Access to
sexual and reproductive health and rights includes safe and legal abortion care
but, for many women in Europe, significant barriers remain. Caroline Hickson is
Regional Director of the International Planned Parenthood Federation European
Network (IPPF EN). We spoke to Caroline about access to abortion across the
region and IPPF EN’s advocacy work.
You work
across countries with very different laws and policies on abortion. Where is
there good access to abortion care and where is access most challenging?
Unfortunately,
the big picture is that there are still obstacles to reproductive freedom and
abortion care everywhere in Europe.
Even where you
have supportive legislation, you don’t necessarily have good access to abortion
care. Italy is a good example of a country where you have a legal right to
abortion, but when you actually get down to it, between 80 and 90% of doctors
deny abortion care on so-called grounds of conscience. In reality, it’s less to
do with conscience and more to do with the institutional context in Italy. Hospital
management is very conservative and can be quite closely linked to the Vatican.
If a doctor chooses to provide abortion care, they risk isolation and
discrimination and their career progression can be limited.
A lot of
countries have gestational limits in cases where a woman’s life or health is in
danger, and even in cases of rape or severe malformation that can only be
detected at a very late gestational age; these vary across the region. Italy
and Portugal have a limit of up to 12 weeks for abortion on demand, whereas in Bulgaria
the limit is 21 weeks depending on the health of the woman. In Finland and the Netherlands,
the limit is 24 weeks if the woman’s health is at risk, so women can access
care when they need it.
In other countries
there are other barriers, like needing more than one doctor to approve abortion
care. In Albania and Estonia, you need three doctors and, in Latvia, France,
Austria, Ukraine and Israel, in some cases you need a whole committee of
professionals. It is simply not the case that a woman is trusted to understand
what she needs and the care she needs, and to decide that privately with her
doctor. You have to be put in the hands of a committee and there is no
guarantee that you won’t face bias.
Then you also
have costs. The direct costs of abortion really vary in our region. In Serbia,
for example, it can cost between 41 and 50% of the average monthly wage, and in
Azerbaijan up to 70%. You might have access to abortion on paper, but if you
simply can’t afford to pay for it, there is no access.
There are some
countries with better access to abortion care. The Netherlands is one; North
Macedonia has just passed a fairly progressive abortion law; and you do have
countries where the costs are low because the state has included it in their
universal care system, but often only for part of the population, so for
example, in many countries, vulnerable groups like undocumented migrants,
asylum seekers and very poor uninsured women are not properly covered.
How is the
current political climate affecting sexual and reproductive health and rights?
There is a very
strong outside force working to ensure that even greater obstacles are put in
the way of abortion care.
Even in my
native country of Ireland, as soon as the referendum
was passed, an investigative journalist uncovered that an American organisation
was training volunteers to stand outside where women would access abortions, to
try to talk those women out of abortions. I’m very proud of the Irish media
because they came in and uncovered this, but it’s not unique to Ireland.
I’ve just been
to Ukraine where you have an incredibly regressive anti-choice movement out on
the streets, trying to reverse progress on women’s health and autonomy in
family and society. The first target of these traditional retrograde forces is
women’s access to reproductive freedom and privacy, particularly indoctrinating
young people. I think that’s really frightening.
However, what
is interesting and reassuring is that there is finally a realisation that
abortion and other reproductive rights are under attack in Europe. That
realisation is prompting people to stand up and say, no, this is not Europe.
Abortion is a social norm in Europe and it’s been a social norm for many years
in most countries. It’s underpinned by a consensus. We are really seeing people
standing up for these rights. For example, Poland has a very restrictive
abortion law, but when the government tried to restrict it even more, we saw an
incredible outpouring of women onto the streets in protest. The very
politicised use of women’s reproductive coercion in the US is also waking
people up in Europe. There’s still a big risk to these freedoms that we used to
take for granted and we have to take that seriously.
How does
IPPF EN work with its member associations to create change?
The most
important thing we do is link organisations across borders. We don’t claim to
sit here in Brussels with all the knowledge! But we are connected to people who
have been working on reproductive health and rights for years so, for example, when
Ireland was embarking on its referendum, our member there was able to talk to
our member in Portugal, who had gone through a very similar process. Linking
our members and partners together is the key thing that we do.
We also
aggregate what’s happening in the region as a whole, to see the bigger picture.
We have just completed an abortion legislation update across 50 countries. It’s
not looking at what the legislation is, because there are other reports that do
that, rather it’s looking at the feedback of people on the ground on how legislation
is implemented. We can pull out trends and our members can then clearly see;
this isn’t just happening in my country – how are members in other countries
responding to this? I think there’s a really important sense of solidarity and
support. Particularly when rights are under attack, it’s important to know that
you’re not alone.
Does your advocacy
work include working with the European Union?
We really
believe that we have to defend European values. We work with a number of members
of the European parliament (MEPs) who are strongly supportive of reproductive
freedom. These issues of reproductive rights and freedom are closely connected
with democracy and the rule of law; with protection and care of people. There’s
an increasing realisation that the forces trying to overturn those things are
connected.
We work with a cross-party
group in the European parliament who are known as the ‘All of Us’ group. They
stand for sexual and reproductive rights and freedoms, and they signed a manifesto urging the European Union (EU) and its
member states to ensure reproductive freedom.
I think the
European parliament has been very strong in standing up for reproductive
rights. We are opening up the discussion about what values mean in the EU and
who we are as a group of European nations. Reproductive freedom for all has to
be at the heart of what we stand for in Europe.
For more
information on IPPF EN, visit: https://www.ippfen.org/
This eFeature
appeared in the June 2019 edition of the Eurobulletin.