IN-DEPTH ANALYSIS Requested by the FEMM committee Access to abortion services for women in the EU Slovakia Policy Department for Citizens’ Rights and Constitutional Affairs Directorate-General for Internal Policies PE 659.922– October 2020 EN Access to abortion services for women in the EU Slovakia Abstract This paper, commissioned by the European Parliament’s Policy Department for Citizens’ Rights and Constitutional Affairs at the request of the FEMM Committee, provides basic information on access to abortion services in Slovakia. The legal status of abortions in the country is under permanent pressure despite the legally binding decision by the Constitutional Court back in 2007 which safeguarded women´s right to free choice. Eleven proposals to restrict abortion have been presented in the National Parliament, in the last two years. Medical abortion is not available in the country, and together with conscientious objection applied in health services and current COVID-19 pandemics access to abortion services is further limited. This document was requested by the European Parliament's Committee on Women’s rights and Gender Equality. AUTHORS Olga Pietruchova, independent gender equality expert, Slovakia ADMINISTRATOR RESPONSIBLE Martina SCHONARD EDITORIAL ASSISTANT Sandrina MARCUZZO LINGUISTIC VERSIONS Original: EN ABOUT THE EDITOR Policy departments provide in-house and external expertise to support EP committees and other parliamentary bodies in shaping legislation and exercising democratic scrutiny over EU internal policies. To contact the Policy Department or to subscribe for updates, please write to: Policy Department for Citizens’ Rights and Constitutional Affairs European Parliament B-1047 Brussels Email: [email protected] Manuscript completed in October 2020 © European Union, 2020 This document is available on the internet at: http://www.europarl.europa.eu/supporting-analyses DISCLAIMER AND COPYRIGHT The opinions expressed in this document are the sole responsibility of the authors and do not necessarily represent the official position of the European Parliament. Reproduction and translation for non-commercial purposes are authorised, provided the source is acknowledged and the European Parliament is given prior notice and sent a copy. © Cover image from the authors database. The poster used in a campaign against an abortion ban in 2002 by the Proc-choice coalition Access to abortion services for women in the EU - Slovakia CONTENTS LIST OF ABBREVIATIONS 4 LIST OF FIGURES 5 LIST OF BOXES 5 EXECUTIVE SUMMARY 6 GENERAL INFORMATION ON SRHR IN SLOVAKIA 7 1.1. Abortion and SRHR debate in Slovakia 7 1.2. National laws relating to accessing abortion 8 1.3. Abortion incidence and contraceptive use in Slovakia 9 Abortion incidence 9 Contraceptive use 10 ACCESS TO ABORTION SERVICES 11 2.1. Procedure and methods available 11 2.2. Public insurance schemes 12 2.3. Conscientious objection 12 2.3.1. Conscientious objection by abortion providers 12 2.3.2. Conscientious objection in access to contraception 13 2.4. Access to abortion during the COVID-19 pandemics 13 3. CURRENT TRENDS AND ACTIVITIES 15 3.1. Civil society stakeholders 15 3.1.1. Anti-choice 15 3.1.2. Pro-choice 15 3.2. Recent legal proposals to restrict abortions 16 3.2.1. Response by the civil society and experts 18 4. CONCLUSIONS AND RECOMMENDATION TO EUROPEAN PARLIAMENT 19 REFERENCES 20 ANNEX 21 I. Committee on the Elimination of Discrimination against Women 21 Concluding observations on the combined fifth and sixth periodic reports of Slovakia in the area of health (CEDAW/C/SVK/CO/5-6, 20/11/2015) 21 PE 659.922 3 IPOL | Policy Department for Citizens’ Rights and Constitutional Affairs LIST OF ABBREVIATIONS CEDAW Committee on the Elimination of Discrimination against Women CoE Council of Europe FIAPAC International Federation of Professional Abortion and Contraception Associates FIGO International Federation for Gynaecology and Obstetrics MEP Member of European Parliament MoH Ministry of Health MP Member of Parliament MS Member States NCZI National Health Information Centre OĽANO Obyčajní ľudia a nezávislé osobnosti, Ordinarly people and independent personalities (rulling party in Slovakia) SaS Sloboda a solidarity, Freedom and Solidarity (political party in Slovakia) SRHR Sexual and reproductive health and rights WHO Word Health Organisation 4 PE 659.922 Access to abortion services for women in the EU - Slovakia LIST OF FIGURES Figure 1 Development of general abortion and miscarriage rate in Slovakia 9 Figure 2 Development of contraceptive use in Slovakia 10 LIST OF BOXES Box 1 Main legal problems and challenges 11 Box 2 Main problems and challenges in access to abortion 13 PE 659.922 5 IPOL | Policy Department for Citizens’ Rights and Constitutional Affairs EXECUTIVE SUMMARY Background Access to sexual and reproductive healthcare services is a fundamental component of sexual and reproductive rights. Under international human rights law and standards, European Union Member States should ensure access to safe and quality sexual and reproductive healthcare. According