THE ANTI-ABORTION LAW IN POLAND

THE FUNCTIONING, SOCIAL EFFECTS, ATTITUDES AND BEHAVIORS

THE REPORT - SEPTEMBER 2000

1. Index
   
2. Introduction - Wanda Nowicka
3. The Effects of The Anti-Abortion Act
4. Attitudes of The Medical Professionalists Towards Abortion The Report on Research of The Effects of The Family Planning, Protection of Human Fetus and Conditions for Termination of Pregnancy Act - Danuta Duch
5. Survey Conducted by The Federation Among Doctors, Nurses and Midwives on The Effects of The Anti-Abortion Act - Wanda Nowicka and Agata Zielińska
6. Attitudes of Rural Women Toward Reproduction Issues Report on The Survey Conducted by RUN - Magdalena Grabowska and Wanda Nowicka
7. Abortion and Values – The Research Report - Danuta Duch
   
   

The Effects of the Anti-Abortion Act - Wanda Nowicka and Monika Tajak

The termination of pregnancy was made legal in Poland in 1956. From 1956 to the early 1990's, abortion was widely accessible, both on medical and social grounds. Terminations were conducted in public hospitals (free of charge) and in private clinics as a paid service.¹
At the beginning of the 90's, social groups connected with the Catholic Church initiated a campaign against legal abortion. In 1992 the medical professional organization, despite resistance from numerous medical doctors, also issued a statement against abortion at the National Assembly of Doctors in 1992, and adopted the Medical Code of Ethics with regulations stating that abortion on social grounds, as well as, when the pregnancy was a result of criminal act was deemed impossible. The possibilities for termination of pregnancy on medical grounds had been seriously limited.²
Different actions restricted access to abortion, making it almost impossible in public hospitals and more expensive in private clinics.

After over three years of discussions and after a number of projects of legal regulations, the Polish Sejm (lower house of Parliament) finally voted for the Family Planning, Protection of Human Fetus and Conditions for Termination of Pregnancy Act, commonly known as the Anti-Abortion Act of 1993.
The legal situation of abortion changed two more times after that. In 1996, the Sejm liberalized the Act, allowing for abortion on social grounds. Nevertheless, after the decision of the Constitutional Tribunal in 1997, the Sejm restricted the conditions once again, withdrawing the possibility of termination of pregnancy on social grounds. This is the situation to date.

The legal regulations concerning the termination of pregnancy

Since the reforms in 1997, Polish regulations allow for termination of pregnancy in the following cases:

• if the pregnancy constitutes a threat to the life or health of the mother, and this threat is confirmed by a doctor other than the one conducting the abortion. The termination of pregnancy is conducted in public hospital.
• if the pre-natal examination or other medical reasons point at the high probability of severe and irreversible damage to the fetus or on an incurable disease, life-threatening of a child (confirmed by a medical doctor other than the one conducting the abortion). The termination of pregnancy is conducted in a public hospital.
• if there is a confirmed suspicion that the pregnancy is a result of a criminal act. The termination of pregnancy in this case is allowed, if a woman is less then 12 weeks pregnant. The criminal circumstances, entitling to lawful abortion, have to be confirmed by a prosecutor. The termination of pregnancy may also be conducted in a private clinic.

The written consent of a woman for termination is required. In cases of minors or incapacitated persons, the law requires the written consent from the person's legal guardian. If the minor turned 13 years of age, her consent is also necessary. If a minor is less than 13, a custody court must issue consent, while a girl is entitled to state her own opinion. An incapacitated person also should give a written consent, if her state of mind allows for it. In cases of lack of consent from legal representative, a custody court gives it.

Requirements for termination of pregnancy

In cases where the fetus is damaged or when the pregnancy threatens the life or health of the mother, the termination of pregnancy is allowed but can only be performed by a doctor in a public hospital. Women, who are legally allowed to have an abortion and are covered by the medical insurance program, entitling them to free of charge medical services - are entitled to free of charge termination of pregnancy, conducted in a public health center.

A doctor has the right to use the clause of conscience and refuse to terminate a pregnancy. This, however, can only happen when the delay is sure not to endanger a life, or pose the treat of serious health damage or serious injury. In case of refusal based on the clause of conscience, the doctor is also obliged to refer the patient to another doctor or to a hospital where the abortion can be performed.³

Criminal penalties for the illegal termination of pregnancy

Terminating a pregnancy with a woman's consent violates the statutory regulations and can be punished with up to three years of imprisonment.⁴ Aiding a woman in the termination of pregnancy or talking a woman into illegal abortion is also subject to the same penalty.⁵ If the above actions result in a death of a pregnant woman, the perpetrator may be imprisoned to up to 10.⁶
The penalty for the above-mentioned criminal acts when the fetus achieved the ability of independent life outside the mother's body can be up to 8 years of imprisonment.⁷ Violence against a pregnant woman in any other way terminating a pregnancy without a woman's consent carries the punishment of up to 8 years of imprisonment.⁸ These same actions when the fetus is able to live outside the mother's body, maybe subjected to up to 10 years of imprisonment.⁹ If the criminal act results in death of a pregnant woman, the perpetrator may face from 2 to 12 years of imprisonment.¹⁰
The woman does not face criminal consequences.

