Joanna Z. Mishtal
Heilbrunn Department of Population and Family Health
Mailman School of Public Health
Columbia University
Matters of “Conscience”:
The Politics of Reproductive Healthcare in Poland
The fall of state socialism in Poland in 1989 constituted a critical moment that
redeﬁned policies regulating reproductive health and access to care. As the Polish
state adopted the discourse and agenda of the Catholic Church in its health
policies, reproduction and sexuality became sites of moral governance through the
implementation of the Conscience Clause law, which permits healthcare providers
to deny medical services citing conscience-based objections. Based on ethnographic
ﬁeldwork, this article explores the effects of the implementation of the conscience
clause and argues that the adoption of this law for individual use paved the way
for restrictions on reproductive healthcare on a systemic scale. The special status
afforded to the church is highly signiﬁcant for access to health services deemed by
the church to be matters of morality. The Polish case raises concerns about the place
of women’s rights in postsocialism and the nature of Polish democratization.
Keywords: [reproductive healthcare, democratization, Catholic Church, conscience
clause, Poland]
Since the fall of state socialism in 1989, access to reproductive health services
has become a major concern for women in Poland. As the Polish state adopted the
discourse and agenda of the Catholic Church on reproduction in its health policies,
reproduction and sexuality became sites of moral governance via the Conscience
Clause law (Klauzula Sumienia), which allows doctors to refuse health services because
of conscience-based objections, and the abortion ban that followed. On the
basis of ethnographic ﬁeldwork, I trace the shaping of the church-inﬂuenced restrictions
on reproductive services, and then examine the ways in which the new
policies are affecting Polish women’s access to abortion and family planning, and
how women circumvent the new legislation by pursuing services clandestinely. Despite
signiﬁcant protests, the postsocialist reproductive policies have been implemented
without a referendum, even though opinion polls at the time indicated
that the restrictions do not reﬂect the will of the population. The Polish state has
not balanced the rights of women to reproductive welfare and self-determination
against the political agenda of the church to enforce its religious morality through
policies. The case of Poland not only raises concerns about the place and the
MEDICAL ANTHROPOLOGY QUARTERLY, Vol. 23, Issue 2, pp. 161–183, ISSN 0745-
5194, online ISSN 1548-1387. C 2009 by the American Anthropological Association. All rights
reserved. DOI: 10.1111/j.1548-1387.2009.01053.x
161
162 Medical Anthropology Quarterly
future of women’s rights in postsocialism, but it also highlights the limits of liberal
democracy.
The fall of state socialism in Poland in 1989 constituted a critical moment that
redeﬁned not only political and economic rule but also policies regulating reproductive
and sexual health and rights. During the pre-1989 state socialist period, the
state considerably increased women’s reproductive and sexual autonomy, and, most
critically, abortion for socioeconomic reasons was legalized in 1956 for pregnancies
up to 14 weeks and was offered free of charge in all public hospitals. Approximately
97 percent of all abortions were performed on social grounds between 1956 and
1989 (Niemiec 1997; Zieli´nska 2000). The state openly endorsed family planning
and sex education and established subsidies for both. In 1959, a law was passed
requiring doctors to inform women who had just delivered a child or had an abortion
about their contraceptive options, and the state’s healthcare system began to
cover 70 percent of the cost of prescription contraceptives. The Society for Conscious
Motherhood (Towarzystwo ´Swiadomego Macierzy´nstwa) formed with the
explicit approval of the state, and the group began receiving subsidies for its nationwide
network of family planning clinics (Mazur 1981:5). Sharply breaking with
the previously dominant discourse on the primacy of motherhood, the Polish state
offered women greater reproductive and sexual autonomy, keeping in step with
the socialist gender equity rhetoric. These shifts also reﬂected the secular ideology
of the regime, which exercised the ﬁrst separation of church and state in Poland’s
history.
Simultaneously, the political involvement of the Catholic Church was restrained
by the secular state as the two entities entered into a relationship best characterized
as, what anthropologist Mart Bax calls, “antagonistic interdependency,” whereby
the state recognized the church’s national importance owing to its historical participation
in struggles against foreign occupiers, and the church understood its own
dependence on the state for survival in socialism (Bax 1991; Gautier 1997; Swatos
1994). The antagonistic character of the two institutions was rooted in their competing
visions of secular modernity and Catholic traditionalism, with tensions displayed
in both rhetorical and practical terms. To establish some terms of coexistence, the
church and the state signed a Modus Vivendi—a working agreement containing
several compromises. The state gave in on the issues of public worship, religious
education in schools, and the retention of church property but held its position on
liberalized family planning policies, among other things. The church’s disagreement
with the state’s reproductive policies was evident in direct appeals to parishioners by
the clergy who spoke strongly against abortion but rarely attacked the policy itself
(Swatos 1994). The Polish Church was silent on the issue until 1984, when Cardinal
J´ozef Glemp waged the ﬁrst serious campaign to outlaw abortion. Małgorzata
Fuszara, a prominent Polish gender studies scholar and a sociologist, recalled it in
the following way:
The Church didn’t talk about abortion before ‘89. The Pope, when he was in
Poland in ‘79, didn’t talk about abortion. He talked about it in the US and in
Western Europe, but never in Poland. As soon as the political situation
changed, the ﬁrst projects were to restrict abortion. Clearly, the Church was
waiting for the right moment. [interview, Małgorzata Fuszara, 2002]
The Politics of Reproductive Healthcare in Poland 163
Indeed, the immediate postsocialist period between 1989 and 1993, strongly
inﬂuenced by Catholic nationalism, brought critical transformations in policies regulating
reproductive and sexual health and rights. The rise of nationalism so evident
at this time was not unusual for Poland as many nations of the region began to redeﬁne
themselves as sovereign (Gal and Kligman 2000; Nagengast 1994). Given that
the Polish Catholic Church provided substantial support to the oppositional Solidarity
(Solidarno´s´c) movement—itself a Catholic–nationalist organization—during
the 1980s against the state socialist regime, it was not surprising that the church had
a major say in the postsocialist reforms once Solidarity-derived politicians assumed
power. The involvement of the church in Polish politics resulted from a long-term
effort of the church, beginning in 1918, to establish itself as a political actor not
just in relation to the state, but also within the state structure itself. After 1989,
the clergy secured positions of experts on bioethics in the Ministry of Health consequently
involving the church in matters of “morality,” that is, reproduction and
sexuality.1
Current laws reﬂecting the role of the church in the moral governance of
reproduction over the last 19 years include a near-total ban on abortion instituted
in 1993, restrictions on contraceptives, and the elimination of sex education from
schools.
Of particular importance in regulating reproductive and sexual conduct was the
implementation of the Conscience Clause law. The clause, written into the postsocialist
Medical Code of Ethics in 1991, provides that “a physician can withhold
healthcare services which are not in agreement with his conscience,” but must make
a referral elsewhere where there are “realistic possibilities of obtaining such healthcare”
(Nesterowicz 2001:340). It will become evident that, although the clause was
designed for individual use, it facilitated the withholding of medical services on a
systemic scale, and ultimately served paved way for the abortion ban of 1993.
These restrictions on access to family planning in Poland are best understood
within the broader economic context of postsocialism. Polish women experienced
dwindling ﬁnancial resources as a result of neoliberal transformations to the market
economy because of harsh reductions in maternity and social service provisions
since 1989 (Domanski 2002; Fodor 2002; Fodor et al. 2002:477–483; Kocourkova
2002; Tarkowska 2002). In fact, although women across East Europe became the
new economic “underclass,” the situation is far worse in Poland where women
have twice the likelihood of falling below the poverty line than men (Domanski
2002:393) and constitute the majority of the unemployed because of particularly
acute gendered discrimination in the workplace (Molyneux 1995; UNICEF 1999;
Zajicek and Calasanti 1995). Cutbacks in social services and the worsening economic
situation of women further conﬁne their reproductive choices, because, as
will be explained later, women with sufﬁcient ﬁnancial means have greater ability
to circumvent restrictions on abortion by pursuing services clandestinely.
