Matters of “Conscience”: The Politics of Reproductive Healthcare in Poland

Abstract

The fall of state socialism in Poland in 1989 constituted a critical moment that redefined policies regulating reproductive health and access to care. As the Polish state adopted the discourse and agenda of the Catholic Church in its health policies, reproduction and sexuality became sites of moral governance through the implementation of the Conscience Clause law, which permits healthcare providers to deny medical services citing conscience-based objections. Based on ethnographic fieldwork, this article explores the effects of the implementation of the conscience clause and argues that the adoption of this law for individual use paved the way for restrictions on reproductive healthcare on a systemic scale. The special status afforded to the church is highly significant for access to health services deemed by the church to be matters of morality. The Polish case raises concerns about the place of women's rights in postsocialism and the nature of Polish democratization.

Neoliberal reforms and privatisation of reproductive health services in post-socialist Poland

“…5 This can be especially burdensome and costly for women in rural areas where there may be only one physician. Some physicians restrict prescriptions for the pill to a one-month supply, forcing women to pay for repeated visits.…”

“…32,33 Even legally permissible abortions are difficult to obtain because conscientious objection is frequently declared by the directors of hospitals on behalf on the entire staff. 5 In addition, the abortion ban has reduced access to legal abortion in public facilities because doctors prefer to collect a high fee and avoid public visibility. 34 Thus, women who are eligible for publically funded procedures find it easier and faster to obtain the care clandestinely.…”

“…This paved the way for the "white coat" abortion underground after 1993, mainly of experienced gynaecologists. 5 While the Polish Federation for Women and Family Planning estimates clandestine abortions at 80,000-200,000 per year, the government acknowledges only legal abortions, less than 200 per year in recent years. Moreover, abortion tourism for Polish women is thought to be flourishing, 24 though few data exist.…”

“…The Church was also instrumental in eliminating health insurance coverage for contraception in 2002, and began to encourage physicians to invoke conscientious objection to limit contraceptive prescriptions. 5 Because sterilisation remains illegal, physicians who perform it clandestinely can be punished with imprisonment of up to ten years. The law on voluntary sterilisation is often interpreted so restrictively that even women with serious contraindications to pregnancy are denied access to sterilisation.…”

Between Advanced Medical Technology and Prayer: Infertility Treatment in Post-socialist Poland

“…In the Polish context, it is also essential to emphasise the role of the Catholic Church in the production of meanings and shaping the rights and duties of the state, citizens, and families [e.g. Nowicka 2007;Graff 2008;Mishtal 2009]. …”