For women and girls in the European Union, access to safe abortion care is a postcode lottery. A patchwork of policies and legislation shape whether abortion is free, safe, and legal. At the extreme end, a small minority of countries ban abortion in almost all circumstances, with devastating results. Most others allow abortion on a person’s own request or on broad social grounds, at least in the first trimester of pregnancy. But the devil is in the detail, and the detail frequently changes. Many EU countries impose medically unnecessary requirements prior to care, such as compulsory and discouraging counselling and waiting times – going against World Health Organization advice. In 22 out of 27 countries, doctors are still allowed to deny care based on their own personal beliefs – with dire repercussions for access. Hard-won progress can be swiftly unpicked. Issues such as gestational time limits, parental consent, denial of care by medical professionals, and care for rape survivors – among many other issues – remain subject to fierce debate and legislative change. These are debates that wreak havoc upon the lives of women and girls, but also their families. Denial of care is structural violence: in many of the 27 countries of the EU – a region that likes to present itself on the world stage as a model of progressive values – women and girls are harmed physically, emotionally, and mentally by abortion laws and policies, or the failure to uphold them.  International Safe Abortion Day (28 September) is a time to take stock of progress and threats to safe abortion access over the past year. This feature outlines some of the major developments in abortion legislation – good and bad – across the EU since last September. The rise of the right-wing Over the past few decades, the broad move in the EU has been towards liberalising laws around abortion care. Recently, however, the rise of chauvinist right-wing forces and politicians has seen energy and resources flooding into anti-abortion campaigns, fuelling structural violence against women and girls. In Italy, for example, the growing popularity of far-right and right-wing political parties, particularly in northern areas, has emboldened anti-abortion actors and legislators. With this in mind, the following section runs through some of the main policies and laws that harm people by limiting access to abortion care, introduced over the past 12 months – many of them linked to the rise of far-right and right-wing campaigns and networks in Europe and further afield.   The growth of new anti-abortion legislation Until recently, Malta was the only country in the EU to have a total ban on abortion. In June 2022, the government drew up new legislation, triggered by the case of American tourist Andrea Prudente who had to be airlifted to Spain for care after she suffered an incomplete miscarriage because doctors in Malta were banned and unwilling to intervene while foetal cardiac activity could be detected. In the new bill, the government proposed amending the Criminal Code to allow abortions when a woman’s health was at grave risk – hailed as a small but crucial step to improve abortion care access in this staunchly Catholic country. In the final months of 2022, the bill made steady progress through parliament. However, protests by hardline reproductive bullies, who said the bill’s definition of a health risk was too wide, forced the government to back down and introduce amendments. When the legislation was finally approved in June 2023, parliament voted to allow abortion care only when a woman’s life was at risk, and only with the consent of three specialists – a major bureaucratic hurdle. Maltese reproductive rights experts say this new law will put women’s lives even more at risk than the previous status quo. In Hungary, meanwhile, abortion is legal up to 12 weeks on medical grounds or if the woman is in severe crisis. But in September 2022, the country’s far-right government brought in by decree a measure that forces women seeking care to listen to embryonic cardiac activity before accessing healthcare. In response, IPPF European Network stated: “This requirement has no medical purpose and serves only to humiliate women. It will make accessing abortion more burdensome.” The legislation was brought in without public consultation or without hearing from women.

