Abortion Conference (Week 7)

1) Conference Director (greetings and general overview of the program); 1-2 min
2) Taoiseach (as a politician, his views on the importance of the topic); 1 min
3) Moderator (to introduce each speaker before their presentation, and thank them after the
presentation, and address the audience at the end of the Conference with final remarks)

--- invited speaker: Abortion (the student in each group who selected topic 23 – Abortion:
surgical & medical); 8 min

Individual speakers; 3 min each (students in each group to select a topic in advance, to agree
among themselves who is going to talk about each topic, and read in advance about the topic to
be well prepared to talk about it for 3 minutes, i.e. summing up a text or finding the information
in various texts; no reading…; you may add your own views or add details you already know
about the topic; disregard the names of authors of the texts, you will be given another name as a
presenter)

4) Abortion in Europe: Historical and public health perspective

5) Abortion in early America
6) USA: Legal perspective; Roe vs. Wade
7) USA: The post-Roe country
8) US Congress – legal observations (Women's Protection Act 2021)
9) Abortion in Eastern Europe: Romania
10) Ireland: case study
11) Abortion in Croatia: case study
ABORTION

Excerpts for mini conference:

______________________________________________________________

David HP. Abortion in Europe, 1920-91: a public health perspective. Stud Fam Plann
1992;23(1):1-22

The article is a byproduct of a conference on Abortion and Public Health Approaches to Reducing
Unwanted Pregnancy through Improved Family Planning (FP) Services, held in Tbilisi, Georgia, USSR,
in October 1990. One thought was that the 1990s are a time of "desperate women, troubled health
professionals, and scared politicians." During the reproductive years in developed countries, a
woman is trying to become or actually is pregnant 10% of the time, and 90% of the time she is
avoiding more births or trying to postpone births. Abortion rates show a decline in the countries
where legal abortion is part of a comprehensive family planning program. The lowest rates are in the
Netherlands. Historically Plato recommended abortion for women 40 years, while Hippocrates spoke
against it. During the Dark and Middle Ages, women managed their own fertility regulation including
clandestine abortions. In England in 1803, severe restrictions were put on abortion and other
European and North American countries followed the example. The focus was on preventing life-
threatening infection. The early Hebrews fined for abortion, and the Christians followed, with neither
group considering the act as murder. The techniques had been around for 2.5 millennia, and the last
refinement of technique occurred in 1972. The Catholic Church in 1869 punished with
excommunication the aborting woman and the provider and in 1895, condemned explicitly and
publicly any therapeutic abortion. Medical restraints were common in Europe in the 20th century.
Abortion law has fluctuated in restrictiveness since the turn of the century. Restrictions have been
eased due to recognition of the public health threat, support for women's rights, access to modern
contraceptives, and liberalization of legislation on fertility regulation. There is a growing awareness
that abortion cannot be obliterated by legal codes. It is expected that increases in the use and access
to modern contraceptives will lead to a decline in abortion. The Tbilisi Declaration affirms the right of
reproductive freedom.

______________________________________________________________

Acevedo Z. Abortion in early America. Women Health 1979;4(2):159-67

Abortion was frequently practiced in North America during the period from 1600 to 1900. Many
tribal societies knew how to induce abortions. They used a variety of methods including the use of
black root and cedar root as abortifacient agents. During the colonial period, the legality of abortion
varied from colony to colony and reflected the attitude of the European country which controlled the
specific colony. In the British colonies abortions were legal if they were performed prior to
quickening. In the French colonies abortions were frequently performed despite the fact that they
were considered to be illegal. In the Spanish and Portuguese colonies abortion was illegal. From 1776
until the mid-1800s abortion was viewed as socially unacceptable; however, abortions were not
illegal in most states. During the 1860s a number of states passed anti-abortion laws. Most of these
laws were ambiguous and difficult to enforce. After 1860 stronger anti-abortion laws were passed
and these laws were more vigorously enforced. As a result, many women began to utilize illegal
underground abortion services. Although abortion was legalized in 1970, many women are still
forced to obtain illegal abortion or to perform self-abortions due to the economic constraints
imposed by the Hyde Amendment and the unavailability of services in many areas. Throughout the
colonial period and during the early years of the republic, the abortion situation for slave women was
different than for other women. Slaves were subject to the rules of their owners, and the owners
refused to allow their slaves to terminate pregnancies. The owners wanted their slaves to produce as
many children as possible since these children belonged to the slave owners. This situation persisted
until the end of the slavery era.

