Photograph: Obrani PRAVO NA IZBOR
Edit: Elvira Krithari & Gigi Papoulias
Within 10 minutes of the Bregna border crossing between Slovenia and Croatia is the Slovenian town of Brežice.The city has a population of about 6,000 and a general hospital, and has recently become known as a “medical tourism” destination for Croatian women wishing to have abortions.
In 2018, 58 women from Croatia crossed the border to have an abortion in Brežice. The trend became widely known after Croatian state television reported on the case of a young girl who went to Brežice and managed to terminate her pregnancy, which was a result of sexual abuse by a family member. In Croatia, the young girl’s application for abortion was rejected, on the grounds of “destruction of supporting evidence”.
Doctors beliefs limit patients’ rights
Both Croatia and Slovenia have inherited abortion legislation from their Yugoslav past. In socialist Yugoslavia, the law was liberalized in 1952 in response to a significant increase in illegal abortions. The right to abortion was constitutionally guaranteed in 1974, while in 1978 the law on “Health Measures for the Attainment of the Rights of Free Choice on Childbirth” came into force.
Abortion in Croatia is still regulated by the 1978 law, which means it is allowed, exclusively in hospitals, within the first 10 weeks of pregnancy. After this period, termination is possible only in exceptional cases (such as fetal abnormality), and after the decision of a special committee.
However, in Croatia, there is a growing number of doctors who refuse to perform abortions on the basis of conscientious disagreement. The refusal for reasons of conscience is supported by the 2003 National Law on Medical Practice, which states that “Because of ethical, religious or moral beliefs, the physician has the right to file an objection and refuse to diagnose, treat and provide rehabilitation to a patient – if it is not contrary to the rules of the profession and if it does not cause permanent damage to the health or life of the patient.”
According to the information on the interactive map for “Availability of Medical Services for Abortion in Croatia,” created by two journalists in early 2019, using data from 27 hospitals, it is almost impossible for women in the northeastern part of the country to have an abortion. In four cities in the region, all gynecologists working in public hospitals are conscientious objectors. It is estimated that about 60% of doctors in Croatia refuse to perform abortions, citing a matter of conscience.
“I like to compare this situation to that of conscientious objectors in the (professional) army,” gynecologist Jazenka Grujic told Solomon MAG. Grujic is a member of a union of doctors and health professionals who want to restrict the ability to conscientiously object. “If you are a soldier, you are expected to perform in the line of duty, firing at enemy soldiers, regardless of your personal views on the matter. “Doctors should provide medical services to their patients, regardless of their views on abortion,” Grujic comments.
Conscientious objection in Croatia is not limited to doctors, nurses may also refuse to help during a termination procedure on the same basis. In 2018, it was widely reported in the Croatian media that a woman was unable to get her prescribed birth control pills because the pharmacist cited a conscientious objection.
Conservative reactions and the influence of the Church
For Grujic, these issues of conscientious objection are closely linked to the influence of the Catholic Church in society. Despite being officially a secular state, more than 85% of Croatia’s population is Roman Catholic. The Church exerts a significant influence in all areas of public life and this is most noticeable regarding issues of reproductive rights and gender equality.
When the country had to ratify the Istanbul Convention in the spring of 2018 (Council of Europe Convention on preventing and combating violence against women and domestic violence), the process was met with strong reactions from neoconservative groups linked to the Catholic Church. Those opposed took issue with the use of the term “gender” as a “socially constructed role which can allocate society into either men or women.” Since 2015, conservative and religious organizations and opponents of abortion have been systematically organizing a “March for Life” protest against abortion, calling for “respect for human life from conception to physical death.” As part of their campaign, they pray in front of public hospitals where abortions are performed, for 40 days, twice a year.
On paper, abortion is legal in the Balkans. In reality, however, women who decide to terminate a pregnancy still face social stigma, legal hurdles and restrictions.
In neighboring Serbia, conservative groups are less visible, but Church influence continues to dominate society. “Although Serbia is a secular state, any policy promoted locally or nationally must be supported by the Church,” said Jovana Netković, a member of Belgrade’s BeFem feminist organization.
