Abortion in Kosovo legally adopted but morally condemned

Women's right to abortion, though it is legally guaranteed in Kosovo, is still treated as taboo and morally condemned not only in society but also in higher health institutions as at KKUK. This is where abortion is considered “suicide” by the mother's hand. This discriminating approach, condemned by women's rights attorneys and ombudsman who are demanding the government's action, especially for abortions that are carried out secretly in private orientation.

Leonora Aliu

“Go to D-jam number 18”, is the instruction provided by a nurse at the entrance of the Kosovo University Clinical Centre's Clinical Centre, the highest health institution in the country -- while guiding us to a corridor at the right side after entering this clinic.

There's the hall where abortions are performed or “the writing with the mother's hands”, as some of this clinic's employees name this gynecological medical procedure.

The grim corridor does not distinguish from the corridors of other clinics in QKUK, built since communism, when it had even begun its work in December 1958 and then as Pristina Hospital, and later 1999 as the Clinical and University Center.

At the end of the corridor is Dr. Jakup Ismaili, chief of Family Accession and Planning at the Gynecology Clinic, which hosts our team. With one phone in his hand, coordinating teams the size of one hall to another because of the burdens that the hospital has, he suggests that we wait. To move away to the accession room to discuss the subject we were meeting. The room where he shows that even parties expect is not much different from a dark and carey room, but is found in the country's highest health institution.

The wind had also been expected in that room in 2017 (the complete identity of which it would be protected) when it went looking for an abortion.

The wind was pregnant with her first child, when her complications had begun, and the first weeks of pregnancy had been checked by her in private office. Her reluctance to visit the KKUK had resulted from poor reputation “as she explains, of the Gynecological Clinic and experiences of women and girls who had performed services there, about the treatment and insults they had received. “I didn't want to go through any extra stress, except for pregnancy”, she relates.

But complications in the animal, because the fruit was diagnosed with hydrops, had sent to the door of the only clinic in Kosovo that is legally allowed to perform abortions that are over the tenth week of pregnancy.

The wind was then 16 weeks. And when she entered the consulting room for her case, she was informed that it is the professional Commission that should decide whether she can have an abortion or not.

It is the Law on Dispression of State and the Law on Health in Kosovo that stipulates that any abortion on the tenth week can be performed only with the consent of the Professional Health Commission, consisting of three professionals: two obstetric gynecologists and a psychiatrist.

I'm at QKUU for abortion in the 17th week because the commission that forms there finds that the fruit can't be developed further. Normally as a mother I was expected to become for the first time, I have experienced that experience with great pain. I was laid down in the Diagnostics Department and there I was two days later I was sent back to where I had an abortion and I was given 10 capsules, every two hours I was placed”, reports the wind that was standing only with her husband.

Spiritual and physical pain is said to have often made me scream in the room where he was standing, but that does not say that he had helped the clinic's doctors and staff. On the contrary, the insults and insults that she had heard women receive at that clinic would have to be heard too. “The caregivers who changed and came, to put the capsules, were not patient, when I shouted out of pain they were directed in high tones. It was like that by 21 p.m. After 21 p.m., our sister came to check on us alone. My sister was watching me every half hour. At about 1: 00 p.m., pain began, and until my husband woke up from sleep my medical sister just had an abortion with another woman's sister who was nearby helping me with”, says Windy, who says she had no good reaction from the medical sister who had been asleep at the time she was abortion. That's what the nurse told you about when she had an abortion, not in an abortion room, but in the hospital room. The wind reminds him of the worst experiences and worst experience at QKUK. The “has not been a good experience and always remembers it, it has been trauma”, she says. The wind does not recall the names of the personnel it remembers not to have cared for as it says, enough for it. And on the part of the Gynecological Clinic, it has not been possible to understand any information because the requests directed at this institution and the director of the clinic for the interview have been ignored. Questions and some interview requests have been addressed to the Information Office as well as to the director of the Gynecological Clinic, but no response has been offered until the date of the article's publication.