This study reveals the reciprocal effect of how politics affects reproduction and
how reproduction is used instrumentally and symbolically in the political process
of power consolidation, which remains underexplored in anthropological literature
of East Europe, although it has been examined elsewhere in Europe, especially in
Italy and Ireland (Gal and Kligman 2000:17; Kolchevska 2005:2). Feminist scholar
Natasha Kolchevska argues (2005) in her recent review of gender as an analytic
category in Slavic Studies scholarship that research on East Europe continues to
164 Medical Anthropology Quarterly
be dominated by topics of national identity and nationalism, whereas gender remains
an understudied area. Sociologist Gail Kligman’s ethnographic study (1998)
of reproductive rights restrictions in Ceaus¸escu’s state socialist Romania constitutes
the only notable ethnography of East Europe that demonstrates both the effects of
pronatalist laws on Romanian women and the ways in which political agendas have
been molded by reproduction. Speciﬁcally, Kligman’s study investigated the effects
of Ceaus¸escu’s pronatalist regime on women’s ability to control their reproduction
and maintain health in state socialist Romania. The ethnography revealed the workings
of a severely oppressive antiabortion state in the Soviet bloc (and the only one
that banned abortion) and its impact, which included a surge in maternal mortality
because of illegal abortions, a rise in infant abandonment, and an epidemic of infant
HIV infections.
Demonstrating the ineffectiveness of even the most restrictive abortion policies in
stimulating birth rate (which Ceaus¸escu had hoped would result), Kligman showed
how women turned to clandestine abortions even under the most dire and risky of
circumstances, and how physicians, risking imprisonment, subverted the law by providing
care. She observed that, although these “duplicitous practices” by Romanian
women and doctors were “structurally determined survival mechanism[s]” and were
intended to manipulate the system that also manipulated them (Kligman 1998:14–
15), they created a kind of public complicity with Ceaus¸escu’s regime. As compared
to the postsocialist restrictions on abortion in Poland, the main difference lies in the
role of religious institutions in shaping reproductive regulation—Ceaus¸escu’s thrust
was to maximize population growth as a way to achieve national greatness, while
the emphasis in Poland has been on the morality of reproductive conduct.
This study therefore, also contributes to scholarship on the inﬂuence of institutions
on women’s health, in particular the inﬂuence of religious institutions on
shaping policies regulating reproduction and sexuality. A recent review of the major
themes on the topic of women’s health in ethnographic literature reveals substantial
scholarly attention to the way local religious and moral constructions inﬂuence
women’s health, but it also points to a relative dearth of studies examining the
inﬂuence of religion as an institution (Inhorn 2006). Studies of religion often focus
on systems of meanings, but a lesser emphasis is placed on power. Considerations
of power in the context of church–state relations and reproduction are especially
relevant in cases of Ireland and Italy.
Ireland’s restrictive reproductive policies in a strongly Catholic context offer an
instructive comparison with Poland. Abortion became a criminal offense in Ireland
in the 19th century, and the current law is the most severe in Europe, making the
doctor and the woman liable to life imprisonment (Yishai 1993:212). Even though
Ireland’s constitution contains a clear church–state separation, the law explicitly
incorporates Roman Catholic morality and language. Irish women primarily rely
on abortion tourism to England and Wales where they receive the services legally.
The analysis of the rise of the Catholic Church in Ireland by Tom Inglis (1991)
shows that in the 19th century the church assumed a major political role when the
colonizing English State shifted its policy from repression to paciﬁcation and control
of the Irish people.
England saw the church and its increasing organization as a competent vehicle
through which the Irish could “become civil and morally respectable as other
The Politics of Reproductive Healthcare in Poland 165
modern Europeans” (Inglis 1991:56). Thus, the church was given control of social
services, especially education, health, and social welfare—the perceived vehicles of
civility. The case of Ireland is instructive as juxtaposed against that of Poland: while
the Irish Church enjoyed an uninterrupted rein since the 19th century and therefore
easily maintained its political power to regulate reproductive laws, the Polish
Church suffered 50 years of political weakness in matters of reproductive policies,
yet it resurged with a remarkable force in postsocialism, which calls attention to the
church’s political astuteness and its long-term vision.
David Kertzer’s historical investigation (1993) of ways in which Catholic morality
shaped Italian policies regulating women’s bodies in the 19th century offers
another valuable study of church–state relations and their impact on reproductive
options and behavior. Kertzer’s archival research revealed a pervasive abandonment
and subsequent high mortality of infants in Italy in the 1800s. Because unwed mothers
were perceived as morally corrupt by the Catholic Church, the church, working
in tandem with the Italian state, institutionalized the abandonment of infants into
foundling homes as a way of “atoning for their [mothers’] sins, avoiding ‘public
scandal,’ and preventing a child from being raised outside the church-approved
family” (Kertzer 1991:11). Women were policed by state ofﬁcials, often working
through local midwives, who aimed to ensure that unwed mothers gave up their
“illegitimate” children. When it became apparent that lactating women were needed
to sustain the infants, many of the same unwed mothers were coerced into becoming
wet nurses at foundling homes but prevented from nursing their own babies because
the authorities feared they might become emotionally attached.
The trauma that was inﬂicted on women is captured by anthropologist Elizabeth
Krause in her ethnographic examination of memory of “the trade in milk and
foundlings,” which suggests that the suffering that women endured led many to
eventually embrace small families, which in turn might be reﬂected in today’s very
low birth rate in Italy (2007:414). Whereas the Italian state was the primary executor
of the foundling policy, the religious regime played a decisive role in infusing the
policies with religious gender norms and promoting the system of surveillance.
Relative to the case of Poland, the analyses of Ireland and Italy are inspiring in the
way they reveal the need to better understand the relationship between the church
and the state, and its various and complex effects that are reﬂected in contemporary
reproductive policies and behaviors.
Therefore, in this study I demonstrate, borrowing from anthropologists Mart
Bax (1991:9–10) and Eric Wolf (1991), that the institutional regime of the Polish
Catholic Church is “a political constellation” involving “the formulation of ideologies
and the working out of tactics and strategies of ‘how to ﬁght and how to win’”
to expand power from a centralized structure to broadly dispersed mechanisms
of control. I show that these mechanisms are situated at the level of reproductive
healthcare and reveal the ways in which such methods have a gender-speciﬁc target
and effect, ultimately calling attention to the implications of Poland’s embrace of
the church and its rejection of women’s concerns for the democratization process.
In the ﬁrst section below I describe the research methods and the sample population.
The second section examines the reproductive rights reforms and explains
how the Conscience Clause law paved the way for systemic limitations on access
to reproductive healthcare. Third, I demonstrate the effects of the new policies and
166 Medical Anthropology Quarterly
the way women negotiate the new environment; in particular I investigate the emergence
of the abortion underground. The ﬁnal section connects these ﬁndings to some
present-day developments and the broader context of postsocialist democratization
in Poland.
Methods
The ﬁndings in this article draw on 19 months of ethnographic ﬁeldwork in Krakow,
Warsaw, and Gda´nsk. I conducted research in the summers of 2000 and 2001,
throughout 2002, and in the summer of 2007. This article relies on ﬁndings from
participant-observation and in-depth interviews with 123 women from a range
of socioeconomic backgrounds (36 women of lower-, 63 of middle-, and 24 of
upper-socioeconomic stratum). In addition to drawing the sample from a number
of initial contacts (seeds) I established in 2000 and 2001, I conducted ﬁeldwork
in two social service ofﬁces in Krakow in neighborhoods of Podg´orze and Nowa
Huta. My interviews with women generated rich qualitative data about life stories,
memories of state socialism, reproductive desires and decisions, experiences with
family planning and medical care, and understandings and meanings of abortion
policies, feminism, and women’s activism.
I also interviewed 26 physicians specializing in obstetrics and gynecology and six
family planning instructors in three major healthcare facilities: the Greater Krakow
OB-GYN Clinic, the Wawel Medical Specialty Clinic, and the Małopolska ProFamily
Health Clinic. Being a native Polish speaker allowed me to conduct all of
the research in Polish. These interviews probed the meanings that doctors attached
to the reproductive health reforms implemented in the 1990s and the effects such
meanings had on their provision of women’s care. In particular, I focused on whether
doctors identiﬁed with the Catholic restrictions on reproductive healthcare and on
the degree to which their own provision of care was governed by their religiosity.
For the purposes of this article, I focus on religiosity as it is manifested in the public
rather than private realm, that is, as the individual intensity with which doctors
embraced Catholic tenets in their medical practice.
