Polish women are scared to fall pregnant amid concerns they won't be able to abort in case of complications that could endanger their lives, an activist told Euronews.
Poland will on 27 January mark the first anniversary of the introduction of a near-total ban on abortion.
That came after the country's constitutional court decreed it unconstitutional for women to terminate their pregnancies even in cases of severe and irreversible foetal defects.
Since then, the only exceptions to the near-total abortion ban have been in cases of rape or incest or when the mother's health is in danger.
But in practice that has been difficult, say activists. They say two women have died over the last year because they were refused abortions even though their health was in peril.
"Women now in Poland, they are afraid to get pregnant," Urszula Grycuk, international advocacy coordinator at the Federation for Women and Family Planning (Federa) in Poland, told Euronews.
"They often call the federation helpline and they ask: 'What happens if...? Will I get that type of service or not?"
Proponents of the law say "every life is precious" and that it was a way to prevent the abortion of fetuses with Down's syndrome.
Fear of prosecution
Even though pregnancies with foetal diseases and defects could be terminated before the implementation of the law, the number of so-called legal abortions in Poland has hardly fluctuated since January 2021 with just under 1,100 women allowed to abort over the past 12 months.
Poland has consistently had the lowest official abortion rate -- which refers to the total number of abortions per 1,000 females of childbearing age (15-49) -- among European Union member states that allow abortion at just 0.1 from 2013 to 2019, according to Eurostat data.
Figures are not available for all 27 EU member states but AbortReport.eu, a project run by French pharmaceutical company Exelgyn, found that Sweden, the UK and France had the highest abortion rates in 2018 ranging from 15.4 to 19.
Malta bans abortion in all cases.
NGOs estimate that between 150,000 and 200,000 people access abortion in Poland every year through pills or by travelling abroad.
Yet, the constitutional court's decision in Poland had an immediate chilling effect, say activists. Four people reached out to Abortion Without Borders the day following the ruling to report they were denied an abortion despite the law not being in vigour.
Doctors and hospitals are scared of being prosecuted and now tend to be over-zealous in their respect of the law, Grycuk told Euronews.
Under the current legislation, women who take pills at home or who travel abroad to abort cannot be pursued legally but anyone who helps them can. These include any medical professionals, family members, partners and friends or even activists.
Woman's death sparks protests
Izabela, not her real name, died in September 2021 of septic shock. The 30-year-old woman was in her 22nd week of pregnancy and scans had revealed multiple defects with the foetus but doctors did not perform an abortion, choosing instead to carry out a caesarian after the baby's death.
Her death sparked massive protests after it was reported in early November.
The hospital where the woman died issued a statement saying they were “joined in pain” with her loved ones and others mourning her, and insisted that its staff had done everything to save her and the fetus.
A prominent member of the ruling party, Marek Suski, denied any connection to the court ruling.
“Medical errors occur ... and unfortunately women sometimes still die in childbirth,” Suski said on state TV.
Days after, a man said his partner had also died because doctors refused to perform an abortion.
Federa has meanwhile launched a lawsuit against a hospital that allegedly denied an abortion to a woman whose foetus had acrania -- meaning there was no fetal skull and brain tissue was exposed to amniotic fluid -- despite the severe impact on her mental health the pregnancy was having.
Acrania usually leads to anencephaly and almost all babies born with anencephaly die shortly after birth.
The woman, referred to as Agata, had obtained two separate certificates from independent psychiatrists who attested that she had developed reactive psychotic disorders as the result of her traumatic pregnancy and was, therefore, a suicide risk, say Federa.
"This hospital, following the refusal of care issued an official statement in which it said that denial of abortion care was due to the ruling and fear of criminal sanctions," Grycuk said. "The hospital admitted that a year ago, the abortion would have been carried out in this particular case."
The two psychiatric evaluations should have been enough for Agata to get a legal abortion, but the hospital cited a legal opinion issued by Ordo Iuris that mental health disorders are not grounds for termination.
Ordo Iuris is a Catholic organisation and think tank. It is seen as vastly influential over the ruling conservative Law and Justice party (PiS). The organisation's founder now sits on the Polish Supreme Court and many of its alumni occupy important positions in the government or state bodies.
Women 'are afraid to get pregnant'
"We deal with a lot of cases that are close to Izabela," Grycuk added. "It's deeply worrying that instead of taking it as a warning, as a very alarming case that never should happen again, some doctors show this level of fear. And they should just do their job.