______________________________________________________________

Kunins H, Rosenfield A. Abortion: A legal and public health perspective. Annu Rev Publ Health
1991;12:361-82

The decriminalization of abortion in the United States, which began in the late 1950s and culminated
with the Roe v. Wade decision in 1973, is well known. (…)

In the latter half of the nineteenth century, the practice of abortion in the US shifted from one
governed by earlier British common law to a heavily regulated, and criminalized, medical procedure.
This period matched our own for the amount of controversy and debate surrounding abortion. Many
of the themes that characterize the current controversy emerged from the controversy and debate
that occurred in this earlier period. Before the nineteenth century, no legislation had been passed in
the US regarding the legality of abortion. Thus, American courts relied on British common law
doctrine to hand down decisions. Under common law, abortion was a criminal act only after the
pregnant woman felt fetal movement (quickening). Before quickening, however, abortion was not
criminal; at that time, it was medically impossible to confirm a pregnancy before quickening had
occurred. During the first half of the nineteenth century, many state legislatures began to pass laws
that regulated the practice of abortion. These laws largely preserved the common law doctrine of
quickening; however, they set precedents for the practice of abortion to be subjected to statutory,
rather than common law, regulation. From 1860 to 1880, state legislatures again intervened in the
issue of abortion. (…)

In addition, many of the laws held the woman, as well as the abortionist, criminally liable. The major
advocates for criminalization of abortion were an emerging group of organized doctors primarily
associated with the American Medical Association (AMA) and anti-obscenity crusaders led by
Anthony Comstock. Surprisingly, feminists supported doctors in their anti-abortion stance, whereas
religious groups were virtually absent from the debates. Physicians associated with the AMA, which
had been formed in 1847, were a dominant, if not major, force in criminalizing abortion in the United
States. Through their writings, lectures, and, perhaps most importantly, their successful lobbying of
state legislators to pass anti-abortion statutes, these doctors galvanized efforts to restrict the
practice of abortion. Historians attribute a variety of motivations to the physicians' anti-abortion
position, which ranged from the explicit concerns for maternal health and issues of morality to the
more subtle, and often unstated, designs for professional power and control over women's fertility.

(…)
In 1973, the Roe v. Wade decision established a woman's constitutional right to an abortion. A Texan,
Jane Roe (alias), sued to obtain an abortion although her life was not threatened by the pregnancy.
Her claim was that a Texas statute prohibiting abortion infringed on her right of privacy. Justice
Blackmun delivered the landmark decision that upheld Roe's right of privacy to terminate an
unwanted pregnancy. The ruling established a trimester framework by which the state's interest in
potential life of the fetus and in women's health becomes more compelling as the pregnancy
progresses. (…)

Under the trimester framework, abortion is not regulable by the State during the first trimester. At
this stage, the State lacks a compelling interest in either the health of the mother or the potential life
of the fetus. Blackmun accorded formal responsibility to the medical doctor by stating that for first
trimester abortions, "the abortion decision and its effectuation must be left to the medical judgment
of the pregnant woman's attending physician". In the second trimester, the State's interest in the
woman's health becomes compelling; therefore, the State may regulate abortion to protect women's
health. Blackmun argued that the State's interest in potential life becomes compelling at the point in
the pregnancy when the fetus becomes viable. From Roe, we implicitly understand viability to be at
the beginning of the third trimester, at which time the State may "regulate, and even proscribe,
abortion except where it is necessary, in appropriate medical judgment, for the preservation of the
life or health of the mother".

