I. Georgian filmmaker embedded in a birth clinic for a year to make abortion drama
by Leila Fadel, Olivia Hampton
Growing up in the shadow of the Caucasus Mountains in rural Georgia, Dea Kulumbegashvili was one of the few young women who didn’t become a teenage bride and mom. Her classmates were married off young or faced rape and domestic violence, and they struggled to pursue their education or develop a successful career, Kulumbegashvili said on Morning Edition as she discussed her new film, April.
The feature drama is a provocative and haunting portrait of a woman who performs home abortions in this same region for free, outside of her regular job as an obstetrician at the hospital. Her patients don’t have the means to pay for the procedure and, in some cases, were raped. The film was largely shot in secret at a time of increased abortion restrictions in Georgia. Images of the gritty challenges these women face contrast with their bucolic surroundings — poppy fields and cherry groves with the mountains rising in the distance.
Kulumbegashvili spoke with NPR’s Leila Fadel about what inspired her to make her film — about a doctor who is risking everything to give abortions to women in rural Georgia.
Dea Kulumbegashvili: Well, first of all, this is the place where I grew up. I lived there until I was 17 and this is where my family lives until now. I go there at least once a year, and I used to meet my former classmates who were my age and they had like eight children. When we were 15, my classmates started to get married and it was not something they wanted to do, but it was mostly either like encouraged or arranged marriages or kidnappings, which was also kind of part of how the marriages would be arranged. I was very lucky that my father was very critical of all of this and he kind of made sure that we would not end up getting married this way. And, I guess, out of luck because I was born into a family which prioritized my education and my future, I was able to have a profession and to go on and to make films, while many people from my childhood, like my best friend, for example, they were not able to make the same choices at the end.
So there is a gray area in a way in all of Georgia, basically, because officially abortions are legal. But up until 12 weeks it’s possible to get an abortion with the pill specifically, but it’s kind of impossible to get an abortion at the end of the day, especially outside of a capital and outside of like two major or three major cities in Georgia, because every hospital makes their own decisions whether they to practice abortions or not, and most of the hospitals just don’t practice abortions, and there is no law that requires them to practice abortions, basically. It’s encouraged on the government level, on the official level, that abortions are kind of a huge taboo and it’s almost impossible to obtain an abortion other than if it’s a medical emergency, obviously, that involves women’s health. And it’s not possible to find the pill at any of the pharmacies.
Fadel: So it’s not technically illegal, but it’s pretty much impossible if they don’t go to the big cities.
Kulumbegashvili: Yes…. [interview continues at length]…. my goal really was to somehow make the experience of the main character, of Nina, very tangible. I wanted her to bring us inside those houses, to bring us to these women. And I wanted to feel what she feels, even though she feels very distant and maybe we really never know what she’s thinking about, and to experience this really spectacular nature of my home region. It’s important for me to show it all, because together with the violence, it’s important to understand that there is also all this beauty and it’s part of the life there as well. It’s true that this film is hard to watch. And recently I was thinking that maybe only now I started to get out also from the experience of making it, because it was a difficult experience for me as well….
PHOTO by Arseni Khachaturan
SOURCE: National Public Radio, 30 April 2025
Kulumbegashvili (on the set of the film):
…And when you’re there and when you see things every day, somehow the film shaped into what it is and there is maybe a sense of rage in it. I don’t think it’s hopeless. It’s possible to see how much Nina feels empathy and there is a possibility of love, and it’s just some sort of maybe desperate scream to be seen by all the women who are in this film.
II. Georgia introduced dangerous new restrictions onto abortion access in early 2024
In October 2023, the Ministry of Health in Georgia introduced new restrictions to accessing abortion care in the country. This surprising move was not made in consultation with any health experts and has already led to a number of challenges for those seeking abortion services.
Though officially abortion is available on request up to 12 weeks of pregnancy, these new amendments introduce additional obstacles to the procedure. These mandatory requirements conflict with the World Health Organisation’s (WHO) recommendations, particularly regarding pre-abortion counselling.
People seeking abortions are forced to undergo a compulsory five-day waiting period
This was always the case, but now even the flexibility of reducing the waiting period to three days for pregnancies above 12 weeks gestation has been removed.
The WHO recommends against the imposition of enforced waiting periods for abortion care The evidence shows that such measures delay access to abortion, and can increase the logistical and economic burden on those seeking care, sometimes to the extent that the abortion becomes unattainable. There is no medical reason to force women to wait for an abortion, and in fact it undermines their autonomy to make a decision about their own pregnancy.
We were therefore shocked when the Ministry of Health announced that patients seeking abortions must now first have an interview with a social worker, a psychologist, and an obstetrician-gynaecologist.
Abortion-seekers must also undergo more than one mandatory ultrasound.
Again, this flies in the face of expert advice. The WHO recommends against the use of ultrasound scanning as a prerequisite for providing abortion services, noting that it is “not necessary from a clinical perspective.”
Patients are required to have an ultrasound during their first visit to a clinic to determine the gestation period. And now it is also mandatory to have a second ultrasound after the five-day waiting period. This additional step of course contributes to an overall increase in service costs. It is also a waste of the patient’s time, and not medically required.
A medical abortion can now only be performed in a specific type of medical facility
Abortions can only be performed in an in-patient medical centre by a certified obstetrician-gynaecologist. This limits the locations where abortion care can be provided, but also those who can provide it. These valid centres are mainly in cities so this affects those in rural areas particularly.
If the doctor violates the five-day mandatory waiting period, that can cost them their licence. If the prescription for abortion medication is made by anyone but an obstetrician-gynecologist and/or reproductive specialist, that can be classified as a criminal act.
Understandably we are hearing that in trying to navigate the complexities of these changes, some doctors are hesitating to provide services due to uncertainties.
We continue to do our best to support people seeking safe abortion care in Georgia.
We work with a number of communities who are already underserved when it comes to abortion care. They will be most at risk from these additional barriers. People have already told us they are getting stigmatizing questions from psychologists about seeking abortions, for example “Don’t you think you might regret it over time?”. Given these conditions, our focus now shifts towards developing a trained pool of social workers and psychologists equipped to provide adequate counselling. We aim to negotiate with clinics to reduce the costs of secondary ultrasounds and psychologist services, offering them our support free of charge.
We are also actively engaged in advocacy to remove these punitive requirements. We are pleased that civil society organisations and professional associations are also vocal about their opposition to these amendments. We stand alongside the entire National Reproductive Health Coalition in fighting for fairer access to abortion care.
SOURCE: Medea Khmelidze, Program Manager, Real People Real Vision, a Safe Abortion Action Fund grantee partner in Georgia, 19 March 2024.