The actual number of abortions in Poland was not even known when the termination of pregnancy was legal and widely practiced. Statistics only covered cases of abortions performed in public hospitals. It was widely known that most terminations were conducted in private clinics and these were not covered by any of the official statistics. Estimates concerning the actual number of abortions were very different, sometime even ten times higher than officially recorded. Currently, since the ban on abortion, it has become even harder to estimate the real number of abortions. One thing is sure - the number of abortions quoted in official statistics proves only the fact that legal abortions are less and less accessible in public medical centers, and indicates the existence of a large-scale underground abortion. These suspicions are also supported by demographical data on the dropping birthrate. They are also indirectly confirmed by researches (public opinion polls) on the use of contraception, which point to the small scale of such a use.
Readers can find more information about this in the chapter: “The scale of abortion underground“.
The following data and tables come from the report of the Council of Ministers for the Realization of the Family Planning, Protection of Human Fetus and Conditions for Termination of Pregnancy Act, Warsaw 1999.

Table 1:

* regulation allowing for abortion on social grounds was binding only in 1997
** data presented in a governmental report do not sum up to 151

Table 2: Abortions, life births, fertility rate and spontaneous miscarriages in years 1965 – 1999

Official statistics reflect a decrease in the number of abortions from 1965 to 1992.

In 1994, after the introduction of the Act, the official number of abortions conducted in public medical centers decreased to 782 cases. In years 1993 to 1998, the number of legal terminations of pregnancies decreased by three times and in 1998 it has reached the level of 310. The data for the year 1999 is still more shocking - in relation to previous year, the number of legal terminations of pregnancy dropped by more then a half and reached the level of 151 cases per year. It absolutely confirms the Federation's experience last year and the results of conducted studies - the possibility of legal abortion in a public hospital is currently almost nonexistent. The dramatic decrease in the number of official terminations on the basis of health problems was down to 94 cases in 1999 (!) - more then four times less cases than in 1997 and more than two times less than in 1998. This indicates huge difficulties in obtaining legal abortions for these reasons. At the same time, the health indicators clearly show that there was no radical improvement in health of Polish women in 1999. The Federation's conclusions, both direct experience from help-line calls and research in the medical environment, confirm this situation.
The data for 1997, the year when the regulations allowing for the termination on social grounds had been reintroduced, are especially interesting. There were 3047 abortions conducted in public hospitals - that is much more than in previous and following years. 2524 abortions were conducted on social grounds, what constituted almost 83% of all terminations. This shows clearly that most of abortions were and probably still are conducted (illegally) on social grounds, when women are not able to take the responsibility for maternity.

The Federation's studies in 1999 and 2000 confirm the results of the research conducted by the organization in 1993 and 1996.

1. The anti-abortion law did not eliminate and probably did not limit the phenomenon of abortion. Illegal terminations are still common. The scale of the problem can be estimated at 80.000 to 200.000 abortions per year.
2. Illegal abortions are conducted by doctors and are very expensive. This is known as the abortion underground.
3. A number of women travel abroad to have an abortion. This is known as the abortion tourism. In comparison to previous research, this has significantly decreased in popularity and has taken on a more individual character than organised.
4. Restrictive regulations did not eliminate abortions on social grounds; it has only led to major limitation of access to legal abortion. Public hospitals rarely terminate pregnancies. Some clients of the abortion underground are actually women who have a legal right to an abortion but who, for a number of reasons, could not exercise it. Comparing to previous studies conducted by the Federation, this phenomenon has become significantly stronger.
5. Awareness about conditions for lawful termination of pregnancy is highly unsatisfactory, both in the society in general, as well as among the medical staff.
6. The Federation's experience shows that the anti-abortion law caused many health and personal problems to hundreds of thousands of women in Poland.

