Hungary’s Pronatalist Government Issues “Listen to the Foetal ‘Heartbeat’” Decree Tightening Abortion Rules – a Birth Rate Incentive?

analysis

On 15 September, without prior public consultation, the Hungarian Interior Minister issued a decree protecting foetal life and amending the country’s relatively liberal abortion rules. The new passage now added to the form that women use to apply for an abortion leaves room for diverse interpretations: “The medical record presented establishes that the pregnant woman was provided with a clearly identifiable indication of foetal vital signs by the health care provider.” This article investigates the background to this decree, taking a critical view of the flagship family policy of the alliance between FIDESZ and the Christian-Democratic People’s Party, which has been governing Hungary with a two-thirds majority in Parliament since 2010.

an image of a doctor showing an ultrasound picture of a baby to a pregnant woman

Pro-Life, Anti-LGBTQ

“A chance for life: From now on, women will listen to the heartbeat of the foetus!” Dóra Dúró, deputy leader of the far-right Our Homeland party in Hungary, announced triumphantly on Facebook, adding: “Our life begins at the moment of conception (…) Listening to the heartbeat […enables…] the foetus to tell the mother: ‘I am alive and I feel’.”

Infamous for shredding A Fairy Tale for Everyone, a children’s anthology of fairy tales featuring heroes who are disadvantaged, LGBTQ, or from other minorities, Dúró has been advocating for the “heartbeat amendment” since 2016. By issuing the decree, the Government has taken a step towards Our Homeland, which, for the very first time, entered Parliament as a third force in April 2022. As the co-chair of the Hungarian Socialist Party, Ágnes Kunhalmi, noted in a Facebook entry, “the electoral base of Fidesz and Our Homeland converges,” and strengthening the identity of this voter base is crucial for Fidesz“ as the economic situation deteriorates and people are hit by Government tax increases and austerity measures.”

In 2020, Hungary signed the “Geneva Consensus Declaration”, an anti-abortion declaration reaffirming that there is no international right to abortion, along with 30 other states such as Brazil, Trump’s USA, Belarus, Poland, Saudi Arabia, Bahrain, the United Arab Emirates, Iraq, Sudan, South Sudan, Libya – in other words, many illiberal or authoritarian states.

According to the current abortion legislation in Hungary, terminations can be completed in the first 12 weeks of pregnancy. The process leading to an abortion is long, though. First one needs a letter from a gynaecologist confirming the pregnancy, followed by two visits from family services giving advice on adoption and state benefits. The appointments have to take place at least three days apart, and a referral for an abortion at a hospital can only be obtained afterwards. A legal aid service run by the NGO Patent, which focuses on the rights of women, said it has been increasingly receiving calls from desperate clients who simply did not get an appointment for advice from family services before the 12-week deadline and therefore missed their opportunity to abort.

Dr Mária Herczog, a sociologist and child welfare expert who is the President of the Family Child Youth Association points out that while abortion has been legal in Hungary since 1945, with tightening in 1952 and easing in 1953 and 1956, the 1992 law on the protection on the “life of the foetus issued by the conservative government of Prime Minister József Antall, and not on abortion, as the previous regulations on abortion, was the first step towards the “heartbeat decree”. The LXXIX. Law of 1992 defines: “Pregnancy may be terminated only in case of danger or in the event of a serious crisis of the pregnant woman […] The pregnant woman shall submit her application for termination of pregnancy in person to a member of the Family Protection Service […]” However, Dr Herczog deplores that whereas women going through an abortion should be accompanied by specially trained staff, this is not the case in the latter service, which makes the process of an abortion even more difficult and potentially traumatising for a woman. Andrea Pető, a Hungarian historian and a Professor at the Department of Gender Studies at Central European University, Vienna, Austria had already warned in a Facebook post three years ago that “heartbeat” was a rhetorical device used by American Christian fundamentalists to prohibit abortion and that the terminology would probably trickle down into Hungarian public media.