The European Safe Abortion Networking Group is a group of national, regional and international SRHR organisations based in Europe, working for universal access to safe, legal abortion. The group was formed in 2019 and has been meeting online bi-monthly since the Covid pandemic began. Many people assume everything is OK with abortion in Europe. And it’s true that most of the countries in the region have very good laws and services compared to the rest of the world and that much has improved over the last years with strong national advocacy campaigns, feminist-run clinics, and active support from a long list of political parties, human rights bodies and the World Health Organization. But we still have a long way to go to make abortions universally accessible to everyone who seeks them. In many of our countries, even those with good laws on paper, access in practice is far from perfect, and making change happen is a slow process. We are going through a period where anti-rights movements are posing a serious threat to abortion access across the region. Most European countries allow abortion on request in the first 12-14 weeks of pregnancy - although not without any regulatory, practical or medically unnecessary obstacles. Access to second and especially third trimester abortions, however, can be very limited and hemmed in with conditions, restrictions and requiring third party approval (doctors, parents), even though later abortions are so few and needed in the most desperate of situations. In a number of countries, abortion is still in the penal code, which permits legal systems to prosecute individuals for having or providing abortions, and also adds to stigma and discrimination. Moreover, there are still countries where most or all abortions are illegal, including Malta, Andorra and Poland, and where women are compelled to seek abortions outside the law - especially the growing numbers using pills but not under a clinician’s control. Women having abortions, and advocates for abortion rights are being prosecuted too, in Poland, Andorra, Malta and England. Almost invisibly, across the whole panorama of legal and clinical restrictions, thousands of women are still having to travel within and between countries to get abortions, often supported by under-resourced grassroots organisations and collectives instead of being supported by the State. The pandemic years made many things more difficult. Medical abortion pills were scarce in some countries and still are - and some countries still do not even allow abortion pills at all (e.g. Slovakia, Hungary). Travel across borders for abortions, especially later abortions, obviously became more difficult. On the other hand, some countries have approved the use of telemedicine and self-managed abortion with pills up to some point in the first trimester and it has now become a permanent option in some countries (such as France and the UK) and is well-established as an option within the care pathway in Ireland. Here are some of the most important legal and service-related changes and improvements we are calling for and will campaign for in our countries and across the region going forward: Complete decriminalisation of abortion in all countries, both as a harm reduction strategy to reduce maternal mortality and morbidity but also to ensure the full enjoyment of human rights, bodily autonomy and voluntary motherhood. Universal access to safe, legal abortions, as early as possible and for as long as needed, with choice of method. Self-managed abortion with pills up to 12 weeks should be allowed in all countries as recommended by the World Health Organization. Statement and Call for Action by the European Safe Abortion Networking Group for International Safe Abortion Day, 28 September 2023 Approval of combined medical abortion pills, and approval of misoprostol as an abortifacient, in all countries. Medical abortion pills are a very safe method, not only in the first trimester but also for later abortion, and are on the WHO Essential Medicines List. All countries should implement the 2022 World Health Organization Abortion Care guidelines including training for the range of health care providers, including pharmacists, who can provide services. Increase access to abortion beyond 12 weeks through training and education for midwives, nurses and doctors. Policies must be gender inclusive, that is, applying to women, girls and all people who can become pregnant and who seek an abortion.  

IPPF EN is deeply worried by recent reports of denial of healthcare in Romania that speak to a shocking wider systemic problem. Last week, the case of Alexandra, a 25-year-old mother of three, who was denied emergency obstetric care in a hospital for seven hours, has ignited protests in Romania and heavy media coverage. The cause of death was an obstetric emergency which led to sepsis, acute cardio-respiratory insufficiency and acute pulmonary edema. Alexandra endured terrible pain for hours and asked for help from those whose duty was to save her, but her pleas went unanswered. The case is being investigated by the police. Alexandra's case is one of many pointing to a crumbling healthcare system that is harming all Romanian citizens. The country’s healthcare system is rated 34 out of 35 by the Euro Health Consumer Index. Things are especially dire for groups of people who are already made vulnerable by the system, such as women, Roma people and those living in poverty. Institutionalised stigma and discrimination run deep, with patients reporting being denied care or not being given quality care due to the colour of their skin or their ability to pay. The system is broken for everyone, but it is groups already facing challenging circumstances who bear the brunt. “From 2018 until 2021, there was an 183% increase in the maternal mortality rate. It’s unconceivable for an EU Member State to have such a high maternal and infant mortality rate. And it’s devastating that so many women have lost their lives, leaving their families behind. And while women’s health paints a grim picture, the problem is more widespread touching on all areas of health. Romania is among the countries that spends the least on healthcare as a share of GDP.” said Gabriel Brumariu from SECS, IPPF’s Romanian Member Association.

