'I lost control of my life' How one Russian region made abortions almost impossible to get — without passing any new laws
The Russian government declared 2024 the Year of the Family. In practice, this meant tighter restrictions on reproductive rights, including limiting access to certain emergency contraceptives, outlawing so-called “childfree propaganda,” and sending priests with anti-abortion films into schools, universities, and women’s clinics. Officials and lawmakers also spent the year debating the prospect of a nationwide abortion ban.
Although no such ban has been passed yet, in some regions it’s already become a de facto reality. In places like the Republic of Karelia, women face so many barriers to accessing abortion services that many are forced to travel to neighboring regions for care. Despite national laws that still protect the right to abortion, local restrictions in Karelia have made the procedure increasingly difficult to obtain. Meduza has translated a report by the independent outlet Glasnaya detailing the growing obstacles women face when seeking abortions in the western Russian region.
‘They told me nothing was visible on the ultrasound’
In the summer of 2024, Elizaveta (name changed), a resident of Karelia’s capital, Petrozavodsk, took a pregnancy test. It came back positive. She scheduled an appointment at the regional perinatal center, but after an examination and ultrasound, the medical staff told her they “didn’t see a pregnancy.”
“I asked, ‘What about the positive test?’ They told me the results didn’t mean anything — and that since nothing showed up on the ultrasound, there might not be a pregnancy. I wasn’t okay with that kind of uncertainty. We agreed I would come back for a follow-up in two weeks,” Elizaveta recalls.
Elizaveta couldn’t stop worrying — she didn’t want to have a child. She went to a private lab and took a blood test for the hormone hCG, a reliable indicator of pregnancy. The result was positive. A second hCG test a few days later showed rising levels, confirming the pregnancy was progressing.
By the time she returned to the perinatal center for her follow-up appointment, Elizaveta felt confident that she was pregnant. But the same thing happened again. “They told me nothing was visible, again. That’s when I started pushing back. I mean, what kind of nonsense is that? How could they not see anything if my hCG levels were rising? It’s not like I was getting the ultrasound the day after a missed period.” She insisted on another examination. “Only after I started arguing did they finally confirm the pregnancy — saying they’d just now seen it,” she says.
What happened next took her by surprise. Instead of asking whether she wanted to continue the pregnancy, the doctor immediately began congratulating her. “Pregnancy isn’t always welcome. It wasn’t for me. I told her I wanted an abortion — not a congratulations.” After that, she says, the moralizing began: “The doctor, with a very serious face, told me that in the 21st century, there can be no reason not to give birth.”
Elizaveta explained that she had health issues and was taking medication that’s unsafe for pregnancy. Her concerns were brushed aside. “They didn’t even want to hear me out,” she recalls.
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Still, she persisted. “They told me I’d have to go through a mandatory consultation with a psychologist,” she recalls.
Without that, they wouldn’t approve an abortion under the public health insurance system. But I couldn’t see the psychologist right away — not the same day, not even the next. There was a waitlist. A week, maybe two. And after that, there’s the ‘week of silence’ — mandatory since 2011, supposedly to give women time to think things over. That meant at least two more weeks added to my pregnancy term. I realized that at this rate, I’d miss the window for a medical abortion. And honestly, I think that was the goal.
Elizaveta then asked at the front desk about a medical abortion, which is listed as a paid service the center offers — she assumed that if it wasn’t covered under public insurance, she could at least pay out of pocket. “But they said the same thing: to get a medical abortion — even privately — you still have to go through the psychologist,” she says. “You still have to wait for an appointment. Then comes the ‘week of silence.’ Just like with the public option. So again, there was no way I’d make it in time for a medical abortion. It felt like a trap,” she recalls.
She began searching for private clinics in Petrozavodsk, only to find that none were licensed to perform abortions anymore. “I was truly shocked. I never imagined there would be no way to get even a private medical abortion anywhere in the region,” she says.
Her only options were to try for a surgical abortion through the local perinatal center — or travel to St. Petersburg. “I was overwhelmed. I didn’t want a surgical abortion — it’s more invasive and carries more risks. But in Karelia, there just weren’t any other options. Medical abortion at the perinatal center was clearly off the table. And I couldn’t be sure they wouldn’t stall long enough for me to miss the window for a surgical abortion too,” she says.