No Public Consensus, Ad Hoc Regulation – Mind Your Own Uterus!

The abortion decree has been severely criticized by women’s rights and human rights organisations, leading to a demonstration of thousands in Budapest on 28 September and disapproval from the Council of Europe’s Commissioner for Human Rights, Dunja Mijatović, on that same day, which is dedicated to International Safe Abortion. In a statement, she declared:

“Most countries in Europe are progressively removing barriers which impede women’s and girls’ effective access to abortion care. (…) Regrettably, some European countries have moved in the opposite direction, taking steps which roll back progress achieved in the area of sexual and reproductive health and rights.”

A demonstrator in Budapest who was a retiree told the independent online media outlet telex.hu that this was an extremely heartless regulation, making women who request an abortion see themselves as murderers. Young ladies chanted “My body, my womb!” and their banners called on Interior Minister Sándor Pintér to ‘mind [his] own uterus’. A doula highlighted that in order to increase birth rates, the Government should assure women that there would be enough obstetricians, midwives, nurseries, kindergartens, schools and teachers – instead of adopting abortion restrictions – and deplored the lamentable state of the Hungarian healthcare system, in particular obstetrics wards.

A Bleak Health Care System, and Not Only in Obstetrics

The liberal weekly Magyar Narancs has recently reported about rural hospitals struggling with a lack of personnel, leading hospitals in Szolnok or Mohács, for instance, to ask expecting women to go elsewhere to deliver, which could mean travelling long distances.

A study published in Social Science & Medicine in 2017 highlights that it is common for women in Central and Eastern Europe to “make informal cash payments to ensure continuity of provider, i.e., to have a ‘chosen’ doctor who provided their prenatal care, be present for birth. High rates of obstetric interventions and disrespectful maternity care are also common to the region.”

The conservative weekly Válasz Online recounts how the phasing out of that gratuity (gifting or tipping for health services) in January 2021 has radically restructured the turnover of maternity hospitals in Budapest. Along with the gratuity, the system of the “chosen” doctor has disappeared, so many women who want a family-friendly birth experience go to a private hospital, if they can afford it.

According to Másállapotot a szülészetben (A Different State in Midwifery), a women’s movement, “[for] too many women, pregnancy means suffering, humiliation, illness or even death.” They point out that in Hungary, the number of artificially-induced deliveries and Caesarean sections is unrealistically high, with many women being subjected to medical interventions without their consent, often unnecessarily; being humiliated during their pregnancy, including in the delivery room; or being discriminated against on the basis of race, ethnicity or economic background. Many experience the fact that their pain during pregnancy and childbirth is simply ignored by health care staff. The informal obstetric database Ablak a világra collected mothers' experiences of childbirth through a questionnaire that has been completed by more than 12,000 women, revealing alarming statistics about the rate of episiotomies during childbirth (65%), whereas 12% of the respondents had to give birth with their legs tied down.

The COVID-19 pandemic has also brought new problems to the surface in the health sector, the Hungarian Hospital Association said in a statement this June, denouncing weakened primary care in disadvantaged areas, staff shortages, burnt-out personnel and hospitals having hardly any money for medicines, instruments, dressings and utilities, the liberal news site 444.hu reports.

 

Population Decline – What Real Birth Rate Stimuli Would Look Like

According to a study by the Hungarian National Bank and data from the Central Statistical Office, Hungary’s population has been decreasing since the early 1980s, as the diminishing annual number of births cannot compensate for the number of deaths. To obtain a demographic shift by 2030, 2,000 more children should have been born each year starting from the year 2000, which would mean attaining a fertility rate of 2.1 instead of the current 1.49.

Dr Herczog underlines in her presentations that what families need most is a child-friendly society where parents can plan ahead and count on reliable services, high quality, inclusive, accessible and affordable day care services for children of all ages, including after-school activities  and flexible, long opening hours and summer holidays at such institutions that are truly adapted to working parents’ needs and long-term, predictable social policy and family support provisions for all . In an interview with the private TV channel ATV entitled “Why aren’t more children born in Hungary?”, she bemoaned the catastrophic pay for childcare workers, which reflects the low prestige of these professions, even though those who take care of children between the ages of 0 to 6 are the actual “miracle makers”, this being a “decisive” age group in child development.