On 28 June, Malta’s Parliament adopted a new law, known as Bill 28, intended originally to increase protection for women by allowing abortion care in exceptional cases. However, the final version of the law specifies that abortion is only allowed when a woman is at risk of dying and denies life-saving care to a person experiencing an obstetric emergency unless she is in a licenced hospital and has the consent of a panel of three specialists. This is a devastating step backwards in the only European Union country to have a total ban on abortion in all circumstances. “The new law introduces dangerous and insurmountable obstacles to saving women’s lives, given that obstetric emergencies are very fast-moving situations in which you can die without rapid medical intervention – as we have seen in Poland, Ireland and Italy when access to abortion care was withheld until it was too late,” said IPPF EN’s Irene Donadio. The adoption of Bill 28 is all the more shocking given that the government’s objective when it announced the reform in 2022 was to ensure a bare minimum of access to abortion care in cases where a woman’s life or health was at severe risk*. Pro-choice doctors and activists in Malta had supported a bill that aimed to lessen just slightly the longstanding stranglehold of the law on pregnant women**. Instead, as a result of ultraconservative anti-choice opposition to women’s reproductive freedom and safety, the protections of the initial proposal were subsequently watered down to the point that on 23 June, prochoice doctors associations and groups for women rights withdrew their support for the bill. The Council of Europe’s Commissioner for Human Rights echoed their concerns on 26 June, calling for the Maltese parliament to pause and reflect to avoid steps backwards. But calls to change course were not heard. “This backtracking, and the subsequent adoption this week of a bill that not only fails to protect, but actively exacerbates the existing harm done to women by Malta’s medieval abortion legislation, is a humiliating miscalculation by the ruling party. The government has handed victory to Malta’s reproductive bullies on a plate,” continued Donadio. “The terrifying result of the government’s botched political move is that women can die under their watch. People will be deterred from visiting Malta, seeing that its leaders have doubled down on denying emergency medical care to anyone suffering an obstetric emergency. The only people to gain new protections are certain doctors who are afraid to shoulder responsibility for the lives of their patients. If the government wants to make the situation less desperate, it must decriminalise abortion so that at least women can take their health and lives into their own hands, with the support of brave pro-choice doctors and networks, and without the fear of prosecution,” she added.     --- *In 2022, facing scrutiny due to the high-profile emergency evacuation from Malta of Andrea Prudente, an American tourist undergoing a life-threatening miscarriage, the government proposed to amend the law to introduce a minimum of protection for women. **The original draft bill proposed to legalise abortion in cases where a woman’s health was at grave risk. --- For more information, contact: [email protected] [email protected] Additional background and latest information via Doctors for Choice and Voice for Choice.  

Protests will be held across Poland on June 14 as the news of yet another woman losing her life shakes Polish society. The 33-year-old woman, identified only as Dorota, went to the hospital after her water broke in the fifth month of her pregnancy. She died there of sepsis three days later. She was told to lie in her hospital bed with her legs up because this might help restore amniotic fluid and was given limited medical care and information about her state. No one from the medical staff explained to her or her family the real danger she was in and that there was little to no chance that the fetus would survive. Sepsis develops very rapidly in situations such as Dorota’s, yet lifesaving medical care was delayed and Dorota and her family were denied the right to know that abortion care would have been possible and would have saved Dorota from a death sentence. Prosecutors and the patients’ ombudsman in Poland are investigating the death of Dorota amid the family’s accusations that the doctors kept them in the dark and didn't take the necessary steps to save her. Two years ago, Poland's conservative government severely restricted access to abortion care, but the law does allow for doctors to intervene and perform an abortion if the woman's health or life is in danger. Yet, we have seen time and time again with the cases of Iza, Agnieszka, Anna, and now Dorota, that this law is killing women and hurting families.  Denying access to abortion care is a sinister form of gender-based violence which can amount to femicide. This law has real consequences on women, life and death consequences, and it’s beyond inexplicable how the ruling party can continue to cause so much needless suffering. But make no mistake, doctors continue to have the responsibility to protect the health of women. Fear of prosecution needs to stop being used as an excuse in a country where no doctor has ever been the target of law enforcement in cases where abortion care was provided when the life or health of women were at risk. Yes, those holding political power are responsible for violating women’s rights and causing this suffering, but doctors who do not help a person in need are complicit. The wellbeing of patients should come first not only when it comes to abortion care, but regarding all reproductive matters. Gynaecological and obstetric violence is widespread in Poland and we want doctors to speak out and work towards social change. Their silence and lack of action, their betrayal of the trust patients place in them, leads to tragedy. We ask doctors to stop sitting on the sidelines while their patients are suffering and even dying. And we ask the government to lift this draconian virtual ban on abortion care. See you in the streets.

Today, the District Court in Warsaw found Justyna Wydrzyńska guilty for helping a woman in an abusive relationship to access abortion pills. She was sentenced to eight months of community service for 30 hours/month and will now have a criminal record. "We are deeply saddened by the decision and outraged by the entire process. Condemning a person for an act of empathy and compassion towards another human being is unconceivable. We are in awe of Justyna’s bravery in the face of 18 months of judicial persecution by an apparatus targeting anyone who dares challenge the state’s immoral attacks on healthcare and human rights", said Irene Donadio of the International Planned Parenthood Federation, European Network (IPPF EN).

