Boss in his own belly | medical contact

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Abortion and the legislation that surrounds it is a controversial topic, so there is an ongoing medical-ethical debate. In the Netherlands, the issue of the reflection period prior to abortion is particularly relevant. Opinions on whether or not there is a cooling-off period are divided, and at times both sides seem to be getting more and more firm in their convictions. Recently, the majority of the House of Representatives was in favor of abolishing the reflection period. Although many have an opinion about it, it is hardly talked about by those who have actually undergone it.1 And this while one in eight pregnancies in the Netherlands ends in abortion.2 We reiterate the arguments of the defenders and the opponents and we discussed. current legislation and debate in the Netherlands and in other countries.

international News

Last year, the state of Texas introduced a very strict new abortion law. Abortion is only legal there if you are less than six weeks pregnant and if you meet very strict conditions. A pregnancy resulting from rape is not one of these conditions. A woman who undergoes an abortion and those involved could be fined $10,000.3

Abortion regulations are also becoming stricter within Europe. At the end of January 2021, De Volkskrant headlined: ‘Street protests rage in Poland after almost total ban on abortion’.4 Poland decided to completely ban abortion unless the life of the mother is in danger or if the pregnancy is the result of rape or incest.

In the Netherlands, this news caused a lot of controversy to say the least, with women and men rising en masse to protest access to abortion as part of women’s right: ‘Boss in your own womb’. International events strike a chord. By the way, it is certainly not the case that everyone in the Netherlands unanimously supports access to abortion. But the international developments mentioned are at odds with the fact that the European Union declared abortion a genuine human right in July 2021.

Abolition of the reflection period

Therefore, abortion itself is already an issue, but in the Netherlands there is also another discussion: the mandatory reflection period for abortion. Currently, the regulations are as follows. A woman who is between 16 days and 24 weeks pregnant can go to an abortion clinic with or without the mediation of her GP with a desire for an abortion. Here she is forced to see the ultrasound and then wait five working days before the abortion is started.5 For comparison: in Germany a pregnancy can be terminated up to 12 weeks. And in Belgium, a pregnancy can still be terminated after 24 weeks in case of severe fetal abnormalities. This is also possible in the Netherlands, but in practice it is very difficult. Regarding the reflection period: in Italy it is seven days and in Slovenia it is two days.6

In the Netherlands we apply the rules of the Termination of Pregnancy Act (Wafz), which was introduced in 1984, 38 years ago. The abortion that does not meet the requirements indicated above and, therefore, includes a period of reflection, will be valued in accordance with the criminal law. In recent years, various parties have spoken in favor of amending the existing law by abolishing the reflection period, but this request has been repeatedly rejected. The new coalition agreement states that the government wants to ensure accessible abortion care and also that it wants to improve aftercare for women who choose abortion.7 Despite recent reports, it is not yet certain that the law be modified. It is important to mention that the reflection period can always be used if there are doubts about the choice of abortion or if the woman in question needs it.

Pros and cons

Previous research by Amsterdam UMC, among others, shows that women find the cooling-off period to be very heavy. Rutgers, the center of knowledge on sexuality, considers that the mandatory imposition of five days is too rigid and convincing. Abolishing the cooling-off period would remove unnecessary mental barriers for pregnant women. Having an abortion is a drastic experience, but the choice should not be taken lightly either. Even before someone goes to a clinic, it will be well thought out. D66, GroenLinks and PvdA openly oppose the cooling-off period. Organizations such as Bureau Clara Wichmann, of Bovengrondse and Amnesty International believe that this law affects the autonomy of women and describe the period of reflection as condescending. They point out that with the abolition of the reflection period, more women fall within the window in which they are eligible for a less invasive form of abortion, such as an abortion pill in the first nine weeks.8 The Humanist Association has also recently introduced the introduction of buffer zones in abortion clinics in the care center. By introducing a buffer zone where protests are not allowed, access to an abortion clinic remains unhindered. Hopefully, this will also lower the physical threshold.9

Proponents of the reflection period, such as the SGP and ChristenUnie, believe that the reflection period is necessary because an abortion carries a lot of responsibility. For example, Kees van der Staaij (SGP) said: ‘When making an important decision involving unborn human life, there is a sense of responsibility.’ A statement that bothers opponents of the reflection period because it suggests that women cannot assume this responsibility.

Other groups opposed to abortion in general also indirectly oppose any change in the legislation in favor of abortion. These are, for example, Christian groups like Scream for Life and Jesus Lives. They are known for their demonstrations at abortion clinics and for actively targeting women who enter these clinics.8 Speaking out is a fundamental right and therefore cannot be prohibited.10 Scream for Life offers through its site web, among other things, medical assistance to women who repent. the decision to take a first abortion pill and with which they can reverse the effect. They also share the adverse physical consequences of an abortion and the experiences of women who regret their abortion.11 It is worth mentioning that there are few figures on the number of women who, after being certain of having an abortion, find in these five days has thought. There are also few figures on the proportion of women who are late for the reflection period and who do not come at all because of it. Finally, the government website also mentions that the cooling-off period is not only in the woman’s interest, but that the doctor must also be satisfied that someone is making a voluntary and conscious choice.5

The taboo around sexuality

Another important point is that there is still a lot of ignorance about sexuality and pregnancy. Rutgers research shows that 59 percent of young Dutch people under the age of 25 don’t readily talk about their abortion experience and nearly half of them are even ashamed of it. A recent NOS survey found that 42 schools have had lessons in recent years from organizations that clearly state they are against abortion. And in the meantime, according to Rutgers, it’s just as important to mention free choice, especially in the case of an unwanted or unwanted pregnancy. For this reason, among other things, they advocated for better education about sexuality and pregnancy to remove the taboo surrounding this.1 Preventing unwanted pregnancies is ultimately best. Perhaps the time of reflection in itself is not what should be emphasized, but rather how we, as a society, deal with these issues.

While some countries are tightening the reins, others are increasingly deviating from previously prevailing conservative norms. Where the Netherlands appears to be progressive, lowering the physical and mental threshold for abortion remains a challenge. It is important to continue to look critically at the rules and laws that we pursue as a society and their consequences for the individual. Women are central to the issue of abortion and currently the majority in the House of Representatives are men. Is it desirable for men to make decisions on matters that ultimately primarily concern women? There is no answer to the ethical question of when a fertilized egg actually becomes a person with a right to life. But in what scenario do the rights of a fetus become more important than those of the woman in question? In the future, it is good for doctors to consider the impact of an abortion on a woman’s health, just as much as the impact of an (unwanted) pregnancy. It is important to start the conversation and support each woman in choosing her.


melina van eijck











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