Los
Angeles Times, August 1, 2007
Legal
abortion comes to Portugal
The
heavily Catholic nation is one of the last in the EU to allow
the procedure, which many doctors refuse to do.
By Tracy Wilkinson
DATELINE:
LISBON -- For years, Portuguese women seeking an abortion crossed
over the border to Spain, where Yolanda Hernandez awaited.
Now, Hernandez
is coming to them.
In the abortion
business for nearly three decades, Hernandez is opening Portugal's
first private abortion clinic.
Sitting on
the top of a hill just off an important Lisbon thoroughfare, Avenida
da Liberdade, this imposing white building is no back-alley basement.
Glass doors under a large sign declaring the clinic's name, Dos
Arcos, lead into a spacious waiting room lined with freshly painted
royal-blue chairs.
A staff of
22 Spanish and Portuguese gynecologists, technicians and administrators
was in place the other day, and receptionists were busily penciling
in the first appointments. Thirty women showed up on opening day.
"We are
the first clinic," said Hernandez, who has been preparing
for this moment for years. "After us, many more will come
along."
Until this
month, heavily Catholic Portugal remained one of the last countries
in Europe forbidding most abortions. In addition, it was the rare
country that criminally prosecuted women who had abortions and
doctors who performed them -- a legal regime that the Portuguese
prime minister described as a "national disgrace" and
that critics elsewhere branded as "medieval."
Seen as
modernization
A law that
went into effect this month makes Hernandez's clinic possible
and brings Portugal in line with the majority of its fellow European
Union members. Abortions can now be performed without restriction
during the first 10 weeks of pregnancy, and under some circumstances
through the second trimester.
Many in Portugal,
a conservative nation long seen as the continent's sleepy stepchild,
regard the law as a crucial step in a process of modernization
and reform.
At the same
time, abortion has proved to be an issue that, unlike any other,
provoked emotional, divisive debate in a country more accustomed
to resisting radical change and reaching compromises
Even with
the law, numerous doctors are refusing to perform the procedure
and are declaring themselves "conscientious objectors."
Several public
hospitals said they would not be able to offer abortions, despite
the legal obligation to do so, because they lacked the doctors
or necessary equipment.
Clinics such
as the one operated by Hernandez will have to fill the void. The
$4-million Dos Arcos is part of a chain of Spanish abortion clinics,
a couple of which operate along the border with Portugal, where
as many as 10,000 Portuguese women have been traveling annually
to evade the restrictions here.
"The
connection has always existed," Hernandez said. Portuguese
women have constituted 60% of her business in the Spanish clinics,
she said; the trip from Lisbon to Spain's side of the border is
just 150 miles.
The new law
notwithstanding, Hernandez does not expect a flood of patients
at the Lisbon facility, initially. Even though the two-story,
12-bed structure has a private VIP suite (with a private entrance),
reticence remains strong regarding something seen as shameful
in much of Portuguese society. That will change, but slowly, she
said.
"With
so many years of clandestinity, the fear has its impact,"
said Hernandez, a taut, energetic woman of 49 years with fashionable
close-cropped hair and large blue-gray eyes behind wire-rimmed
glasses.
A bitter
campaign
In Portugal,
a country of only 10 million people, health officials estimate
that 23,000 women a year have obtained illegal abortions; abortion-rights
activists estimate that nearly half end up in hospital emergency
rooms because of botched procedures.
The campaign
to legalize abortion in Portugal was not violent, but it was certainly
bitter.
Anti-abortion
activists on street corners handed out plastic replicas of embryos
and shopping bags bearing slogans opposing the legislation. Newspapers
published reports on Portugal's dangerously low birthrate.
The powerful
Roman Catholic Church in Portugal condemned the proposed law as
a "blow against civilization" that would authorize "an
abominable crime."
Priests preached
from their pulpits, and bishops led a vigil at the Fatima shrine,
revered by Catholics for what they believe was an appearance by
the Virgin Mary nearly a century ago.
Hernandez
was scorned in public forums as a Spanish outsider, nothing short
of a mercenary executioner, a baby killer.
The debate
cleaved distinct lines in Portuguese society: Along with the refusenik
doctors and the church hierarchy, conservative rural Portugal
opposed lifting the restrictions, while the urban elite, the young
and many women supported the legislation.
Nearly 60%
of voters in a February national referendum approved of liberalizing
the abortion law, but the poll was declared invalid because of
a low turnout. The Socialist-led government of Prime Minister
Jose Socrates, with a majority in parliament, decided to draft
and enact the measure anyway.
"We all
thought we were behind the times," said Maria de Belem, a
former health minister and congresswoman in Socrates' Socialist
Party who championed liberalizing the abortion law as an urgent
public health issue.
Without better
family planning and access to birth control as a first step, and
abortion as a last resort, she said, Portugal cannot fight a growing
epidemic of unwanted children who end up on the streets, abused
or crowding into the few government-run institutions.
"We cannot
deny the social reality when women cannot practice their reproductive
rights," Belem said. "We cannot close our eyes to a
very difficult situation for Portuguese families and couples with
real problems, who cannot support the children they already have."
Public hospitals
without doctors willing to perform abortions are supposed to contract
with private doctors or, eventually, private clinics such as Dos
Arcos to guarantee access for women choosing to end their pregnancies.
Hernandez said she had signed contracts with three hospitals,
including Lisbon's Sao Francisco Xavier Hospital, where all doctors
declared themselves conscientious objectors.
'That's
a human being'
Gynecologist
Joao Malta has been practicing in Lisbon for 19 years and belongs
to what he calls a "pro-life network" of medical personnel
who discourage abortion.
Malta said
he refuses to perform abortions in all but extreme cases: when
the woman is in danger of dying or the fetus is so badly impaired
that it would not survive after birth. In his view, a very sick
fetus or a pregnancy resulting from rape are not sufficient cause.
"I do
not kill my patients," Malta, 44, said in his wellappointed
office, with about half a dozen women filling a small waiting
room. "If I see an embryo that's 2 1/2 millimeters, I can
see a heart beating, and, for me, that's a human being."
Malta said
he and doctors like him would campaign to reverse the law, but
that it might take time.
Although Portuguese
women of means have been able to evade restrictions by traveling
to Spain, that has not been an option for the poor, who often
have resorted to taking harsh drugs to force a miscarriage or
submitting to unsanitary and unsafe underground operations.
Though the
law was praised by Socrates as a sign of progress, it is by no
means among the most liberal such measures. Women seeking an abortion
are required to meet with a doctor and then wait three days, for
what officials call "reflection," before taking the
final step.
Portuguese
President Anibal Cavaco Silva, a conservative, proposed a requirement
that each woman be shown ultrasound pictures of the fetus before
the abortion. The provision was not included.
Cavaco Silva
ratified the final law anyway, even as he declared abortion "a
social evil to be avoided."
wilkinson@latimes.com
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