Paula lost her uterus after being transferred from Galicia to Madrid for an abortion. OSCAR CORRAL / EL PAÍS

“I haven’t been the same since,” says Paula, bursting into tears as she recalls the events of four years ago when she had to travel 354 miles from Burela, in Lugo, Galicia, to Madrid by car to terminate a much-wanted pregnancy that was impossible to carry through to term.

The Galician public health service, SERGAS, refused to perform the necessary termination, invoking the doctor’s right to objection on moral grounds, referring her instead to a private clinic in Madrid. The journey was difficult and as soon as she arrived, she was transferred to the emergency ward at La Paz hospital where her womb was removed in order to save her life.

The Galician public health service has now been ordered to pay out €270,000 in compensation for negligence, but Paula’s ordeal exposes the problems that still exist in Spain when it comes to terminating late pregnancies on health grounds. “The doctors' right to object almost cost me my life,” says Paula.

I had been having vaginal pains for days but the hospital said it was just wind Paula

A series of blunders in effectively diagnosing the congenital anomaly suffered by the fetus at the hospital in Burela meant that Paula was already seven months pregnant by the time her unborn child was declared “incompatible with life”.

She could then find no one who would terminate the pregnancy, either in the Costa Burela or any of Galicia’s other public hospitals. Eventually, SERGAS declared that “in order to respect the professionals’ right to objection on moral grounds”, the authorities would pay for the termination of the pregnancy in a clinic in Madrid, by which time Paula had moved into her 32nd week.

“I had to leave my three-year-old daughter with my mother and make the trip by car with my partner,” she recalls. “I had been having vaginal pains for days but I was told at the hospital it was just wind.”

In fact, Paula’s pain was due to an irregularity in the womb. By the time she arrived at the private clinic, she was bleeding heavily and transferred to La Paz where she had a cesarean to remove the fetus which survived only 90 minutes. She then had her womb removed to stop the bleeding. Though she survived, she would not be able to have any more children.

“It was really traumatic,” she remembers. “They asked if we wanted to see the baby and if we wanted to try resuscitation despite the fact there was no compatibility with life. There was a cremation and we had to go home with the ashes.”

Damage for which there is no compensation

Back home in Galicia, Paula received around €80 from the health service to reimburse her for the cost of her trip to Madrid, including her partner’s hotel bill. “They didn’t even call me from the hospital in Burela for a check up, like they normally do with women after giving birth, never mind to apologize for their unbelievable negligence,” she says.

This negligence has caused “physical and psychological damage for which there is no compensation”, according to the magistrate. Paula has been receiving psychiatric treatment since her loss.

The magistrate added that the unnecessary prolongation of Paula’s pregnancy represents a spectacular failure in the public health system. Meanwhile, Marcos Amboage, a Lugo-based magistrate involved in the case, says he understands that it is hard to accept the fact there is no public health center in Galicia that will terminate a pregnancy as per the law.

Following the court’s decision, the President of Galicia Alberto Núñez Feijóo, made a public apology to Paula – not her real name – on behalf of the authorities while declaring he would looking for a formula that would reconcile the right of Galician women to an abortion with doctors’ rights to object on moral grounds to carrying out an abortion.

Paula’s lawyer, Francisca Fernández, says that her client’s case is by no means an isolated one. She has been involved in two other cases where women are suing the public health services in Galicia on account of doctors’ moral objections. Despite this, the public health service in Galicia says it guarantees the right to an abortion according to terms specified by law, pointing to two late terminations in A Coruña y Ourense that have just been carried out.

Doctors can refuse to perform abortions on moral ground only if doesn't affect a patient's access to care

Galicia is no exception when it comes to sidestepping the need to terminate pregnancies. Across the country, only a small percentage of legal abortions are performed by regional public health services. Most – 90% in 2014 – are referred to private clinics funded by the state for the purpose. This is perfectly legal but complications arise when the termination is urgent and when the private clinic is hundreds of miles away.

Lawful objection

The 2010 abortion law specifically states that the termination of pregnancies due to fetal congenital anomaly or incurable illness should preferably be carried out in public health service centers as they are more complicated and often required in later pregnancy. According to figures from Spain’s Ministry of Health, this type of termination accounted for around 300 out of the 94,796 abortions carried out in 2014.

A doctor’s objection to performing an abortion on moral grounds is taken into account by the 2010 law but on certain conditions. Article 19.2 states that health professionals directly involved in the voluntary termination of a pregnancy can exercise their right to conscientious objection as long as it does not affect the patient’s access to care.

However, a report called Deficiencies and Inequality in Spain’s Sexual and Reproductive Health Care compiled by 13 organizations, including Women’s Link and Médicos del Mundo, highlights that access to abortions within the public health service varies depending on the autonomous community. And it points out that in 2014, not one abortion was carried out in public hospitals in Aragon, Extremadura, Castile-La Mancha and Murcia: all were referred to private clinics.

Also controversial are the methods used to terminate a pregnancy. Doctors may simply prescribe a pharmaceutical product, allowing for minimal involvement. In Galicia, an investigation is underway into the public health services’ use of pharmaceuticals in terminations between 14 and 22 weeks related to congenital anomalies or the mother’s health.

The health service's negligence caused “physical and psychological damage for which no compensation exists”

Blanca Cañedo, spokesperson in Asturias for the Association of Accredited Abortion Clinics (ACAI) insists on the necessity of training doctors to perform the abortions surgically. She believes that using pharmaceutical drugs is “brutal at 14 weeks since it induces contractions that last for days until the fetus is expelled.”

The President of the National Federation of Family Planning (FPFE), Luis Enrique Sánchez, believes that one of the main reasons that some public hospitals don’t carry out abortions is that the health authorities have not insisted on it as an obligation, allowing gynecological units to dodge the issue, citing organizational difficulties, a shortage of surgeons or other resources for doing so. “It’s a lack of political will from those in charge of health,” says Sánchez.

In Paula’s case, the court’s ruling has exposed the public health service’s resources as inadequate. Paula is convinced that if she had had a termination in Galicia, she would not have lost her womb and the chance to conceive and give birth again.