In Central and Eastern Europe, the pandemic has further restricted reproductive rights

In Central and Eastern Europe, the pandemic has further restricted reproductive rights

Romanian women show support for Polish women during a flashmob in Piata Universitatii Square in Bucharest on 3 October 2016. Hundreds of thousands of people across Poland participated in a ‘women’s strike’ to oppose a proposed near-total ban on abortions in the devoutly Catholic country, which has been ruled by the right-wing, national-conservative Law and Justice party since 2015. The ban eventually came into force on 27 January 2021.

(AFP/Daniel Mihailescu)

This March, Klaudia Kuzdub received a discrete, anonymous package in her mailbox containing five pills wrapped in plain paper. The 26-year-old IT worker from Kraków, Poland, swallowed the first pill, a drug called Mifepristone; 24-hours later, as instructed by email, she took four tablets of Misoprostol. With her best friend at her side, Klaudia had just undergone a medical abortion, a method that is approved by the World Health Organization up until the twelfth week of pregnancy. The pills had been sent to Klaudia from Women Help Women, an international non-profit organisation that helps women access abortions. “The hardest part was to have to wait for the package. The organisation had specified that it couldn’t guarantee anything with the pandemic. I was lucky – it was there in just a week,” says Klaudia.

As of 27 January 2021, abortions are only legal in Poland in the case of rape, incest, or if a woman’s life or health is at stake. Poland already had some of the most restrictive abortion laws in Europe, but an October 2020 ruling found that a 1993 law, which only allowed for abortions in the case of severe foetal abnormalities, was unconstitutional. Given the fact that in 2019, 98 per cent of the 1,200 legal abortions that were carried out took place on these grounds, the ruling effectively banned most pregnancy terminations.

The preservation of ‘traditional family values’ has formed the bedrock of the right-wing, ultra-conservative agenda of the Law and Justice party (PiS) since it came to power in 2015.

In 2016, nationwide protests known as the ‘Black Monday’ women’s strike prevented PiS, goaded by ultra-conservative forces backed by the Catholic Church, from instituting an almost total abortion ban at the time. But in the long war for reproductive justice for Polish women, the January 2021 law means that the government has won the latest battle.

Although Poland’s near-total abortion ban struck during the middle of the second wave of the Covid-19 pandemic, the Polish pro-choice movement managed to successfully launch the Abortion Without Borders coalition just three months before the start of the pandemic. This umbrella initiative, which includes Women Help Women as well as five other NGOs, became well-known to the public during the mass protests that took place last autumn in response to the ruling. As a result of the new abortion ban and the pandemic, its widely-publicised abortion helpline received 6,500 calls between October 2020 and April 2021.

Even before January, it is thought that most of the 100,000 clandestine abortions carried out by Polish women were at-home medical abortions. However, the restricted mobility caused by the pandemic has only increased demand. In the past six months, Women Help Women has received 47,000 inquiries and posted out 10,000 abortion pills. “The law in Poland doesn’t criminalise a person who is doing their own abortion, so it’s completely safe,” says Kinga Jelinska, who founded Women Help Women in 2014. However, sometimes doctors harass their patients.

When Klaudia went to her local hospital after she experienced some bleeding following her abortion, the gynaecologist threatened to report her to the authorities. Even after an ultrasound, the doctor refused to confirm that Klaudia’s pregnancy had been terminated. “I got scared,” Klaudia recalls. A few weeks later, she received a call from the police saying that they would investigate her case, although she has not heard from them since.

A six-day journey to a clinic

For Poles travelling to neighbouring countries such as the Czech Republic, Slovakia and Germany to access a surgical abortion, travel restrictions have made their journeys much more complicated. “Actually Covid-19 is only one more obstacle. It shows what people who don’t want to be pregnant are willing to do,” says Mara Clarke, founder of the Abortion Support Network. The UK based charity – which is also a part of Abortion Without Borders – facilitates abortions for Poles in UK clinics and provides financial assistance for medical abortions in other European countries where abortions are highly restricted.

“When they announced that they were closing the airports last year, the Polish helpline got 115 calls within two days,” says Clarke. The gradual easing of the lockdown means that more abortion travel is taking place, but with greater restrictions. What used to be a one-to-two-day trip can now take up to six days. It also costs much more now: the price of an abortion has gone up in some clinics, and travellers also have to factor in Covid tests, and in some cases, quarantine costs.

There are other obstacles: fewer available appointments at clinics; inaccessible accommodation due to travel bans; queues at the border crossings. On top of that, add the difficulty of organising childcare. “Eighty per cent of the Polish patients that come to our clinic [already] have a family,” explains Anna Jaskolska, the Polish assistant at Gynmed, a clinic in Vienna, Austria, specialising in abortions and family planning. “You also need to explain to your family why you are travelling during the pandemic,” reflects Clarke, referring to the fact that abortions are often taboo.

