APPENDIX 1 - ABORTION IN THE NETHERLANDS
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.