Woman human rights defender, Vanessa Mendoza Cortés, from Andorra could soon face trial for speaking out on women’s rights and the right to abortion before the United Nations (UN). If Vanessa is convicted, she faces a big fine of 30.000 Euros and could have a criminal record.  Vanessa Mendoza Cortés is a psychologist and the president of the women’s rights organization, Stop Violence, (Associació Stop Violències, in Catalan), which focuses on gender-based violence, sexual and reproductive rights, and advocates for safe and legal abortion in Andorra. Vanessa has been targeted by her government for the past four years, simply for exercising her right to freedom of expression and criticising the full ban on abortion care in the country. Vanessa spoke in front of the United Nations Committee on the Elimination of Discrimination against Women (CEDAW) in 2019, as part of the regular and critical exchange of information conducted between this UN body and human rights defenders around the world.  Following a complaint from the Andorran government, the public prosecutor brought charges against her. While previous charges of defamation, which carried prison sentences, were dropped in 2021, thanks to international pressure, Vanessa continues to be harassed by the prosecution, who is accusing her of crime ‘against the prestige of the institutions’.  

Spain has introduced new legislation allowing gender self-determination, banning conversion therapy, introducing menstrual leave and easing abortion limits. Here’s what you need to know: Anyone aged 16+ can change their gender on official documents without medical supervision Conversion therapy, in any form, intended to change a person's sexual orientation or identity or gender expression is banned New abortion legislation makes it easier for women to access medical or surgical abortions in public hospitals and clinics  Arbitrary and medically unnecessary three-day waiting period before accessing abortion care is suppressed  Denial of abortion care based on personal beliefs will now become more transparent due to a new registry that takes stock of medical professionals in the public health system who refuse to perform abortions The previous requirement for women aged 16 and 17 to obtain parental consent for abortions is scrapped, along with the 3-day period of reflection and the obligation to provide information on maternity benefits for those seeking abortion care Up to 5 days of menstrual leave for people with painful periods - thus Spain becomes the first country in Europe to introduce menstrual leave Provision of free sanitary products in schools, prisons and women’s centers and free hormonal contraceptives and the morning after pill at state-run health centers Paid leave before childbirth additional to the maternity leave, from the 39th week until the moment of birth Compulsory comprehensive sexual education at all stages of education, reinforcing previous regulations. The bill on sexual and reproductive health and abortion care recognizes rights that were already in the 2010 Spanish law and had subsequently been restricted, and includes new measures that entail the normalization of important aspects of sexual and reproductive health.