Looking for answers, Elizaveta turned to pro-choice communities and Telegram channels — and realized she wasn’t alone. Many other women shared similar experiences.
Reading other women’s stories in these pro-choice communities, I learned that clinics will ‘lose’ lab results, claim there are abnormal findings, and require consultations not only with a psychologist, but with a social worker too — anything to stall and run down the clock.
In the end, Elizaveta decided to travel to St. Petersburg, where she quickly found a private clinic that agreed to perform a medical abortion. It had only been a few days since her last appointment in Petrozavodsk. “When I saw the doctor in St. Petersburg, they told me I was already almost eight weeks along. That meant I would’ve had almost no time left even for a surgical abortion back in Petrozavodsk, once you factor in the psychologist appointment and the ‘week of silence.’ I was lucky the clinic I found still offered medical abortions at that stage,” she says.
The experience reminded her of stories from abroad. “I’d read about women in Poland having to travel to other countries for abortions, but I never thought I’d be in the same boat,” she says. “We never had such strict restrictions. Abortion isn’t banned — it’s still technically available through public healthcare and even listed among paid services. I think it’s all kept quiet on purpose — so people don’t speak out or even realize there’s a problem.”
‘Blatantly manipulative’
The website of the Karelia Regional Perinatal Center features a section titled “Information about abortion.” One article, called “The harm of abortion,” discusses so-called "post-abortion syndrome,” describing it as a “complication of pregnancy termination on par with inflammation, bleeding, or adhesions.” However, post-abortion syndrome is not recognized in the International Statistical Classification of Diseases and Related Health Problems, and there are no clear diagnostic criteria for it.
Glasnaya asked Alina, a pro-choice activist from Petrozavodsk, to comment on the information on the center’s website. Alina is a former midwife and currently a medical student. “The materials are blatantly manipulative,” she says. “For example, the authors use vague phrases like ‘medical psychologists and psychotherapists believe’ or ‘it has been proven that life begins at conception.’ But there’s not a single citation — no indication of who supposedly believes this or what the proof is.”
Alina also notes that rare complications are presented on the site as if they’re common and to be expected.
She recommends referring to the official Russian clinical guidelines for medical abortion, which are based on evidence and cite hundreds of studies:
Here’s what they say: “The rate of heavy bleeding requiring uterine curettage is between 0.23 and 2.6 percent (1.4 percent up to 49 days of amenorrhea, and 2.6 percent up to 63 days). The incidence of bleeding requiring a blood transfusion (500 ml or more) is one in 1,000 cases. […] The rate of infectious complications in two large studies involving 34,000 and 46,421 women up to 26 weeks of pregnancy was one percent and 0.9 percent, respectively.”
In other cases, Alina says, the site crosses the line from manipulation into outright misinformation. For example, one page claims that “doctors often observe infertility after a first abortion (especially if it’s the first pregnancy), followed by various reproductive issues (complications during pregnancy, miscarriage, infertility).” But according to the official clinical guidelines, “ovulation can resume as early as 8–10 days after an abortion — regardless of whether it was medical or surgical — and 78–83 percent of women ovulate during the first post-abortion cycle. […] Pregnancy termination in a medical setting, when free of complications, does not lead to infertility.”
‘Who decided we no longer have the right to our own bodies?’
By March 2024, it was clear that access to abortion in Karelia had become a serious issue. A local resident named Lyubov contacted the regional news outlet Daily Karelia after she was unable to find a single private clinic in the republic offering medical abortions.
Lyubov had called every private provider in the regional capital. “This procedure used to be available to any woman here, in many clinics and hospitals,” she told journalists.
But this week, I haven’t been able to find a single place that will do it. Every clinic has turned me away, saying they received a directive from the Karelian Health Ministry banning the procedure. The ministry, meanwhile, denies having issued any such order. […] At public women’s health clinics, it feels like they’re deliberately stalling: tests, a mandatory psychologist visit, then the ‘week of silence.’ As a result, a woman might miss the legal window altogether. […] I don’t understand — who decided women in our republic no longer have the right to their own bodies? No law has been passed about any of this.