QKUK staff moralistic access to abortion

On the other hand, when it comes to abortion, a legally permitted medical procedure, is suggested to be conducted at clinics licensed for gynecological services, and over the tenth week only at QKUKUK. The abortion in Kosovo, as opposed to some developed countries that are more rigorous or banned as Italy to assume, is a medical procedure permitted by law. The Law on Distractation in Kosovo defines parameters and conditions under which abortion is allowed. Until the tenth week of pregnancy, estimated from the first day of the last menstrual cycle before the conception, abortion can be performed with the mother's consent as voluntary. The purpose of the law is to be to prevent the possibility or mortality of the mother. By the tenth week, an abortion can be performed by any institution licensed for gynecological services. Although the conditions under which private agencies work remain unclear, and the protocol of abortions and the conditions under which it was carried out. Pregnants over the tenth week are allowed to be interrupted only because of health causes - only if the mother or fruit is at risk of life and health or fruit is abnormal. The approval for abortions over the tenth week should be made by the Professional Health Commission at the QKUK Gynecology Clinic, which is headed by the clinic director plus a professor (acterial Egypt) and a psychiatrist. While pregnancies resulting from criminal acts such as rape, unwanted sexual relations with victims of trafficking, or dealing with minors or incest are legally allowed until the second week.

The chief of Family Accession and Planning at the Gynecological Clinic in KKUK, Jakup Ismaili, shows that most of the abortions performed in this clinic are abortions for health causes, or even family planning among married couples. Suppose with married women who have two and more children and who because of their socioeconomic causes, cut out their pregnancy until the tenth week.

752 abortions where pregnancies have been suspended until the tenth week have been performed by this clinic from 2012 until September 2018.

If you see the numbers of those years, you can see that the number for more or less remains the same. In 2012, according to data provided by Ismajli, 67 abortions were filed at the CKUK Gynecology Clinic, in 2013 there are 124, in 2014 there are 130, in 2015 there are 106 protocols, in 2016 there are 111, in 2017-2, and this year by August 93. Currently, the CKUK's Gynecological Clinic has data from 2011.

Dr. Ishmael says it's about an average age of 25 women, and almost all of them are women who have had marital status.

“Abort is legal and willful until the tenth week of pregnancy, with the patient's insistence on any reason which is social, economic, planned family... for example, there are too many children, family planning. Until the tenth week of pregnancy is performed, normally completed by analysis, explains the way, complications and abortions are conducted until the tenth week”, Ismaili says. “After the tenth week, until 22nd week, abortions that have some reason both from mother and baby. Whether it's a mother's disease or anomalies. But in this category there were cases of rape, such as non-definated cases of violence, they until 22nd week”, he relates.

An abortion trend from the pre-war period to the present has not been possible to reveal because, according to information from the clinic archive, abortion protocols are set to be eliminated every five years from 200 years. Until those before 2000. The reasons for eliminating these data have not been given.

What is understood at QKUK, however, is that the staff of the Gynecology Clinic is opposed to abortion. In 2016, the director of this clinic, Myrvete Pacharada, described the abortion as “suicide” in an interview given to BIRN, while the state of Kosovo has decided to consider it a legal right of women and girls. “Neither religion nor science allow killing of child”, she said. In that year, a poster was even placed in the hall where abortions were performed in her clinic, which said “abort a crime committed with the hands of her mother”. She saw this poster as every mother coming in to have an abortion. Today that poster of much criticism in the media is no longer found. However, the approach of staff is the same for abortion. Jakup Ismaili, authorized to give an interview by Director Myrvete Pacharada, (who has not responded to the demands of one interview after another), shows why they have that approach by showing that they try to persuade patients not to have an abortion. You know, I, in advance, each patient who's going to have an abortion, and I get a hand job, sometimes when they even call on their husband, even though they're broken, and we've arrived a thousand together, convince me not to interrupt my pregnancy. So it's not the first insulation on the table, I don't have ten and a half hours to waste an hour or two... ”, he starts to tell you how they try to convince patients not to have an abortion. And when asked why they try to convince them of a procedure that patients have legal rights for, he says because abortion is “suicide”. Why is it now, human side? It's a murder. Let me show you a photographer who shapes a child in seven weeks... Seven weeks without the fruit, it can't be like you and me. There are contraception methods today, there are different kinds of contraception methods. I need to get used to education, emancipu, but don't come to my unwanted pregnancy...”, says Ismaili.

25 abortions had been rejected in this clinic only last year by 142 requests that the abortion clinic had accepted. The law on pregnancy does not permit abortion because of the gender of fruit. However, KKUK has offered no answers to what are the reasons why 25 requests for abortion have been rejected this year.

The approach of the clinic staff to abortion, which, however, is the legal right of women in Kosovo, is criticised by the organisation that deals with the protection and avocation for women's right to Kosovo.

Adelina Berisha, an activist at the Women's Group Network, who has also launched reports on women's health and on reproductive health and abortions, calls KKUK staff access extremely wrong.