Blackmun's denial of judicial responsibility for the decision regarding the point at which life begins
created an important model for federal involvement in that problematic question: "We need not
resolve the difficult question of when life begins. When those trained in the respective disciplines of
medicine, philosophy, and theology are unable to arrive at any consensus, the judiciary, at this point
in the development of man's [sic] knowledge , is not in a position to speculate as to the answer".
However, Blackmun noted that fetuses have never been regarded in the law as full persons. Thus,
according to Blackmun, the State interest in protecting life becomes compelling when the fetus is
able to exist outside the mother's womb as a separate and full person. This is the viability point
during the pregnancy, when the State may regulate or proscribe abortion to protect its interest.
Blackmun stated that viability occurs at the earliest at 24 weeks. (…)

Abortion laws were liberalized in several states a few years before the Roe v. Wade decision, but only
four states, Alaska, Hawaii, New York and Washington, had abortion laws that were compatible with
Roe. Fifteen other states had somewhat liberalized abortion laws that needed modification after the
Roe decision. All other states needed to completely reform their state laws.

Abortion-Related Complications and Mortality

Abortions have been among the most commonly performed surgical procedures since the Roe v.
Wade decision. When performed by properly trained personnel, they are also among the safest.

In 1985, slightly more than 50% of abortions at more than 21 weeks LMP were performed using
dilatation and evacuation; and nearly two thirds of abortions between 16 and 20 weeks LMP were
performed with this method. Hysterectomies and hysterotomies, as methods of abortion, had
virtually disappeared in 1982.

Abortion in an International Context

As of 1 990, approximately three quarters of the world's population lives in countries in which
abortion is available for health reasons , but only about 40% live in countries where is is available on
demand . The most restrictive abortion policies exist in Latin America, sub-Saharan Africa, and some
of the fundamentalist Arab nations. Abortion policies in Western, Central, and Eastern Europe are
generally nonrestrictive, with the exception of Ireland and Malta.

Approximately 33 million legal abortions are performed every year. Once the number of illegal
abortions is added, that number rises to an estimated 40 to 60 million . Fourteen million and 11
million abortions are performed each year in China and the Soviet Union, respectively.

Romania provides an often quoted example of the effect of changing abortion policy on population
fertility rates and abortion-related mortality rates. Abortion policies were first liberalized in 1957 and
were followed by a decline in the birth rate. In 1966, abortion laws were tightened in the first
pronatalist policy changes. The birth rate rose from 14.3 per 1,000 population in 1966 to 26.7 in
1968, which suggests that women were no longer terminating pregnancies at the same rate. By 1983,
however, the birth rate had again dropped to its original rate, mainly because of both an increase in
the practice of contraception and illegal abortion. (…) The pronatalist policies of the Ceaucescu
Government were so onerous that liberalization of the abortion policy was one of the very first
actions of the new Government in December 1989, after Ceaucescu was overthrown. (…)

Overall, the World Health Organization has estimated that 20%-40% of all maternal deaths in
developing countries are due to complications of illegal and/or unsafely performed abortion
procedures.

______________________________________________________________

Sofer D. Abortion Care in America. American Journal of Nursing 2022;122(10):16-18

As early as 1993, in a letter to the New York Times, a Colorado physician wrote, “The use of the word
‘abortionist’ in [your] headline . . . was highly offensive to many physicians such as myself who
provide abortion services. . . . [This] is a highly charged word that is pejorative, derogatory, and
defamatory. . . . The world has changed, and I would hope your usage reflected that.”

Nearly three decades later, Justice Samuel Alito used this very word when writing the June 24
majority opinion in the case of Dobbs v. Jackson Women's Health Organization to refer to clinicians
providing abortion care. The ruling, which overturned the 1973 Roe v. Wade decision by proclaiming
the U.S. Constitution does not protect the right to an abortion, has transferred abortion care from
the health care arena to the legislature, using words such as “abortionist” to suggest criminality and
leaving each state to determine its own stance.