The abortion underground

All available sources of information show that the abortion underground in Poland is very well developed. Accessing a private clinic, in which one can obtain an illegal termination of pregnancy, is much easier in big cities and towns. Finding the appropriate press advertisement is the key.¹¹ In local press this is harder to find. In small towns and villages, doctors are not anonymous and are afraid of being stigmatized. Despite the possibility of finding an abortion provider in rural areas, women prefer to travel further, just to be sure that the information about the abortion will not reach the local community. Very often, this fear is justified.
Lately, some doctors have suggested terminating pregnancy using the RU-486 pill.
The price for illegal abortion stands between 1500 PLN (around 330 USD) to 3000 PLN (around 675 USD), with the average price of more than 2000 PLN. The RU-486 pill, which has not been registered for sale, is offered for about 1000 PLN (that is around 225 USD). It is questionable as to whether doctors inform their patients about all possible side effects of this particular method (i.e. about the necessity of finishing the termination by surgical abortion). It raises serious health concern for women who use this (cheaper than traditional) method of termination of pregnancy. More and more women and men are calling the Federation's help-line, asking for the RU-486 pill and it's accessibility in Poland. The Federation has information about a case in which a doctor prescribed the pill to be bought in pharmacy, which illustrates lack of knowledge not only about the law, but also about procedures concerning abortion.
The media constantly report the fates of women who were forced to use the services of abortion underground.¹² The following report presents a couple of them (see: Appendix 1). Despite the ban on abortion, the risk of the “crime“ being discovered was still minimal not so long ago. One can only suppose that the scale of illegal abortions is wider than the number of cases registered in police statistics. Out of 42 cases concerning the violation of the anti-abortion legislation in 1998, only 3 cases went to court, while the rest were either dismissed or the investigations were denied.¹³ 62 such cases were recorded in Poland in 1999, out of which 6 resulted in formal prosecution against a total of 11 people.¹⁴ In most cases, investigations were based on information from medical care centers. It was not infrequent that those undergoing underground abortions required medical intervention and hospitalization. Hospitals informed the prosecutor's office about illegal activity. One of investigations run at the moment concerns unprofessional abortions conducted by a doctor from Szczecin.¹⁵ In some cases, the partners of pregnant women reported illegal abortions.

The following table illustrates the number of confirmed law violations (data submitted by the Police): (Table 3)

Table 3: Crimes registered according to legal qualifications

Source: Statistics of the Police Headquarters

• starting from 14.02.1997 registration of cases according to the Act of 30.08.96 on the change of the Family Planning (...) Act was abandoned and the registration according to Art. 152a § 1-2 and Art. 152b §1-3 was introduced
• Legal qualifications according to Criminal Code of 1997 (in force from 1.09.1998)

The new policies of the police towards cases of termination of pregnancy

The year 2000 brought a disturbing fact, the increase of police activity in investigating the illegal abortions. Not only the above confirms the quoted statistics. In January 2000, the police, using the force, entered a private clinic in Lubliniec,¹⁶ after receiving information about an illegal abortion being performed in the clinic. Women's rights organizations believe that the rights of this particular woman have been violated, especially when she was forced to undergo a gynecological examination. The Ombudsman for Human Rights received an official claim in this case.
The similar case took place in Katowice, in March this year.¹⁷ Police entered the clinic by force, after months of observation, at the exact moment a woman was being prepared for an abortion. As a result of this action, the clinic was closed and the investigation still stands. The investigation began after information was received from a hospital, which had admitted a woman with post-abortion complications.
Another case strongly connected with the above topic concerns the abandonment of a newborn child in Kielce.¹⁸ The prosecution is accusing the police of grave violation of law because a woman was detained and submitted to gynecological examinations. It became clear only after hours that the woman was at the moment pregnant and could not possibly have abandoned a newborn child. What is most staggering in the latter case is that a woman can become a suspect even on the basis of anonymous information.
One can suspect, that activity of social groups supporting the unconditional ban on abortion (their insistence on restricting the anti-abortion law, and pressuring of medical staff and the criminal justice system to more rigorously enforce the regulations) are causing this change of the police policy towards violations of the Anti-Abortion Act.

Infanticide, abandonment

One of the effects of the ban on abortion (also due to the lack of sexual education and contraception counselling services) is women giving birth to children against their will. These situations sometimes lead to abandonment or infanticide. The less drastic, although equally difficult, choice in such situations is leaving the child in a hospital and childcare institutions.
Despite the fact that police statistics do not note an increase in number of infanticides since the start of the Act, these statistics are only a tip of the iceberg. Most of such cases will undoubtedly never see the light of day.
In May 2000, the public learned of a woman who committed double infanticide. Because the investigation procedures were kept confidential, there was no information available on the woman's motivation. The poll conducted by the Federation among lawyers in Warsaw confirmed the suspicion that the sentence of 25 years imprisonment was too high. The woman stated clearly that she was guilty, but this did not cause a more lenient sentence.

Table 4: Infanticide, abandonment, and abandonment resulting the death of a child

Source: Data of The Press Department of the Police Headquarters

Table 5: The number of children left in hospitals

Based on reports of the Council of Ministers on the realization of the Family Planning (…) Act in 1998 and 1999

Statistics show that from 1993 to 1998, the number of children being left by their mothers in hospitals almost doubled and reached the level of 594. In 1999, the number of such children grew by 1/4 in relation to previous year and reached 737. These numbers contradict the media's conclusions about women being irresponsible. Leaving a child in the hospital is a much more responsible solution for both the woman, who is not capable of raising her own child, and for the child.