Additionally, I conducted research in three women’s rights NGOs: Women’s
Foundation eFKa, Women’s Rights Center, and the Federation for Women and Family
Planning. I spent a signiﬁcant amount of time conducting participant-observation,
semistructured interviews, and informal conversations, as well as reading documents
and archived press articles on issues concerning women’s and reproductive rights
and health. I also analyzed demographic, statistical, and policy documents generated
by the Polish state, the European Union, and the Vatican.
The names of all interviewees have been changed, except for those who agreed to
speak on record—Wanda Nowicka, Kazia Szczuka, and Małgorzata Fuszara. The
addresses of clinics and their names have been modiﬁed or given pseudonyms.
From Individual Objections to Systemic Restrictions
When the state socialist regime fell in 1989, the primary goal of the church’s lobbying
was to restrict access to abortion. Women quickly found that the security of their
rights during the socialist era was predicated on a particular political rhetoric of
The Politics of Reproductive Healthcare in Poland 167
gender equity granted in a top-down approach by the socialists,2
and they learned of
their rights’ fragility only when the church regained dominance after the power shift
of 1989. According to Wanda Nowicka, the director of the Federation for Women
and Family Planning (FWFP), women’s shock at the new proposals was profound:
It was as if people simply couldn’t get their minds around the idea that an
abortion ban could happen, that such a thing is possible. Many people,
especially on the left, were simply unprepared to respond to the upsurge of
the right-wing Church machinery and the wave of moralization that came
with it, despite the whole debate, so it came as a shock. [interview, Wanda
Nowicka, 2007]
Within a year of the transition, under the pressure from the church, the state
acquiesced by implementing an executive order requiring women seeking abortions
to get permissions from two gynecologists, a physician, and a psychologist, rather
than from just one physician, as was the case until then. Abortion was still permissible
on social grounds alone, but the new difﬁculties in accessing the service set
off a ﬁerce protest from the Solidarity Women’s Section; the group was promptly
dissolved for divisive “politicking” (Long 1996:171; Nowicka 2001:232–233; Penn
2005:288–290).
Although the new mandatory consultations were state subsidized, it took a considerable
amount of effort and time to carry out all four visits before the 14-week
time limit elapsed. Moreover, if any of the providers denied permission (judging, for
example, that the economic hardship presented as the reason for seeking abortion
sounded unconvincing or was not sufﬁciently severe), the time that lapsed seeking
further appointments made it difﬁcult to complete the required visits in the allotted
time, thus placing considerable limits on the right to seek abortion.
The most crucial development in restricting family planning access was the implementation
of the Conscience Clause. In 1991, the church pressured the medical
establishment to modify their ethics regulations by mobilizing the Catholic factions
within the medical community. As a result, an emergency conference to discuss new
medical ethics was organized by a group of Catholic physicians, and the resulting
Extraordinary National Assembly of Physicians concluded with the adoption of the
new Medical Code of Ethics. The new code included two relevant elements: the Conscience
Clause law and a restrictive new code speciﬁcally on abortion, which stated
that only life- or health-threatening circumstances or a pregnancy from a crime could
warrant a termination. A substantial group of doctors at the Assembly strongly opposed
the latter, in particular since the restriction proposed in the code was in
direct violation of the Polish abortion law, which at that time still allowed socioeconomic
hardship reasons for the procedure. Forty delegates walked out of the
Assembly in protest of the proposal’s undemocratic process, effectively excluding
themselves from the vote on the new code, which ensued anyway. Thus only doctors
who favored abortion restrictions voted on the code (Nowicka 1994; Regulska
1998; Szawarski 1992). The dispute between the Catholic Assembly and Poland’s
Civil Rights Ombudsmen, Ewa Łetowska and later Tadeusz Zieli´nski, about the
legitimacy of the new Medical Code of Ethics continued for a while, but in the
meantime the Catholic Members of the Parliament proposed a bill banning abortion
168 Medical Anthropology Quarterly
(Rich 1992:1221). Strikingly, the limitations on abortion in the Medical Code of
Ethics was nearly duplicated two years later, in 1993, by the new law banning
abortion in nearly all circumstances.
The Conscience Clause inscribed in the new Medical Code of Ethics triggered a
surge of refusals of services in cases of abortion in hospitals (still permissible for
hardship reasons until 1993, and then narrowed to a few exceptions), prescription
contraceptives, and emergency contraceptives (Nowicka 2008a:34–35). The clause
speciﬁes the following regulation of a conscience-based objection:
A physician can withhold healthcare services which are not in agreement
with his conscience (with the exception described in Article 30). He has the
obligation to indicate realistic possibilities of obtaining such healthcare
services from another physician or in another healthcare facility as well as he
has the obligation to substantiate and document this fact in the medical
documentation. The physician who works in a capacity of an employee also
has the obligation to inform his superior in writing prior to declining the
service.3
Although it speciﬁes the allowance for an individual physician, the clause quickly
became a tool of denying care on a more systemic scale than if an objection
was utilized by a particular doctor in a particular case. In fact, in the years before
the ban took effect, the clause was used to restrict abortions that were still
legal; the large drop of legally performed procedures recorded by the state from
105,333 in 1990 to 11,640 in 1992 reﬂects this phenomenon (U.S. Census Bureau
1995).
The shift from individual objections to systemic restrictions became evident as
entire healthcare facilities began to withhold abortion services via directives imposed
on gynecologists by the management. The example of the Greater Krakow OB-GYN
Clinic is emblematic of how the clause was used in the early 1990s as recalled by
one of the managing doctors of the facility whom I interviewed about the events
following the implementation of this law:
Author: How did the healthcare community here react to the Conscience
Clause?
Dr. Dembski: This building where we’re talking right now on Szopena Street
number 78, the Greater Krakow OB/GYN Clinic, was one of the ﬁrst in
Poland where we adopted a moratorium on abortion in accord with the new
Conscience Clause [policy]. So even before the law banning abortion was in
place, in this building abortions for social reasons were no longer performed.
That’s because people who didn’t want it done here began to have a voice.
Author: You mean doctors?
Dr. Dembski: Yes, of course doctors, but also the society.
Author: And that was before the abortion ban?
Dr. Dembski: Yes, it was two or three years before, because we had the
so-called moratoria and this was done in two or three hospitals besides ours
The Politics of Reproductive Healthcare in Poland 169
in Krakow. And a number of clinics also decided to adopt a moratorium on
abortion.
Another doctor in the same facility recalled the situation as follows when I asked
her how the Conscience Clause policy was received:
We received the news of the [Conscience] Clause with great joy. Granted, a
number of doctors here used abortion for ﬁnancial proﬁt, but the rest of us
felt that our conscience was being violated because, truth be told, everyone
who participated in abortions, or who assisted, be it a doctor or a nurse or
an anesthesiologist, acted unethically.
Not all doctors agreed with this view. Some understood the law as a divisive
wedge and an imposition of a particular morality on the medical community. As
one doctor explained, “the Conscience Clause and the subsequent abortion law
polarized the medical community because of the severity of the restrictions that
were suddenly in place but also because the laws were ideologically driven.” Another
doctor noted that “in Krakow, the restrictions are especially ideology based because
the bishop and the clergy are particularly vocal against contraception and abortion.”
The Conscience Clause paved the way for the abortion ban implemented in 1993.
At the outset, the Polish Episcopate lobbied Members of the Parliament belonging
to the Polish Catholic and Social Association to draft and ﬁle the “Law on the Legal
Protection for the Conceived Child.” Opponents of the ban requested a nationwide
referendum given that public opinion surveys at the time showed 82 percent of Poles
opposing a total ban on abortion, and 60 percent favoring legal access to abortion
with no or minimal restrictions (Nowakowska and Korzeniowska 2000:219–225).
At the height of the debate, women’s organizations led by the Federation for Women
and Family Planning formed the Committee to Create a Referendum and collected
1.3 million signatures (well surpassing the 500,000 signatures needed under the
Polish Charter of Civil Rights) to put the bill to a nationwide vote. Nevertheless, the
conservative Prime Minister Suchocka (who later became the Polish ambassador to
the Vatican) rejected the petition; a referendum was never held and the abortion
ban was passed in 1993 (Fuszara 1991; Nowakowska and Korzeniowska 2000;
Sieminska 1994; Zieli´nska 2000).
