Although voluntary termination of pregnancy up to ten weeks’ gestation has been legal in Portugal since 2007, a project to reform the performance evaluation system for family doctors could penalize professionals whose patients decide to have an abortion.
The plan also intends to include the incidence or not of sexually transmitted infections in women as an indicator of evaluation of professionals. The project, which is still under evaluation by the Ministry of Health, was revealed by the Público newspaper and gained enormous repercussion in the country, with the right to a heated debate in Parliament on Tuesday (10).
The changes concern professionals who work in the so-called Family Health Units of type B, in which part of the salary is variable, linked to the fulfillment of certain performance criteria, including the patients’ family planning. Under the project, the “absence of voluntary termination of pregnancy” in the previous 12 months would be considered in the evaluation and, therefore, would have an influence on the amount of remuneration linked to the performance of health professionals.
The absence of a diagnosis of sexually transmitted infections in women in the 12 months prior to the reference date would also become a monitoring criterion.
Doctor João Rodrigues, coordinator for the reform of primary health care, defended the changes pointing out the need to evaluate professionals and create performance stimuli. “This indicator can and should help in the bet that should be made on prevention”, he told Público. “Scientifically how can I measure preventive activity? Only if I have IVG or not [interrupção voluntária da gravidez]because this is the end result.”
Rodrigues also argued that the objective of the changes is to improve the quality of care, with greater availability of consultations and provision of information to patients, reducing the number of unwanted pregnancies. According to him, the impact of the new indicators on the salaries of professionals would be very low.
The president of the Ordem dos Médicos, the entity that regulates medical practice in the country, declared himself against the proposed amendment. In an interview with TSF radio, Miguel Guimarães stated that pregnancy is not a disease and, therefore, cannot be included as an evaluation criterion. “It makes no sense, it’s a totally unacceptable and unacceptable situation”, he said, noting that the termination of pregnancy is a fundamental and acquired right of women.
The FNAM (National Federation of Physicians) also took a stand against the proposal. “The monitoring of sexually transmitted diseases in women – which has no parallel in men – constitutes unacceptable gender discrimination”, said the entity, according to which the change “translates a patriarchal view of female sexuality”.
The federation classified the inclusion of voluntary termination of pregnancy among the professional evaluation criteria as “a sign of an incomprehensible civilizational and ideological setback”, which would make health workers responsible “for a personal decision, which interests only people with a uterus”.
The proposal came to light a few days after the debate over that same right heated up in the United States, with the leak of a Supreme Court document indicating that the court must now reverse an understanding that supported the national guarantee to the procedure.
The repercussion of the Portuguese project quickly reached Parliament, where there was already a session scheduled with the Minister of Health to discuss the budget for the area in 2022.
Marta Temido was asked about the changes by representatives of parties from different political spectrums, from the center-right to the communists, and highlighted that the inclusion of voluntary termination of pregnancy as a criterion for failure in family planning was proposed by a technical group, not by the ministry. .
“You can disagree or agree, but when we stop debating, we stop serving what our function is,” he said. “I think everyone understands the circumstance of having an IVG, for women who have had it, which is something deeply penalizing from the point of view of physical and mental health. Not considering this aspect is hypocrisy.”
The Ministry of Health, in any case, has not officially commented on the proposal. Abortion up to ten weeks’ gestation was decriminalized in Portugal in 2007, after a referendum. The country has one of the most restrictive legislation in Europe regarding the length of pregnancy: in neighboring Spain, termination of pregnancy is possible up to the 14th week of pregnancy and in the Netherlands, up to the 22nd.
The last national report from the DGS (Directorate-General for Health) with data on IVGs was released in 2019, with information for the year 2018. Between 2011 and 2018, there was a 28% drop in the number of abortions performed in the country.
According to the authorities, among the main factors that led to this result are orientation campaigns and the choice of contraceptive methods after the procedure.