The abortion tourism

Information collected by the Federation shows that traveling to obtain an abortion is slowly becoming marginalized. In years 1995 - 97 a couple of court cases took place against agencies organizing abortion tourism across the eastern and southern borders of Poland (i.e. Cieszyn, Lublin), which effectively scared potential organizers off. For women this means less choice of places to conduct an abortion and an increase in prices, because termination of pregnancy is usually more expensive in Poland than it is abroad. For example, in Holland abortion costs 250 USD plus the costs of travel, in Kaliningrad the price does not exceed 150 USD. At the same time, in Poland prices are as high as 3000 PLN (around 675 USD). German doctors inform that women from Poland travel to Germany to have abortions, for example from S�ubice to Frankfurt or Oder. Sporadically, women individually go to clinics in Russia (Kaliningrad), Lithuania or Belarus, but there have been limitations introduced to conducting abortions for foreigners in these countries, as well as in Czech Republic. The only effect of such policies is increasing prices for abortion for Polish women. Usually, women who live close to the border and have contacts abroad use these “services.“ It is more difficult for women from central Poland, with no contacts.

The information received by the Federation from Holland shows there are at least a couple of hundred abortions performed by Polish women.

Accessibility of lawful abortion in public hospitals

The anti-abortion law is much stricter de facto that it is de jure. Women, who are entitled to have a legal abortion, according to conditions set up by the law, are very often denied the procedure. The accessibility of legal abortion in public hospitals has continually worsened from 1993. There is a number of hospitals which publicly admitted that they do not perform abortions. It was specifically visible in the year 1996, when the more liberal version of the Act was in force. This is when the medical communities in a number of regions (i.e. the former provinces of Katowice, Tarnów, Rzeszów, Kraków, Nowy Sàcz, and Suwa�ki) refused to allow for abortion in public hospitals.¹⁹ The government did not do anything to secure women access to appropriate medical services, even though fully lawful.
Naming the hospital after a saint means, among other things, that this particular center does not conduct abortions.
Hospital hierarchy shows that directors decide about refusing to terminate pregnancies, even if other doctors privately represent different opinion in this matter. This was confirmed by the studies made by the Federation. The conscience clause, written into the Medical Profession Act, states, that in cases of refusal on this basis, a doctor is obliged to inform a patient about it right away, as well as to refer the patient to other medical services in other center. In practice, neither hospitals nor doctors do this.

Medical causes allowing the lawful abortion

The Act is open-ended in its regulations concerning conditions for legal termination of pregnancy. It is especially visible with the assessment of the state of woman's health. The Act allows for an abortion when a mother's life or health is threatened by pregnancy. There is now a growing tendency to refuse issuing the medical certificates entitling a woman to have an abortion. The Federation has been informed of a number of cases in which women suffering from severe health complications were refused such certificates. It seems that doctors care only that a woman can survive the birth. What happens to her after birth is less important (see: Appendix 1). It is quite common that doctors send women to see another doctor. Sometimes, doctors question certificates issued by other doctors. Eventually, women choose private clinics.
Quite often, doctors who claim that abortion in Poland is absolutely illegal and that there are no regulations allowing for it in special circumstances misinform women. This illustrates the lack of knowledge about regulations among medical staff. The studies made by the Federation also show the existing reluctance towards abortion in public hospitals for both ideological and opportunistic reasons. Sometimes this attitude results from fear of being stigmatized in the professional community as an “abortionist“.
There are also rare cases of reversed actions, when doctors conduct an abortion on social grounds in public hospitals, giving fictitious health conditions entitling for abortion or writing in “miscarriage in process“ on the hospital records. This is so rare because it needs the co-operation of at least two doctors: one who will issue a certificate allowing the abortion, and the second to perform the procedure. Additionally, the doctor conducting a termination has to work in safe professional environment so as not to arouse the suspicions of the authorities. The research conducted among doctors shows that this threat is the most common cause for not performing such activities.
Women having medical reasons for the termination of pregnancy have stopped coming to public health care centers. Those who do come find themselves in difficult financial situations and are often refused the abortion. The Federation's study²⁰ shows that more than 90% of women claiming severe health problems could also claim hard personal situation. Most often these women are unemployed or on welfare, have complicated living and personal situations, and already have children (very often handicapped or disabled). It confirms the old truth that living conditions strongly influence health and that people who are not well off, are more often of weaker health. In all European countries, except Ireland, they would have the unquestionable right to abortion. In Poland, while seeking access to lawful abortion, they meet with disregard.
Women with unwanted pregnancies also have loads of anxieties, which stop them from turning to public medical centers. They are afraid of being registered as pregnant because if the abortion were refused it would make their use of private clinics impossible or could cause trouble later. Second of all, they are afraid of their case being made publicly known. More than 20% of women surveyed by the RUN during the research on the situation of women inhabitants of rural areas confirmed that information from gynecological clinics is not confidential. Lately, these fears are multiplied by the fear of police intervention.
Moreover, these women want to avoid the disrespectful and degrading treatment of public medical staff. Last but not least they are afraid of problems with obtaining the certificates, entitling to lawful abortion.

