Stories

Bucharest, 2025 – Romania’s democracy has just weathered an unprecedented stress test. In 2024 alone, the country held five elections – local, parliamentary, European, and a twice-held presidential vote – a marathon that culminated in the shock cancellation of a presidential runoff after a far-right populist surged unexpectedly into the lead. The political atmosphere was rife with nationalist fervour, anti-rights rhetoric, and alleged foreign interference amplifying extremist messages. “We were seeing a big tsunami of far-right, nationalist, conservative, populist forces… It’s very hard to point to them and just say they are only far right… they’re also very populistic and very conservative,” recalls Gabriel Brumariu, director of the Society for Education on Contraception and Sexuality (SECS) in Romania. As anti-rights narratives spread, it became clear that sexual and reproductive health and rights (SRHR) organisations like SECS were care advocates on the frontlines defending democracy itself. 

15-year-old Natasa (pseudonym), a young Roma girl, is one of millions of people forced to flee Ukraine because of the devastating war - causing the largest humanitarian crisis in Europe since WWII. Seeking safety and shelter in Hungary with her mother, Natasa instead encountered a different kind of struggle: systemic neglect, discrimination, and institutional violence. Shortly after arriving, Natasa discovered she was pregnant. It was her second pregnancy — her first had ended in miscarriage. She and her mother, living in precarious conditions under a government rent subsidy program, were referred to EMMA — a maternal health and rights advocacy organization — by a housing service provider. During their first meeting, EMMA provided Natasa with non-judgmental counselling on her options, including both continuing the pregnancy and abortion care. EMMA also arranged for a pregnancy test at a public health center. But instead of compassionate care, Natasa was met with suspicion and coercion. A doctor insisted on a vaginal ultrasound despite her fears that it might cause another miscarriage. The doctor then openly disapproved of her decision to continue the pregnancy, making Natasa unwilling to return. EMMA immediately referred her to a trauma-informed gynaecological clinic, where she finally received respectful and supportive prenatal care. For a time, things were going well. Natasa attended regular check-ups, engaged in childbirth preparation, and received psychosocial support. But the sense of safety she had begun to regain was once again shattered when her landlord evicted her due to her pregnancy, and her partner became abusive. With intervention from a specialist in domestic violence, Natasa’s home environment became once more stable. At 35 weeks of pregnancy, Natasa was hospitalized due to a suspected rupture of the amniotic sac. Once again, her voice and autonomy were ignored. Her refusal of a vaginal examination was ignored, and she was treated disrespectfully, leading her to leave the hospital against medical advice. A private physician later confirmed there was no rupture and advised a follow-up. When she returned to the hospital, the abuse escalated. Doctors attempted another vaginal exam without her consent, prevented her from contacting her mother, and conducted the procedure without the presence of a legal guardian. As a result, her cervix was damaged and she began to bleed. She was urgently transferred to another hospital. There, finally, she was treated with the dignity and care she deserved and safely gave birth to a healthy baby girl. What Natasa endured is gynecological and obstetric violence — a violation of human rights rooted in racism, sexism, and ageism. Following the birth, Natasa and her mother received daily emotional support from EMMA. Legal aid was arranged, and she was connected with professionals to explore justice and accountability to reclaim her voice. Two months on from the delivery, Natasa and her daughter are doing well. Natasa has received evidence-based contraceptive care counselling and made an informed choice to have an IUD inserted. Natasa’s story is not unique, but it is urgent. The fact that Natasa repeatedly faced a lack of compassion and even violence from medical staff speaks volumes about how widespread the problem truly is. Underage refugee women, particularly from marginalized groups like the Roma community, face intersecting forms of violence when accessing sexual and reproductive healthcare. Their safety, dignity, and rights must be non-negotiable. Due to the work of organisations such as EMMA everyone, regardless of their background, age, legal status, or financial means, can receive respectful care that prioritizes their well-being and autonomy.