“In a post-Roe country,” write law professor David S. Cohen and colleagues in a draft article, “The
New Abortion Battleground,” to be published in 2023 in the Columbia Law Review, “states will
attempt to impose their local abortion policies as widely as possible, even across state lines, and will
battle one another over these choices; at the same time, the federal government may intervene to
thwart state attempts to control abortion law. In other words, the interjurisdictional abortion wars
are coming.” (…)

At least 12 states—Alabama, Arkansas, Idaho, Kentucky, Louisiana, Mississippi, Missouri, Oklahoma,

South Dakota, Tennessee, Texas, and Wisconsin—have banned abortions, in most cases with no
exceptions for rape or incest. (Last year, Texas passed another law, known as the Texas Heartbeat
Act, severely limiting abortions; its total ban took effect on September 1, 2021.) Another five states—
Ohio, Georgia, North Carolina, Utah, and Florida—have banned abortion at six, 15, 18, or 20 weeks.
As we went to press, an abortion ban in Indiana was expected to soon take effect. Bans in Arizona,
Iowa, Michigan, Montana, North Dakota, South Carolina, West Virginia, and Wyoming are
temporarily blocked as legal challenges make their way through the courts.

Countering these bans, some states are expanding abortion protections. These include California,
Connecticut, Hawaii, Illinois, Minnesota, New Jersey, New York, Oregon, Vermont, and Washington.
New York Governor Kathy Hochul, for instance, has created a $25 million abortion provider support
fund and allocated an additional $10 million toward security grants for reproductive health care
centers. Other states are leaving the decision to voters…

FEAR OF PROSECUTION

The penalty for violating bans can be draconian. In Texas, according to the Guttmacher Institute, it
can result in a first- or second-degree felony charge and a civil penalty of at least $100,000. This
would equate abortion with crimes such as attempted capital murder, aggravated sexual assault, and
aggravated kidnapping, which carry sentences of five to 99 years or life in prison.

Although even the strictest abortion bans provide exceptions for when the pregnant person's life is in
danger, such exceptions may be meaningless, as “danger” can be ambiguous and not necessarily
immediate. Among the best-known examples of clinicians' fear of prosecution despite a patient's
deteriorating condition is the 2012 case in Ireland of Savita Halappanavar, a dentist who was having
a miscarriage at 17 weeks' gestation but was denied an abortion while fetal heart activity was
present. By the time heart activity had stopped, Halappanavar had become irreversibly septic and
died at age 31. Her case led to Ireland's 2013 Protection of Life During Pregnancy Act, giving Irish
women the right to an abortion if their life is in danger or if there's a risk of suicide.

“Many of the procedures and medications used to perform induced abortions in the United States
are also crucial for treating spontaneous abortions (or miscarriages),” says Sandra K. Cesario, PhD,
MS, RNC, FAAN, professor and PhD program director in the College of Nursing at Texas Woman's
University in Houston and president of the Association of Women's Health, Obstetric and Neonatal
Nurses. “There is fear among health care professionals that they will be prosecuted for performing
an induced abortion while administering care for a woman experiencing a spontaneous abortion.”

A study at two Texas hospitals in the aftermath of the state's abortion legislation is providing early
evidence of clinicians' fear. Of 28 women at 22 weeks' gestation or less presenting with
complications such as preterm premature rupture of membranes, preeclampsia with severe features,
or vaginal bleeding, 57% suffered serious maternal morbidity compared with 33% who were able to
terminate their pregnancies under similar clinical circumstances in states that do not have abortion
restrictions. Maternal morbidity included conditions such as clinical chorioamnionitis and
hemorrhage. Nine patients required intensive care admission, dilatation and curettage, or
readmission. “Because of the intense politicization of these issues nationally,” write the researchers
July 5 online in the American Journal of Obstetrics and Gynecology, “some have questioned, ‘What
does the threat of death have to be?’ and ‘How imminent must it be?’”

