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

Survey conducted by the federation among doctors, nurses and midwives on the effects of the anti-abortion act
-Wanda Nowicka and Agata Zielińska

Professional medical environment has a major influence on the practical functioning of the Anti-Abortion Act. Doctors and middle medical staff, having an every day contact with women facing the problem of unwanted pregnancy, know more about effects of the Anti-Abortion Act than any other professional environment. Opinions and attitudes of medical staff play a cardinal role in women's lives. Having this in mind, the Federation conducted another study within this group in 1999.
Anonymous questionnaires were prepared and sent to gynecological centers all over the country. The Federation received answers from 193 staff in various positions.

Information about respondents

Women constituted the majority of those who sent the filled questionnaire back. There were 154 women in all 193 respondents, constituting 79.8% of the group. It is important to note that the survey required an additional engagement from the respondents - mailing the forms in return. Even more important was that these responses were personally motivated, not influenced by the persuasion of a researcher or the promise of a reward. The above shows that the group taking part in the survey was socio-psychologically specific. They were people who wanted to make a statement about the Anti-Abortion Act and wanted their voice to be heard.
The fact that significantly more women responded to the questionnaire may result from the fact that this problem concerns them more than men and because women are more sensitive to social issues in general. In the group of respondents, 90 were midwives (46.6%). Together with nurses they constituted 126 respondents (65.3%). 49 respondents (25.4%) were gynecologists, among them 19 were women. Therefore, the majority of answers comes from the middle professional staff. This group, in general, is very feminized.
Almost 50% of respondents work in public hospitals.
The vast majority of respondents live in urban areas. This is highly relevant for interpreting the results. In the light of this fact, conclusions about problems concerning abortions faced by women living in rural areas must be necessarily limited.
When interpreting the results, we have sometimes referred to earlier studies conducted on request for the Federation for Women and Family Planning (which used in-depth interviews (focus groups); see: The report from the research on effects of the Act on family planning). Conclusions from both studies are very similar, making them highly credible.

Research goals

• To collect data about the practical effects of The Act on Family Planning, Protection of Human Fetus and Conditions for Termination of Pregnancy
• To objectively illustrate all aspects of the Act's practical functioning in Poland
• the Act's influence on the functioning of the health care system
• refusals of legal abortions in public hospitals
• To show the situation of Polish women in relation to the problem of abortion
• - the ban on abortion's influence on women's lives and health,
• - the effects of the abortion underground on women,
• To assess the extent and functioning of the abortion underground

The extent of the problem

We can assess with good approximation that the surveyed group meets with a problem of unwanted pregnancy relatively often. Women wanting to terminate an unwanted pregnancy came to 63.2% of the respondents. 45 people (23.3%) claimed that, in their work, they came across cases of women, who had post-abortion complications. 39 of them claimed that abortions were illegally conducted in private clinics. Half of respondents, who met with women having post-abortion complications, stated that in such situations, women admitted attempting to have an abortion.
Based on this data, abortion, despite being banned, tends to be a rather frequent occurrence. A very large part of medical personnel comes across women facing this problem. It should also be noted that responses came from a small group of medical staff and surely not all of them admitted that abortions were performed in their institutions of employment. The scale of the problem is therefore much larger than noted.

Reasons for termination of pregnancies

Almost all those surveyed coming across cases of women wanting to have an abortion at work stated that the most frequent motivation for women to terminate an unwanted pregnancy, is a difficult financial situation and living conditions. This was declared by 99.2% of respondents, who dealt with women coming to them with unwanted pregnancies. This could be a reflection of the general social situation, but also of the lack of adequate state social policy. The difficult socio-economical situation of women significantly limits their possibilities of securing adequate living conditions for their future children. Other motivations listed were: bad health condition of a pregnant woman (31 respondents ; 25.4%), their older age (31 respondents ; 25.4%), or young age (28 respondents ; 23%). These numbers relate to people who met with women planning abortions (122 respondents).
When speaking of inappropriate age for having children, we can relate to an earlier study conducted among gynecologists, where respondents mentioned that unwanted pregnancies happen mainly to young women, who are not familiar with contraception or menopausal women, who do not use contraception assuming that they no longer need it. In both cases it seems that women lack specialized care and advice from their gynecologists.