Putting compassion at the heart of reproductive health For decades, access to sexual and reproductive health and rights (SRHR) in Poland has been fraught with barriers—legal restrictions, social stigma, and economic hardship have all too often stood between people and the essential care they need. For many, particularly women and marginalized communities, SRHR services have remained out of reach. In October 2020, the crisis deepened. Poland’s illegally appointed Constitutional Tribunal ruled that abortion on the grounds of severe foetal impairment was unconstitutional, eliminating the only practical legal avenue for women to access abortion care in most cases. The result has been devastating: many women are now forced to carry pregnancies against their will, even in cases of fatal or severe fetal anomalies. Those who can afford it travel abroad; those who cannot are left to seek underground and increasingly inaccessible options. On top of that, obstetric violence is also an issue in Poland, with women experiencing disrespectful and abusive care during childbirth. Poland received the lowest score in the 2025 Contraception Policy Atlas for access to contraceptive care, primarily due to restrictive policies and insufficient government support. Moreover, relationship and sexuality education in schools is neither comprehensive nor mandatory, and it tends to reflect conservative values, with teachers often receiving limited training. In this context, in 2024, the FEDERA Health Centre opened its doors as Poland’s first NGO-operated SRHR medical facility, breaking new ground in the fight for reproductive justice. This centre is more than just a clinic, it is a safe space and a hope that no one will be left behind. Through this centre people in Poland now have access to compassionate and non-judgmental care, designed specifically for sexual, reproductive, and mental well-being. An environment where people in need are heard, respected, and truly cared for. One such example is that of a 25-year-old patient from El Salvador who came to the clinic with no legal status in Poland, no health insurance, and no knowledge of the language. By the time she arrived, she was already 30 weeks pregnant and had not seen a doctor once during her pregnancy. Fear of public institutions and language barriers had kept her from seeking care. In the FEDERA clinic, she received all the necessary prenatal tests and examinations, along with legal support to begin the process of securing legal residency in Poland. For the first time in months, she was able to focus on her health and the health of her child, without fear.   SRHR as care, safety, and protection from harm At FEDERA Health Centre, SRHR is understood not just as a medical need, but as a matter of safety, protection, and human dignity. The centre offers vital services—contraceptive counselling, gynaecological care, STI testing and treatment, and sexuality counselling—all delivered with respect, confidentiality, and compassion. Crucially, the centre reaches those who have long been excluded: survivors of sexual violence, transgender and non-binary individuals, people living with disabilities, and sex workers.   Meeting the urgent needs of refugees and asylum seekers Conflict knows no borders—and neither should care. Since Russia invaded Ukraine, thousands of women and girls have crossed into Poland in search of safety. But safety also means access to SRHR. FEDERA Health Centre has responded with urgency and care. Since September alone, more than 150 Ukrainian refugee women have received SRH services, including contraceptive, pregnancy care, breast cancer screenings, and HIV testing. These are not just statistics—they are lives protected, trauma mitigated, futures preserved. One of those lives is a 34-year-old patient who arrived in Poland shortly after the invasion. Focused entirely on creating a safe life for her children, while her husband remained in Ukraine, serving on the front lines - she didn’t think about her own health for months. That changed when she learned about the FEDERA Health Centre services, specifically designed for Ukrainian refugees. She signed up for a screening, during which a high-risk HPV strain was detected. Thanks to early diagnosis, she was able to begin an HPV vaccination series. For the first time since the war began, she felt that someone was taking care of her too.   Mental health is reproductive health FEDERA Health Centre is one of the few places in Poland where reproductive health is fully integrated with mental health support. A dedicated team of psychotherapists works alongside medical professionals to support clients dealing with anxiety, depression, trauma, and emotional distress. This holistic model of care recognizes that reproductive health goes hand in hand with mental well-being.   A call to European leaders and donors The FEDERA Health Centre is more than a medical facility—it is a model of resilience, compassion, and rights-based care where every person—regardless of gender, status, or circumstance, can access the care they need to live a safe, healthy and happy life. By supporting these types of initiatives, we are not only ensuring care for all but also standing with women, LGBTQ+ individuals, migrants, and survivors. The current context in Poland underscores the critical importance of sustained advocacy and action to address unmet reproductive health needs. Despite the change in government in 2024, women and pregnant people in Poland, as well as Ukrainian refugees, continue to face substantial barriers in accessing SRHR care within the Polish healthcare system. Immediate measures are essential - from reforming restrictive abortion laws to ensuring respectful maternity care - so that everyone can enjoy reproductive safety and freedom.   * This case study is published as part of the Open Society Foundations project, Meeting the Essential Sexual and Reproductive Health Needs of Communities Affected by the War in Ukraine and Neighboring Countries.

