In the early seventies, like in most European countries, abortion was forbidden. Many abortions were done by non skilled people, so-called "angelmakers", and hospitalization or even death of the patient was not rare. Few doctors ventured to do an abortion, either for gain or for real concern with the fate of the unmarried mother. Most gynecologists declared to be against abortion. Some were so fervently against that they only did it for an exorbitant fee. The public opinion in the Netherlands took an ever increasing liberal view concerning abortion, especially when abortion became possible in other countries. Politicians were about equally divided in conservatives, against, and progressives in favor of abortion. A safe and reliable Abortion Service, initiated by a small group of medical pioneers, was well established when at last in 1981 the Abortion Act was passed.

The Act allows abortions to be done in Hospitals and dedicated Abortion Clinics. A hospital or clinic may be licensed for first trimester abortions only, or for both first- and second trimester abortions (up till 23 weeks). In the Clinics abortions were mostly done under local anesthesia. Nowadays conscious sedation is available for those women who want it. The Hospitals, being of a somewhat conservative nature, generally prefer general anesthesia. At this moment there are some twenty Abortion Clinics in the Netherlands. By law abortion up till 23 weeks is available on demand to every woman in the Netherlands. The doctor should confirm the women's emergency situation, check if the women considered other options, and comes voluntary. For Netherlands subjects and foreign residents the service is free, the clinics are paid on a real cost base by the Government which ensures their non profit character. The only condition is that the woman discusses her case with a doctor and that she waits five days after this discussion to consider meticulously her decision. A clinic may accept a patient on her oral declaration that she met these requirements, proof is not necessary. The woman decides herself whether she wants her pregnancy to be terminated regardless of the advice of her doctor. A minor (under 16 years) needs approval of one of her parents or her guardian. If a minor is estranged from her parents a Court of Justice may approve in loco parentis. If the parents refuse approval the Court may overrule their refusal if that is considered in the interest of the minor. This is the same procedure as in the case of parents refusing their child to undergo a necessary operation or blood transfusion. An appeal on religious reasons is generally not accepted.

A doctor may refuse to cooperate with an abortion but he is not allowed to refuse a woman the possibility. For instance denying that she is pregnant till her pregnancy is too far advanced is considered medical misdemeanor. If he is against abortion he must tell the woman so and advise her to see another doctor.

Although gratis abortion virtually on demand is available to every woman the number of abortions in the Netherlands is the lowest in the world. The friendly and understanding way the woman is encountered prevents psychologic problems and motivates her to accept contraceptive advice. If a woman comes the third time for an abortion she is treated in exactly the same way without reproof. She is advised that she is welcome to come again but that she can better take contraceptives or have a sterilization done. This attitude works. Repeated abortions are rare, and regret seldom. In the southern -catholic- part of the country, the abortion rate is relatively higher than in the liberal northern part. Also contraception is worse, and feelings of guilt after the intervention are more frequent.

Since 1970 more than a million abortions have been done in the Netherlands, most in the Abortion Clinics, less in Hospitals. This number is so great because soon the Netherlands rather than UK became the abortion country in Europe

so that more foreign than dutch women were treated. The number of foreign patients has declined considerably while abortion gradually became available in other countries. The number of complications has remained low. Only one fatal complication occurred in one of the clinics , three fatalities were reported from hospitals, all due to complications of anesthesia. One of these is described in chapter 12. If all patients who underwent an abortion would have delivered a child the number of fatalities would have been 88, that is the maternal death rate for deliveries in the Netherlands. It is therefore safer to have an abortion than a delivery. This interesting aspect of termination of pregnancy is never taken into account by pro life activists, who keep hammering on the dangers of abortion.

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