Shocking lack of access to and information about abortion and contraception
In late June, millions of American women saw their constitutional right to abortion removed overnight after the Supreme Court overturned the landmark precedent set in 1973 through the Roe v Wade case, which effectively blocked individual states from banning abortion outright. With women’s reproductive rights back at the centre of public debate, governments worldwide – including that of Cyprus – have been forced to reckon with their own approach to the subject.
A discussion last week by the House human rights committee exposed the difficulties faced by those seeking to prevent or terminate a pregnancy in Cyprus, particularly through the national health scheme Gesy. The discussion, tabled by Akel, focused on women’s reproductive and sexual rights, covering access to abortion and contraception, and focusing on which aspects are covered by Gesy.
The legislation was amended in 2018 to legalise abortion in Cyprus in certain cases. It states, a pregnancy can be terminated in a period of up to 19 weeks if it is a consequence of sexual abuse, rape or incest, or at any time if a medical abnormality is detected or if it is expected to create a serious medical issue, either physical or mental, to a woman.
The above is covered by Gesy. However another provision – which states that a pregnant woman can choose to have an abortion for any reason during the first 12 weeks of pregnancy– is not. It is not seen as “medically necessary”, according to Gesy operator the Health Insurance Organisation (HIO).
In a press release, the family planning association, whose head Maria Epaminonda participated in the committee meeting, highlighted that this discrepancy limits access to free-choice abortion to those who can afford to go private, which makes it discriminatory.
At one Nicosia district school, some girls have taken matters into their hands. They have established an informal fund to which they contribute in case one girl in their group needs an abortion.
“Women who can bear the financial cost of terminating an unwanted pregnancy will have options, while women who are unable to pay the prohibitive cost in the private sector are forced to proceed with a pregnancy they do not want, or refer to unsafe ways to terminate,” it said.
“We hope that the HIO will reconsider its decision and recognise that the decision to terminate a pregnancy cannot be approached like plastic surgery, which is not ‘medically necessary’.”
Speaking to the Sunday Mail, Epaminonda explained the procedure of terminating a pregnancy under the 19-week rule through Gesy, which on paper is booked just like any other operation through a state hospital. But in reality, getting an abortion is not as straightforward, with women having to face additional obstacles.
“It has been reported to us in several cases that some hospitals in certain districts have turned away women seeking to terminate, telling them abortions are illegal,” she said. “Some were even refused an appointment, either from receptionists or medical professionals telling them to go elsewhere.”
Shockingly, an Okypy representative confirmed during the committee meeting that some anaesthesiologists refused to offer their services for abortion procedures citing religious beliefs, which has forced the state health services organisation to outsource them.
When a doctor refuses to perform an abortion, a woman who is already in a difficult position has to make additional calls and plead with doctors in hopes of finding someone who will carry out the procedure, Epaminonda said, suggesting that instead, Gesy should establish a referral system so that those seeking abortions can be automatically redirected to someone who is willing to perform them.
Some women are tempted to falsely say they have been raped to gain a Gesy abortion. Asked whether additional proof is needed to confirm that a pregnancy is the result of rape, Epaminonda said that while pre-2018 a woman would need a certificate from the police, today her word is enough, as it is commonly known that rapes are underreported. “If a woman says it is rape then that’s enough,” she said, stressing that this is again tricky to navigate as it could make a genuine rape victim feel more exposed.
“On the other hand, provided she knows the legislation, a woman could say she has been raped in order to make sure she gets an abortion, which again would put her in a difficult position by forcing her to lie about her circumstances to have access to a service she is entitled to as a basic right.
“Most women that call us want to know if abortion is legal, where and if they can get one…they don’t know their rights, what the legislation says, or where to go for support or services,” Epaminonda said.
She added that there is a serious lack of information on reproductive and sexual health in Cyprus, and the information that does exist is not widely accessible. “There is nowhere people can go to find the information they need on these issues, and this is the people who have access to the internet, or a phone, or those who can read Greek.”
Epaminonda said this extends to medical professionals themselves, who only received a circular with the updated legislation in 2018 after making a complaint to the HIO. During the discussion last week, Disy deputy Rita Superman raised the issue of a lack of figures on abortions, which the HIO tried to justify by saying the reason for that was that the legislation was revised quite recently.
Asked whether there is a possibility that doctors don’t log the abortions they carry out, Epaminonda speculated that due to the stigma associated with abortion, many could be hiding it.
“Doctors have the power here. So even if let’s say they perform 50 abortions a month, they could be logging them in the system as something else, something related, and there’s really nobody to check that, there are no control systems.”
But Epaminonda pointed out that we don’t have data on other aspects of reproductive rights that are not considered taboo, like STI numbers. “We don’t even know how or where to get tested in Cyprus; we don’t have self-tests or drop-in clinics like in the UK, for example,” she said, repeating that there is not enough information about sexual health in general.
“We have no data on contraception use, we don’t have a per-age group breakdown… I do hope that Gesy will start retaining this data because it is the only way to know how to draw up future strategies and programmes and how to improve services.”
Epaminonda argued that contraception is another important subject that is rarely discussed in Cyprus, with limited choice and access to different methods, aside from the costs involved which can be prohibitive for some people. In this writer’s experience, some gynaecologists can be reluctant to prescribe the contraceptive pill, which costs around €10, while a woman looking for emergency contraception (the morning after pill) will have to ask for it at a pharmacy and pay about €30.
Another option that is widely used internationally, intrauterine devices (IUD) or coils, are not offered as contraception at state hospitals, according to Epaminonda. “They are fitted for medical reasons – whatever this may mean – which obviously means they will work as contraception as well.”
Some gynaecologists will fit a coil, she explained, but at a cost of around €250, which again is not accessible to everyone. As a comparison, in the UK the NHS runs clinics dedicated to sexual health, where anyone can access information, get tested, and provide contraceptive methods – all offered for free.
Confirming what Epaminonda said, all organisations participating in last week’s discussion agreed that women are not adequately informed about their reproductive rights and are offered no psychological support or counselling before or after they terminate a pregnancy.
Akel MP Giorgos Koukoumas, who led last week’s discussion, said that HIO may have to re-evaluate the definition of “emergency medical procedure”.
“Banning abortions has never, nowhere in the world, contributed to reducing unwanted pregnancies or abortions,” Koukoumas said, stressing that limiting access to safe abortions gives way to unsafe ones and endangers women’s lives.
The State of World Population 2022 report, released in late March by UNFPA, the United Nations sexual and reproductive health agency, showed that nearly half of all the world’s pregnancies, a total of 121 million each year, are unintended. “For the women and girls affected, the most life-altering reproductive choice—whether or not to become pregnant—is no choice at all,” the report said.
“We will continue to push for the inclusion of free-choice abortions to be covered by Gesy upon request, as is provided for in the legislation,” Epaminonda said.