"On an everyday basis, we have cases of women who are not afforded necessary abortion or pregnancy care. It is about pregnancy care, not about abortion care any more because their life and their health are not protected.
"So women now in Poland, they are afraid to get pregnant," she stressed, warning that "women are at risk of not receiving quality pregnancy care according to the standards in place in developed countries."
Activists say it means even women who should qualify for a legal abortion face extra hurdles. Agata ended up getting an abortion but she had to travel to another city with a hospital that accepted the two psychiatrics' certificates.
"Now you need to know where to go. You need to know what psychiatrist will issue that certificate," Grycuk said.
The European Court of Justice (ECJ) reported in July that it had received over 1,000 complaints about the January 2021 law and asked Warsaw to submit responses to 12 of them.
Among the applicants the ECJ chose were women who were not pregnant but planned to start a family including a 27-year-old who said she was fearful she would be deprived of requisite medical care in case of complications. Her partner suffers from a chromosome-related disease that put her chances of a healthy birth at below 50%. The ECJ noted that "she is worried that this situation will negatively affect her pregnancy."
"The applicant submits that the Constitutional Court’s judgment has a chilling effect on her family plans. She is so worried that she put aside the decision to start a family," it added.
Euronews has contacted Poland's Ministry of Family and Social Policy for comment.
Protesters were 'chanting' our number
The introduction of the law had one consequence the government probably didn't foresee.
"The Polish government's actions gave us an advertising campaign we couldn't have bought," Mara Clarke, Director of the Abortion Support Network (ASN), told Euronews.
The UK-registered ASN is part of a group of six NGOs who collectively make up Abortion Without Borders.
Some of the charities — from Poland, the Netherlands, the Czech Republic and Austria — provide information on pregnancy options, practical support for women forced to travel abroad, or even financial assistance.
"People were painting the Abortion Without Borders phone number on churches and bus shelters", while others "were chanting" it during protests following the constitutional court's ruling, Clarke said.
"In the three days after the Constitutional Tribunal, I mean, we got like 2,000 calls in a couple of days. It was crazy," she added.
In the 12 months to December 2021, Abortion Without Borders says it helped 32,000 Polish women access abortion, compared with 5,200 in the previous year. It supported 1,100 to travel abroad for an abortion, compared to 262 the year before.
The cost of an abortion in a hospital or clinic varies depending on the country and on the expectant women's health condition and the foetal defect.
COVID and Brexit create extra hurdles
Organising travel for Polish women forced to go abroad to abort because of foetal defects or risks to their own health was made all the more difficult and costly because of COVID-19 and Brexit.
At the start of 2021, COVID test requirements were bumping up the average ASN grant by at least €200-€300.
Meanwhile, the need for a passport to enter Britain since its departure from the European Union means British hospitals and clinics are no longer an option for Polish women who only have a European ID.
And then, there were travel disruptions.
"We had a woman who because they shut the airport due to COVID, had to drive to an airport in Germany to get to the UK. She got in a car crash on the way and missed her flight. The delay caused by the accident and hospital visit delayed her appointment, and when she came to England, she scanned two days over the legal limit and had to continue the pregnancy," Clarke said.
All this comes on top of other realities some women may face.
"So many of our clients are escaping domestic abuse so it just adds to the layers. Even sometimes sneaking out to the local women's clinic is difficult, right? You have three kids, you have a husband who doesn't want to let you out of his sight, you've got a mother-in-law that tracks your menstrual cycles — all of these are based on real cases, by the way. I'm not making any of this up," Clarke emphasised.
'Doing the government's work'
But the increased workload for charities also came with increased funds as donations went up after the constitutional ruling.
"All six organisations in Abortion Without Borders definitely saw an increase in donations," Clarke told Euronews.
Among those were 1.6 million zloty (€350,000) raised by the Abortion Dream Team in a crowdfunding campaign and a €10,000 donation from the Belgian government.
Still, for activists, the work sometimes took its toll, especially as "we know this work is the state’s responsibility, not poorly resourced NGOs or informal groups," Grycuk said.
And they had to contend with the abuse with the Federa activist reporting having been harassed, receiving bomb and death threats or arriving at work to find "murderer" written on the door.
"This is our reality. It sounds strange to say, but we kind of take it as a part of the job in a country like Poland. This is rather sad to say because one day it really might get dangerous," she concluded.