It is impossible to overestimate projects like «You are not alone»
«I remember Kazan, remember Astrakhan, remember Revel, but I don’t remember Shpak». It is a famous phrase from comedy «Ivan Vasilyevich is changing his profession» that is remembered in reference to the report by Oleg Philippov, Doctor of Medicine, Professor, Deputy Director of Department of Medical Aid for Children and Obstetrics Service of Healthcare Ministry of the Russian Federation. Participants of the Forum «Centuries-long family traditions — the foundation of Russia’s future», that was held November 26-27, 2015 in Kazan, learnt that according to official data about one million abortions are made in Russia every year. It is almost the size of population of Kazan. That is, annually Russia voluntarily abandons population of the whole city. According to Oleg Philippov, he understood long time ago that it is inadmissible to have an abortion, that «prevention of abortions is vital as currently it is the only real reserve we should use to save the nation». We should realize that only together can we improve the demographic situation in Russia. For us to stop giving up on children’s lives presented us by God there should be personal rejection of an abortion by EVERY woman. Abortions should become taboo for everybody. Especially today, when clause 70 allows a doctor to refuse to perform an abortion. In 1999 there was no such right but obstetrician-gynecologist Oleg Philippov, who worked at the gynecological clinic of the Tomsk Medical University refused to perform abortions.
«Society needs certain soft power that would help achieve a lot. It should be the power, not force» says Oleg Philippov. Just like it happened in Belgorod in the beginning of June 2015, the report of Oleg Philippov in Kazan generated great interest. He confirmed that project «You are not alone», that was launched in Krasnoyarsk, has been developing in the right direction and sometimes it even develops a little bit ahead of initiatives of Ministry of Healthcare of the Russian Federation. Oleg Philippov presented slides with figures and diagrams that showed the current situation regarding abortions and births in Russia. He spoke about the necessity to use a voluntary consent form signed by a woman where she is warned about all the consequences of an abortion. Once again he emphasized the legal right of a doctor to refuse to perform an abortion. He mentioned the instruction from Ministry of Healthcare № 155 dated 28 October 2015 where they suggest to consider performance of abortion as a separate area of expertise that requires a separate license. There was also a suggestion to present an ultrasound visualization of a fetus and its heartbeat to women who have doubts whether to keep the baby or to have an abortion. Besides, the report of Oleg Philippov contained information about the instruction to introduce payments to psychologists at women’s consultation clinics into the system of compulsory health insurance. Thus, there is hope that the single mechanism for financing of psychologists’ work at obstetrics institutions will start working properly. For your attention find below the complete text of the report by Oleg Philippov that was delivered at the round-table discussion on «Prevention of abortions — reserve for saving the nation. Experience of „You are not alone“ project».
Dear colleagues, questions that will be raised here today are of great importance. Speaking about the aspects of work of Ministry of Healthcare I will present the statistic picture on number of abortions performed at medical organizations which are subordinated to Healthcare Ministry. It is our 13th form. According to Federal State Statistics Service, quantity of abortions is always higher. If we say that in 2014 there was 814,000 abortions in medical institutions of Ministry of Healthcare, considering medical institutions which are not subordinated to the Ministry and which submit their data directly to Federal State Statistics Service, this figure is almost a million abortions.
We say that quantity of abortions is decreasing. No doubt, it is decreasing. But what is a million? Dear colleagues, just imagine one million citizens — it is almost the population of Kazan. That is why it is of course a political issue. We can’t help paying attention to it.
In 69% cases abortions are performed by request of a woman. This is the target group we can influence: 24% women don’t want to have one more baby or want to postpone its birth, or a partner is against the baby, or other reasons which can be absolutely eliminated. We just have to help the woman to make the reproductive choice. To help, and not to push so hard in a situation when she already feels stressed.
We worked on the order related to the form of the consent form to be signed by a woman for an abortion in 2007. Today there are many discussions about some additions to the consent form. I would like to remind you that in the current form all the complications after an abortion are enumerated. I visit subjects of the Russian Federation, I come to gynecological wards where they perform abortions and I don’t see these consent forms in clinical records of abortions. We should do our best to provide this consent form to a woman at a women’s consultation clinic at the time when she is given time to think.
When we speak about rooms of medical and social psychological counseling at women’s consultation clinics I would like to ask you not to forget about the category of disabled women. They appear to be out of the picture. But a woman’s disability can be caused by different diseases when a reproductive function is preserved (for instance, serious cardiac defect). These women have the condition when they will not be able to carry the baby; they are greatly exposed to maternal mortality. And this category of women should be under the care of not only obstetricians-gynecologists, but of psychologists and social workers as well.
Today an obstetrician-gynecologist is entitled not to perform an abortion in case a woman has no medical reasons for that. In the previous legislation about public health such a norm didn’t exist.
In 1990s I worked as an obstetrician-gynecologist at the gynecological clinic of the Tomsk Medical University. My firm decision not to perform abortions drew attention from not only colleagues but from mass media as well. And the feedback was both positive (many people supported me) and negative («Look who’s talking! How dares he not to do his job? It’s his functional duties»). Today a doctor has a legal right to choose.
According to the instruction of Ministry of Healthcare № 155 dated October 28th 2015 the Federal Fund of Obligatory Medical Insurance developed a draft order that approves of the form with a stated wish of an insured person not to use his taxes paid to cover the cost of abortions.
At the moment we are working on introduction of a separate license to perform abortions and provide related services. It means the license for obstetrics and gynecology alone will not be enough for performing an abortion. In this case we will be able to see clearly the quantity of medical organizations of gynecological sphere that are working in this area. It will help to improve the quality of information and have correct statistic data.
Currently we make amendments to Order 572 regarding the suggested ultrasound examination for visualization of a fetus and its heartbeat before an abortion.
There is another important aspect. Funds of Obligatory Medical Insurance should be used to pay for the work of social workers and specialists-psychologists on pre-abortion counseling, on prevention of abortions at women’s consultation clinics. It will be described in the instruction letter of Russian Ministry of Healthcare about creation of territory-based programmes of state guarantees in your regions. It is important as there are a lot of difficulties at the moment related to covering the cost of services of pre-abortion counseling. As soon as these instructions are signed by Minister and published I think the situation will become much better".
Prepared by Irina Akhundova