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Abortion Ban: a Physical, Psychological and Socioeconomic Enquiry

Authors: Daria Fagioli, Lisa Fontanella, Federica Franceri, Francesca Mozzanica, Marta Sciunnach.



October 22nd, 2020 is considered to be a setback for women’s right, as abortion in Poland returned to be the center of current issues. This date marked the day in which the Constitutional Tribunal of Poland ruled that abortions for ‘severe and irreversible fetal defect or incurable illness that threatens the fetus’ violate the country’s Constitution. This means that abortion in Poland would be legal only in cases of rape and incest and in order to safeguard the life and health of the woman. However, even in these cases, access to care in practice is strongly limited by multiple barriers. Even before the recent changes, the legislative situation of the country in matters of abortion rights was already one of the most restrictive in Europe right after Malta, the only country in the EU that prohibits abortions entirely.


On a political note, the main consequences of this decision were protests that broke out across the entire nation, and political pressure from the international arena. Nothing remotely similar has ever been witnessed in Poland since the fall of Communism (1989). About 430,000 people attended more than 400 demonstrations across the country, and online supporters have shown their solidarity to the protesters by using the hashtag: #ThisIsWar. The Center for Reproductive Rights and Human Rights claimed that this decision “puts the health and lives of women in Poland at great risk and violates Poland’s Obligations under international human treaties”. As a matter of fact, Poland should respect the international agreements by putting its laws in line with the general European ideal and ought to guarantee women’s access to care when mental or physical health is at risk. Pressures also arrived from the main international associations such as Amnesty International.


The repercussions of the Constitutional Court’s ruling do not only touch the political surface but they entail huge physical, mental, and socioeconomic risks.


Physical risks


A major issue related to abortion concerns the physical risks it involves. Abortion in itself is not harmful to women’s physical health when it is performed safely, as stated by the National Abortion Federation. On the contrary, there is consensus within the scientific community that unsafe abortion is a major public health problem — as recognised by all government delegations at the International Conference on Population and Development (ICPD) held in Cairo in 1994. As to the definition provided by the World Health Organization (WHO), unsafe abortion is a procedure for terminating a pregnancy that is “[…] carried out either by a person lacking the necessary skills or in an environment that does not conform to minimal medical standards, or both”. Worldwide, 45% of all abortions are unsafe, as it emerges from the 2017 report by the Guttmacher Institute.


The most extreme risk related to abortion is death: according to WHO estimates, between 4.7% and 13.2% of maternal deaths are due to unsafe abortion, which means that between 22,000 and 68,000 women die of unsafe abortion annually. As a result, unsafe abortion represents the fifth most common cause of maternal death globally. Moreover, the United Nations sexual and reproductive health agency (UNFPA) reports that 8.5 million women annually need medical attention from unsafe abortion and 3 millions of these women do not receive it. According to the International Planned Parenthood Federation, unsafe abortion may cause haemorrhage, uterine perforation, tearing of the cervix, severe damage to the genitals and abdomen, internal infection of the abdomen and blood poisoning in the short term. Other serious physical health problems caused by unsafe abortion in the medium and long term include reproductive tract infection (RTI), pelvic inflammatory disease (PID), chronic pain and infertility.


Interestingly, laws that restrict abortion are not associated with lower rate of unsafe abortions, says Médecins Sans Frontières (MSF). Furthermore, according to the WHO, almost every death and disability determined by abortion could be prevented by — among other factors — legal induced abortion whereas restrictive laws represent one of the main barriers to accessing safe abortion. The Center for Reproductive Rights’ map, displaying the current state of abortion laws in the world, shows that Poland is the only country in Eastern Europe where some limitations apply.




Psychological risks


Defenders of a law on abortion restrictions, such as the one in Poland, all agree that this procedure could harm women’s mental health. A woman could feel a sense of guilt and despair for having ‘killed a baby’ and she might experience a sudden change in hormones due to the end of pregnancy. Moreover, judgments from other people in the community can be a cause of stress and isolation for a woman, even though she does not consider abortion as morally wrong. Finally, the medical procedure can be itself painful and emotionally traumatic. Of course, nobody questions that deciding to have an abortion is a simple task.


However, let’s for a moment think about why abortion may not harm women’s mental health. Abortion is and still remains a choice, if women believe that they cannot deal with it, they can choose not to do it. Additionally, women can decide to have an abortion because they have much bigger issues going on in their lives which can be themselves cause of mental harm. An unintended pregnancy is a source of depression and anxiety and no one but the pregnant woman knows how it feels like to have a life growing in your body against your will. And it goes without saying that abortion is sometimes the only solution for a woman that all of sudden realizes that she cannot afford a baby or that neither her partner nor her parents are going to support her.


According to the Turnaway Study (2020), the claim that abortion causes mental harm is not backed by scientific evidence. By having interviewed a thousand women in the United States who had or were denied an abortion for five years after unintended pregnancies, it came up that abortion should not be associated with mental health harm. Findings test and confirm the hypothesis that abortion does not increase risks of depression, stress, anxiety and suicidal thoughts. Nonetheless, mental injuries following an abortion in the long run are strongly linked with former factors that affected women’s mental health such as child abuse, sexual assault and intimate partner violence. Still not having an abortion implies greater risk of psychological pathologies than being granted one. The study focuses on general outcomes and it does not overlook possible emotional responses that women may be going through when ending their pregnancy. But this concerns women and women only. It is not the government’s role to rule over their decisions.