Termination of pregnancy resulting from criminal act (rape)

Women rarely report rape to the authorities. Women, with good reason, do not believe in a just sentence and are afraid of secondary victimization from the justice system. Meanwhile, without a certificate from the prosecutor's office, a woman has no chance to legally terminate a pregnancy resulting from rape. There are cases when the justice system makes things harder. In 1999, the media publicized the case of a prosecutor (female) who refused, motivated by her moral beliefs, to sign the papers confirming that the rape investigation had started. It is no wonder that in 1998 there were 53 abortions conducted on the basis of regulations allowing for it in case of rape, despite the 2000 rapes that are reported to the police each year, and the remainder that stays unreported for various reasons. The 1999 data is even more shocking; only one abortion was performed on this particular basis.

The accessibility of pre-natal examinations

The Act obliges state governmental administration and local authorities to secure free access to information and pre-natal examinations, specifically when there is a high risk or justified suspicion of the genetic damage of a fetus or an untreatable, life-threatening disease.²¹
In practice, the access to pre-natal examinations in Poland is limited. There are no longer routine examinations for pregnant women over 35 years of age, despite the international standards. In 1999, the possibility of obtaining such examinations was even more limited. This was confirmed by a survey done by the Federation in genetics medical centers, which provide these services.
These pre-natal examinations determine if the fetus is damaged, indicating circumstances justifying the termination of pregnancy. Doctors are not very willing to direct their patients to these examinations, even when there is a justified suspicion of the fetus having genetic defects. In this case, the doctor's lack of encouragement is misconduct. There are number of cases of women being sent from one doctor to another for nothing (see: Appendix 2). Genetics specialists clearly state that doctors of other specializations do not have enough knowledge about pre-natal examinations. Very often, women who are interested in the problem know more than their doctors.
Access to examinations can be limited even more by the newly introduced regulations in the criminal code and in the Medical Profession Act,²² which restrict penalties for “damaging the body of a fetus or causing the damage to health, threatening its life.“ The criminal penalty at the moment is up to 2 years of imprisonment.
Some genetics institutes complain that their contracts with medical insurance agencies (Kasy Chorych) do not fully cover the examination costs, leading to further limitation of access to them.
As a result, few cases (officially 40-50 a year) of termination of pregnancy on the basis of the damage of fetus are recorded in Poland.
In 1999, 309 cases of pathological development of the fetus have been recorded, 50 abortions were conducted on this basis. Women meet with numerous barriers trying to get a referral for an examination of this sort. Sometimes having the examination results is also not enough to obtain a lawful abortion. The Federation is aware of the fact that one of the Warsaw's hospitals make women ahead of examination to sign a statement stating that they have received information about the hospital's policy of not terminating pregnancies because of genetic disorders. This means that women are unable to exercise their statutory right. The data received by the Federation directly from genetics centers on the pre-natal examinations, conducted in 1999 (and confirmed in the governmental report) show that last year the number of such examinations increased and reached the level of 2204 cases (in 1997 there were 1648 in 1998 - 1612 cases). This was probably caused by a widely covered parliamentary debate on the legal restriction of the access to examinations. What resulted from this debate was higher awareness of women.

The scale of abortion underground

Because abortion has moved to underground, it is very hard to estimate the number of illegal abortions. This is even more so the case because the actual number of all terminations was never known. All speculations are justified in this situation. The only sure thing is that despite the government's claims, the underground is very well developed.
Demographic data can shed some light on the scale of the abortion underground. Specialists claim that there may be a correlation between the number of births and the number of abortions. In countries of our region, where the indexes are still similar to these concerning Poland, there exist a relatively large number of abortions compared with the number of births (a result of the small percentage of women using modern contraception). In Lithuania in 1998, the number of births was around 36,800 and number of abortions around 27,500, almost 75% of births. In 1995, this same index was almost 92% (around 41,100 births to 37,700 abortions). In Latvia, the number of abortions is higher than births. In 1998 there were 18,691 births comparing to 25,076 abortions, and in 1999, 19,328 births comparing to 22,970 abortions. In Czech Republic in 1991, the birthrate was slightly lower than the number of abortions (respectively: 117,037 and 129,354) and was systematically decreasing. In 1998, the number of abortions constituted 57% of the number of births (respectively: 51,791 and 90,535).
It is hard to estimate these percentages for Poland. The number of children born in Poland yearly is around 400,000, and steadily decreasing. In the 80s, the official number of abortions constituted around 1/5 the number of births (see: Table 2). If one relates this data to the 90ties, we would have around 80,000 cases of abortion a year. Despite the fact that more couples are now using contraception, the actual number of abortions was always higher. Counting carefully, the number of illegal abortions nowadays must be at least several dozen of thousands.
In the available analyses, it is estimated that in the 80ties, the relation of births to abortions was 1:1. Taking the significant improvement in the use of contraception (in comparison to the 80ties) into consideration, demographers assess that at the moment the above-mentioned relation is 2:1. If these estimations were true, it would suggest that almost 190,000 women in Poland a year have an abortion. These estimations are backed by research conducted on women living in rural areas. Based on this research, in 1999, around 90,000 of women (inhabitants of rural areas, who constitute 30% of the women's population) had an abortion.
Despite the fact that the actual number of terminations is impossible to estimate, it is possible to get a clearer picture of the facts.