Pointing to her personal experiences at the clinic, which she says abuses women and fails to meet the conditions for physical treatment. We know the QKUK itself, the highest health institution has abused the rights when women, for example, had to be born in the corridor. So these are some facts that tell us. But overall the interest of Kosovo society is not in women. Very simple. Just because reproductive health is viewed as a problem that directly affects women, which is wrong because reproductive health affects both men and women, even when all is of interest to target women and interest is less”, she begins to explain.

I know when I went as a teenager to my first gynecological visit because of some cycle problems, and I know that the first door there was that control room. I was 15 years old and there was a room where I went to the gynecologist for the first time and I walked into that room and there you had five other chairs, and there's a woman with a big belly just before she was born, and I had a kid who didn't have the same problem with that. Even someone has been sick in there and we've all been to one place. It was very traumatic and shocking. Because first I thought the doctor would call me in and talk to me and talk to me about my problems before he puts me in the chair. It's a lot of shocking dishes for me, and it's got me right there. Sit down. Starting with this from the first expected to take place in Kosovo hospitals, and here it is probably still more sensitive because of the nature of work”, Berisha says.

The new Health Minister, Uran Ismaili, has launched the wave of reforms within the health system, and has recently promoted the supply of gynaecology with new beds from the 750 new beds contingent for all KKUK. At the Gynecological Clinic staff is aware of existing conditions, however, it is their approach to abortion that made them more vulnerable to criticism. The moment you're allowed to law and abortion constitutions is no one here anymore to morale or call on what I know based on religion or base on anything else. This is a direct violation of the law itself... luckily we're comfortable with the laws, and the doctor has no business with a girl or is committing a crime. While it is allowed until the tenth week, it is bound to apply the law”, says activist Berisha, who thinks abortion despite being legally regulated in Kosovo, is practically not yet considered right. “ [The law] is in line with European laws and with states that respect the gender issue most. But in practice since this is implemented, this is the whole mistake, because since we know there are only five hospitals that have the right to perform abortion because they meet all the conditions, but on the other hand we all know abortion is happening illegally in all private agencies”, says Berisha. The Law on Distractation in Kosovo was adopted on November 6, 2008, and was in effect in January 2009 after it was declared in the official issue of Parliament's decision. Although he allows abortion to be just, he is considered to have shortcomings and needs to be adopted.

The Office of the Ombudsman of Kosovo in 2016 had launched a report entitled “Rights in Sexual and Reproductive Health in Kosovo: A reality beyond the law? According to the same report, the Law on Distractation calls for revision, including the removal of abortion restrictions for girls over 16 and is recommended that public service providers should improve their services on abortion. “Abortion public sector experts should improve their services including improving respect for user rights, and providing comprehensive care, including precise information, non-requisite advice if required by a wife, abortion services without delay, and contraceptive services following abortion to help prevent future unplanned pregnancies”, the report says. The government, according to the ombudsman, should ensure that sexual and reproductive health services, including abortion services, meet the needs of all teenagers.

Among the two authors of the IAP report, Majlinda Sinani-Lulaj has shown that out of the 63 recommendations that have been made, most of them addressing the government have not received any answers at all. Lulaj says that rights to reproductive and sexual health cannot be seen, nor understood, as decoupled by socio-economic and culturalised complexity in the country and generally, Kosovo has rebuilt the health system and has a strong legal framework in the area of rights in reproductive and sexual health, which is consistent with principles established by the Constitution and international human rights instruments, directly implemented in our country. “However, guaranteed on paper, compared to the level of implementation of these guarantees, stay quite apart. The presence of reproductive health services, including abortion services, is essential for the joy of women's rights on the basis of non-discrimination. The state must take measures to make services acceptable, secure and respect women's right to dignity and privacy”, Lolaj says. She emphasises that Abort as the topic has been one of the seven key issues the Kosovo report on reproductive and sexual health has addressed. From 25 recommendations to the Ministry of Health, recommendations 1, 5, 8, 10, 11, 12, 13ʹ b), 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24 are considered implemented. From 20 (21) recommendations to the government (ZKM), we have not received an answer about them, although, for some, we have knowledge that there have been positive developments and we are currently in the process of evaluating their implementation status”, Lulaj relates. However, these are not the main dilemma the ombudsman's office raises in its recommendations. “In the National Value of Rights on Reproductive and Sexual Health, the findings point out that the abortion rate in Kosovo is very high and that, despite the fact that there are a number of public institutions licensed to offer abortion, often this happens illegally, through private institutions, where safe abortion standards are not guaranteed. On the other hand, there is no comprehensive record system for maternity deaths, which makes it difficult to collect accurate data for the number of deaths and causes, Lulaj says. Showing thus that the institution that monitors human rights discriminations and violations shared the same dilemma as that of almost women's health activists with a basic human right.