Since the onset of the Russian invasion, countless people in Ukraine have faced not only the trauma of war, but the increased threat and terrifying reported incidence of abuse, sexual and gender-based violence (SGBV) and trafficking. Amid this humanitarian crisis, Women’s Health and Family Planning - Ukraine (WHFP) has remained steadfast in its mission to restore access to lifesaving sexual and reproductive health (SRH) and gender-based violence (SGBV) services for those most at risk. Amid the terrifying devastation experienced through a humanitarian crisis, people need first and foremost safety and protection. In 2024, WHFP, in partnership with the Public Health Centre, launched an innovative online training course for healthcare professionals: “Comprehensive Medical Care for Survivors of Sexual and Gender-Based Violence.” The course is a vital tool to equip doctors with the skills they need to recognize signs of abuse, respond with compassion, and offer concrete support—often becoming the first lifeline for survivors.

For Roma women and girls in Romania, the struggle to access abortion care brings them into contact with horrific levels of racism and discrimination, hardwired into mainstream Romanian society and institutions over centuries. This discrimination prevents many of the country’s 2 million-strong Roma population from having adequate access to healthcare, education, housing, employment, and other aspects of daily life and rights. For women and girls, these challenges are magnified by sexism and chauvinism. In this Q&A, equal opportunity expert Roxana-Magdalena Oprea of E-Romnja, a Roma women’s rights organisation, discusses the experiences of Roma women and girls within Romania’s healthcare system and why far more must be done to uphold their rights.   Could you give a brief overview of systemic barriers to the rights of Roma women in Romania?  The Roma population has long been one of the most discriminated against groups in Romania. Five hundred years of Roma slavery, the Holocaust and deportations to Transnistria, eugenic policies, and the assimilation policies of the Communist period represent systems of oppression that generated historical and political contexts in which the Roma population was systematically persecuted, abused, or even decimated. In 2020, the European Commission launched an infringement procedure against Romania for the state's failure to implement the Framework Decision on combating racism through criminal measures. Roma women remain among the most vulnerable categories when it comes to access to education, health, housing, the labour market, social protection, and other aspects of daily life. All these systemic barriers reinforce inequalities between Roma women and the mainstream population, and perpetuate Roma women's vulnerabilities. Looking specifically at health – infant and maternal mortality are higher among the Roma population, and Roma women in particular face additional obstacles (obstetric violence, segregation in maternity hospitals, racist attitudes and behaviours from medical staff) that make them even more vulnerable. For Roma women, the intersection of ethnicity, gender, class, skin colour, and so on creates different experiences of discrimination, as systems of oppression overlap. To illustrate, I would mention the case of a young deaf Roma woman who was denied maternity care and gave birth on a pavement outside a hospital. What are the main cost barriers that Roma people face when trying to access abortion care? In Romania, the cost of an abortion on request varies, from more affordable in the public system to prohibitive in the private system. The problem is that within the public health system, there are very few medical units where abortions can be performed. Many doctors refuse to perform curettages – either by invoking the option to refuse a medical act on ethical or religious grounds, or by drawing attention to a lack of appropriate medical facilities. Some doctors direct patients to private clinics where the costs depend on the procedure (medical or surgical etc), but a Roma woman cannot afford the cost of private care. Frequently, doctors’ refusal to provide abortion on request is redoubled by all kinds of contemptuous attitudes towards women who seek this type of care. In addition to these barriers, in the case of Roma women, those from rural areas or other vulnerable groups face barriers related to access, as a trip to the nearest hospital can cost several hundred Romanian lei [$70-100]. Other barriers they encounter are poor quality insurance, lack of family planning clinics, lack of family practice physicians, and the refusal of family doctors to issue referral tickets for appointments. And let's not forget about racism. How do institutional racism and discrimination, as well as stigma and discrimination within society at large, affect access to abortion care and increase costs for Roma communities?  