The number of abortions in Kumanovo is dropping, employees at the Kumanovo General Infirmary inform. The Gynecology and Obstetrics Ward management says that the number of abortions last year (2016) was 227. The number of abortions has reduced recently, especially over the past 10 years. As for the women of Roma ethnicity, only 19 women had an abortion last year, 14 of whom were mothers of three. The reasons for abortion vary, but most often women decide to take this step once they fulfill themselves as mothers and when there are favorable conditions for them to extend their family.
Our two collocutors are mothers, employed women who are successful in their jobs, and one of them is a Roma and the other a Macedonian.
The 42-year-old woman from Kumanovo, employed, a mother of two, has had an abortion recently in the seventh week of her pregnancy. She has refused to go into detail, but she has said that the doctors behaved properly and asked her if she wished to keep the baby. They provided her with all the information about the abortion, including the risk it entails. She visited a psychologist and had a counseling two days before the scheduled abortion. The psychologist gave her material to become familiar with the risks, the method and the procedures applied during abortion. She said that the psychologist showed understanding for her decision when he asked her how many children she already had. She signed a letter of consent at the psychiatrist’s office, after which she talked to the anesthesiologist. Afterward, she paid 4,000 denars and went to the gynecologist with the required documents.
“I personally believe that the counseling is a nuisance and unnecessary when a woman has already decided to have an abortion. It exerts psychological pressure. Furthermore, I had to leave work, wait and waste the time that I had planned to spend on running errands. Also, it made me reconsider my decision,” the 42-year-old Kumanovo resident says.
After the abortion, she received support from the gynecologist, the anesthesiologist and the whole medical staff.
The 34-year-old mother of two underage children and a wife from Kumanovo who spoke on condition of anonymity has told us that she had second thoughts about having an abortion. She says that she became pregnant completely by chance. Both she and her husband are employed, but they barely make ends meet for their family of four with two small children.
“This was a difficult decision, but I really do not have enough income to raise three children. When they are young, we can somehow provide livelihood for them because they wear each other’s clothes, but raising a child is still costly and the expenses grow just as the children do,” the Kumanovo resident says.
She explains that, after her gynecologist told her she was pregnant, she talked to her husband and they decided that she should have an abortion. She attended the counseling with the hospital psychological team. She says that she hesitated all along and that she was sorry that she had to end her pregnancy.
“I really hesitated a lot and I had a guilty conscience because I knew that many women cannot conceive and have pregnancy problems. However, on the other hand, I do have two children who are safe and sound and I sometimes have no money to offer them a decent life, even though I have a job, so a third child is out of the question,” the Kumanovo resident says.
Not even the child support payment for a third child made her change her mind because she believes that this payment suffices when the children are smaller, but not when they grow up. Furthermore, she says that she was afraid of the complications after the abortion. She terminated her pregnancy when she was six weeks pregnant.
Biljana Ivanovska, a psychologist at the Kumanovo General Infirmary, explains that, after the gynecologist determines that a patient is pregnant, in compliance with the protocol, he sends her to the hospital psychological service.
“Two Health Ministry forms are completed here, one of which informs the patients of the risks during pregnancy termination. We try to make our patients change their mind, but they are usually adamant when it comes to having an abortion,” Ivanovska explains.
She adds that there have been cases when the patient has been dissuaded.
“This rarely happens, but this is a great success both for us and the mother,” Ivanovska says.
Part of the psychologists on this team explain that they refuse to burden additionally their patients with the protocols that are imposed after such interventions. The psychologists stress that the women are already having a hard time, so they do not pressure them to change their mind.
The Gynecology and Obstetrics Ward head, Dr. Niso Tasov, says that sometimes patients decide not to have an abortion on their own.
“It is most often women older than 35 who already have grownup children and who become pregnant by accident that have an abortion,” Dr. Tasov explains.
He adds that, usually, when the mother is healthy, they try to dissuade her. In most cases, the partner or another family member helps them with the dissuasion. However, he adds that they agree to an abortion if the woman has already had two Caesarian sections or certain health issues because her health may deteriorate during pregnancy, but he underlines that it is important that she has at least two children.
“In 99%, we advise them not to have an abortion,” Dr. Tasov asserts. He recalls that 15-20 years ago, that is, in 1998, 1999, 2000, 2001 and 2002, the number of abortions were about 800 a year.
“I believe that women receive more information nowadays, they use contraception and they pay attention to their health because we always tell them that every abortion, regardless of how successful it is, has certain consequences,” Dr. Tasov adds.
According to Dr. Tasov, apart from women obtaining more information about birth control, the psychological counselling, which the Health Ministry has introduced, as well as the child support payment for a third child, also plays a part.
“I think that this is of great importance,” Tasov says.
It is important that the woman should receive counseling on time. He informs that abortion complications have been reduced to a minimum, but explains that, in medicine, “two and two do not always make four.”
“Abortion can cause complications in the form of coagulation, inflammation, and so forth,” Dr. Tasov says.
The abortion risks and complications increase if the abortion is performed at the later stages of pregnancy and they depend on the method used, the gynecologist’s experience, the women’s behavior after abortion. The risks increase if the abortion is performed during first pregnancy. Some complications, such as heavy bleeding, uterine wall injuries (perforation), complications from anesthesia, shock, and even death, may occur during the intervention itself or four hours later. As for the complications that can occur later, these are: bleeding over a leftover tissue, inflammation of the genital organs, failure to terminate the pregnancy, ectopic pregnancy that has not been determined during the intervention, varicose veins and so forth. Belated complications may occur one month after the abortion or later in the form of the inability to get pregnant again, increased risk of spontaneous abortion and premature births, Rh sensitization (if the woman has an Rh negative factor, but failed to receive protective injection after the abortion), irregular menstruation cycle, vaginal discharge and the like.
Dr. Tasov recommends the women to pay special attention to their health after an abortion, rest more, drink antibiotics and see a doctor if they are bleeding.