Views & Reviews Review of the Week

Secrets and lies

BMJ 2008; 336 doi: (Published 03 January 2008) Cite this as: BMJ 2008;336:47
  1. Khalid Ali, senior lecturer in geriatrics, Brighton and Sussex Medical School

    An award winning film portrays the political dangers and serious health risks faced by women seeking abortions in Ceauşescu’s Romania, writes Khalid Ali

    Tackling the sensitive issue of illegal abortion, director Cristian Mungiu tells the story of two young women in Ceauşescu’s 1980s communist Romania. The film received critical acclaim on the international circuits and won the Palme d’Or at Cannes film festival last year.

    Set in 1987, the story follows two close friends living in a dormitory, one of whom, Gabita (Laura Vasiliu), falls pregnant, while the other, Otilia (Anamaria Marinca), tries to help her get an abortion. The film follows the two desperate women over the course of a night, from when they secretly book a hotel room and during their negotiations over the price of procuring the abortion with a mysterious man (Mr Bebe), right through until the following morning.

    The abortionist is a cold blooded, exploitative dealer (a real criminal, far from the sensitive, good natured mother figure in Mike Leigh’s Vera Drake (BMJ 2004;329:1107, doi: 10.1136/bmj.329.7474.1107) who knows that the two women are at his mercy. Septic abortion and death from uncontrolled bleeding are risks they have to accept. The clinical details of the procedure appear cold and violent, and lacking basic hygiene. All dealings are cloaked in secrecy to avoid detection. And while the abortion is taking place, Romanian secret police officers lurk in the hotel lobby.

    The harsh realities of the oppressive regime and the disintegration of the social support network are brilliantly observed when Otilia goes to her boyfriend’s party, leaving her vulnerable friend with no one to help her. Otilia tells her boyfriend the truth, but discovers that he does not approve of abortion. She is shocked, realising that should she become pregnant she could easily end up in the same boat as Gabita and have to rely on illegal abortion.

    After Gabita’s termination, Otilia has to get rid of the aborted fetus in the dark, deserted streets of Romania. The catastrophic significance of what has happened is etched on her face. By the morning the stress of the night has taken its toll on the two women and they are two crushed human beings. After such a harrowing experience, can they ever again be the same young women they once were, full of the hope of having a normal family life?

    It seems clear where the film’s sympathies lie—critical of the Romanian government’s motives and condemnatory of a healthcare system that could keep quiet in the face of such oppression of women’s rights. And whatever viewers’ own convictions about abortion, they are likely to wonder how what Gabita and Otilia go through could happen in the modern world.

    Abortion was a criminal offence in Romania from 1966 until 1989. Women and doctors undergoing and performing abortions faced lengthy jail sentences: illegal induced abortion was punishable by up to 12 years’ imprisonment and self induced abortion by six months to two years. At that time Romania had a policy of increasing the country’s population, and set up special units within the state security police to combat abortion, imposed special taxes on single and childless couples, and introduced compulsory gynaecological examinations in schools. This all led to the emergence of a black market dealing in abortion as if it were any other smuggled good. Ironically, Romania had one of the highest abortion rates in Europe (78 out of 1000 women aged 15-44 had one), and one of the highest maternal mortality rates (150 maternal deaths per 100 000 live births), and there were thousands of unwanted children in institutions.

    4 months, 3 weeks & 2 days acts as a commentary on a political regime and a social system that sacrificed its people to a dictator’s tyranny. It renews the debate about the legality of abortion, women’s rights, and the role of the state in governing procreation and freedom of conception. As unsafe abortion rises to pandemic proportions in developing countries (Lancet 2006;368:1908-19), serious steps are needed to stop this tragedy. It is high time that doctors stand up and get involved in policy making to help end such human loss and suffering.


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