Institutional racism affects the access of Roma women in general to any type of public or private services. On the topic of abortion on request specifically – I don't feel there is necessarily a stigma associated with Roma women. At the same time, there is no quantitative data to demonstrate that Roma women face more obstetric violence or discrimination than majority women when accessing reproductive health services, but as a grassroots activist I know this is happening. It is debatable why there is no quantitative data on this topic and why, every time, Roma women are left out of research that could come up with this evidence. Change occurs by directly addressing the systemic problems, not masking them, not beautifying them, not making them invisible. It is also important to look at the reasons behind pleas of chauvinist politicians and other regressive actors to make contraception and abortion care accessible to vulnerable groups of women. Are their arguments of a socio-economic nature or are eugenicist ideologies behind their wish to control the bodies and birth rates of “undesirable” categories of people? It is a theme that we must reflect on! How does intersectional discrimination affect Roma women and girls and their access to abortion care?  Public policies do not pay enough attention to the intersectional dimensions of discrimination and the causal link between systemic racism and health inequalities faced by Roma women. This lack of consideration can lead to a shallow understanding of the issues, and means that inequalities are treated in isolation, without considering the complex interactions between gender, ethnicity, class and other dimensions of oppression. In general, the problems faced by Roma women in accessing the public health system in Romania are: prolonged waiting times; poor quality medical interventions; reluctance or refusal of doctors to consult or admit Roma patients; and humiliation, classism, and discrimination. Racism is so pronounced that even if Roma women urgently need medical services, they avoid going to hospital. Recently, an organisation that E-Romnja works with contacted us to ask us to accompany a Roma woman to the hospital for an abortion on request, to ensure that the woman would not be discriminated against. What impact do developments at EU level have on the Roma community's sexual and reproductive health and rights? The rise of the far right, the lack of representation of Roma women in national or international politics, anti-Gypsyism, pandemics, wars, social inequities – these are cyclical realities that cause irreparable damage to the Roma community and remain a challenge on the human rights agenda. The fear is that the Roma minority will become a target again, as happened for example during the pandemic, when the wave of hatred against the Roma intensified. When it comes to reproductive rights, Roma women are over-represented in a negative sense. In recent history, we have plenty of examples of Romanian politicians who have spoken publicly about Roma women’s bodies and their supposed hyperfertility – their fear being that the Roma population will outnumber the majority population. Let’s not forget that in neighbouring countries (Czech Republic, Slovakia, Hungary, Bulgaria), forced sterilisation of Roma women was state policy implemented by doctors until very recently. History also indicates that in extremist regimes, sexual violence against women – especially women from vulnerable minority groups – increases and their rights are more often violated. How does E-Romnja support women and girls' access to abortion care? What are your priority focus areas, and what do you see as main current and future threats ? We support Roma women and girls with money – for travel expenses, medicine, and even for abortion. We also organise workshops on reproductive health topics for Roma girls and women in the communities where we work, as well as workshops with medical professionals and public authorities to raise awareness of the problems and barriers in the system encountered by Roma girls and women. Our current and long-term priorities are challenges around sexual violence and child marriage, access to reproductive health and social services, and community development. As for the main threats – beyond those already mentioned, I would add the lack of interest among donors/funders for this cause, and the interference of the Church in political decision-making on the subject. *** Read more about the how high costs and a broken health system are freezing many people out of abortion care in Romania, in this recent interview with IPPF's Romanian Member Association, SECS.  Photo of protest banner by E-Romnja. The slogan reads “Who is afraid of the Roma woman’s womb?”. Roxana explains that this question results from "our historical, collective, political, and vindictive anger addressed to all racists, abusers, and aggressors, who feel disturbed and threatened by our colours, bodies, and fertile uteruses." Article by Imogen Mathers for IPPF EN   This content is funded by the European Union through the Citizens, Equality, Rights and Values Programme. Disclaimer: Views and opinions expressed are those of IPPF EN and do not necessarily reflect those of the European Union or the European Commission. Neither the European Union or the European Commission can be held responsible for them.                   