Contraception

Women, who come to doctors with unwanted pregnancies, most often do not use any method of contraception (73 respondents; 59.8%), think of withdrawal as a valid method (66 people; 54.1%), use natural methods (59 people; 48.4%), or condoms, which also seem to be unreliable (43 respondents; 35.2%). It appears that women do not have sufficient knowledge of effective contraception. This was pointed out by 81 respondents (66.4%). First of all, it indicates the insufficient contraception advisory services. Doctors asked whether women following an abortion in a hospital are being counseled about family planning, only in 33% of cases stated that they are always informed. 52% of respondents said that a woman is advised about contraception only if she asks for it.
This problem has been present for a long time and is important for the health of women and their future children. The vast majority of respondents worked in urban areas. Their opinions do not cover the situation in rural areas, where awareness about effective methods of contraception is even lower.
Moral and religious beliefs or high financial costs of contraception were named by respondents as other explanations for the inefficient methods in use.

When asked about obstacles preventing women from having abortions, respondents answered differently. Half of them (97 people) stated that it is very difficult to find a place in Poland, where the abortion can be conducted. On the other hand, 50 respondents stated that there are no difficulties in accessing abortion, except for the fact that abortion is prohibited. It is highly probable that such opinion is a result of the fact that respondents themselves know of possibilities of accessing illegally abortion services.
Among the 72 respondents, who worked in medical institutions where abortions are not conducted, 11 people justified this fact with legal limitations. A similar number of respondents claimed that it was forbidden by hospital directors.
According to 31 respondents (16.1%) there are no obstacles for abortion.

According to 164 (85%) respondents, most abortions are performed in private clinics. The second most popular option is abortion abroad (61 respondents; 31.6%). It is important to keep in mind that most of the respondents work in public hospitals, and this is where women wanting to have an abortion come to see them. At the same time, respondents claim that abortions are performed in private clinics, this may indicate that women are directed there from public health care institutions. 25.9% of respondents have heard of sending patients to private clinics. 33.2% of respondents stated that this is a method of increasing the number of private abortions conducted for a payment.
These answers paint an array of possibilities for having an abortion in Poland. Basing on the above answers, we concluded that having an abortion in Poland can be difficult, but the possibility is there: in private clinics or abroad. The collected data signifies the existence of an abortion underground in Poland, where women are being sent, even through the public health care system.

As it seems, abortion can be most problematic for poor women. Respondents mentioned this group most often (49 people - 25.4%). We can conclude that it is not privately conducted abortions that are problematic in Poland, but their price. This is why poorer women have limited access to it, even if paradoxically they need it more often. The legal status of abortion does not seem to have relevant meaning.

21 respondents (10.9%) stated that abortions were conducted in the hospitals where they work. There are no real differences between professional groups, age groups or places of work.
Out of the 72 respondents who said that their employers did not permit performing abortions, 40 ( 55.6%) did not know why. Maybe they are not interested in the topic.

11 people justified refusals of abortion with legal regulations, while 10 respondents stated that it is the director's instruction forbidding all doctors to perform abortions. Out of the respondents who declared that abortions are performed in their place of work, 15 stated that the number of abortions decreased. In these health care institutions, only some doctors conduct abortions; no respondent declared that all doctors were ready to do it.

The most frequent reason given by respondents to explain why public health care institutions refuse to perform abortion is an attempt to increase their number conducted in private clinics. 1/3 (64 people) of respondents, most often women, midwives and nurses, gave this reason. According to men, the doctor's religious and moral beliefs influence the refusal most often. Equally important, in the opinion of male respondents, are anxieties about being stigmatized by groups which are against abortion, including the Church and medical professional organizations. We have to note that male respondents in this survey embrace mostly male gynecologists. Furthermore, doctors are the ones who are responsible for conducting abortions; they are the ones who bear the guilt. Thus, it is mainly doctors, not nurses or midwives, who are vulnerable to social stigmatization. This might be one reason why the opinions of the middle level medical staff and doctors differ.
50 people (25.9%) heard about a situation where a legal abortion was refused and a patient was sent to a private clinic in a bigger town. The number of respondents in these groups, however, is too small to allow for conclusions on statistically relevant dependencies. Nevertheless, the collected data allows for a hypothesis. One of the possible reasons justifying directing patients to private clinics in larger towns may be the wider scope of services and possibilities offered. In rural areas, there is probably only one gynecologist, who is subjected to social control. This is what doctors fear most. They have their practice in a public hospital, after and sometimes during their working hours. According to respondents (120 people - 62.2%) there is a need to regulate the specific conflict situation where a woman has the legal right to an abortion and a doctor has the legal right to refuse conducting it. The best solution in such situation should be, according to respondents, to make a head of a refusing institution responsible for finding a public hospital which would perform an abortion.
One of respondents describes a solution which he/she is familiar with:

Most respondents - 171 people (88.6%) did not take part in any debate regarding anti-abortion law. Most often they could not justify this fact fully, but explained it with their overall lack of interest, lack of information, and lack of possibilities for taking part in discussions (35 people; 22%). 22 people (12.2%) did take part in debates and, among them, 10 (almost half) were motivated to participation by their world-views. A significant part of respondents stayed ambivalent towards discussions about legal possibilities for abortion. Respondents also pointed out the law's lack of influence on the actual number of abortions. This can also explain the lack of interest in debating the Act. Many respondents did not answer this question.