to the World Health Organization (WHO), sexual and reproductive rights is an umbrella term for four separate areas: sexual health, sexual rights, reproductive health, and reproductive rights (SRHR). The situation regarding SRHR in Slovakia does not only meet required international standards, but it has worsened in the last two decades. The legal status of abortions in the country is being constantly challenged despite the legally binding decision by the Constitutional Court back in 2007 which safeguarded woman’s rights to reproductive self-determination. Eleven proposals to restrict abortion have been presented in the National Parliament, in the last two years. As the abortion debate in the country is very emotional, it is often misused by some political parties to conceal more serious political problems. The general public in Slovakia is rather favourable in supporting the free choice of women when deciding about abortion. According to the latest opinion poll1, only 17% of the respondents want to tighten access to abortion for women. Nonetheless, the predominant role of the religious and conservative institutions and actors in the country and its influence on policymakers all-across the political spectrum hampers and obstructs any possible positive development. The best example is the unavailability of medical abortion, even though the pill was registered by the Slovak Drugs Agency back in 2013. Because of the lobbying of the Catholic Church by the Prime Minister, the Ministry of Health did not authorise its use in practice2. The relatively high financial cost of abortion (which equals the minimum living costs in the country) and contraception make it inaccessible for groups of women at risk of poverty and social exclusion, students, and women from the Roma community. Furthermore, the conscientious objection applicable in the health services sector and the currently ongoing COVID- 19 pandemics limit access to abortion services further, particularly in areas with a strong influence of the religious and conservative institutions and actors. Consequently, the civil society under the lead of some feminist NGOs can only focus on keeping the status quo instead of lobbying for positive development. On one hand, they are in such a situation loaded with advocacy activities; on the other hand, the government has de facto cancelled the financial support. Thus, the SRHR in the country is at risk as never before. Aim The aim of this paper if to provide comprehensive background information about SRHR, particularly abortion rights and services, in Slovakia. 1 http://www.ivo.sk/8705/sk/aktuality/vo-verejnosti-prevazuje-nazor-ze-sucasny-interrupcny-zakon-netreba-menit 2 https://spravy.pravda.sk/domace/clanok/323472-potratova-tabletka-na-slovensku-nebude/ 6 PE 659.922 Access to abortion services for women in the EU - Slovakia GENERAL INFORMATION ON SRHR IN SLOVAKIA Abortion debate started in Slovakia after the adoption and ratification of the Concordat with the Holy See (2000). During the two decades, several legal proposals have been discussed in the National Parliament to restrict access to abortion and family planning methods. 1.1. Abortion and SRHR debate in Slovakia In 2001, a group of conservative MPs filed a motion to the Constitution Court to examine the abortion law. It was a reaction to the failed attempt to ban abortions in an amendment to the Slovak constitution in 2001. Article 15 of the Slovak constitution says that everyone has a right to live and that human life is worth protecting even before birth. The abortion law, on the other hand, allows for abortions to be carried out up to the 12th week of pregnancy. The MPs who submitted the motion said that the act on abortions contradicts the sentence in the Constitution that says that human life is worth protection even before birth. They argued that in Slovakia, it is legal to perform abortions within the first three months without giving any reason. In 2007, the Constitutional Court of the Slovak Republic held abortion on demand of a pregnant woman in the first 12 weeks of pregnancy conforms with the right to life (including the clause stating that human life is worthy of protection even before birth) as set out in the Constitution.3 The court ruled that the procedure protects the foetus, as a woman must go through a tough procedure if she wants an abortion, under the law: filing a request, receiving a medical examination, going through an interview with a doctor, receiving a second approval of the decision, and paying for the surgery. The time limit of 12 weeks is associated with the physiology of the developing foetus. The court gave woman’s right to reproductive self-determination a full and equal standing in the constitutional order, using a balancing framework, according to which multiple constitutional rights and values are vindicated, none completely overruling any other, and favouring compromised rather than absolute regulation.4 Several attempts to restrict the access to abortion have been discussed in the National Parliament, since the Constitutional Court ruling.