To abort or not, helping women figure it out

Now what? Not everyone is prepared for motherhood AFP

Deciding whether to go through with an unplanned pregnancy can be difficult. Staff members at a clinic in Bern offer support to women of all ages and walks of life.

Afternoon sunshine as well as literature in several languages fill the waiting room on an upper floor of the women’s clinic at Bern University Hospital. It’s the family planning department, where women seeking advice can get their questions answered.

Since 2002, the cost of an abortion has been covered by basic health insurance in Switzerland. This policy came as part of a vote to legalise abortions carried out in the first trimester of pregnancy. Opponents now argue that people who object to abortions for moral reasons shouldn’t have to help finance them through their healthcare premiums. (See infobox, “The Initiative”.)

At Bern University Hospital, terminating a pregnancy medically costs about CHF800 ($885); for a surgical termination it’s circa CHF2,000 ($2,215). There is no charge for the consultations, which are financed by canton Bern.

Each year, the clinic advises about 400 women, both from Switzerland and abroad. They usually come on their own, but are sometimes accompanied by their partner or a close friend or relative. According to doctor Jenny Lütjens, the number of women has been stable since 2002.

“The consultation lasts 90 minutes, and if necessary, we can make another appointment. We don’t push them to make a decision; instead, we support them in the decision-making process,” Lütjens told swissinfo.ch.

The initiative

Launched by an inter-party committee made up essentially of conservative Christians, the initiative “funding of abortion is a private matter – relieving the burden on health insurance by removing the costs of termination of pregnancy from basic health insurance” calls for the introduction of a new article in the federal constitution. It states:

“With rare exceptions concerning the mother, termination of pregnancy and foetal reduction are not included in compulsory health insurance”.

Like every constitutional change, the initiative will require a majority both of the nation’s people and of the cantons to pass.

Voters will have their say on February 9, 2014.

Difficult situations

Most of the women are between 20 and 35, with very few younger ones. Lütjens and her colleagues try to get a sense of each woman’s personal situation and her feelings about the pregnancy.

“Many of them are in a difficult situation, either financially or personally,” Lütjens said. While younger women might not be ready to become mothers, there are also mothers who feel they already have enough children. Or perhaps they’ve just separated from the would-be fathers.

Bettina*, the 35-year-old mother of a three-year-old boy, visited the clinic last autumn. She was two-months pregnant, and had just recovered from gastric bypass surgery – not ideal for a healthy pregnancy. In addition, money was extremely tight at home, so she chose to terminate.

“It was very difficult to decide to have the abortion, because my husband and I would have liked to have had the child. But it just wasn’t feasible,” Bettina told swissinfo.ch.

Hospital clients who are unsure whether they can handle or afford to have a baby may be referred to social worker Sandra Schertenleib, who helps them make an informed decision.

“They’re often unaware of their options, so it’s my job to show them the possibilities. I often help them get the confidence they need in a seemingly hopeless situation. The women themselves find a suitable solution,” Schertenleib told swissinfo.ch.

For example, if a woman says she has no income or only a very limited one, Schertenleib might suggest looking into welfare. If childcare is the issue, she gives advice on where the mother-to-be might find support – such as a group home for young mothers.

“It’s not just very young women who have problems. It can also be older ones who already have a child or two or a new job, and they’re not sure how they could manage another child,” Schertenleib said.

As she points out, there are many people in Switzerland living in precarious financial situations.

“A child can bring a person down to or below the poverty line. So the question is how to cope,” she said.

Bettina is grateful for the care she received at the clinic.

“They treated me with respect and took my worries seriously. They were kind to me,” she remembers.

Keeping tabs

If the patient decides to terminate the pregnancy – as is the case about 80% of the time at Bern University Hospital – the hospital can arrange it.

“It’s not that so many decide to terminate based on our advice; it’s that many came in requesting an abortion,” Lütjens pointed out.

The clinic schedules follow-up appointments to see how each woman is doing post-abortion, both physically and mentally.

“During that first appointment, the women have to absorb so much information. We cover the decision, medical issues, contraception, appointments, their partnerships. It’s just too much, so it’s important to check in again a month later,” Lütjens said.

Contraception is a key aspect of the follow-up discussion, to ensure that the patients find a reliable method that suits them – and ideally prevents them from having to deal with an unplanned pregnancy ever again.

swissinfo.ch

No regrets

A woman who fought for insurance coverage and is fighting the current move to remove it is Anne-Marie Rey, a retired politician from canton Bern.

“My contraception had failed, and I absolutely didn’t want to have a child at that point in my life. I was about six weeks pregnant,” remembers Rey, who had an abortion some 50 years ago – when the procedure was illegal in Switzerland.

“I was never sorry about it, and I never had any problems in connection with it – neither physical nor psychological. I was very happy to be able to have this abortion,” Rey told swissinfo.ch. After she completed her training as a dance instructor, Rey and her husband later had three children.

Rey – who wrote a book about her experiences – also maintains a website that publishes the stories of other women who have faced the difficult decision of whether to terminate.

Hoping for a “no” vote

Under the initiative going before voters, abortion would remain legal, but paying for it would be a private responsibility.

“It would have been impossible to pay for the abortion right now, so I probably would have had the child,” said Bettina.

While considerably smaller than the cost of raising a child, the fee for terminating a pregnancy can pose a significant burden, agrees social worker Schertenleib, who notes that social services would be unlikely to reimburse such a one-time expense.

She feels a change in the law won’t result in fewer abortions, rather “it will lead to more abortions carried out under difficult circumstances” .

Lütjens, the doctor, is of the same opinion: “If the initiative is accepted, women who are already in a bad situation will find themselves in a much worse one.” She fears that those who can’t afford an abortion might seek dangerous alternatives such as unapproved drugs or instruments.

Alternatively, women might wait too long trying to save the money for one. As it stands now, about 75% of abortions in Switzerland take place before the eighth week.

Elvira Bader, a former Christian Democrat parliamentarian and co-chair of the “yes” committee, argues however that private insurance premiums are not so high that people could not afford them. Nor would the cost of an abortion “reduce someone to beggary”, she says.

Supporters point to studies carried out in the US that show that when abortion is funded privately, sexuality is handled with greater awareness and individual responsibility. 

* Name withheld

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