The only place still providing medical abortions was the regional perinatal center. But there, as with Elizaveta before her, Lyubov quickly realized she was unlikely to get the procedure in time.
Journalists from Daily Karelia reached out to the Karelian Health Ministry. Officials responded that there was no ban on abortions in state clinics and that private providers had stopped offering them due to a “lack of licenses.” The ministry’s press office was unable to point to any specific law or official directive behind the shift but referenced a 2020 order requiring that abortions be performed in inpatient settings. When asked why the procedures had been allowed in outpatient clinics for nearly four years after the order was issued, the ministry had no answer.
Later reporting suggested the change had originated with the regional prosecutor’s office. Until 2017, a general license for obstetrics and gynecology included the right to perform abortions. That year, abortion was reclassified as a separate medical service requiring its own license. Clinics that held the older licenses were initially told by the regional Health Ministry that their documents remained valid — and continued offering abortions accordingly. That changed in early 2024, when prosecutors and health inspectors began visiting clinics and informing them that abortions could no longer be performed under the old licenses.
Now, clinics are facing serious obstacles to obtaining new licenses, as the updated requirements mandate that the facility include an inpatient unit, operating room, and intensive care ward. (In Karelia, licenses cannot be issued solely for medical abortions.) In effect, if a clinic wants to provide any kind of abortion, it must be equipped to offer all types — including surgical ones.
Pro-choice activist Alina corroborated this information. “Yes, it’s tied to licensing changes. The logic is that if a clinic provides medical abortions, it must also be prepared to perform surgical evacuation of the uterus in case of an incomplete abortion. That might sound reasonable. But according to Russian clinical guidelines, incomplete abortions happen in only 0.5–0.6 percent of cases. And even then, they can typically be resolved on an outpatient basis with misoprostol or vacuum aspiration. Surgery isn’t automatically required.”
Alina believes that purported concern for women’s health is being used as a pretext for imposing covert restrictions.
“Realistically, maybe one in a thousand women would need further medical care. That’s not a serious burden on the healthcare system," she explains. "But now everyone is being funneled into the perinatal center, which — according to its own website — only provides medical abortions up to six weeks. But most women don’t even learn they’re pregnant until the fourth or fifth week." She continues:
It’s important to remember that doctors date pregnancies not from the moment of conception, but from the first day of a woman’s last period — the so-called gestational or obstetric weeks. So if you think you became pregnant two weeks ago, your official term is already four weeks. If it’s been three weeks, then it’s counted as five. Add to that the mandatory ‘week of silence,’ the psychologist consultation, and potential delays — like those Elizaveta faced — and it becomes almost impossible to meet the deadline for a medical abortion.
‘They send women 200 kilometers away to give birth’
In July 2024, Karelia’s Committee on Health and Social Policy approved a new social benefits program: a one-time payment of 100,000 rubles ($1,200) for students under 25 who give birth. The initiative, proposed by Karelia’s head Artur Parfenchikov, was backed by deputies from United Russia, the right-wing Liberal Democratic Party (LDPR), the Pensioners’ Party, and the New People party.
At the committee meeting, deputy Emilia Slabunova raised concerns about a clause excluding students whose babies are stillborn. “I have to say: this provision is completely wrong. When a young woman goes through childbirth and then suffers such a tragedy, denying her the 100,000 rubles she needs for recovery [is just wrong]. Maybe we could still extend the payment in those cases,” Slabunova said.
Pro-choice activist Alina sees the push to lower the age of first childbirth as misguided. “A lot of officials seem to believe that the earlier a woman has her first child, the more children she’ll eventually have. But that’s just not true," she explains.
In the 1990s, Russian women were having their first babies younger — the average age was 22.6 in 1994, compared to 26.2 today — but that didn’t lead to higher birth rates. In countries like Israel, the U.S., and Australia, women tend to have children later than in Russia, yet their fertility rates are higher. There’s no direct link between the age of first childbirth and the number of children a woman ends up having. More often, it’s poor-quality reproductive and maternity care that discourages women from having more — or any — children.