The abortion debate continued, however, and in 1996 the Polish Parliament, temporarily
holding a left-leaning majority supported by President Kwa´sniewski, passed
the Family Planning Act, which liberalized the 1993 law by permitting abortion for
socioeconomic reasons. But only a year later, parliamentary power shifted once
again in favor of the Catholic–nationalist Solidarity Election Action (AWS), which
promptly took the liberalized abortion law to the Constitutional Tribunal. The Tribunal
restricted the law back to its 1993 form, claiming socioeconomic reasons for
abortion to be unconstitutional and justifying its unilateral action by declaring that
moral issues cannot be subjected to a popular vote (Zieli´nska 2000:34). The position
of the Tribunal, consistent with the dominant rhetoric of the early 1990s when
the initial restrictions were being implemented, made it clear that reproduction was
now ﬁrmly established in the political rather than the health realm. The Tribunal,
embracing the absolute morality of the church, depicted all matters of reproduction
170 Medical Anthropology Quarterly
and sexuality as proper objects of political regulation, rather than decisions that can
be left to an individual’s conscience.
Many women in the feminist movement recalled a sense of having lost the language
with which to speak about reproductive rights during this time; as one activist
remarked, before 1989 “abortion wasn’t weighted down by the language
of morality, that it’s the killing of the unborn. Before, it was a normal thing,
part of everyday life. Since then it became a sin” (interview, Renata Dabrowska,
2002). Kinga Dunin, a long-standing feminist activist and a journalist, recalled
her experience: “The language with which we talked about abortion was taken
away from us. It became ‘life is sacred’ and ‘killing is bad.’ So if I’m agreeing that
abortion is bad because I’m killing, then every argument in favor of abortion access
doesn’t work, because: If it’s bad, then why do it?” (interview, Kinga Dunin,
2002).
The current law makes abortion illegal in all but three cases: when the woman’s
life or health is in danger, when a prenatal test shows a serious incurable fetal
deformity, or when the pregnancy is the result of rape or incest and has been
reported to the police. Because of potential complications, all terminations in the
ﬁrst two cases can only be carried out in a hospital.
Although the church was decisive in initiating and shaping the law, the Episcopate
was displeased with the three exceptions contained in the ﬁnal version of the
bill as the church wished for a complete ban, even in life-threatening cases. However,
opinion polls suggested that the life, health, severe fetal deformity, and crime
exceptions were strongly favored by the population, the majority of which opposed
restrictions on abortion to begin with. In the end, the church backed away from
insisting for a total ban (Nowakowska and Korzeniowska 2000:219–225). Despite
these exceptions, the Polish abortion law is the most restrictive in Europe outside
of Ireland.
Just as the Conscience Clause paved the way for the abortion ban, the law
continues to be evoked to further limit the narrow range of abortions still legally
permissible. According to Wanda Nowicka, the research conducted by the FWFP
showed that physicians who choose not to perform legally permissible abortions
typically also do not refer women to other facilities, leaving them without recourse,
even though doctors are legally obligated to provide a “realistic possibility” for the
procedure elsewhere. Here she explained how this law translates into a denial of
reproductive care on a large scale in public hospitals:
The most problematic issue is that the Conscience Clause objection is
practiced by the entire hospital, not by individual doctors, [. . . ] which, of
course, goes against the individually based nature of the Clause. If the head
of a particular hospital is against abortions, he or she declares on behalf of
the whole personnel that abortions are not performed in this hospital.
Period. End of conversation. Individual doctors who have opposing opinions
never speak up in favor of abortions because they risk losing their jobs.
Doctors who participated in the two studies that we did conﬁrmed that such
practices exist to a great extent. [interview, Wanda Nowicka, 2002]
The Politics of Reproductive Healthcare in Poland 171
The FWFP has been forwarding their survey results to the Ministry of Health
hoping to spotlight the routine denial of legally sanctioned services. In 2003, the
Minister of Health, Marek Balicki, himself a physician, publicly acknowledged the
existence of this phenomenon and released a formal letter to the governors of all
provinces in Poland urging that they “remind the public healthcare facilities providing
gynecological and obstetrical services [. . . ] about the unconditional obligation
to adhere to the [abortion] law,” which allows for three circumstances under which
abortions are legal. He noted that “it was disconcerting to see that women have difﬁculty
in exercising their right to obtain abortions in those cases that are permitted
by the law,” that they lack “free access to information” and “free access to means
of family planning.”4
He also stated that the clause may not be applied “at will.”
Instead, he said,
[it] refers exclusively to a speciﬁc physician in a speciﬁc case, and under no
circumstances could be used by an entire clinic or hospital based on the idea
of collective conscience of the facility via a general directive of the head of
the clinic.5
Despite Balicki’s statements, no obvious or tangible consequences to his action
emerged given his negligible power and means to enforce the law. Although he
was a member of the Democratic Left Alliance (SLD) Party and served in a leftist
administration ruling at the time, he was in the minority in his public advocacy for
reproductive rights and thus had little power to enforce his position. Violations of
the clause per se have not been challenged in court thus far, though several cases of
violation of the referral requirement have been reported. Most recent of these was
the case of Agata, a 14-year-old girl who got pregnant as a result of rape and, with
the help of her mother, pursued abortion in the local hospital in Lublin. During the
short time that Agata was admitted to the hospital to await the decision of the
director, priest Krzysztof Podstawka was called, who then attempted to convince
Agata to carry the pregnancy to term. The hospital’s director, Jacek Solarz, declared
that the doctors in his facility would not perform the procedure or provide a referral.
The Federation for Women and Family Planning appealed to the Minister of Health,
the Bureau of Patient’s Rights, and even the Prime Minister Donald Tusk, but Dr.
Solarz responded when asked about denying Agata the referral by saying: “We have
not been looking thus far for another hospital. I’m not afraid of legal sanctions
because ethics is above the law” (Szlachetka and Pochrzest 2008). In the end,
according to the media, Agata and her mother traveled to another city to obtain
the procedure. This highly publicized case demonstrates but one instance of what
appears to be a common practice of using the Conscience Clause as the means by
which an individual provider makes a decision on behalf of the entire hospital as
well as other possible providers in an effort to curtail the access to the service.
Pro Humana Vita: Application of Catholic Directives in Medical Practice
The widespread use of the Conscience Clause also curtails access to contraceptives.
Although contraception (except sterilization) is legal, and thus theoretically accessible
in Poland, the church strongly opposes it. The church holds that all hormonal
172 Medical Anthropology Quarterly
contraceptives act as abortifacients by preventing a fertilized egg from attaching
to the uterine wall, and therefore their use is a grave sin. The Vatican cites the
following statement by Pope John Paul II to argue this position:
It is being demonstrated in an alarming way by the development of chemical
products, intrauterine devices and vaccines which, distributed with the same
ease as contraceptives, really act as abortifacients in the very early stages of
the development of the life of the new human being.6
Furthermore, sex for nonprocreative purposes is viewed by the church as sinful,
and thus any form of contraception is forbidden, except for periodic abstinence,
popularly referred to in Poland as the “calendar” (kalendarzyk) method.7
My research
with the providers at the Małopolska Pro-Family Health Clinic illuminates
how this approach to birth control is conceptualized as both beneﬁcial to the woman
and scientiﬁcally sound.8
The clinic is known for its Catholic approach to healthcare
and its embrace of the tenets of the Encyclical of Pope Paul VI on the Regulation
of Birth released by the Vatican on July 25, 1968, which urged Catholic medical
communities around the world to provide reproductive and sexual healthcare that
centers on procreation.9
In the waiting room of the clinic, the cruciﬁx hung prominently
above the reception desk and the Pope John Paul II calendar was afﬁxed to
the waiting room wall. The dominant themes that emerged from these narratives
were the moral unacceptability and health risks of contraceptives, and the scientiﬁc
basis for the effectiveness and safety of the calendar method. Dr. Malina’s interview
excerpts are emblematic of this approach. I broached this topic by asking about his
view on natural contraception—a term that is often used interchangeably with the
calendar in popular discourse:
Dr. Malina: Look, there’s no such thing as natural contraception, that’s the
wrong word. We support methods of observing fertility that give the spouses
a sense of when they are fertile. I don’t at all give out contraceptives because
I don’t want to, in some sense, take on that responsibility. I’m a believing [in
God] person [jestem wierzacy]. I believe that contraception is wrong.