Considering the recent dismissal of five teachers from a well-known Budapest secondary school who had been protesting against the austerity imposed on teachers, accessing a predictable, high-standard education delivered by respected personnel for children from 0 to 18 remains a far-fetched dream for most Hungarians.

As the well-known actor Pál Mácsai put it in a recent interview with telex.hu, Hungarians lack the possibility of long-term planning, which makes them unhappy and peeved, an experience they also have from their history. This is being reinforced by their being constantly provoked against foreign nationals and against each other, feeling threatened by the climate catastrophe, overpopulation, poverty and increasing gas prices, all of which leads to a ceaseless irritation that covers them like a sizzling rain.

Selective Incentives Leaving the Poor Behind

Pro-family policy has defined the rhetoric of Hungary’s staunchly conservative Government. In recent years, they have announced several fertility rate incentives, such as tax deductions, housing provisions, and loan benefits for families, while remaining unyielding towards immigration. However, critics say the pronatalist package is selective, benefitting the upper and middle class while ignoring the poor. As a Government-friendly economist, László Bogár, put it in an interview with the media outlet of Somogy County, Sonline in 2013:

One third of Hungarian society is in a state of destitution, and the Government is being forced to make cruel decisions to help those who are left standing. (…) The bottom third is (…) below any physiological minimum. (…) This is the stratum that has the largest number of children.”

Speaking with the author of this article, Dr Herczog pointed out that this is a global trend: As living standards rise, the number of new-borns falls, not just for financial reasons, but also to maintain quality of life and self-fulfilment for a growing number of people. The overall mentality of society is what would have to change, as it is in the interest of the community (people with and without! offspring) that children be born: “If we accept the fact that families with a lower social status and in a lower economic situation have more children, then it would not only be fair, but also economically rational, to support these families with all our efforts.”

Heartbeat Decree Hypocritical

The sociologist scorns the abortion decree as phoney and tokenistic. “If the focus is on abortion prevention, then the Government should not have banned sex education in schools and mass communication platforms for those under 18. Instead, high-quality contraceptives should be made widely available, accompanied by information campaigns on preventing unwanted pregnancy, body awareness, and male contraception.” According to Dr Herczog, the “pro-life” movement also fails to discuss what should happen to non-aborted, unwanted children, how the state and society should bear responsibility for providing optimal conditions for their development, preferably in their own families.

Moreover, the terminology used here is misleading. The “heartbeat” heard during the early weeks of pregnancy is actually the sound of the ultrasound machine used to monitor the embryo. In reference to the restrictive abortion laws affecting the US in 2019, The Guardian newspaper introduced a new style guide in line with the view of the American College of Obstetricians and Gynecologists (ACOG), encouraging editors to avoid medically misleading terms like “heartbeat bill”. The newspaper cites ACOG president Dr Ted Anderson, who declared: “What’s interpreted as a heartbeat in these bills is actually the electrically-induced flickering of a portion of foetal tissue that will become the heart as the embryo develops.”

Obstetrician Dr Dina Wafa told the online news platform Szeretlek Magyarország that the decree is vague. “In most cases, one finds out one is pregnant in the fourth or fifth week. Under the amended rule, this is when a pregnant woman should listen to the foetal ‘heartbeat’, but there is no heartbeat until the sixth week of pregnancy, so there is virtually nothing to listen to.

What’s more, the health law itself says that a patient “has the right to receive fully personalised information (…), but also the right to refuse it.” So, “if a pregnant woman waives her right to hear a foetal ‘heartbeat’ and the doctor has her listen to it anyway, the latter is in breach of this other law.”

“This is going to be a typical Hungarian story,” Herczog comments. “We write one thing, but we do something else.”