Darya (named changed), another Karelia resident, tells Glasnaya she's felt pressure from doctors to have kids even outside the context of abortion. “In November 2023, I was hospitalized for hyperplasia and underwent a scraping procedure — without anesthesia. They gave me painkillers only afterward,” she recalls.
Last year, I saw a gynecologist every three or four months for check-ups. Every time I walked in, the first question was, “Why haven’t you had kids yet?” If I said, “I don’t want to,” they’d give me a sour look. I’m sure if I tried to get an abortion, the pressure would be three times worse — and the delays even longer. And all of this was happening in a town without a maternity ward. They send women to Segezha — 200 kilometers away (120 miles) — to give birth.”
Another resident, Vasilisa (name changed), describes her experience with the healthcare system in Petrozavodsk.
The specialized gynecological ward here was shut down. Now, patients like me are packed into two rooms in the second surgical department of the city’s emergency hospital. I spent a week there on pregnancy watch. It’s just a general surgery wing — with homeless patients, broken bathroom locks, the works. Maybe after the 20th week they’ll transfer you to the perinatal center, but that place serves the entire republic and it’s completely overwhelmed.
There have already been cases of women scheduled to be admitted in their 40th week being turned away due to a lack of available beds. In one case, a woman’s placenta detached in her 41st week — the baby didn’t survive.
“That’s where I had my C-section,” Vasilisa recalls. “They rushed me from the ICU to the ward while a nurse shouted, ‘Run while there’s still a spot!’ And now they’ve dumped all abortion procedures on that same unit too.”
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Meanwhile, on January 28, 2025, Sergey Leonov, head of the State Duma’s Health Protection Committee, announced that abortions should only be performed through Russia’s national health insurance system:
I believe the government should oversee all abortions in Russia. If we restrict the procedure to the national insurance system, we’ll be able to ensure full compliance with all requirements — including mandatory psychological counseling and the so-called ‘waiting period.’
Alina believes this approach will only increase the burden on the already overwhelmed regional perinatal center:
We’re seeing this all over Russia — abortions being pushed out of private clinics. It’s often framed as a move to improve care, but public hospitals can’t just absorb more patients out of nowhere. It puts huge strain on the medical staff.
‘Denial of medical care’
Glasnaya asked a lawyer from the Russian human rights organization Right to Abortion what options women have in situations like Elizaveta’s. She explains that under Russian law, a woman has the right to terminate a pregnancy up to 12 weeks. Since 2021, this 12-week limit has also applied to medication abortions. The latest clinical guidelines confirm that medication abortions are permitted up to 12 weeks — not just up to the eighth or ninth week, as some still claim based on outdated 2015 recommendations.
“This means medical institutions cannot pressure a woman into opting for a surgical procedure if she’s within the legal timeframe,” the lawyer emphasizes. “If a woman seeks care close to the 12-week mark, the clinic is required to provide the service without enforcing the ‘mandatory waiting period.’”
Refusing to schedule an appointment or delaying the process amounts to a denial of medical care. According to the lawyer, safety should always be healthcare providers’ top priority — and the earlier a medication abortion is performed, the lower the health risks for the woman. Healthcare providers therefore have an obligation to carry out procedures promptly, as delays increase medical risks.
“Psychologist consultations before an abortion are mandatory, but unnecessary delays in this step are unacceptable. Abortion is a time-sensitive medical procedure, and prolonged waits for a consultation can violate a patient’s rights,” the lawyer says.
After Elizaveta's experience, she spent several months dealing with anxiety and a sense of helplessness:
I felt like I’d lost control over my own life. It was emotionally very difficult — realizing that I couldn’t make decisions about my own body. And just because I happen to live here, not somewhere else.
I’ve become much more cautious about contraception and stay more informed about any new laws regarding reproductive rights. Now, I follow reproductive justice channels on Telegram and donate to pro-choice initiatives. I don’t want anyone else to go through what I did.
Reporting by Anna Shalamova for Glasnaya