POLAND

The Polish society experience deterioration of health, which best can be observed on mortality and morbidity indicators. It can certainly be attributed to the hardships of everyday life, loss of security, deterioration of healthcare services and lack of preventive measures. Many health services are lacking or of not good quality.

Reproductive health of women is in a poor shape in Poland. Women's morbidity and mortality of reproductive system is high and it is systematically growing. 1994 Report on Demographic Situation of Poland issued by the Government Population Commission anticipates that if the level of health care services does not improve with regard to diagnostics, therapy and prophylactics of cancer, deaths of women resulted from cancer may increase about 40% by the year 2010.

Family planning. While abortion remains illegal, family planning services do not receive adequate proportion of government health spending. Family planning services generally are not provided in public healthcare system. Insufficient number of non-governmental family planning associations is not able to meet all needs of the society in this respect. Women do not have adequate access to contraception due to lack of the state subsidies that would lower prices, insufficient knowledge of medical community and lack of any state programs that would educate women. Sterilisation as a method of family planning is illegal.

The subsidies for five contraceptives introduced in 1997 by the former Government have been withdrawn by new Government in March 1998. These financial reductions for reproductive health have serious impact on women’s family planning choices.

Violence against women Violence against women is one of the most painful problems in Poland, but still inadequately recognised and addressed. There is no systematic data on violence. There are neither preventive measures nor sufficient support mechanisms for victims of violence. Legal regulations such as orders of protection do not exist and the number of shelters and other supportive institutions is drastically inadequate.

The office formerly responsible for preventing gender-based discrimination - Government Plenipotentiary for the Family and Women’s Affairs launched the Government Program against Domestic Violence in 1997. The subsequent Government Plenipotentiary for the Family Affairs has suspended for the Program more than one year. The new programme launched recently by the Government focuses on children, youth, women and men. Twelve anti-violence centres initiated under this programme are aimed at supporting victims, observers and violators all together (information comes from the programme co-ordinator). This approach to violence against women dilutes the problem of gender-based violence and does not give much hope that the situation concerning violence against women will soon improve.

Laws specifically addressing sexual harassment do not exist in Poland although the problem has been recognised by women’s groups.

Legal restrictions to abortion

In 1993 significant changes concerning women’s reproductive rights were introduced in Poland. The Polish Parliament passed an anti-abortion law called the Act on family planning, human embryo protection and conditions of permissibility of abortion. Under the Act, abortions on social grounds were declared illegal. As a practical result, it meant that women in difficult life conditions, including financial situations, could not legally have abortions. The anti-abortion law was liberalised shortly in 1996 (enforced in 1997) to allow abortion until the 12^th week of pregnancy if “a woman is in hard life conditions or in difficult personal situation”. The law was restricted again in 1997 (enforced in 1998) by the 1997 Parliament in response to the Constitutional Tribunal’s decision holding that abortion on social grounds is unconstitutional. The Tribunal justified its decision on the ground that Poland is a democratic state of law, which it interpreted as implying the protection of life at every stage. Article 38 of the Polish Constitution includes the provision of legal protection of life to every human being. The Tribunal’s decision, its justification and its consequences were a real shock for women’s rights and health advocates as well as for many prominent lawyers.

Sterilisation as a method of family planning is illegal.

Equality mechanisms- Government Plenipotentiary for Family and Women - replaced by Government Plenipotentiary for Family

Parliament (1999) - rejected the Bill on Gender Equality and the establishment of the Parliamentary Commission on Equal Status

Substantial role of the Roman-Catholic Church

Strong traditional gender stereotypes imbedded in children education, social life and policies and the media

Limited access to reproductive health services, particularly to family planning counselling and services

Rural women – much more difficult access to health services than urban women

Additionally, the reform of health care system enacted in 1999 has limited accessibility to health care services

Healthcare system does not provide sufficient medical services that would enable women to prevent or detect at early stage typical health problems. There are no screening services and prevention services for female diseases such as: breast and cervical cancers. As a result, cancers, particularly breast cancer, often reach an advanced stage before being detected. Even a pap smear is not available to almost 15% of women. Mammography is not available to 53% of women in Poland. Women often complain about lack or deficiency of adequate medical services. Medical services are particularly inadequate in the countryside. Healthcare system is not addressing to sufficient degree health problems of girls as well as health problems of older women in post-reproductive age.

Patient rights – often not observed

Limited access to sex education and school and counselling on sexual and reproductive health and rights