Approaching it scientiﬁcally, contraception totally upsets the woman’s
hormonal system. While taking contraceptives, 10 years later there’s a
greater frequency of breast cancer and cancers of the reproductive system,
therefore it’s a factor that impedes health. Everything can happen: there
might be epileptic attacks, joint pain, migraines, water retention, mood
disturbances, agitation, aggression, hunger, sadness.
Author: Are you now talking about all contraceptives or just hormonal ones?
Dr. Malina: Yes, hormonal, so pills or injections, but the same is true about
barrier methods and IUDs, and these have the effect of early miscarriage . . .
Additionally, the foreign body in the womb causes a reaction—a lesion and a
discharge of mucus. It’s as if you held something in your mouth—with time
a sore will form, there might be an inﬂammation. Similar thing happens in
the womb.
Author: What about condoms?
The Politics of Reproductive Healthcare in Poland 173
Dr. Malina: That’s another issue. Psychological fear. All contraception
solidiﬁes the fear of the child in spouses because people start using
contraceptives to avoid pregnancy. They fear the pregnancy and that it will
destroy their well-arranged lives. This fear gets transferred onto the child.
They fear, to put it simply, they begin to fear the child. Throughout the long
period of time when they use contraception this mechanism solidiﬁes in their
subconscious minds. We know from statistics that people who use
contraception are more likely to decide to get an abortion because in their
subconscious the association is: child–enemy. The child becomes the source
of fear; that’s the psychological consequence of contraception. That’s why
we talk about the psychological term “contraceptive conscience.” [interview,
Dr. Malina, 2002]
Another gynecologist at the clinic, Dr. G´orska, explained that the clause allows
her to follow particular ways of conducting her medical practice according to her
own sense of religious commitment and asserted that “here in our clinic we completely
do not condone contraception because those are the rules of how we provide
care.” She validated her position by saying that since “patients who believe [in God]
choose against contraception,” and, since “sex education should be carried out by
the church” not doctors, she was justiﬁed in declining to prescribe contraceptives
to those patients who requested them [interview, Dr. G´orska, 2002].
In general, the doctors I spoke to interpret the clause as encouraging providers
to let their religiosity play a signiﬁcant role in the provision of care.10
Indeed, Dr.
G´orska’s explanation suggests that the clause allows condoning, or not, behaviors
deemed immoral by the church, regardless of whether or not the service is formally
included in the state-sanctioned medical care (as with provision of contraceptives).
Therefore, the disciplining effect inherent in the use of the clause by a physician
promotes a form of religious governmentality. The notion of governmentality, which
I borrow from philosopher Michel Foucault (1991) to denote speciﬁc institutional
mechanisms of disciplinary power, is constructive in thinking in the context of these
ﬁndings.
In particular, the focal element of governmentality—the attention to institutions
creating constraining effects in speciﬁc ideological ways—is highly relevant to the
ways in which the Polish Church functions as a disciplining and surveilling institu-
tion.11
The clause offers an implement with which individual doctors sympathetic
to the church’s agenda voluntarily promote a distinct form of religiously sanctioned
reproductive morality. Simultaneously, the law and the doctors operate as tools of
coercive power that legitimize and reproduce the moral authority of the church, by
making the clause compulsory in some hospitals regardless of the desires of individual
doctors and by narrowing women’s reproductive options to the parameters set
by the Vatican.
White Coat Abortion Underground
The abortion ban and use of the Conscience Clause fueled the growth of a clandestine
abortion underground (podziemie aborcyjne) as physicians who previously provided
the procedure in public hospitals began to offer it illegally in their private ofﬁces,
174 Medical Anthropology Quarterly
creating a “white coat” underground, staffed mainly by experienced gynecologists.12
[3;10.5] Since then, abortions in Poland have been readily available for a fee of about
1,000 to 3,000 złotych ($303–$757) and are advertised in newspapers, including
the largest Polish daily Gazeta Wyborcza.13
The ads are short and often contain
only a mobile telephone number and one of the following phrases signaling abortion
services: “all services provided,” “vacuum method,” “anesthesia,” “menstruation
induced,” “complex procedures/discreet,” etc. A woman can call the number to
ﬁnd out the price and location, and she can schedule the procedure for the same
or the next day. Abortions require the synchronization of a gynecologist and an
anesthesiologist given that they are performed under general anesthesia, and in
most cases the more invasive dilation and curettage (D and C) is used, rather than
the newer vacuum method.14
Despite the obvious existence of the underground, until recently the authorities
rarely policed clinics and almost never followed the trails of newspaper advertisements.
Typically neither the doctors nor the women want to reveal the information
unless something goes awry, in particular if health complications or death results.
These situations seem to be relatively infrequent, likely because of the “white coat”
nature of the underground. Nevertheless, the use of general anesthesia and D and
C subject women to unnecessary risks. A few cases in which the woman’s partner
called the authorities in an effort to stop the procedure have also been reported. Occasionally
a clinic might be placed under police surveillance because of someone in
the community who informed against the doctor. In the recent few years, however,
a handful of radical politicians on the political right have begun to demand greater
policing of the underground, responding in part to the accusation that the ban
drives abortions underground rather than preventing them. But even so, there have
been few arrests, and those cases that went to trial ended in suspended sentences,
ﬁnes, and temporary suspension of license to practice medicine, none of which appear
be deterring the doctors (Nowicka 2008a:29–30). Despite the accessibility of
clandestine services and the clinical setting in which abortions are performed, the
experience is harrowing; I offer the following story of Hania, a 22-year-old tour
guide in Krakow.
When I ﬁrst interviewed Hania she had been getting ready for her summer job in
Greece as a tour guide for Polish tourists traveling to Athens. She moved from the
rural Wieliczka to Krakow in 2002 to pursue studies at the Academy of Tourism
and Recreation and viewed tourism as a secure and lucrative job and a chance to
travel outside of Poland. Hania’s mother, herself a nurse, partially supported Hania,
but their ﬁnances were limited since Hania’s father had died two years earlier and
the family had incurred debts during his illness. Her summer job was a valuable
opportunity to earn money and gain work experience, particularly since the main
alternative among her peers was far less desirable fruit-picking seasonal work in
Spain. Hania dated Marek for only four months when she unintentionally became
pregnant. She said they typically used condoms because the pill was too costly but
occasionally relied on the less effective withdrawal method to prevent pregnancy. I
asked Hania how she reacted when she realized she was pregnant:
I wanted to get an abortion that day. I knew they made it so we can’t have
them anymore, but I went to Dr. Jacob at the Academy who prescribed my
The Politics of Reproductive Healthcare in Poland 175
[birth control] pills in the past hoping she’d give me a referral, but she told
me to pick a doctor from the newspaper. So I got the paper and started
calling. I called two ads that said: “vacuum method.” One doctor was in
Katowice and he wanted 1200 [złotych] and the other was in Krakow and
wanted 1400; both could see me that day. I came up with a thousand but
had to borrow the rest from two friends, as an emergency favor, and I chose
the Krakow clinic since he let me bring a friend. The ﬁrst friend I called
couldn’t come; the second met me right away. The clinic told me I was to
meet their driver at a speciﬁc location, and to hold an empty plastic
shopping bag in my left hand. A man pulled up in an old car and told us to
get in. We got in, frightened but we got in. The situation felt anxious and
secretive, I don’t know, but basically he tried to be pleasant as he drove us
outside the city to the doctor’s private house. The sign at the gate said:
“Doctor of Gynecology,” which calmed me a bit. The ofﬁce was very
elegant: it was tiled and the older woman anesthesiologist was quite friendly.
She said the procedure is easy, like pulling a tooth. She came from her
hospital just for this . . . I never learned the doctor’s names. When I woke up
from the anesthesia, he wanted my phone number in case of complications
and told me to return for a checkup, but later I decided I didn’t need to come
back. My friend and I were dropped off on the same street corner, and from
there I took the bus home. I was glad to have it behind me.
Even legally permissible abortions are often performed clandestinely in private
ofﬁces by doctors who otherwise decline to perform them in hospitals, thus not
all doctors who refuse to provide abortions are actually opposed to the procedure
based on their religiosity. In many cases the law serves as a way to protect oneself
from church harassment since doctors who perform legally permissible abortions
in public hospitals expose themselves to scrutiny by colleagues sympathetic to the
church’s agenda. Therefore, sometimes what appears to be a “conscience” issue is
actually the fear of going against the religious norms. According to Dr. Zaremba,
the fear of harassment from the clergy is in fact one of the main reasons abortions
are refused in hospitals:
Here [at the hospital] the most drastic situation is with abortions—
gynecologists here refuse to do them due to fear; and that’s the majority of
gynecologists. [. . .] There are entire hospitals where it’s no longer done. [. . .]
