May 17, 2011 in Health

New analysis published by the UK journal Reproductive Health Matters shows that the criminalisation of abortion in Poland has led to the development of a vast illegal private sector with no controls on price, quality of care or accountability. Since abortion became illegal in the late 1980s the number of abortions carried out in hospitals has fallen by 99%. The private trade in abortions is, however, flourishing, with abortion providers advertising openly in newspapers.

Women have been the biggest losers during this push of abortion provision into the clandestine private sector. The least privileged have been hardest hit: in 2009 the cost of a surgical abortion in Poland was greater than the average monthly income of a Polish citizen. Low-income groups are less able to protest against discrimination due to lack of political influence. Better-off women can pay for abortions generating millions in unregistered, tax-free income for doctors. Some women seek safe, legal abortions abroad in countries such as the UK and Germany.

“In the private sector, illegal abortion must be cautiously arranged and paid for out of pocket,” says Agata Chełstowska, the author of the research and a PhD student at the University of Warsaw. “When a woman enters that sphere, her sin turns into gold. Her private worries become somebody else’s private gain”. The Catholic Church, highly influential in predominantly Catholic Poland, leads the opposition to legal abortion.

Since illegality has monetised abortion, doctors have incentives to keep it clandestine, “Doctors do not want to perform abortions in public hospitals,” says Wanda Nowicka, Executive Director of the Federation for Women and Family Planning. “They are ready, however, to take that risk when a woman comes to their private practice. We are talking about a vast, untaxed source of income. That is why the medical profession is not interested in changing the abortionlaw.”

In several high profile cases, women and girls have been denied legal abortions following rape or because of serious health conditions and have been hounded by the media for seeking them. The 2004 case of a young pregnant woman who died after being denied medical treatment is currently under consideration at the European Court of Human Rights.

Other articles in this issue of Reproductive Health Matters focus on many aspects of health privatisation worldwide and includes studies from Bangladesh, Turkey, Malawi, India, Madagascar and South Africa.

More information: doi:10.1016/S0968-8080(11)37548-9

Beyond the Church’s Reach

Fleeing West from Poland’s Restrictive Abortion Laws

By Jan Puhl

Anti-abortion activists demonstrating in Warsaw.

An increasing number of Polish women are travelling to Germany for abortions. Even as Poland has modernized and become more European, its laws have failed to keep pace.

Having spent 40 years working as a gynecologist, Janusz R. was pretty sure he’d seen everything his job could throw at him. But recently, he was proven wrong.


A few weeks ago a pretty Polish woman came to see Dr. R. in the hospital in the German town of Prenzlau, not far from the Polish border. She was pregnant, but didn’t want to keep the baby. So far so normal. But the man who accompanied her was much more nervous than the men the doctor was used to seeing.


It wasn’t until after the abortion had been successfully carried out that the patient’s boyfriend became more talkative. “I’m a Catholic priest,” he confessed. He said his church was completely out of touch with the times, that Poland’s abortion legislation didn’t “reflect real life in Poland anymore.” R., who had himself been born in neighboring Poland, had never heard such words from a man of the cloth.

He has, however, heard it repeatedly from his patients. More and more women from Poland come to hospitals in Berlin, Prenzlau, Schwedt and other German towns near the border to have an abortion. R. estimates that about 600 such women have turned up at his offices alone this past year. In 2009, it was 400.

Whereas childless German women are heading east because there are no limits on the number of eggs Polish doctors are permitted to fertilize, implant or freeze, Polish women are fleeing to Germany because the law in their country only permits abortions if the mother’s health is at risk, if the fetus is severely deformed, in cases of incest, or following rape.

No Longer an Agrarian Hinterland

During communism, Poland’s abortion legislation was just as liberal as that of the rest of the Eastern bloc. But after 1989, the Polish parliament enacted one of the most restrictive laws in all of Europe. Many Poles are convinced it’s the government’s way of thanking the Catholic Church. After all, the church sheltered anti-communist opposition activists from the authorities for decades.

When Poland became a democracy in 1990, the country’s bishops wanted free, Catholic Poland to be a God-fearing country in which men and women only shared a bed if they were married and only had sex for the purpose of having babies. Poland, though, lies in the heart of Europe. Its economy is booming and it has long ceased to be the agrarian hinterland that it was just 30 years ago.

The result is that Poland’s abortion law is therefore at odds with the everyday lives of Polish women. More and more of them go to college and want to have a career. Statistics indicate that they are waiting longer and longer before having children. And they want to decide themselves when the time is right to become a mother.

Gynecologist R. studied medicine in the Polish city of Gdansk, emigrated to Sweden, and later came to Germany. He has worked as a medical director in top clinics in Stockholm and in the Ruhr Valley. Although he is retired, he can’t bring himself to hang up his white coat for good. “I love my job, and abortions are a necessary evil,” he says.