Katie Watson, JD, a lawyer, bioethicist, and associate professor at Northwestern University in
Chicago, says that although clinicians' concern for their own safety and livelihood is justified, “they
should be interpreting the risk to the patient, not the law.” The Dobbs decision, she adds, is making
legislators practice medicine. “Health care providers need to remember that they must be the ones
practicing medicine, not legislators.”
PERSONAL BELIEFS AND ETHICAL BEHAVIOR

This also brings up the question of ethical behavior: what if a clinician's personal beliefs do not align
with the laws of the state in which they practice?

In states where abortion remains legal, abortion providers who don't believe in reproductive rights
may choose to refrain based on “conscientious refusal.” However, Watson stresses, the objection
must be conducted according to the definition set in an American College of Obstetricians and
Gynecologists Committee Opinion, which states, “Conscientious refusals should be limited if they
constitute an imposition of religious or moral beliefs on patients, negatively affect a patient's health,
are based on scientific misinformation, or create or reinforce racial or socioeconomic inequalities. . . .
Physicians and other health care providers have the duty to refer patients in a timely manner to
other providers if they do not feel that they can in conscience provide the standard reproductive
services that patients request.” In other words, says Watson, “Is ‘conscience’ being used as a shield
or a club? Is it being used as sabotage?”

And what of the reverse situation—the clinician who lives in a state where abortion is banned but
believes providing abortion care is an ethical duty? “Crisis of conscience includes affirmative
conscience,” Watson says. “We tend to talk about conscience as a decision to not participate in
something. But a crisis of conscience can also occur if we are prevented from doing what we believe
is right. At that point, the provider has to struggle between the law and ethics. Should I violate the
law or should I violate my ethics? Everyone will have to assess their own risk tolerance and their
personal situation.”

CURRENT ABORTION OPTIONS

Currently, the regimen approved by the Food and Drug Administration (FDA) for medication abortion
consists of two prescription medications: mifepristone, which blocks progesterone, and misoprostol,
taken 24 to 48 hours later, which causes the uterus to contract and the pregnancy to end. This type
of abortion is FDA sanctioned for up to 10 weeks of gestational age but is used safely off label later
(the World Health Organization recommends its use until 12 weeks).

Two weeks after the reversal of Roe, President Biden signed an executive order to protect access to
reproductive health care services, improve public education, and ensure that pregnant people
receive the emergency medical care afforded to them under the Emergency Medical Treatment and
Labor Act (EMTALA). Days later, Health and Human Services Secretary Xavier Becerra wrote a letter
to providers reminding them of their obligations under EMTALA; within days, Texas filed a lawsuit
against him and other administration health officials.

IMPACT ON MATERNAL MORBIDITY AND MORTALITY

“Black women in the United States are more than three times more likely to die from complications
of pregnancy and birth, such as blood pressure disorders, hemorrhage, cardiomyopathy, embolism,
ectopic pregnancy, and surgical complications following cesarean sections,” says Cesario. “And,
because pregnancy complications are riskier than abortion, I am concerned that recent initiatives to
restrict abortion access could lead to even more deaths of Black women, worsening the disparity.
This issue also extends to other women of color, especially indigenous/Native American women
whose mortality rates are higher than those of White women. Immigrant women (who are most
often women of color) are also at risk for not being able to obtain needed services. Hesitancy to seek
health care, especially if they have to cross state lines, leaves them with few options.” (…)
“For 49 years,” says Watson, “opponents of abortion were not able to change hearts and minds. So
now they are doing it by force. But what is happening is not medicine.” For health care providers, she
adds, it comes down to this: “What will you be proud of in five years and what will you be ashamed
of? What side of history do you want to be on?”