There is no register of the contraception counselling services in Poland. There has also been no complex research conducted on the issue.
The results of surveys show that the use of modern contraception is still relatively rare and that the large part of the society use ways that are not acknowledged as methods of contraception (such as calendar based method or withdrawal). Research on “Pro health and sexual behaviors in an aspect of HIV / AIDS in Poland“ conducted by Zbigniew Izdebski (Warsaw 1997) shows, that out of 1963 respondents (1001 women, 960 men, lack of data on gender in two cases), 55% did not use any method or used the above-mentioned ineffective ways of prevention. Being more specific, 30% did not use any method, 15% used withdrawal, and 10% used a calendar-based method. Out of modern methods, condoms were used most often, by almost 21% of respondents. The birth-control pill is used only by 8,3% of respondents, the IUD by almost 5%.

Table 6

In research conducted by Demoskop (April 1996), 69% of respondents stated that they did not use any protection. In the General Statistics Office (“The state of health of the inhabitants of Poland“) 1996 research study, questions about the use of contraception were asked only to women who were never married (what itself influences the results of such a survey). Almost 30% of women and their partners did not use any of the methods of contraception. The most commonly used birth control methods are the Ogino-Knauss method and withdrawal. Condoms are rarely used.
Concurrently, government report data (see: table below) shows an increase in the use of contraception. It is quite hard to form an opinion on the actual number of women using contraception based on this data.

Table 7: The dynamics of purchase of contraception means

The 1999 governmental report does not give any data (not even estimates) about contraception use by Polish women. Taking under consideration the one sided, prejudiced policy of the government, promoting and giving financial support only to natural methods of family planning and counselling services in that respect, as well as the addition of hormonal contraception to the list of the means causing cancer²³ - one can not expect that contraception use will grow significantly in the near future.

The accessibility of contraception

There are many barriers making contraception use more difficult. The accessibility of hormonal contraception is very limited. There are 20 hormonal oral contraception means registered in medical registers. Until 1998, 8 of these were on the list of medicines, subsidized by the state budget. In 1998, the government withdrew five of them from the list; only three are still subsidized to some extent. These pills have similar ingredients, and are appropriate only for certain women.²⁴ After the withdrawal of subsidies, the Federation for Women and Family Planning issued a claim to the Ombudsman. Despite the Ombudsman's accordance that the actions of the Ministry of Health discriminate against women and its formal request for an explanation, the government did not withdraw the decision.
The accessibility of contraception is also limited due to attitudes of some medical professionals. There is a very well known case where a doctor from Warsaw²⁵ refused to prescribe oral contraception to a woman. A woman issued a claim to the Regional Doctors' Court, which, nevertheless, did not state that this behavior was inappropriate. The doctor was just reprimanded,²⁶ because in public statements he compared doctors prescribing contraception to Doctor Mengele.
The reluctance of medical professionals towards contraception and the lack of recognition of this issue as significant to women's health, were mirrored by the president of the National Medical Court's.²⁷ He publicly stated that doctors are not obligated to prescribe contraception. This suggests that the problem is more serious and is not limited to attitudes of individual doctors.
Sterilization (the most popular method of preventing unwanted pregnancies) is still illegal for both women and men, (see: Appendix 3). Doctors are rarely familiar with emergency contraception and therefore rarely prescribe it. All this causes Polish women to have very limited choices of contraception.
Health care reform and revising the unclear rules of contracting contraception advice services by medical insurance agencies (Kasy Chorych) can also constitute a barrier in access to it. According to rules of contracting, the contraception advisory services can be run only as specialist medical services, not as basic medical care.

The sexual education as part of the school curriculum was withdrawn from it in 1999. ²⁸
The currently run program, preparation for family life, is obligatory for secondary schools and calls for continuation of the program. Its main goal is preparation for family life, and even more so, the promotion of the traditional model of a family, not education about the human sexuality and related dangers. The administration officials and ideologists working in the field of a family and youth do not take the fact that sex is not necessarily connected to marriage under consideration. Equalizing the moment of sexual initiation and the moment of getting married is wishful thinking and does not coincide with the statistics about the age of sexual initiation. The above quoted research of doctor Zbigniew Izdebski in 1997 shows that the age of initiation is decreasing (see: table 8)²⁹

Table 8

At the same time, statistics recorded the significant drop in plans to get married since 1982, especially in the group of youngest people. This means that the period during which young people have sex outside marriages is growing.