For those who are able to get a surgical abortion, welfare provisions have been greatly scaled back. “It would be nice to have a safe and quiet space to offer to people coming to the Czech Republic [for an abortion], especially if they are in an abusive relationship. But currently Poles can only stay up to 12 hours in the Czech Republic to avoid quarantine,” explains Jolanta Nowaczyk, a volunteer from Ciosia Czecia, an activist collective launched specifically to help residents of Poland access abortions in the Czech Republic. Another Covid-19 restriction means that only the patient is allowed into Czech operation rooms: “Outside of the private clinics, the staff are unlikely to speak Polish,” says Nowaczyk.

Compulsory counselling in Hungary, non-urgent abortions in Romania

In Hungary, where surgical (but not medical) abortions are legal until the twelfth week of pregnancy, abortions weren’t restricted by the pandemic. However, abortion patients are legally obligated to undertake two counselling sessions with a district nurse, which sometimes amounts to moral lecturing or emotional blackmail.

“Hungarian patients tell us about their horrendous experiences of those meetings,” says Dr Christian Fiala, the founder of Gynmed, who says that Hungarian patients often come to his clinic for the medical abortions that are outlawed in their country. “We have also had numerous cases of Hungarian persons who come to us because they think they are beyond their twelfth week, when in fact they are sometimes just eight weeks pregnant,” says Fiala (in Austria, abortion is legal until the fourteenth week). “This means that they were lied to in their country,” in an attempt to prevent the abortion all together.

Access to surgical abortion has been even more scarce further east. At the beginning of the pandemic in Romania abortions were not considered an essential health service and so they were unavailable to those with unwanted pregnancies.

Despite abortion until the fourteenth week of pregnancy being guaranteed by Romanian law since 1990, only 11 per cent of public hospitals (among those that actually perform abortions) were providing access to surgical abortions between March and the beginning of May 2020. In Bucharest, Romania’s capital city of two million inhabitants, not a single hospital was available to perform an abortion during this period, with only one exception: a private clinic that charges US$830 for the operation – the equivalent of the monthly average salary. In public hospitals, abortions tend not to cost more than US$120.

The Romanian women’s rights NGO Centrul Filia created a map to show which hospitals were performing abortions during the lockdown, and in many of the country’s poorest regions, there was no help available at all. “Women have tried various solutions to abort in the country, and that can lead to a mortal septicaemia,” says Radu Vladareanu, president of the Romanian Society of Obstetrics and Gynaecology.

Ana-Maria (not her real name), 19, thought about carrying out a DIY abortion, but she eventually found a doctor in Bucharest who was performing the operation in his flat. “Everything seemed clean, but I wasn’t reassured,” she told the sex education NGO Sexul vs Barza who shared her testimony with her agreement. However, other people weren’t so lucky. Centrul Filia obtained information from official sources that revealed that several people carried out unsafe home abortions in the past year.

Even though the government has included abortions in its list of essential health services since May 2020, access today remains limited. The consequences can be fatal: one woman died in September 2020 after she had a surgical abortion in a private clinic because no public hospitals in her area were performing the procedure. Such circumstances are reminiscent of the Ceaușescu era, when the dictator promulgated a 1966 decree against abortion. Until the 1989 revolution, it is estimated that at least 10,000 women died as a result of clandestine abortions.

Unequal access

Medical abortions, which are particularly welcome in rural areas with limited health care facilities, haven’t been more accessible, either. This situation might actually explain why Romania’s birth rate, which has been plunging for years, rose suddenly at the end of 2020. According to data from the National Statistics Institute, in December (nine months after the start of the restrictions) 15,857 children were born in Romania. That’s 433 more compared to December 2019 and 1038 more than December 2018. By contrast, the number of abortions fell by 35 per cent in 2020 compared to 2019.

“I see a clear correlation between the lack of access to abortion and the rise of the birth rate nine months after the lockdown,” explains Adina Paun, a rural midwife, who also argues that “the Orthodox Church – a very powerful institution in some regions – is against abortion but also sex education and contraception.”

Indeed, in the past few years, Romania has seen religious views influencing the field of reproductive rights. According to a 2019 survey by Centrul Filia, almost a third of gynaecological services in public hospitals decided to stop performing surgical abortions, the majority of them citing moral reasons. So-called ‘pregnancy crisis’ clinics have also popped up, pretending to help people who want to get an abortion while actually trying to encourage them to give birth.

Time and again, the Covid-19 pandemic has hit marginalised communities the hardest, and access to abortion is no exception.

People deprived of resources have less chance of accessing the necessary information and are also less able to cover all the abortion expenses, including additional costs caused by the pandemic. As a result, some women have been unable to escape unwanted pregnancies. The situation has been even more critical in Romania and Poland where the issue of access to abortion has been extensively discussed in the media, especially in recent months. Romania is currently working on its next National Reproductive Health Strategy (2021-2024), where the government is sitting around the table with pro-choice organisations such as Centrul Filia. In Poland, while the government has restricted abortion access, the social taboo around abortions is slowly fading as evidenced by the large number of pro-abortion protests that have taken place since 2016. By contrast, in Hungary, conservative views – fuelled by the government – have made abortion even more stigmatised in the political discourse.

The research for this article was partly funded by n-ost, with support from the German Federal Foreign Office