______________________________________________________________

“Women’s Health Protection Act of 2021”

Link: Text - H.R.3755 - 117th Congress (2021-2022): Women's Health Protection Act of 2021 |
Congress.gov | Library of Congress

(1) Abortion services are essential to health care and access to those services is central to people’s
ability to participate equally in the economic and social life of the United States. Abortion access
allows people who are pregnant to make their own decisions about their pregnancies, their families,
and their lives.
(2) Since 1973, the Supreme Court repeatedly has recognized the constitutional right to terminate a
pregnancy before fetal viability, and to terminate a pregnancy after fetal viability where it is necessary,
in the good-faith medical judgment of the treating health care professional, for the preservation of the
life or health of the person who is pregnant.
(7) Abortion-specific restrictions are a tool of gender oppression, as they target health care services
that are used primarily by women. These paternalistic restrictions rely on and reinforce harmful
stereotypes about gender roles, women’s decision-making, and women’s need for protection instead of
support, undermining their ability to control their own lives and well-being. These restrictions harm
the basic autonomy, dignity, and equality of women, and their ability to participate in the social and
economic life of the Nation.
(16) International human rights law recognizes that access to abortion is intrinsically linked to the
rights to life, health, equality and non-discrimination, privacy, and freedom from ill-treatment. United
Nations (UN) human rights treaty monitoring bodies have found that legal abortion services, like other
reproductive health care services, must be available, accessible, affordable, acceptable, and of good
quality. UN human rights treaty bodies have likewise condemned medically unnecessary barriers to
abortion services, including mandatory waiting periods, biased counseling requirements, and third-
party authorization requirements.
(18) UN independent human rights experts have expressed particular concern about barriers to
abortion services in the United States. For example, at the conclusion of his 2017 visit to the United
States, the UN Special Rapporteur on extreme poverty and human rights noted concern that low-
income women face legal and practical obstacles to exercising their constitutional right to access
abortion services, trapping many women in cycles of poverty. Similarly, in May 2020, the UN
Working Group on discrimination against women and girls, along with other human rights experts,
expressed concern that some states had manipulated the COVID–19 crisis to restrict access to
abortion, which the experts recognized as “the latest example illustrating a pattern of restrictions and
retrogressions in access to legal abortion care across the country” and reminded U.S. authorities that
abortion care constitutes essential health care that must remain available during and after the
pandemic. They noted that barriers to abortion access exacerbate systemic inequalities and cause
particular harm to marginalized communities, including low-income people, people of color,
immigrants, people with disabilities, and LGBTQ people.
______________________________________________________________

From:

Death of a dentist in Ireland denied an abortion has worried doctors who say history may repeat in
U.S. (nbcnews.com)

This woman died because of an abortion ban. Americans fear they could be next.

By Patrick Smith (July 4, 2022)

After the Supreme Court’s historic decision to overturn Roe v. Wade, some doctors are highlighting
the 2012 death of a pregnant woman in Ireland and warning that the same thing could happen on a
large scale in the U.S.

Dr. Savita Halappanavar, 31, an Indian-born dentist, died in 2012 in Galway, on Ireland’s west coast,
after she was denied an abortion by doctors who cited the country’s strict laws, even though there
was no chance her baby would survive, according to Ireland’s official report on the case.

Her death shook the foundations of the traditionally conservative and predominantly Roman Catholic
country and catalyzed its pro-abortion rights movement. In a 2018 referendum, Irish people voted by
a two-thirds majority to legalize the procedure.

The avoidable death of Halappanavar, who was 17 weeks pregnant, proved that doctors — not
politicians, police and judges — should help decide the best course of action in similar cases, said Dr.
Sabaratnam Arulkumaran, the expert who wrote the official report on the case in 2013.

“That’s why Biden said that the issue should be between the patient and the doctor, rather than with
the law,” he said by phone, referring to President Joe Biden’s speech reacting to the reversal of Roe
v. Wade on June 24.