Teachers

The classes can be run by any teacher with qualifications to teach in a certain type of school and having a university degree in the area of family social sciences, or who have a post graduate diploma or who took part in courses, preparing for teaching these courses (according to topics included in program's curriculum). The professional training for persons running these classes is prepared by centers of upgrading the teachers' skills. The co-ordination of trainings lies in a competence of the Methodological Center for Psycho-Pedagogical Support in Warsaw.
Loads of information received by the Federation shows that this education for teachers is biased and one-sided, promoting only the catholic vision of the family, and family planning.

Manuals

Experts, including sex therapists, educators and doctors, constantly criticize the manuals accepted by the Ministry of Education. It is disturbing that topics such as contraception, prevention of sexually transmitted diseases (including HIV/AIDS) are marginalized and presented in a minimized way. For example, the goal of the secondary school program is to educate about sexually transmitted diseases and prophylactics.³⁰ The information included in manuals does not give basis for stating that this goal can be achieved, using them as the support for teaching. Prophylactics are identified with temperance, with absolute sexual abstinence: “From the point of view of HIV/AIDS epidemiology, the most effective way would be the come back to traditional morality, in which the one and only appropriate area for sexual activity is mutually faithful married couple.“³¹
Traditional morality, however, differs for men and women. There is a large tolerance for men's extramarital relationships, referred to as “double morality“.
Condoms (one of the most effective ways of preventing HIV/AIDS) are not promoted well. The false and harmful information about the oral hormonal contraception, as well as about other methods of preventing the unwanted pregnancy is outrageous. The manuals promote the traditional role of women as mothers and men as heads of the family. The long-term goal of the program “Preparation for family life“ is to increase the birth rate in Poland.
It is worth stressing that the current contents of books and school programs do not fulfill expectations of neither youth, nor of their parents. The research shows that around 88% of people surveyed support the introduction of sexual education in schools.³²
Only reliable sexual education in schools can lead to responsible and safe sexual behavior. Comparative studies show that sexual education does not cause the decrease of the age of sexual initiation.³³
The Federation issued a formal complaint to the Ombudsman, stating that manuals promoted by the Ministry of Education³⁴ violate the right of youth to reliable information and scientific knowledge, thereby threatening the lives and health of children. The new Ombudsman nevertheless refused to make a statement in this case.
Despite the difficulty of assessing the realization of this program country-wide, the signals reaching the organization show that both the school youth and their teachers have serious reservations towards this program, the former because they are not given the information needed, answering to their needs and questions, and the latter because they feel unprepared and assess the contents of manuals as highly unsatisfactory.

The information presented in the above report allows a relatively in-depth assessment of the effects of the anti-abortion law and the policy of the Polish government. Researching this sphere is particularly hard and gathering the exact quantitative data is almost impossible because it is, after all, illegal. The lack of statistics does not relieve the government from the responsibility of undertaking the in-depth analysis of the actual effects of the anti-abortion regulations.
The Federation for Women and Family Planning expects the government and the parliament to take the effects of the abortion ban seriously and to undertake the legislative actions required to change the legal regulations binding in Poland in this matter, showing that they respect the right of women to decide about maternity, according to best international standards. It is also necessary to secure the appropriate health and educational policies, guaranteed by international obligations, a policy which will aim to help women to prevent unwanted pregnancies.

Appendix 1

The Actual Act

Material prepared on the basis of letters and phone-calls received by the Federation for Women and Family Planning.

The Case of Ms B - January 1999

A woman, aged 40, single mother of two children, living in a small village in Mazovia region. Bad financial situation, she has problems with finding a job (vocational training).
Ms B was a victim of multiple rapes, committed on her by persons she knew and who she is afraid of. As a result of rape, she got pregnant. She definitely did not want to give birth to this child, so she decided to have a lawful abortion, which is possible if a rape is reported to police or prosecution. Ms B did not report it, because making statements about what happened was too hard for her, and additionally she was afraid of revenge from people involved in crime and the reaction of the local community. In an anonymous call to the Federation's help-line, she described her situation - especially about the need for using the abortion underground, even if theoretically law was on her side.

The Case of Ms L - May 1999

Ms L was 38 years of age, unemployed, married for 15 years, living in a big city. Her husband had been physically and verbally abusing her for many years.
She was forced into sexual activity against her will numerous times. For health reasons, she cannot use hormonal contraception, and her husband does not use anything to prevent pregnancy - so the risk of pregnancy is very high. The woman did not want to have a child as a result of forced sexual acts.
Her question was if a married woman, raped by her husband, has the right to abortion if she gets pregnant as a result of rape. At the moment, she lives in constant fear; what is she going to do if she gets pregnant and if the law is to protect her when it happens?

The Case of Ms Z - June 1999

A woman aged 36, married, with an 11-year-old son, living in big city. A short time after a kidney operation, she got pregnant - she only used withdrawal and natural contraception methods. She decided to have an abortion because of her health. She wants to be a mother for her 11-year-old child.
In an anonymous talk with the Federation's help-line, she complained about maltreatment and degradation in hospitals, where she was trying to execute legal right to an abortion. Eventually, she decided to have an illegal abortion in a private clinic.

