Legal abortion comes to Portugal

For years, Portuguese women seeking an abortion crossed over the border to Spain, where Yolanda Hernandez awaited.

Now, Hernandez is coming to them.

In the abortion business for nearly three decades, Hernandez is opening Portugal’s first private abortion clinic.

Sitting on the top of a hill just off an important Lisbon thoroughfare, Avenida da Liberdade, this imposing white building is no back-alley basement. Glass doors under a large sign declaring the clinic’s name, Dos Arcos, lead into a spacious waiting room lined with freshly painted royal-blue chairs.

A staff of 22 Spanish and Portuguese gynecologists, technicians and administrators was in place the other day, and receptionists were busily penciling in the first appointments. Thirty women showed up on opening day.

“We are the first clinic,” said Hernandez, who has been preparing for this moment for years. “After us, many more will come along.”

Until this month, heavily Catholic Portugal remained one of the last countries in Europe forbidding most abortions. In addition, it was the rare country that criminally prosecuted women who had abortions and doctors who performed them -- a legal regime that the Portuguese prime minister described as a “national disgrace” and that critics elsewhere branded as “medieval.”

Seen as modernization

A law that went into effect this month makes Hernandez’s clinic possible and brings Portugal in line with the majority of its fellow European Union members. Abortions can now be performed without restriction during the first 10 weeks of pregnancy, and under some circumstances through the second trimester.

Many in Portugal, a conservative nation long seen as the continent’s sleepy stepchild, regard the law as a crucial step in a process of modernization and reform.

At the same time, abortion has proved to be an issue that, unlike any other, provoked emotional, divisive debate in a country more accustomed to resisting radical change and reaching compromises.

Even with the law, numerous doctors are refusing to perform the procedure and are declaring themselves “conscientious objectors.”

Several public hospitals said they would not be able to offer abortions, despite the legal obligation to do so, because they lacked the doctors or necessary equipment.

Clinics such as the one operated by Hernandez will have to fill the void. The $4-million Dos Arcos is part of a chain of Spanish abortion clinics, a couple of which operate along the border with Portugal, where as many as 10,000 Portuguese women have been traveling annually to evade the restrictions here.

“The connection has always existed,” Hernandez said. Portuguese women have constituted 60% of her business in the Spanish clinics, she said; the trip from Lisbon to Spain’s side of the border is just 150 miles.

The new law notwithstanding, Hernandez does not expect a flood of patients at the Lisbon facility, initially. Even though the two-story, 12-bed structure has a private VIP suite (with a private entrance), reticence remains strong regarding something seen as shameful in much of Portuguese society. That will change, but slowly, she said.

“With so many years of clandestinity, the fear has its impact,” said Hernandez, a taut, energetic woman of 49 years with fashionable close-cropped hair and large blue-gray eyes behind wire-rimmed glasses.

A bitter campaign

In Portugal, a country of only 10 million people, health officials estimate that 23,000 women a year have obtained illegal abortions; abortion-rights activists estimate that nearly half end up in hospital emergency rooms because of botched procedures.

The campaign to legalize abortion in Portugal was not violent, but it was certainly bitter.

Anti-abortion activists on street corners handed out plastic replicas of embryos and shopping bags bearing slogans opposing the legislation. Newspapers published reports on Portugal’s dangerously low birthrate.

The powerful Roman Catholic Church in Portugal condemned the proposed law as a “blow against civilization” that would authorize “an abominable crime.”

Priests preached from their pulpits, and bishops led a vigil at the Fatima shrine, revered by Catholics for what they believe was an appearance by the Virgin Mary nearly a century ago.

Hernandez was scorned in public forums as a Spanish outsider, nothing short of a mercenary executioner, a baby killer.

The debate cleaved distinct lines in Portuguese society: Along with the refusenik doctors and the church hierarchy, conservative rural Portugal opposed lifting the restrictions, while the urban elite, the young and many women supported the legislation.

Nearly 60% of voters in a February national referendum approved of liberalizing the abortion law, but the poll was declared invalid because of a low turnout. The Socialist-led government of Prime Minister Jose Socrates, with a majority in parliament, decided to draft and enact the measure anyway.

“We all thought we were behind the times,” said Maria de Belem, a former health minister and congresswoman in Socrates’ Socialist Party who championed liberalizing the abortion law as an urgent public health issue.

Without better family planning and access to birth control as a first step, and abortion as a last resort, she said, Portugal cannot fight a growing epidemic of unwanted children who end up on the streets, abused or crowding into the few government-run institutions.

“We cannot deny the social reality when women cannot practice their reproductive rights,” Belem said. “We cannot close our eyes to a very difficult situation for Portuguese families and couples with real problems, who cannot support the children they already have.”

Public hospitals without doctors willing to perform abortions are supposed to contract with private doctors or, eventually, private clinics such as Dos Arcos to guarantee access for women choosing to end their pregnancies. Hernandez said she had signed contracts with three hospitals, including Lisbon’s Sao Francisco Xavier Hospital, where all doctors declared themselves conscientious objectors.

‘That’s a human being’

Gynecologist Joao Malta has been practicing in Lisbon for 19 years and belongs to what he calls a “pro-life network” of medical personnel who discourage abortion.

Malta said he refuses to perform abortions in all but extreme cases: when the woman is in danger of dying or the fetus is so badly impaired that it would not survive after birth. In his view, a very sick fetus or a pregnancy resulting from rape are not sufficient cause.

“I do not kill my patients,” Malta, 44, said in his wellappointed office, with about half a dozen women filling a small waiting room. “If I see an embryo that’s 2 1/2 millimeters, I can see a heart beating, and, for me, that’s a human being.”

Malta said he and doctors like him would campaign to reverse the law, but that it might take time.

Although Portuguese women of means have been able to evade restrictions by traveling to Spain, that has not been an option for the poor, who often have resorted to taking harsh drugs to force a miscarriage or submitting to unsanitary and unsafe underground operations.

Though the law was praised by Socrates as a sign of progress, it is by no means among the most liberal such measures. Women seeking an abortion are required to meet with a doctor and then wait three days, for what officials call “reflection,” before taking the final step.

Portuguese President Anibal Cavaco Silva, a conservative, proposed a requirement that each woman be shown ultrasound pictures of the fetus before the abortion. The provision was not included.

Cavaco Silva ratified the final law anyway, even as he declared abortion “a social evil to be avoided.”

wilkinson@latimes.com