The Polish border is only 20 kilometers (12 miles) away, and has in any case been open since Poland adopted the Schengen Agreement in 2007. An abortion can be had in Prenzlau for about €400. The operation is carried out at cost.

Polish women, though, don’t only come to see Dr. R for abortions. Increasingly they want him to deliver their babies or perform regular checkups on their toddlers. Dr. R. offers the kind of gynecological support that still isn’t taken for granted in Poland’s towns and rural areas. In these areas, adolescent girls and women even have difficulties getting the contraceptive pill or other methods of birth control.

Part of a Shady World

“Polish women are much more self-assured than they used to be,” says R. “They bond with men they find sexually attractive, but do not want to marry.” R. has learned that Polish women want the same freedoms as their male compatriots.

Women’s rights activists estimate that as many as 200,000 illegal abortions are carried out in Poland every year. After-hours’ terminations at Polish hospitals, in doctors’ offices or even in private apartments cost about 8,000 zloty, or about €2,000. Gynecologists take out newspaper ads, though these don’t mention their name, just a telephone number. “We offer a full range of services,” runs the typical slogan. Illegal abortions are part of a shady world that everyone knows about, but no one wants to discuss.


Often enough doctors conduct their abortions without either an anesthetist or an assistant in attendance. Sometimes the patients are even required to hold the instruments during the operation. “The doctors are worried they will be discovered, and the women feel ashamed,” R. says. He would prefer them to bring their problems across the border to his hospital.


Dr. R. had four Polish women in his waiting room on one recent morning. He was able to convince one of them to reconsider. The second was due to return a short time later. The third, a 17-year-old schoolgirl, cowered in her bed, still looking a little pale. “All the girls in my class have sex,” she said. “Afterwards they go to confession.”

The fourth patient had come too late: She was already in the 19th week of her pregnancy. In Germany, abortions are only permitted until the 12th week. This patient will probably get back into her car and drive even further west. The Netherlands permit terminations until the 22nd week of gestation.


Parliamentary Hearing on Polish Abortion Tourism reveals the need for Change of Anti-Abortion Law. Polish restrictive 1993’s anti abortion law permitting abortions only if pregnancy results from criminal offence or the life of the mother was seriously threatened or if there was severe deformation of the fetus. The introduction of the law didn’t influence the reduction of number of abortion but led to development of abortion underground and abortion tourism.

The issue of abortion tourism was a topic of parliamentary hearing organized by Federation for Women and Family Planning. Invited guests, RH practitioners from Austria, Germany, the Netherlands , and UK highlighted one of the central characteristic of the phenomenon. In highly restrictive situations, class and socio-economic status play a huge role in whether or not a woman can access safe abortion. Only women who have financial resources can go to Western countries to obtain abortion. It is estimated that some 80, 000 – 200, 000 women undergo illegal abortion every year, and approximately 30, 000 women choose to cross the border in order to undergo a legal procedure. Although statistical data regarding abortion tourism, numbers provided by the speakers suggest the scale of the problem: for example, 400 abortions have been performed on Polish patients this year in German clinic near Polish border. The participants of the hearing underlined that the current abortion law is completely inadequate to meet the needs of women and girls seeking safe abortion care. Therefore, pregnant women and girls who are able to do are virtually forced to become abortion tourists. Although the term is often used in sexist and disparaging ways, what it really points to is that women’s reproductive health needs are being ignored. Women are too frequently being deprived of their right to access safe, compassionate, and professional abortion services close to home.

Source: http://www.federa.org.pl

via  http://eugeniadealtura.wordpress.com/2010/05/15/15-de-mayo-lo-que-es-ilegal-se-puede-ignorar/

This week, New York Times blogger Nicholas Kristof opines, “my sense is that the illegality of abortion isn’t as large an element in maternal mortality as some people believe it is.”  On the one hand, Kristof points to a certain truth–just because abortion is illegal does not mean that it is not available.  Thousands of women undergo relatively safe abortions every day in countries where the procedure is illegal.  However, in these same countries, many more thousands of women end up getting unsafe abortions, since the key to accessing a safe pregnancy termination is usually money.  And most women worldwide–let’s face it–are poor.

The problem with abortion’s illegality is that it creates a class-based abortion industry, where women with money can access safe procedures, but women without, cannot.  Since where it is illegal abortion officially does not occur, government and public health officials can ignore the glaring class disparities in abortion care and in the resulting maternal deaths.  Since it is difficult to regulate an industry that officially does not exist, unscrupulous, unsafe abortion clinics exist alongside relatively safe medical centers, and most women do not have the information they need to make careful decisions about which to visit. (more…)