“I have the impression that the Church is always targeting women when it comes to the issue of birth rates. This has been happening since the war during the 1990s, when the call for an increase in the birth rate was a call to create new generations of soldiers,” Netković told Solomon MAG.
The situation is similar in Romania. “The patriarch even gives medals to doctors who refuse to perform abortions and there are religious voices that put pressure on doctors,” explains Carmen Randou of the Asociaţia Front, a Bucharest-based NGO focusing on women’s rights. In communist Romania, when abortion and contraception were illegal, more than 10,000 women lost their lives by performing self-abortions or seeking black-market abortions. This memory is still alive. “It will probably protect us from more violent reactions (against abortions),” Randou said.
Today, abortion is legal in Romania until the 14th week of pregnancy, although it is not free – the procedure costs between €20 – €130, depending on the clinic, Randou points out. In addition, many state hospitals do not perform abortions for religious reasons (22% of hospitals refuse to perform then during religious holidays) and for moral reasons (32% of hospitals do not perform abortions at all).
Although conscientious objection is not a big issue in Serbia, doctors are always trying to persuade women to give birth. “If you visit the doctor about any gynecological issue, they will often recommend that you just give birth,” Netković explains. In addition, as in Croatia, the abortion procedure is not free, which makes it difficult for women with lower incomes.
Netković notes that abortion is still surrounded by social stigma in Serbian society. The same is true for all the countries of the former Yugoslavia, from Bosnia-Herzegovina to Kosovo, where women who have had abortions are still plagued by prejudice (considered as having “loose morals”) and they rarely share their experiences. In addition, perceptions of motherhood as being sacred continue to prevail throughout the region, especially as most countries face bleak demographic prospects due to mass migration and negative population growth trends.
New laws and restrictions
There is, however, a country in the region where abortion has just become more accessible to women. Until March 2019, abortion legislation in North Macedonia served as an example to be avoided, for pro-choice activists in the region. Previous legislation, passed in 2013, forced women to seek counseling to persuade them to continue their pregnancies – this included seeing ultrasound images of the fetus and then waiting three days before they could gain access to the procedure.
“We have been fighting for six years to change this law,” said Bojan Jovanovski, Executive Director of HERA (Health Education and Research Association), an NGO working in the field of HIV and sexual and reproductive health. When the political environment changed in 2017 and the new social democrats were elected, civil society organizations seized the opportunity, Jovanovski explains. The current legislation is, in his words, “one of the more liberal laws, a good story for the region as a whole.”
“The choice to have an abortion upon request has been extended from 10 to 12 weeks of gestation and can be performed for socio-economic reasons, due to fetal malformations, due to rape and incest but also if there are other medical reasons, without prior approval from the hospital committee (as it was before),” he explains.
In Croatia, women’s rights organizations also support legislative change on abortion. In 1991, when Croatia seceded from Yugoslavia, a Christian NGO appealed against the 1978 Yugoslav abortion law. In 2017, Croatia’s constitutional court ruled that the law did not violate the Constitution, but stated that parliament would have to pass new abortion legislation within two years.
Sania Kovacevic of the Platform Against Violation of Reproductive Rights (Obrani Pravo Na Izbor), which includes activists from various NGOs as well as “concerned citizens” tells us that their organization has filed a series of petitions for future legislation. “Conscientious objection should be abolished, abortion should be completely free so that all women have access to it, sex education and reproductive rights should be introduced in schools,” she said.
In recent years, the Platform has been able to bring the abortion rights debate to the public and to the mainstream media through a series of marches, protests and counter-demonstrations during the annual “Right to Life” march. Kovacevic says that over the years, she has seen more and more women learn about the initiative and take an interest in its goals, which boosts their hopes.
Sanja Cesar, coordinator of CESI (Center for Education, Consulting and Research), an NGO based in Croatia that works in the field of reproductive health and gender rights, believes the new law should be an opportunity to improve the reproductive rights of women in Croatia. She acknowledges, however, that this is unlikely to happen under the current conservative government, as influential conservative religious groups are calling for abortions to be banned. “It is possible that the new legislation will eventually impose more restrictions, such as mandatory counseling for women and longer waiting periods – as was the case in North Macedonia in the past,” Cesar concludes.