Women’s rights activist Justyna Wydrzyńska faces up to three years in prison after being charged with providing abortion pills to a woman who wanted them – the first case of its kind in Europe. In 2020, Wydrzyńska, a member of Polish activist group Abortion Dream Team, answered a request for abortion pills from a woman whom she said seemed to be in an abusive relationship and had decided not to go through a full pregnancy. But the abortion never took place – the pills were intercepted by the woman’s husband, who called the police. Wydrzyńska was arrested and charged with facilitating an abortion. Today, she hopes her case will shine a light on Poland’s strict abortion laws – and the way the judicial system is being used to persecute rights defenders who protest them. At least six women are reported to have died after being denied an abortion since Poland’s Constitutional Tribunal imposed a near-total ban on abortion care just over two years ago. At the time, the ruling prompted massive demonstrations across the country. The initially peaceful protesters were met with excessive force from authorities, who used tear gas, pepper spray and physical assault to subdue them. These attacks were followed by arrests and charges for those defending women’s rights.  Today, the judicial persecution of rights defenders in Poland continues. Prosecutors with a political agenda have brought spurious charges against activists, and cases have been heard by judges loyal to the ruling Law and Justice party. We at the International Planned Parenthood Federation European Network (IPPF EN) have spoken to several activists in Poland as part of our Defend the Defenders campaign, which highlights their plight, fundraises for psychological support and legal assistance in court cases, and asks the European Union to take action to protect activists. Wydrzyńska is one such activist. Speaking to IPPF EN, she said: “Empathy shouldn’t be punished, especially when someone is asking you for help. I feel there is only one chance to show that the law is extremely harmful. Even if I get a jail sentence, I am ready. I think this battle is bigger than my freedom.” Under Polish law, people who have abortions are not criminalised, but those who directly help them are. The government and ultra-conservative right-wing groups want harsher punishments for abortion rights activists. They also target family members, partners and friends who try to help women access abortion care. Wydrzyńska says Poland’s Ministry of Justice has appointed a right-wing judge to her case, which has been adjourned twice after a witness failed to attend, with the next hearing scheduled for next month. It has been reported that at the trial, the judge will allow Ordo Iuris – a Polish fundamentalist organisation that campaigns against abortion rights and LGBTIQ rights in the country – to stand with the prosecution to represent the rights of the foetus.   Persecuting rights defenders Activist Marta Lempart was charged under Covid laws – along with two other women, Klementyna Suchanow and Agnieszka Czerederecka-Fabin – for taking part in the 2020 anti-abortion protests. Each woman faces eight years in prison. Lempart said her case has already been tried once and dismissed by a judge due to a lack of evidence. Now, the prosecution is trying again. Lempart has 106 charges brought against her, including offences relating to breaking COVID regulations, blocking traffic, hanging posters, and littering in public. Most of these charges are pending due to a stand-off between Poland and the EU. Poland’s funding from the bloc has been frozen for over a year, amid concerns from the bloc over the judicial independence in the country. If the reforms demanded by the EU come to fruition, charges against activists like Lempart are likely to be dropped – but in the meantime, the toll on activists’ mental health and finances is severe. Speaking to the IPPF EN, Lempart said: “We can’t count on courts to be fair for long as the crackdown of the independent judiciary in Poland is happening at the maximum speed. The judges' removals from the cases and replacements, based on political decisions of the ruling party are a daily occurrence. “The government now aims for full power to decide which judge gets which case, taking overhead positions in all possible courts. Legal fees and misdemeanour fines are also hefty – if prosecutors can’t put people in jail, they want to cripple them financially.” To make matters worse, the political atmosphere created and fostered by the ruling Law and Justice party means many people feel it is acceptable to intimidate rights defenders in other ways. Some activists have been sent death threats and bomb threats by neo-nazi groups, and Lempart was assigned police protection after an escalating threat was made against her life. And alongside her numerous charges, Lempart has also had a libel case filed against her by the ultra-conservative organisation, Ordo Iuris.   Glimmers of hope It is not just activists under attack – journalists, politicians, independent judges and ordinary citizens in Poland also suffer from politicised assaults. In one case, lawmaker Joanna Scheuring-Wielgus faces two charges for participating in a 2020 protest, in which she held up a banner supporting abortion in a church. The prosecutor’s office in the city of Toruń charged Scheuring-Wielgus with ‘offending religious feelings’ and ‘malicious interference with religious worship’, according to Human Rights Watch. The hearing will take place in January, with each offence – for which she has pleaded not guilty – carrying a penalty of up to two years in prison. In another worrying development, Polish freedom fighters seem to have lost an ally due to recent changes in the Ombudsman’s Office, the supposedly neutral body appointed to investigate complaints made against public officials. The ombudsman, Marcin Wiącek, has dismissed his deputy, Hanna Machińska, who was known for protecting the rights of refugees on the Polish-Belarusian border and for intervening on behalf of protesters detained during pro-abortion and pro-LGBTIQ rights’ protests. Machińska will be replaced with Wojciech Brzozowski, a specialist in religious law. Meanwhile, the EU waits for Poland to meet the milestones its commission set for releasing the Cohesion and Covid Recovery Funds, now frozen due to severe breaches of the rule of law and fundamental rights. But MEPs have expressed concern that the commission’s criteria was not enough – and urged the EU council not to release the funds until Poland has fully complied with EU law. Lempart agrees, believing the EU’s approach emboldens the Law and Justice party. She explained: “The milestones are not in compliance with the EU Court of Justice rulings, so the EU is breaking its own laws. “It sends a clear message that they don’t care about the rule of law in Poland, and there is now an attempt to fast-track cases against protesters before these new changes are implemented.” We must ask ourselves – is this the Europe we want to live in, where rights are negotiable, where women are forced through pregnancy, and rights defenders are dragged to court by fundamentalist governments?  But hope remains, and with Polish parliamentary elections coming up next year, people have a chance to push for positive change. Support for liberalising abortion laws has risen from 37% in 2016 to 70% in 2022, while support for same-sex marriage has risen from 18% to 52% over the same time period.  “Moderate conservatism has been hijacked but the Law and Justice party is destroying itself,” said Lempart. “People saw the violence we faced. There has been a huge wave of support from people who don’t want to be part of the anti-women and anti-LGBT+ campaigns. They are too dogmatic, there must be a middle ground. People are moving more towards love and not hate.”   Originally published in Open Democracy. Credit photo: Spacerowiczka

‘They want to leave women alone with their ‘problem,’ says Polish women’s rights defender, Justyna of the ruling ultra-conservative party in Poland.  Justyna, a mother of three, works in an increasingly hostile environment, one in which women’s sexual and reproductive rights (SRHR) are being completely dismantled. Poland has one of the most restrictive abortion laws in Europe, only permitting abortion when the life or health of the pregnant woman is endangered or in the case of rape or incest. On 22 October 2020, the Polish Court went further and ruled that abortions could no longer happen in cases of foetal illness or abnormality. The only way for women who need a safe abortion is to rely on NGOs and women’s rights defenders, like Justyna, who enable self-administrated abortions; a safe and easy way avoid being forced through a pregnancy.