Socioeconomic risks

Abortion bans have also socioeconomic consequences, both on women, their prole, their families, and society as a whole. Studies conducted in the United States have shown that women denied an abortion were more likely to experience economic hardship and insecurity than women who received an abortion. Indeed, laws that restrict access to abortion may result in worsened economic outcomes for women. Considering the effects on children, studies on the abortion ban in Romania have shown that children displayed worse educational and labor market achievements as adults. Moreover, there is evidence of crowding in the schooling system, higher infant mortality and increased criminal behavior later in these children’s life.

On the other side, granting abortion access affects women’s economic outcomes through lowering fertility because the abortion rates will increase. Having fewer children drives up women’s participation in the labor market, allows them to invest more in their human capital, and increases the relative resources available for other family members. Moreover, abortion access can change women’s expectations about family planning, hence diverting their life course trajectory, and also empowering them within their household.

As a last resort following an abortion ban, unsafe abortion brings economic consequences in terms of direct cost for healthcare systems and indirect cost for women, their families, and society as a whole.

For society as a whole, the economic impact of unsafe abortion is due to direct costs of providing medical care in case of complications, which are generally highly subsidized by the public sector — although women and their families bear a proportion of these costs; and indirect costs. These include the loss of productivity from abortion-related morbidity and mortality among women, the negative impact on children’s health, education and well-being due to the ill health or death of their mother, and the loss of alternative health services caused by the use of scarce medical resources for the treatment of abortion complications. These consequences have an impact not only on health systems and the public sector, but also affect the economic status of households and families: family budgets may be put under strain by the cost of the procedure itself and treatments in case of complications.

Furthermore, unsafe abortion brings social consequences: the risk of being denounced to authorities or imprisoned, the impact on the well-being of children and other family members from the possible death of a mother, and stigma experienced by women and their families. Stigma around abortion is particularly strong where it is highly restricted. It can increase the risk of morbidity and mortality due to unsafe abortion because it can provoke a delay in seeking treatment; in addition, the negative attitude of health workers leads to poor quality of care, including further delays in attending to women seeking post-abortion care.

In conclusion, this article intends to highlight the various and usually overseen risks associated with Poland’s tightening of the law on abortion. The consequences of this ruling are not just political, they are broader and will have a long-term impact not only on Polish women but on the country’s health and economic sector as a whole. Abortion is not about fetal versus women’s rights or government’s ruling over private childbearing. It is about women’s control over their financial security, health and physical integrity, ability to provide for their children and their future. It is about women’s control over their own lives.

References

A Deadly Gap: Meeting the Unmet Need for Reproductive Health Care. (2012, December). United Nations Population Fund (UNFPA). https://www.unfpa.org/sites/default/files/resource-pdf/EN-SRH%20fact%20sheet-DeadlyGap.pdf

Dudley, S., & Kruse, B. (2006, December). Safety of Abortion. National Abortion Federation. https://prochoice.org/wp-content/uploads/safety_of_abortion.pdf

Foster, D. G., Biggs, M. A., Ralph, L., Gerdts, C., Roberts, S., & Glymour, M. M. (2018). Socioeconomic Outcomes of Women Who Receive and Women Who Are Denied Wanted Abortions in the United States. American Journal of Public Health, 108(3), 407–413. https://doi.org/10.2105/ajph.2017.304247

Foster, D. G. (2020). The Turnaway Study. New York: Scribner.

Haddad, L. B., & Nour, N. M. (2009). Unsafe Abortion: Unnecessary Maternal Mortality. Reviews in Obstetrics & Gynecology, 2(2), 122–126.

Hindin, M. J. (2007, October 13). Contraception, Safe Abortion, and Maternal Morbidity. The Lancet, 370(9595), 1294–1295.

Poland’s Constitutional Tribunal Rolls Back Reproductive Rights. (2020, October 22). Center for Reproductive Rights. https://reproductiverights.org/press-room/polands-constitutional-tribunal-rolls-back-reproductive-rights

Pop-Eleches, C. (2006). The Impact of an Abortion Ban on Socio-Economic Outcomes of Children: Evidence from Romania. Journal of Political Economy, 114(4), 744–773.

Preventing Unsafe Abortion. (2020, September 25). World Health Organization. https://www.who.int/news-room/fact-sheets/detail/preventing-unsafe-abortion

Singh, S., García, S. G., Guillaume, A., Okonofua, F., & Prata, N. (2012). The health, social, and economic consequences of unsafe abortion: Papers presented at an IUSSP Seminar, Mexico, 2010. International Journal of Gynecology & Obstetrics, 118, S63–S64. https://doi.org/10.1016/s0020-7292(12)60002-2

Singh, S., Remez, L., Sedgh, G., Kwok, L., & Onda, T. (2017). Abortion Worldwide 2017: Uneven Progress and Unequal Access. Guttmacher Institute. https://www.guttmacher.org/sites/default/files/report_pdf/abortion-worldwide-2017.pdf

The World’s Abortion Laws. (2019, April 26). Center for Reproductive Rights. https://reproductiverights.org/worldabortionlaws

Unsafe Abortion: A Forgotten Emergency. (2019, March 4). Médecins Sans Frontières. https://www.msf.org/unsafe-abortion-forgotten-emergency-womens-health

Unsafe Abortion: The Dangers & the Answers. (2012, April 24). International Planned Parenthood Federation. https://www.ippf.org/blogs/unsafe-abortion-dangers-answers

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