In the early years of the right-wing state it was very severe, then when we got
the leftist government the priests exerted their inﬂuence from the shadows
taking advantage of established connections. If you live in a smaller
community like me, you fear that the neighborhood priest will ﬁnd out and
say from the pulpit: “Don’t go to this doctor!” It’s not worth it for me
ﬁnancially; my private practice will suffer, it will cost me. Sometimes you see
doctors having to shut down their ofﬁces in small towns and open elsewhere;
they have to liquidate. That’s what happens. [interview, Dr. Zaremba, 2002]
Although Dr. Zaremba’s hospital is near Krakow’s center and her private practice
is in her house on the edge of the city 11 miles away, her concern of being targeted
176 Medical Anthropology Quarterly
by the church in her home community for activities at the hospital is well founded.
The clergy routinely urge parishioners to both boycott providers of abortions and
contraceptives, and to spread the word about their practices. Ironically, it is easier
for Dr. Zaremba to perform abortions illegally right in her private ofﬁce because
she believes that her patients would not expose her. Ultimately, the state has no
mechanism to ensure that the abortion law is followed on either end of the spectrum:
to prevent illegal abortions or to ensure that abortions permissible under the law
are in fact available. The state denies that the abortion underground is signiﬁcant
and therefore gathers no data regarding the number of illegal abortions or medical
complications resulting from them.
Although women with sufﬁcient ﬁnancial means can circumvent abortion restrictions
rather easily by paying for clandestine services, low-income women have
a more difﬁcult task. Many low-income women I spoke to said they would “organize”
(zorganizowałabym) the money if the need arose. Similarly to Hania, who had
to borrow 400 of 1,400 złotych from two of her friends, women with fewer resources
borrow or make arrangements to pay doctors in payments. Some providers offer
a sliding fee scale. Furthermore, doctors in smaller cities charge less—Hania had
the option of taking the train to Katowice for a less expensive procedure. Recently,
the Federation for Women and Family Planning has been reporting a new wave
of newspaper advertisements for medical–pharmacological abortions presumably
offering RU-486 (fake pills have been reported); these services are less expensive
and can start from 400 złotych. Simultaneously, some international NGOs began
to offer RU-486 online for only 200 złotych and report selling primarily to Polish
women (Nowicka 2008a:25–27).15
In some cases however, an unwanted pregnancy
results in infant abandonment, which surged after the 1993 abortion ban
and continued to climb steadily since then, as well as in infanticide, which was the
highest recorded between 1991 and 1994 but has declined considerably in recent
years.16
Many women can also circumvent barriers to contraceptive access resulting from
the Conscience Clause by pursuing doctors willing to prescribe the pill, but a lowincome
woman faces larger barriers. She can become trapped in situations in which
her regional doctor, similar to Dr. G´orska, is unwilling to prescribe contraceptives,
but she cannot afford to pursue care privately with another provider. In such situations,
Catholic teachings narrow her contraceptive options to less reliable methods
of periodic abstinence, withdrawal, and condoms and consequently dictate the quality
of care she receives.
Conclusions
After the fall of state socialism in 1989, abortion was one of the ﬁrst issues raised
by the church and the Catholic–nationalist state in Poland. Nineteen years later,
the politics of reproduction continues to occupy a central place in Poland’s political
debates—in March 2007 the Catholic League of Polish Families party (a
coalition member) called for an amendment to the Constitution that would ban all
abortions. On April 13, 2007, the Polish Parliament rejected the amendment. In
September 2008, the Polish Federation for Women and Family Planning reported
that the minister of health, Ewa Kopacz, proposed a legislative action that would
The Politics of Reproductive Healthcare in Poland 177
register all pregnant women and monitor them to ensure that registered pregnancies
were brought to term. This move was explained as a way to curb the abortion
underground. In a response, Nowicka aptly argued that the pregnancy-monitoring
proposal harks back to “the times of Ceaus¸escu,” and that “under the pretext of
caring about women and their health, the Minister wants to tighten the system of
control over women, over their reproductive functions and decisions.”17
Although,
Romania’s locus of repressive power was situated at the level of the socialist state, in
Poland the socialist state actually restrained the authoritarian power of the church
on issues of reproduction. “Communism gave us a feeling that there was equality;
abortion was legal and so on” offered Kazia Szczuka, a feminist author and historian
(interview, Kazia Szczuka, 2002).
However, when the regime fell, the church began to impart its agenda through
state policies—acting de facto as a parastate—and to demonstrate clearly the ways
in which both the postsocialist state and religious forms of institutional power have
had a repressive effect on women’s rights, raising questions about the nature of
Polish democratization.
The politics of reproduction in Poland is signiﬁcant because it dramatically
impacts not only women’s experiences with health and body autonomy but also
women’s position in the society. Exploring this topic anthropologically informs our
understanding of the postsocialist transformations of institutional power and the
ways in which these dynamics give shape to Polish domestic and international reproductive
rights agendas. This study is revealing on two distinct levels: it exposes
the actual process through which speciﬁc church-inspired policies were written into
law, and it reveals the detrimental effects these policies have had on women’s access
to care and on the emergence of abortion underground. These ﬁndings suggest that,
for the Catholic Church as an institutional regime, the Conscience Clause was a
critical political tool to expand the conﬁnes of its centralized power by incorporating
subtle forms of regulation through which the ubiquity of power becomes less
visible as it is broadly dispersed via a wide range of processes and techniques of
control, rather than being directly wielded by the clergy (Foucault 1977, 1991).
The ﬁndings further demonstrate that the church regime as a political power
constellation was primarily legitimized by religious understanding of an absolute
morality and what can and cannot be subjected to a popular vote, as well as “propagated
by religious specialists,” namely doctors (Bax 1991:9). What emerges from
this study is instructive regarding the larger policy trends in East Europe, given that
the Vatican has recently been calling for incorporating the Conscience Clause into
medical laws in other nations of the region, especially Slovakia where abortion is
legal, thereby providing a way for some doctors to circumvent the liberal abortion
law currently in place.
Despite the sporadic international media coverage of Polish abortion struggle, the
prevailing view of postsocialist Poland in the eyes of the West is one of a “successful
democracy,” a view that conﬂates democracy with free market economics. In fact,
as of 2004 funding linked to Title VIII, Soviet–Eastern European Research and
Training Act of 1983—which sponsored studies aimed to “promote democracy” in
the post-Soviet region—was discontinued, except for the Balkan nations, suggesting
that nations to the north “achieved” democracy (Hamilton 2003:1). In reality, the
democratization process in Poland has been wrought with contradictions of an
178 Medical Anthropology Quarterly
emerging democracy, on the one hand, and a religious regime intolerant of individual
rights (esp. women’s rights) and political and religious pluralism, on the other hand.
This study challenges the metanarrative of a “successful democracy” by revealing
some of the repressive effects of the prevailing, but not always visible, mechanisms
of power.
This study also asks broader questions about the role of women’s rights in a
liberal state. The hallmark of Polish postsocialist politics has been the disregard for
women’s concerns, including the rejection of Solidarity Women’s Section’s protests
about restrictions on abortion in 1990, the rejection of the petition with 1.3 million
signatures calling for a referendum on abortion in 1993, the implementation of a
law that according to surveys was clearly in conﬂict with the will of the people, and
the denial of the existence of an abortion underground. In the words of journalist
Kinga Dunin, Poland is suffering from “the lack of political culture, the inability
to think in categories of a liberal state, in which if I think it’s bad and you think
it’s good then we need the kind of law that allows me to do what I want, and you
[to do] what you want. Therefore discussion about abortion shouldn’t be about
morality but about how to organize a state that represents people with a variety of
perspectives” (interview, Kinga Dunin, 2002).