Hitting the road in the desperate search for abortion care For thousands of women and girls in Croatia, getting an abortion involves travelling for hours, even days, across this small but poorly connected country in search of appointments. Whether by ferry, bus, or both, these journeys mark the beginning of an arduous and expensive ordeal – one that piles stress and costs onto people needing an abortion and forces many to leave Croatia altogether. On paper, a very different picture emerges. “By the law, abortion is quite accessible in Croatia,” says Marija Trcol of human rights and civic participation organisation PaRiter. Abortion on request is legal for up to ten weeks, and all public hospitals with obstetrics and gynaecology departments should provide care. But dig a little deeper and the extent of the crisis quickly reveals itself. “Actually there is no hospital with accessible abortion in Croatia,” Marija says. “There’s a really big discrepancy between [law and reality], which is why Croatia is perceived as a state with accessible abortion.” Different factors push people to travel far from home for care – from shortages in medical staff and problems rife within Croatian healthcare overall, to stigma and discrimination attached to abortion in this deeply Catholic country, where the growing influence of the church and chauvinist campaigners is intensifying structural violence against women. Scrutiny of these factors – among others – reveals catastrophic issues within Croatian healthcare and social attitudes to women, and why the struggle for abortion care is increasingly expensive and traumatic. Abortion’s hefty price tag For many people, the first barrier is Croatia’s complex geography: there is no abortion care in the islands or rural communities, and people must travel to mainland cities for appointments. In a nation of islands, mountains, and creakingly slow bus networks, this can be time-consuming and expensive. “It’s a small country but it’s really complicated to [reach] certain hospitals,” says Marija. “Public transport in Croatia is the worst – cities are not well-connected with buses, and it takes half of a day to a whole day just to travel to the hospital.” Ferries are expensive, costing €30-100 one-way. There are also no sick days for abortion care on request: people must book a day off, which can be complicated to arrange and lose you a day or more’s pay. Then there is the price of the abortion itself. Abortions on request are around €300 in public hospitals and up to €800 in private clinics. People with rhesus negative blood must pay an extra €50-80 euros for anti-D injections. Almost everyone has to fund their own care: the state only pays in specific cases of medical indication or rape, and the process for rape cases is deeply flawed, exacerbating trauma. These costs are “a massive chunk of your salary, especially if you are not economically stable, like women in some violent relationships,” says Marija. “For people with low socioeconomic status, I would say it’s impossible.” “The median salary in Croatia is around €900,” and women often work in low paid sectors or roles, she says. The country has a 12% gender pay gap, and 21% of women are at risk of poverty – shooting up to 48% for single women and 32% for single parents.  Many groups face additional cultural or logistical barriers to care. The Roma community has long experienced stigma and discrimination when attempting to access state services, including abortion care, Marija says. People with disabilities are also more vulnerable. “For people who need assistance to go to a doctor, this is something that the state does not provide at all,” she explains. “If you are deaf, for example, I don’t see how you can have an abortion without huge expenses.” These restrictions underline how transformative abortion telemedicine would be in Croatia, where it is currently banned. Croatian abortion law was drawn up in 1978 when abortions were exclusively surgical, meaning lawmakers decreed that procedures must take place in hospital. Fast forward five decades, and millions of people globally now use abortion pills at home in line with WHO guidelines, making abortion cheaper and more accessible, and reducing stigma. Spiralling denial of care One of the most significant barriers is the dramatic fall in the number of doctors and hospitals providing abortion care. ‘Conscientious objection’ – the practice of refusing to provide care on grounds of personal beliefs – lies at the crux of this crisis, as in many European countries. Since being legalised in 2003, it is now “normalised”, Marija says. The law doesn’t just apply to gynaecologists: any member of an abortion care team can invoke it, and a procedure will be cancelled if most of the team object, Marija explains. Even if no one objects, senior management can stop procedures going ahead, and hospital managers have sometimes fired staff for providing abortions, Marija says. This has had a catastrophic impact. By 2018, 59% of health workers were refusing to provide abortions. According to recent research by the gynaecologist Jasenka Grujić, there are now two hospitals in Croatia where all staff refuse to provide abortion care, 12 hospitals where 50-100% of staff refuse, and 9 hospitals where 1-49% of staff refuse.  