Abortion care in Georgia: women face big disparity between law and reality
On International Women’s Day, ENRO published a series of new articles highlighting obstacles to women’s reproductive freedom in Georgia, focusing particularly on barriers to abortion care and presenting the work of IPPF’s Georgian member association, HERA XXI.
“Georgia, a low-middle income country located at the crossroads between western Asia and eastern Europe, has come a long way since gaining independence from the Soviet Union in 1991. Back then, violent civil unrest against the authoritarian government caused war on the streets of the capital, Tbilisi, and sent the government fleeing to Armenia. A three-year-long civil war created political instability and crippled the economy. Severe, countrywide corruption marred public and private institutions for decades, and issues like healthcare and social welfare were sent to the very bottom of the priority pile.
Since then, democratic reforms have been implemented and much of the country now dreams of joining the European Union. The iconic blue flags with a circle of gold stars hang everywhere – in youth centres, schools, hospitals and even people’s homes. To this day however, Georgia still faces major issues. Parts of the country are disputed, and large chunks are under Russian control. Unemployment is high - currently 12.6% of the population are out of work, and this figure increases in rural regions.
The outlook for women in the country is poorer than for men. Georgia is a patriarchal society with hangovers from Soviet times about the ‘traditional’ roles women should play – namely that they should be the main caregivers of the family. Georgia is also a religious country, with 83.4% of the population identifying as Orthodox Christian, and there is a lot of stigma surrounding abortion. The country has a long way to go when it comes to women’s reproductive freedom.
Although Georgia’s legislation requires abortion care to be available to women who need it, in reality there are a number of barriers that harm women by making it difficult if not impossible for them to access compassionate, quality care.
These include the limited number of care providers, high costs, biased and non-confidential counselling and mandatory waiting periods. When it comes to family planning, in a country-wide assessment of women’s sexual and reproductive health rights, IPPF's Georgian member HERA XXI estimates that only 17% of women in the country have received family planning information from professional sources.
The obstacles and barriers which prevent women from accessing compassionate abortion care in Georgia are part of a broader trend. Across Europe and in countries which are strongly influenced by ultraconservative, patriarchal values in neighbouring Russia, coordinated actions by reproductive bullies result in regressive pressures and policies.
With little government support, HERA XXI is working to ensure sexual and reproductive health care and sexuality education for women and young people across the country. The organisation carries out political advocacy to encourage decision-makers to improve women’s access to care. They work with clinics to support the introduction of safer abortion methods, and thanks to a partnership with UNFPA, enable them to provide some contraceptive care free of charge. They also run a peer-to-peer sexuality education scheme, enabling young people to support their friends in developing crucial life skills needed to navigate relationships and sexuality.
However, with limited funding, HERA XXI alone cannot meet the need. In Akhaltsikhe, a small city in the southwest of Georgia with high levels of poverty and unemployment, for example, they are one of the few organisations providing sexual and reproductive health care and education. Yet they are only able to cover a relatively small part of the region, according to Youth Leader Marine Sudadze. “If we had more funding we would scale up and enter more villages. Large areas of the community are still not being reached,” she says.”
When governments deny women free and safe reproductive lives – Here is Tamar's story
“Tamar (not her real name) was 30 and a mother of two children when she found out she was facing an unintended pregnancy. She and her husband had endured a miserable marriage and were in the process of splitting up, and although employed as a teacher, she couldn’t afford to raise another child alone. “The salary doesn’t pay that well. It’s not enough to meet basic needs. My job is not enough to support my family, no way,” she says.
Tamar, now 45, lives in the southwest of Georgia. Poverty levels are high in her region and life for communities can be hard. Women tend to be caregivers, at home raising children, and many people are unemployed. There are many obstacles to women’s sexual and reproductive freedom.
IPPF member HERA XXI is one of the few organisations providing sexual and reproductive health care and sexuality education to women and young people in this region, which comprises the city of Akhaltsikhe and surrounding villages. They’re only able to cover a relatively small part of the area according to Marine Sudadze, a community leader and director of HERA XXI's local youth centre. She says a big problem is that the government neglects women’s sexual and reproductive health and rights: “They will claim that they are funding programmes that benefit women, but when it comes to reproductive health we don’t see that support,” she says.
One major problem that results in unintended pregnancies is the state’s ongoing failure to equip young people with crucial life skills relating to sexuality and relationships. “Back then I couldn’t even recognise a condom, it was something very alien,” says Tamar, referring to the period before her first unintended pregnancy.
As abortion care takes place in private clinics across Georgia, the price of the treatment can vary greatly. Generally, however, it is very expensive for women from smaller cities and rural communities like Tamar. Because of the prohibitive cost, many attempt to take matters into their own hands.
“When I found out I was pregnant and I tried to end the pregnancy with a self-administered calcium injection,” says Tamar. The injection caused blood poisoning and proved to be life-threatening. Tamar needed emergency medical treatment.
“It was terrible; first of all I was trying to hide what I had done. I was also very angry about not getting support,” says Tamar, who felt abandoned by her government for not providing the health education or affordable care that would have protected her from harm. Only after recovering from this painful experience did Tamar finally receive contraceptive care from the doctors.
About five years ago Tamar was faced with another unintended pregnancy during an informal relationship. She describes feeling that her only option was to end the pregnancy. “I was worried what people would think… It wasn’t a problem for me to have a child out of wedlock, but it would have been a problem in my community,” she says. Tamar explains that many elements of a woman’s sexual and reproductive lives are stigmatised in the region. “A woman might be ashamed if someone found contraception in their handbag, they’re worried that they’ll be criticised or mocked. Even if a woman buys a pregnancy test, people have a reaction to that, because during communist times sex was hidden away, it was not openly talked about,” she says. Georgia was part of the Soviet Union from 1921 to 1991, and many values and traditions from this time persist across the country.
Stigma and discrimination resulting from patriarchal cultural norms force many Georgian women to travel long distances to other cities, at great financial burden, to preserve their privacy. Shockingly, they are also perpetuated by medical professionals, many of whom deny women compassionate, confidential care. This was the case for Tamar, who had to rely on the help of her family to get the support and treatment she needed. “My brothers had to pay for me to go to the doctor and have the abortion. It was not only about the paying, it was also getting the required attention. It was complicated; they used their connections.”
Like many women, Tamar wanted to keep the abortion secret as she was worried about mistreatment from her community, but when she got to the surgery, “I found that the doctors knew my ex-husband. They did not respect my wish to keep it secret,” says Tamar. The doctor violated her right to privacy by sharing her personal information with her ex-husband against her wishes.
Five years later, she doesn’t feel much has changed for women in the country: “I can’t guarantee my situation could not happen to somebody else, even in modern times,” she says. Yet, despite her painful history and the longstanding challenges to women’s reproductive rights in Georgia, Tamar still manages to look forward: “Although I have gone through hard times, I try to see positives,” she says.
You can read the next blog in IPPF series on obstacles to abortion care and women's reproductive freedom in Georgia and find out how IPPF EN is standing firm against reproductive coercion in Europe and Central Asia.”
Photo: Akhaltsikhe, southwest Georgia. HERA XXI is one of the few organisations providing sexual and reproductive health care and education in the city and surrounding villages.
Credit Jon Spaull/IPPF EN