Most respondents are not familiar with rules of conduct and procedures allowing a woman to legally terminate a pregnancy. When asked about legal procedures, 139 out of 193 respondents (72%) did not give any or gave partly correct answers. Only 54 respondents gave correct answers. Considering the fact that respondents had unlimited time for answering and could use the text of the Act, we can conclude that a significant part of respondents does not have adequate knowledge about procedures accompanying the legal termination of pregnancy and some of them may not even have in their offices instructions for proceeding based on the Act. One of respondents wrote:

74 respondents (38.3%) were not at all familiar with the health reasons authorizing abortion. In the opinion of 64 people (33.2%) the only sufficient reason is a threat to a woman's life. A smaller number mentioned following indications authorizing abortion: cardiological defects, cancer, and psychological disorders.
For some respondents, only hospital directors are responsible for a decision about performing abortion - both lawfully and not.
Legal conditions are not always taken into consideration in practice, and maybe that's why they are not very well known.

Representatives of the gynecological profession surveyed were not familiar with legal regulations. This fact should not be ignored, because legal regulations are overlooked in this situation. Previous research came to similar conclusions.

More than half of respondents (117 people; 65%) think that the current law is too restrictive and should be liberalized. More men than women, and more gynecologists than nurses share this view. Most respondents see the need for changes in the law, though some made statements in defense of the current regulations (42 people - 21.8%).

Most respondents, who made their statements about the influence of the Act on the number of abortions in Poland, claimed that the regulations limit the number of abortions (114 people; 59.1%). Opinions about the scale of this influence differ: around 1/3 of respondents (60 people) believe that the law lead to a significant decrease in the number of abortions, while almost the same percentage of respondents (54 people; 28%) believed that the change was not large. 56 people (29%) stated that legal regulations did not influence the number of abortions performed.

Only 23 respondents (12.2%) claimed that the Act did not cause an increase in number of children abandoned in hospitals by their mothers. 89 people (46.1%) could not assess the scale of it, but 81 respondents (42%) stated that restriction of legal regulations caused an increase in the number of children abandoned following birth in hospitals. Previous interviews conducted among gynecological professionals also support this view.
The conclusion from the previous concerning the decrease in a number of abortions can explain such situation. If restrictive regulations prevented women from terminating pregnancies, then, maybe, the Act forced them to give birth and leave a child in a hospital.

Most respondents, 120 people (62.2%), noted an increased interest in contraception among patients. Most women are interested in oral (hormonal) contraception, as noted by 88 respondents (73.3%). The interest in condoms (15 people; 12.5%) and diaphragms (16 people;13.3%) was less frequent. The data collected could demonstrate the law's actual influence. However, such increase could be also explained differently. The responses included statements showing the general growth of women's awareness about contraception, as well as, the improvement in the comprehensiveness of an offer of the pharmaceutical companies.

Conclusions drawn about the law's impact on the interest in contraception should, therefore, be cautious. More conclusive analysis is not possible without a more precise data and a more developed research focused specifically on this issue.
The connection between the Anti-Abortion Act and the decreasing number of abortions is not clear. This decrease could be a result of the increased interest in effective contraception. This, on the other hand, is not necessarily, as pointed above, a consequence of more restrictive abortion regulations. It could be linked to the general growth of awareness among women. Therefore, the law's influence on women's attitudes towards family planning is not clearly determined. Conclusive answer on this point would require an examination of various other factors.

There is no doubt that the Anti-Abortion Act resulted in limiting access to abortions in public hospitals. This is the reason for the decrease in official statistics on the number of abortions. This superficial decrease is sufficient to satisfy those who created the legal restrictions. Abortions, nevertheless, are performed, and without there being tremendous difficulties in accessing them. They are conducted elsewhere and for a fee. The actual effect of the Act has been the increase in the price of abortion. This was also concluded from the previous research conducted among medical professionals.

The restrictive law puts an unequal burden on poor women, they are main victims of this regulation. The cost increase forces poor women to have unwanted children, for whom they are not able to secure decent living conditions. In perspective, the effect will be a growth in number of children in poor families, and later, impoverishment of society. Another foreseen effect could be a larger number of abandoned children, who are then given away to child-care institutions, instead of being wanted and cherished by their biological families.

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