Another problem is that “there is no regulation of denial of care in hospitals at a state level at all,” Marija says. For example, hospitals should ensure there is always at least one team available to provide abortions, but currently there is no government pressure on them to do this, she explains. Many abortion facilities are only open a few hours a day, a few days a week, and certain gynaecologists have become so notorious for being “really harsh to women” that people avoid them altogether. Forced to travel abroad for care A notorious case from 2022 reveals how doctors use denial of care and evasion to suppress reproductive justice. Mirela Čavadja was in the 24th week of pregnancy when doctors told her the fetus was unlikely to survive. Every hospital she contacted in Zagreb refused to provide abortion care – some citing ‘conscientious objection’, others saying “they were not equipped with knowledge and equipment to perform this kind of abortion, although by law this needs to be accessible in Croatia,” Marija explains. Finally, Mirela had to go to Slovenia for an abortion – a familiar path for women with medical indication in later pregnancy. Marija says doctors frequently tell such women to travel to Slovenia and foot the €5,000 bill themselves, despite the state being legally obligated to reimburse costs if Croatia lacks capacity to deliver care when it is medically indicated. This is yet another example of doctors participating in reproductive violence against women. Women at different stages of pregnancy also travel to Bosnia and Herzegovina or as far afield as the Netherlands to access abortion care – a shocking indictment of the state of abortion care coverage in Croatia Dearth of data The lack of data on abortion coverage exacerbates the struggle for appointments. Hospitals are supposed to send annual data reports to the Institute of Public Health, but there are no sanctions if they don’t and no way to find out if reporting is accurate, Marija says. Many hospitals say they provide abortion care, “and then the woman comes and they won’t do it,” she explains.  For women's rights activists, unreliable data seriously hampers their work. For women and girls, it means they can spend hours ringing around trying to get appointments, or turn up for an appointment and be turned away. “So this is something that we are going to campaign for – give us the true data and please give us the list of teams who are doing the abortions.” Data leaks linked to abortion stigma  The leaking of confidential patient data by medical staff to “shame” women who have had abortions is another serious problem – and yet another reason why women seek care far from home, Marija says. “If you live in a smaller place, then you sometimes choose to travel to a big city, because even if care is accessible, there’s a big chance of data being leaked and the whole place will know that you had an abortion,” she explains. Such leaks are illegal but completely normalised, and “there are no sanctions.” Even government ministers are involved: in the uproar following Mirela Čavadja’s case, the minister of health – himself a doctor – “went public with all of [Mirela’s] medical data” to the media. He remains in post. Misogynistic networks target abortion Growing links between anti-abortion actors, politicians, the church, the far right, and healthcare providers are a major threat to abortion care in Croatia. Since the breakup of Yugoslavia in the early 1990s, the power of the Catholic church has surged. “The church has a really big influence on politics and on the health system regarding reproductive health,” Marija says. With the entry of the far-right Homeland Movement into coalition government in April, Croatia’s government has shifted further right, and many in government have strong ties with the church and the growing anti-gender movement, Marija adds. She explains that different groups – including the ultraconservative Poland-linked ‘kneelers’, and ‘40 Days for Life’ abortion clinic picketers – target people providing or accessing abortion care, and are often backed by the church or global networks. The ‘kneelers’ are so entrenched that “they’re now part of the government,” Marija says. Women’s rights activists have been mobilising in response, including by calling for criminalisation of harassment of women seeking abortion care, but the threat remains dire, calling for massive, united efforts by campaigners. Mobilising to protect women This brings us back to the perception gap. Public support for abortion care is high at 65-75%, but this is a “quiet majority”, which hasn’t yet recognised the threats facing abortion access, Marija says. To galvanise people to speak up, campaigners need to expose gaps between perceptions and reality – and this calls for more trustworthy data. With this in mind, PaRiter is running a survey on abortion access and hopes that “through the next two years we’ll have established some kind of independent monitoring system on abortion,” with the support of other feminist organisations, within their capacities and means.   PaRiter is also scrutinising contradictions between Croatia’s stance on women’s rights and its European and international commitments, and plans to report yearly on findings. Despite the government’s shift rightwards, Marija says “our hope is that they are still going to want to look good in the EU’s eyes” and so constrain attacks on women’s rights, but “they are signing things like there is no tomorrow and are not doing anything to make things better.” Given the formidable forces lining up to attack women’s rights, civil society networks (national, regional and global) must work together to protect women’s rights, Marija says. For example, the Croatian coalition for My Voice, My Choice, a European citizens’ initiative calling for a financial mechanism to guarantee safe abortion access in the EU, has done a “fantastic job,” mobilising huge public support for safe abortion access, now and for generations to come. ***   Words by Imogen Mathers for IPPF EN Illustration by Alissa Thaler for IPPF EN   This content is funded by the European Union through the Citizens, Equality, Rights and Values Programme. Disclaimer: Views and opinions expressed are those of IPPF EN and do not necessarily reflect those of the European Union or the European Commission. Neither the European Union or the European Commission can be held responsible for them.