records, claiming that this is the only system to prevent misuse of free healthcare provided by the
A new law guaranteeing free healthcare to children, pregnant women and new mothers in Serbia could have unexpected detrimental consequences. Namely, Article 5 of this newly adopted law requires that terminations of pregnancies, along with the identification details of the patient, be reported to the government health insurance fund.
Article 5 has been fueling heated debates over a potential register [Sr] of terminated pregnancies and abortions being compiled by the government. Doctors are concerned that penal provisions on healthcare facilities and practitioners who fail to send reports of their patients' abortions might corner them to break confidentiality bounds and medical ethics. Meanwhile, the government is denying accusations of creating abortion records, claiming that this is the only system to prevent misuse of free healthcare[Sr] provided by the new law.
While there is something inherently frightening about circulation of medical records, particularly when it comes to controversial interventions such as abortions, the debate over Article 5 is overshadowing two aspects that are crucial for women's rights in Serbia and beyond. First and foremost, debates over Article 5 are masking an overall state of urgency globally, even within the 'progressive' bounds of western states. And secondly, sexual and reproductive health rights mean much more than the right to abortion. We must acknowledge this because true emancipation will be achieved comprehensively and transnationally or not at all.
Moving towards a transnational perspective
Historically, Serbia has had quite progressive abortion policies. As early as 1969, complete liberalisation of abortion came into effect under Tito's Yugoslavia. By contrast, founding EU member state Belgium only legalized abortion in 1990 after a 17-year long battle and 15 proposed laws defeated. Today, Ireland only allows abortion under limited circumstances, when the mother's life is endangered.
It is unfortunate that current debates in Serbia's media make no mention of the wider state of affairs globally or even bordering nations.
It is unfortunate that current debates in Serbia's media make no mention of the wider state of affairs globally or even bordering nations. Two years ago, the Hungarian parliament adopted a new constitution by two-thirds majority vote. The constitution's paragraph on the protection of unborn fetuses could very well pave paths to a legal ban on abortion. On December 10, the EU Parliament rejected a report on sexual and reproductive health rights by a tight margin (334 against, 327 in favor). This non-binding report called for universal access to sexual and reproductive health and rights throughout Europe, including safe and legal abortion services; imperative sex education in primary and secondary schools; and the prevention and treatment of sexually transmitted diseases. The adopted alternative merely states that sexual and reproductive health rights are a matter for member states.
The US continues to harbor some of the most draconian ideas and policies on abortion, despite being a promoter of human rights worldwide. Michigan's legislature passed on December 12 a measure banning coverage for abortion in private health plans, providing no exceptions for rape and incest. Earlier this year, several states adopted laws mandating women to view a real-time ultrasound image of their fetus and listen to the fetal heart prior to proceeding with abortion. Last year, Republican Senate nominee from Missouri questioned the medical legitimacy of unwanted pregnancies resulting from rape. "It seems to me, from what I understand from doctors, [pregnancies resulting from rape are] really rare. If it's a legitimate rape, the female body has ways to try to shut that whole thing down."
The relevance of US internal affairs to small countries should not be overseen. The US is, by far, the largest international donor in funding volume (net flows estimated to be at $30.5bn in 2012), however funding distribution depends on the perspectives of the administration in power. For example, the Bush administration ban on US funding to international family planning groups supporting or even providing information on abortions was reversed by the Obama administration.
The larger context: Women's rights
Nearly two decades ago at the 1994 UN International Conference on Population and Development (ICPD) in Cairo, 179 nations committed to the basic sexual and reproductive health rights. These, they agreed, include the ability to make free and informed decisions about one's body, health, relationships, marriage and childbearing.
Debates over abortion and Article 5 of the new law should occur within a broader discussion of the overall poor state of women's sexual and reproductive health, rights and opportunities in Serbia and elsewhere. Poverty and gender inequality are preventing Serbian women from making "free and informed decisions" guaranteed at the 1994 ICPD in Cairo, and are basically doing the family planning for them. With massive rates of unemployment (estimated to be around 50 percent among youth and 25 percent [Sr] in the general population), it is becoming increasingly difficult for many women to have a say about their fertility. Vast gender inequality at the labor market - both in terms of employment and wages - is contributing to women's dependency on men and is limiting their ability to negotiate contraception use. It is also common for employers to ask questions about marital status and family planning when interviewing young female candidates for jobs. If hired, many women get fired for pregnancy. It is not surprising then that many Serbian women resort to (rather than choose) abortion as a family planning method.
Similar mechanisms are contributing to an opposite outcome, high fertility, among teenage Roma girls in Serbia and surrounding countries. Lack of adequate housing and a lack of access to education and healthcare services are pushing many Roma girls to marry early and are compromising their family planning. The adolescent birth rate among the Roma population in Serbia is more than 6 times the national average, with one in three Roma girls giving birth before the age of 18. According to UN data, the average age of marriage among Roma girls in Albania is 15.5 and the average age of first-child bearing is 16.9. These pregnancies, among the most vulnerable youth are underpinned by parallel problems that drive high abortion rates in the general population. However, the two issues are never discussed jointly.
Sexual and reproductive health rights span beyond healthcare policy - they mirror women's and girls' overall wellbeing and position in society. It is the underlying structural disparities that must be addressed to ensure sexual and reproductive health rights. A study recently published in the Lancet Global Health journal showed that the South African financial support grants to poor households with children reduce transactional sex (sex for food, school fees, money or other material benefits) and sex with much older men among teenage girls. These findings highlight the extent of the problem. Globally, deprivation and inequality play key roles in sexual and reproductive health rights.
Twenty years after the landmark conference in Cairo, women's lives have only seen minimal improvement. Substantial progress on women's issues requires political will and action. For this to happen, we - as participatory citizens of democracies - must expand the debates on women's sexual and reproductive health rights to comprehensive and transnational levels. Only then will positive achievements be sustained and extended to small players in the world arena such as Serbia.
Marija Pantelic is an independent writer from Serbia. She is pursuing a PhD at the Department of Social Policy and Intervention, University of Oxford.
Source: Al Jazeera