In March, as Albania entered its national COVID-19 lockdown, Stela*, from a poor Egyptian family living in Tirana, began to worry that she was pregnant. Unsure of where to go for help during the pandemic, which has caused many clinics to suspend sexual and reproductive health services, she decided to “self-abort”.
She managed to reach a hospital a few days later, and found out that she wasn’t pregnant, but she had already tried a dangerous “traditional way” to end pregnancies. "I got a glass full of red wine, boiled it well, emptied the contents of a package of aspirin [containing several tablets], mixed it until they all melted and I drank it,” Stela explains.
While women in Albania have had rights to safe, legal abortion, on request, since 1995, the pandemic has shut down many of these services. While reduced access to abortion under coronavirus has become a major news issue internationally, it has not been reported by the media in most of the Western Balkans.
As in other countries, rights advocates warn that restricted access is deepening pre-existing divides, with poor and migrant women hardest hit. Bruna Hylviu, Executive Director of the Albania Center of Population and Development, fears that one of the consequences of COVID-19 will be a rise in unsafe abortions.
She says her group, which is a member of the International Planned Parenthood Federation (IPPF), usually runs mobile clinics that are the only providers of abortion services for many migrant and rural women. Although Albania began easing its lockdown at the start of May, these mobile clinics are still not operating.
In Tirana, Albania’s capital, gynaecologist Avenir Balili said that his private clinic is also “closed for the second month in a row because of patients’ fear [to contract the virus] and their inability to move".
He is using Skype to continue consultations during the lockdown, which is set to last until June. Women living in more remote areas, and without internet access, are likely suffering the most from the lack of gynaecological services during the crisis, said Balili.
But Mirela Rista, a doctor at the Koço Glozheni obstetrics and gynaecology hospital in Tirana, said these services were now almost impossible to access in the city too.
During the first six weeks of Albania’s lockdown, Rista said, most abortions were being postponed as well as contraceptive consultations. Since then, the situation for women has worsened and "the pandemic has led to the closure of gynaecological services in private clinics and in all public institutions”.
Suspended services worldwide
Around the world, the coronavirus outbreak is challenging every national health system. A survey conducted by the International Planned Parenthood Federation (IPPF) found that thousands of clinics have closed, and many countries are experiencing shortages of contraceptives and HIV medicines too.
These impacts have received widespread media coverage internationally. The World Health Organization has classified reproductive health services as “essential” and governments including in France, Ireland, England and Wales have introduced new measures to enable telemedicine appointments for medical abortions.
The Balkans region has been particularly affected by clinic closures, according to IPPF’s survey, while another report from IPPF and the European Parliamentary Forum for Sexual and Reproductive Rights found that some services for Roma girls and women have been suspended across Bulgaria, Romania and Serbia.
"They didn't accept me, they said the wards were closed and they couldn’t do anything"
In Albania, Kristina*, a woman from the Roma community in the Shkoza neighbourhood on the outskirts of Tirana, told openDemocracy that when she called hospitals and clinics looking for an abortion, “they didn't accept me, they said the wards were closed and they couldn’t do anything".
She is worried about how she will support a second child “because I’m barely able to raise my other boy”, as she lives off a small income from odd jobs. But because of the pandemic’s impact on services, she doesn’t have a choice.
Ervis Daka, executive director of the Community Action Center, an NGO which supports the rights of Roma and Egyptian communities in Albania, said they had fought for a clinic in the Shkoza neighbourhood since 2018 without success, and that the pandemic is compounding the long-standing lack of services.
Hylviu from the Albania Center of Population and Development thinks these problems could have been averted or limited if medical abortions were more widely available. This involves taking two pills – mifepristone and misoprostol – over three to five days, but medical abortions have not yet been legalised in Albania.
According to another 2020 report from IPPF, medical abortion has not yet been legalised in Albania and Bosnia and Herzegovina – although “medication is available however in these countries on the black market through various means”.
As the government starts to ease movement restrictions, Hylviu says access to abortion may improve but women might still avoid or delay visiting hospitals in fear of contracting the virus.
Intensified obstacles in Serbia
Women in Serbia have similarly been affected, with the pandemic intensifying long-standing obstacles to accessing services, particularly for the Roma community.
One of these obstacles is the fact that a woman must first get a referral from a doctor before visiting a gynaecologist or other specialist for an abortion, says Dragana Stojanovic, executive director of the Association for Sexual and Reproductive Health of Serbia (SRH), another IPPF member.
But this requirement increases women’s risks of being exposed to coronavirus, Stojanovic says, and women have also faced unclear directions from the government on which hospitals still perform abortions.
“In the current situation, a far smaller number of health institutions, both public and private, perform abortions”, said Katarina Sedlecki, a gynaecologist at the national Institute for Maternal and Child Health Care’s Republican Center for Family Planning.
Several clinics confirmed this by phone. A staff member at the Clinic for Gynaecology and Obstetrics in Niš in southern Serbia said: “We accept only emergency cases – that is the order. Abortion service is available only in cases of medical emergency, such as bleeding.”
Bojan Lukić, head of the Clinical Hospital Center’s gynaecology department in Niš, said that abortions have been suspended because of coronavirus and hospitals have been instructed to put all resources, including anaesthesiologists, in the service of combatting COVID-19.
Sofija Mandić, a lawyer and board member of the NGO, Centre for Women's Support, said that such orders would be against Serbian law as the constitution says that “everyone has the right to decide freely on the birth of children”.
“This freedom cannot be abolished or restricted during a state of emergency and war, by any means,” Mandić stresses.
The family planning centre’s Sedlecki said that women who are determined to access abortion services will be able to find a way even during the current crisis as some private clinics are still providing services.
But these services are costly, even at public hospitals. With average net incomes around 500 euros a month, having an abortion in Serbia can cost between one third or one half of a monthly salary.
Such costs, said Stojanović at the Association for Sexual and Reproductive Health, seem to be an “attempt to punish women who want to terminate their pregnancy” and undermine women’s right to choose.
* Names changed to protect privacy.
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