The Case of Ms K - September 1999

A woman aged 39, married, a nurse by profession, her husband also a nurse; one child aged 18, one extra-uterine pregnancy. After getting pregnant, even if the pregnancy was not planned - the couple decided to have this child. Because the age of the mother they have nevertheless decided to go through pre-natal examinations. Unfortunately, they also had to pay for examinations - 1200 PLN - because the insurance company stated that according to rules in this particular agency, they are not entitled to have them free of charge.
The results of tests conducted in the Genetics Institute in Poznaƒ indicated Downs Syndrome. Considering that they will not be able to support this child financially, the couple decided to have an abortion, to which they were legally entitled. They called the Mother's Center in ¸ódê, where nobody offered to help. They were told that abortion in Poland is illegal and they can't be helped in their situation.

Ms and Mr. K live in a small town in the west of Poland. In a hospital they were told things like: “we don't have a necessary equipment to terminate a pregnancy at this stage“. The hospital's director did not want to sign a statement that they won't terminate pregnancy. The statement would be necessary to conduct the abortion in Warsaw. After intervention from the Federation, there was a possibility of conducting the termination in Warsaw, but a statement from a regional medical insurance agency was still needed, that the termination will be re-funded. They didn't issue such statement. Despite that, Ms K contacted more than 40 doctors in a country, none of whom wanted to help her. “The director of one of hospitals told me that I can stick the Act up my... and do it myself, because the law is not on my side“.

“Today, after selling the car to afford it, I'm going to ¸ódê, to - in primitive and unknown conditions - do what you claim is legally secured for me. It is very sad but this country is not normal“.

The Case of Ms T - May 2000

A 29-year-old inhabitant of Warsaw, pregnant from 8-9 weeks, the mother of two children (aged 5 and 6). Under the care of social services, disabled. The general state of health: shortsightedness -24 diopters, strong changes of the retina, two cesarean births (1,5 years one after the other). Neurologically tested because of health problems of still unknown source. Very low blood pressure (90/30), anemic. Lately taken to the emergency (she fainted) and then taken to the hospital at Kasprzak street.
Two optometrists issued medical certificates that the pregnancy constitutes serious threat to the state of sight of their patient, but stated only that they would therefore not recommend the natural birth.
One of them while asked if the pregnancy could result in further damage of the retina said that “maybe it will, maybe it won't. The placenta can also detach, so everything brings risks.“ At the same time they added that the patient has to look after herself and avoid carrying heavy things.
After we found a hospital in which doctors were ready to conduct a lawful abortion, it came out that the certificate stating that natural birth is not recommended was not enough to conduct a termination of pregnancy. A certificate stating that the pregnancy is life threatening, unhealthy or that labor is not recommended at all was necessary.

The general doctor in a health care center, who earlier informed the patient that her pregnancy is life-threatening, during the next visit agreed to issue the certificate about the threat for patient's health.
After the following contact with a gynecologist, we were given the information that the woman is expected to come for a visit to the hospital. During the gynecological consultation, the doctor wrote a statement saying (on the back of the recommendation from the first doctor) that according to him, two previously made cesarean cuts are not enough reason for an abortion. The patient was not even examined, the doctor was not interested in other aspects of her health, in particular he did not concern indications from opticians.
Doing this, he questioned the certificate issued by other doctor and took away patient's chance for a lawful abortion. This case confirms our conviction that doctors disrespect women's health problems and avoid issuing written certificates about the patient's state, even if during consultations they inform about possible threats.

Note: Ms T is active in one of the foundations for the protection of the life of unborn children. Therefore, she is aware of the fact that such organizations offer support during pregnancies, but then leave mothers alone when the child is born.

Appendix 2

Appendix 3

The correspondence with the Federation on the issue of sterilization

I was very surprised when, a couple of years ago, I received a very rude answer from the Medical Academy in Krakow, stating that vasectomy in Poland was illegal. Some time after that, during urological operation (conducted illegally, because it was outside my region of registration) a doctor, who was paid to conduct an operation, told me that he will not conduct vasectomy and quoted the relevant regulation of the criminal code. Conducting the operation abroad was not of any problem for me. I didn't even know the address of the clinic - so, on my written request to the Post Office in Gorlitz in Germany, I was sent all the addresses of relevant hospitals. I wrote a letter to one of hospitals, received quick answer, registered in a hospital (with a help from interpreter) via phone and after couple of days I was sterilized with no additional formalities. The operation under anesthesia was conducted in a local hospital, in great conditions (comparing to Polish hospitals). I paid 400 DM and could come out the hospital right away. The results of the post-operation examinations were sent to me by post.

Why does the Polish Constitution violate human rights? Why doesn't the government of fanatics resign?

M.J.

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