In Halappanavar’s case, doctors opted against an abortion because the fetus had a heart rate and
anyone carrying out a termination could theoretically have been prosecuted later.

“Because the fetal heart rate was present all the time, the obstetrician did not do a termination. If
someone decided that she had done it illegally, she would have gone to jail,” he said.

Arulkumaran, a professor emeritus of obstetrics and gynecology at St. George’s University of London,
added that women’s lives are at stake in the U.S.

“I think maternal mortality will go up,” he said. “I think those who are going to be affected are those
from lower socioeconomic groups, adolescents, those who don’t have facilities to go for
termination.”

Back pain first sent Halappanavar to Galway University Hospital on Oct. 21, 2012. She was sent home
but returned just hours later after she “felt something coming down” and said she had “pushed a leg
back in.” A midwife confirmed that no fetal parts could be seen, according to the official report. Later
that day, she described the pain as “unbearable,” according to the official report.

She was admitted, and on Oct. 23, a doctor told her a miscarriage was “inevitable” because of the
rupturing of the membranes that protect the fetus in the womb, even though her baby was a normal
size and was registering a heartbeat. The medical team had decided to “monitor the fetal heart in
case an accelerated delivery might be possible once the fetal heart stopped,” the official report said.
In Halappanavar’s case, an accelerated delivery would likely have meant a medically induced
miscarriage.

When Halappanavar and her husband, Praveen, asked on Oct. 23 about medically inducing the
miscarriage instead of delaying the inevitable, a doctor told them, “Under Irish law, if there’s no
evidence of risk to the life of the mother, our hands are tied so long as there’s a fetal heart[beat],”
the official report said.

The report added that once their waters have broken, pregnant women are at very high risk of
infection, which in some cases can be fatal.

On Oct. 28 at 1:09 a.m., having caught an infection and gone into septic shock, Halappanavar was
pronounced dead.

“It was a life-threatening condition, but they took the view of not doing anything because of the legal
framework,” Arulkumaran said in the interview.

______________________________________________________________

Thousands rally in Croatia after woman denied abortion

Thousands have rallied across Croatia in solidarity with a woman who was denied an abortion
despite her fetus having serious health problems
By The Associated Press - May 12, 2022

ZAGREB, Croatia -- Thousands rallied across Croatia Thursday in solidarity with a woman who was
denied an abortion despite her fetus having serious health problems, and whose weeks-long ordeal
has sparked public outrage.

Protests demanding a better public health system and respect of women's right to choice were held
in several cities and towns throughout the predominantly conservative and strongly Catholic nation.

Shouting “Enough!," participants carried banners reading ”Master of my own body" or “Woman's
toughest decision is not yours," as they vowed to “stay angry.”

“Let's be furious and scream until the system provides the health protection we deserve!" one of the
speakers told the noisy crowd in the capital Zagreb. “Changes can come only through solidarity.”

Mirela Cavajda was 20 weeks pregnant when doctors informed her that her fetus had a brain tumor
and no chance of a normal life. She said doctors refused to terminate the pregnancy and advised
Cavajda to seek the procedure in neighboring Slovenia instead.

The case has rekindled a years-long debate about abortion in Croatia, a member of the European
Union. Under public pressure, a medical commission later approved a termination, which the health
authorities said would mean an induced childbirth at this stage.
Abortions are legal and allowed after the 10th week of pregnancy if there are serious health threats
to the woman or fetus but doctors often refuse to perform them. Scores of Croatian women have
traveled abroad for an abortion over the years.

Cavajda said the ordeal has been very hard for her and her family.

"Why prolong the waiting, why should I keep waking up or going to bed wondering if he had died,
whether I’ll get blood poisoning or not?” she said. “The worst is yet to come for me.”

The existing law that permits abortions dates back to 1978, when the country was part of the
Communist-run former Yugoslavia. Croatia became an independent country in 1991, and since then
increasingly influential conservative and religious groups have tried to get abortion banned.