Philosopher and a feminist scholar Nanette Funk proposes (2004) that it is the
lack of political individualism in Poland that translates into the lack of support
for women’s rights. Funk notes (2004:700) that even some of the most prominent
liberal thinkers in Poland “recognized collective goods and rights and emphasized
individual duties, obligations of sacriﬁce and responsibility to others, the nation,
family, God, and the state; these goods could override individual rights.” Thus,
she contends, the secondary status of individual rights ingrained in Polish political
culture prevents the legitimation of women’s rights in postsocialism.
Gila Stopler, a feminist and legal scholar whose scholarship is particularly relevant
to the case of Poland, suggests, however, that it is not the lack of political culture
or political individualism alone but the special status of the church that undermines
the liberal tenets of egalitarianism. Stopler argues that “the relationship between
patriarchal religion and the state in liberal democracies adversely affects the rights
of all women, and the liberal states cannot live up to their commitment to women’s
equality without signiﬁcantly changing their relations with patriarchal religions”
(2005:191). Stopler also asserts that a mere legalistic separation of church and
state, as in Ireland or the United States, for example, does not predict the degree of
political inﬂuence of religion. Instead, she proposes, “in the modern Western liberal
democracies it is religion’s access to politics that determines its access to power and
its ability to impose its agenda, not its institutional relationship with the state” (Stopler
2005:204). Therefore, the “liberal bind”—the conﬂict between certain religious
agendas and women’s rights—cannot be simply resolved by a legalistic separation
of church and state. As the case of Poland makes clear, the special status and recognition
afforded to the Catholic Church (resulting esp. from its historical role in the
resistance against the communist regime) is highly signiﬁcant for women’s rights,
because the church traditionally chooses to intervene in those policies that mainly
pertain to women, including reproductive rights and family policy. Consequently,
Stopler’s work suggests that to resolve the “liberal bind” the states must consider
The Politics of Reproductive Healthcare in Poland 179
disestablishing religion from state matters in every way, including symbolically and
ﬁnancially, or risk undermining the political legitimacy of democracy.
At present, the Polish state’s endorsement, rather than disestablishment, of religion
suggests a continued momentum of close church–state cooperation. The
state’s approval of the politics of morality speciﬁcally targeting women’s autonomy
“[makes] the basic citizen of democracy male” (Verdery 1996:13), and raises
concerns about the nature and future of Polish democratization.
Notes
Acknowledgments. This research was generously supported by the Fulbright Scholarship,
the American Council of Learned Societies–Dissertation Fellowship in East European Studies,
and the Thomas Edwin Devaney Dissertation Fellowship. The postdoctoral writing
phase was funded by the Charlotte Ellertson Postdoctoral Fellowship. I owe a major debt
to Donna Goldstein for many years of unﬂagging guidance and support. I also want to
thank Wendy Chavkin, Wanda Nowicka, Lonia Jakubowska, Ursula Lauper, Ewa Hauser,
and Ann Snitow for valuable feedback on the drafts of this article, and I extend my appreciation
to the three anonymous reviewers for their helpful suggestions and comments. I
am also grateful to the many women, doctors, and reproductive rights activists who shared
their experiences and perspectives with me.
1. Examples of Catholic priests in the Ministry of Health include Father Wojciech
Bołoz (The Bioethics Committee) (http://www.kb.mz.gov.pl/index.html, accessed
March 14, 2009); Father Stefan Gralak (The Council of the Healthcare Worker
in Warsaw—a nationwide organization of health professionals) (http://www.mz.gov.pl/
wwwmz/index?mr=m111111&ms=1&ml=pl&mi=7&mx=0&mt=&my=356&ma=02395,
accessed March 14, 2009); and Father Arkadiusz Nowak (the national section on AIDS
and drug use) (http://www.bip.aids.gov.pl/, accessed March 14, 2009).
2. Unlike in the West, where feminist movements struggled for women’s rights to
abortion, education, and employment, these rights were granted by the socialist state in
Poland and elsewhere in Eastern Europe.
3. Article 30 of the Medical Code of Ethics obliges physicians to provide care if a delay
could endanger the life or cause serious “derangement of health” of the patient Article 39,
Medical Law, 12/5/1996, # 28, #152 (Nesterowicz 2001:340).
4. See Balicki (2003).
5. See Balicki (2003).
6. See Pope John Paul II (1995).
7. Periodic abstinence (or natural family planning) might simply mean calculating
the infertile days based on the length of the previous menstrual cycle, but it might also
include basal body temperature measurement and the observation of the viscosity of vaginal
discharge.
8. The doctors I interviewed estimated that 25–35 percent of physicians routinely
use the clause to withhold services. It is difﬁcult to conﬁrm this estimate given that some
physicians oppose abortion but allow contraception, and some who prescribe contraceptives
conceal this practice for fear of harassment, whereas others claim that they allow
contraceptives in principle but in practice encourage women to refrain from either.
9. See Pope Paul VI (1968).
10. Despite the popular media depictions of Poland as a monolithic nation of devout
Catholics (the Catholic afﬁliation of Poles is indeed high at 89%), only 51 percent declare
themselves to be “regularly practicing Catholics.” This discrepancy suggests that individual
180 Medical Anthropology Quarterly
religiosity, as manifested in adherence to religious practices, varies widely (Centrum Badania
Opinii Społecznej 2005).
11. Unlike Foucault, however, I relate the analysis to the ways in which such methods
have a gender-speciﬁc target and effect, rather than viewing power as simply ubiquitous
and target blind.
12. This is an interesting point of difference as compared to the U.S. abortion underground
before Roe v. Wade: U.S. doctors were not trained in abortion per se in contrast
to Poland, where doctors drew on decades of experience performing legally sanctioned
procedures.
13. The FWFP estimates that 80,000–200,000 illegal abortions are performed annually,
although it is difﬁcult to conﬁrm these calculations. Abortion tourism to border
nations plays a smaller role, given that procedures are readily available in medical clinics
throughout Poland. Recently, medical abortion using RU-486 is beginning to be offered on
the Internet.
14. Abortions in the United States and most of Europe are performed under local
anesthesia using the vacuum method (medical abortions are only gradually becoming more
common). The doctors I interviewed in Poland explained they used general anesthesia and
dilation and curettage because physicians are most familiar with these traditional procedure
and they receive no training in the vacuum method since abortion became illegal. Some
doctors also mentioned that they believed that women expect to be put to sleep for the
procedure. A minority of doctors use the vacuum method.
15. It should be noted that because this research was situated in urban areas, it does
not include some of the poorest populations of women that reside in rural areas, which
constitute approximately 38 percent of Poland.
16. See Policja (Polish Police 2009).
17. See Nowicka 2008b.
References Cited
Balicki, M.
2003 The Letter of the Minister of Health Regarding the Responsibility to Observe
Women’s Rights. March, 7. Electronic document, http://www.balicki.pl/, accessed
October 15, 2006.
Bax, Mart
1991 Religious Regimes and State-Formation: Toward a Research Perspective. In Religious
Regimes and State Formation. E. R. Wolf, ed. Pp. 7–27. Albany: State University
of New York Press.
Centrum Badania Opinii Społecznej (CBOS) (Center for the Study of Social Opinion)
2005 “Values and Norms in the Lives of Poles.” Report, August 2. Electronic document,
http://www.cbos.pl/PL/Raporty/r2005.shtml, accessed 4/9/2007.
Domanski, Henryk
2002 Is the East European “Underclass” Feminized? Communist and Post-Communist
Studies 35(4):383–394.
Fodor, Eva
2002 Gender and the Experience of Poverty in Eastern Europe and Russia after 1989.
Communist and Post-Communist Studies 35(4):369–382.
Fodor, Eva, Christy Glass, Janette Kawachi, and Livia Popescu
2002 Family Policies and Gender in Hungary, Poland, and Romania. Communist and
Post-Communist Studies 35(4):475–490.
The Politics of Reproductive Healthcare in Poland 181
Foucault, Michel
1977 Discipline and Punish: Birth of the Prison. New York: Vintage.
1991 Governmentality. In The Foucault Effect. G. Burchell, C. Gordon, and P. Miller,
eds. Pp. 87–104. Chicago: University of Chicago Press.
Funk, Nanette
2004 Feminist Critiques of Liberalism: Can They Travel East? Signs 29(3):695–720.
Fuszara, Małgorzata
1991 Legal Regulation of Abortion in Poland. Signs: Journal of Women in Culture and
Society 17(1):117–128.
Gal, Susan, and Gail Kligman
2000 The Politics of Gender after Socialism. Princeton: Princeton University Press.
Gautier, Mary L.
1997 Church Attendance and Religious Belief in Postcommunist Societies. Journal for
the Scientiﬁc Study of Religion 36:289–296.
Hamilton, Lee H.
2003 Why Title VIII Is Important Today and in the Future. In State Department
INR Conference on Title VIII. Electronic document, http:www.wilsoncenter.org/
about/director/docs/Hamilton/_titleVIII.doc, accessed March 16, 2009.
Inglis, Tom
1991 The Struggle for Control of the Irish Body: State, Church, and Society in
Nineteenth-Century Ireland. In Religious Regimes and State-Formation. E. R. Wolf,
ed. Pp. 55–72. Albany: State University of New York Press.
Inhorn, Marcia C.
2006 Deﬁning Women’s Health: A Dozen Messages from More than 150 Ethnographies.
Medical Anthropology Quarterly 20(3):345–378.
Johannisson, E., L. Kov´acs, B. A. Resch, and N. P. Bruyniks, eds.
1996 Assessment of Research and Service Needs in Reproductive Health in Eastern
Europe: Concerns and Commitments. New York: Parthenon.
John Paul II, Pope
1995 To the Bishops, Priests and Deacons, Men and Women, Religious Lay
Faithful and All People of Good Will on the Value and Inviolability of Human
Life. In Encyclical Evangelium Vitae 13:10. March 25. Electronic document,
http://www.vatican.va/holy_father/john_paul_ii/encyclicals/documents/hf_jpii_enc_25031995_evangelium-vitae_en.html,
accessed March 19, 2009.
Kertzer, David I.
1991 Gender Ideology and Infant Abandonment in Nineteenth-Century Italy. Journal
of Interdisciplinary History 22(1):1–25.
1993 Sacriﬁced for Honor: Italian Infant Abandonment and the Politics of Reproductive
Control. Boston.
Kligman, Gail
1998 The Politics of Duplicity: Controlling Reproduction in Ceaus¸escu’s Romania.
Berkeley: University of California Press.
Kocourkova, Jirina
2002 Leave Arrangements and Childcare Services in Central Europe: Policies and Practices
before and after the Transition. Community, Work and Family 5(3):301–318.
Kolchevska, Natasha
2005 Gender and Slavic Studies: Overview and Goals for the Future. NewsNet—
American Association for the Advancement of Slavic Studies 45(5):1–4.
Krause, Elizabeth L.
2007 Memory and Meaning: Genealogy of a Fertile Protest. Journal of Modern Italian
Studies 12(4):406–416.
182 Medical Anthropology Quarterly
Long, Kristi S.
1996 We All Fought for Freedom: Women in Poland’s Solidarity Movement. Boulder,
CO: Westview.
Mazur, Peter
1981 Contraception and Abortion in Poland. Family Planning Perspectives 13(4):5.
Molyneux, Maxine
1995 Gendered Transitions in Eastern Europe. Feminist Studies 21:637–645.
Nagengast, Carole
1994 Violence, Terror, and the Crisis of the State. Annual Review of Anthropology
23:109–136.
Nesterowicz, Mirosław
2001 Medical Law. 5th edition. Torun: Dom Organizatora.
Niemiec, Niemiec, Tomasz K.
1997 Reproductive Health and Family Planning in Poland. In Assessment of Research
and Service Needs in Reproductive Health in Eastern Europe: Concerns and Commitments.
E. Johannisson, L. Kov´acs, B. A. Resch, and N. P. Bruyniks, eds. Pp:195–198.
New York: Parthenon, 1997.
Nowakowska, Urszula, and Maja Korzeniowska
2000 Women’s Reproductive Rights. In Polish Women in the 90s. U. Nowakowska, ed.
Pp. 219–248. Warsaw: Women’s Rights Center.
Nowicka, Wanda
1994 Two Steps Back: Poland’s New Abortion Law. Journal of Women’s History 5:151–
155.
2001 Struggles for and against Legal Abortion in Poland. In Advocating for Abortion
Access. B. Klugman and D. Budlender, eds. Pp. 223–250. Johannesburg: Women’s
Health Project.
2008a The Anti-Abortion Act in Poland—The Legal and Actual State. In Reproductive
Rights in Poland: The Effects of the Anti-Abortion Law in Poland, Report 2008. W.
Nowicka, ed. Pp. 17–44. Warsaw: Federation for Women and Family Planning.
2008b Platforma idzie tropem Giertycha: Wanda Nowicka komentuje ostatni pomysł
minister zdrowia. September 17. Electronic document, http://www.federa.org.pl/?
page=news&newsid=516&lang=1, accessed March 16, 2009.
Paul VI, Pope
1968 Encyclical Letter Humanae Vitae of the Supreme Pontiff Paul VI to His Venerable
Brothers the Patriarchs, Archbishops, Bishops and Other Local Ordinaries in Peace
and Communion with the Apostolic See, to the Clergy and Faithful of the Whole
Catholic Worls, and to All Men of Good Will, on the Regulation of Birth. Electronic
document, http://www.vatican.va/holy_father/paul_vi/encyclicals/documents/hf_pvi_enc_25071968_humanae-vitae_en.html,
accessed March 14, 2009.
Penn, Shana
2005 Solidarity’s Secret: The Women Who Defeated Communism in Poland. Ann Arbor:
University of Michigan Press.
Policja (Polish Police)
2009 Statystyka—Dzieciob´ojstwo i porzucenie. Electronic document, http://www.
policja.pl/portal/pol/4/308/, accessed on January 26, 2009.
Regulska, Joanna
1998 Transition to Local Democracy: Do Polish Women Have a Chance? In Women
in the Politics of Postcommunist Eastern Europe. M. Rueschemeyer, ed. Pp. 33–63.
New York: Sharpe.
Rich, Vera
1992 Poland: Medical Ethics Code. Lancet 339(8803):1221.
The Politics of Reproductive Healthcare in Poland 183
Sieminska, Renata
1994 Polish Women as the Object and Subject of Politics during and after the Communist
Party. In Women and Politics Worldwide. B. J. Nelson and N. Chowdhury, eds.
Pp. 608–624. New Haven, CT: Yale University Press.
Stopler, Gila
2005 The Liberal Bind: The Conﬂict between Women’s Rights and Patriarchal Religion
in the Liberal State. Social Theory and Practice 31(2):191–231.
Swatos, William
1994 Politics and Religion in Central and Eastern Europe. Westport, CT: Praeger.
Szawarski, Zbigniew
1992 Polish Doctors Vote to Stop Carrying out Abortions. British Medical Journal
304(6820):137.
Szlachetka, Małgorzata, and Agnieszka Pochrzest
2008 Agata z Matka Chca Aborcji. Szpital Odmawia. Gazeta Wyborcza. Electronic document,
http://wyborcza.pl/1,76842,5304048,Agata_z_matka_chca_aborcji__Szpital
_odmawia.html, accessed June 12, 2008.
Tarkowska, El˙zbieta
2002 Intra-Household Gender Inequality: Hidden Dimensions of Poverty among Polish
Women. Communist and Post-Communist Studies 35(4):411–432.
UNICEF
1999 Women in Transition. MONEE Project Regional Monitoring Report, 6. Florence:
UNICEF Child Development Center.
U.S. Census Bureau
1995 Population Division. Washington, DC: U.S. Department of Commerce Economics
and Statistics Administration.
Verdery, Katherine
1996 What Was Socialism, and What Comes Next? Princeton: Princeton University
Press.
Wolf, Eric R.
1991 Introduction. In Religious Regimes and State-Formation. E. R. Wolf. ed. Pp. 1–6.
Albany: State University of New York Press.
Yishai, Yael
1993 Public Ideas and Public Policy: Abortion Politics in Four Democracies. Comparative
Politics 25(2):207–228.
Zajicek, Anna, and Toni Calasanti
1995 Impact of Socioeconomic Restructuring on Polish Women. In Family, Women
and Employment in Central Eastern Europe. B. Lobodzinska, ed. Westport, CT:
Greenwood.
Zieli´nska, Eleonora
2000 Between Ideology, Politics, and Common Sense: The Discourse of Reproductive
Rights in Poland. In Reproducing Gender: Politics, Publics, and Everyday Life after
Socialism. S. Gal and G. Kligman, eds. Pp. 23–57. Princeton: Princeton University
Press.