A doctor’s written notice authorising an abortion procedure is required to obtain an abortion in Poland, where strict abortion laws only allow abortion in cases of a threat to a woman’s life or health, severe and permanent handicaps of the fetus, and rape or incest. The Catholic Church was influential in a 1993 compromise that led to Poland’s current abortion laws.

Poland, a country of 38 million where the Catholic Church retains considerable clout, has one of the most restrictive abortion laws in the 27-nation European Union.

Official statistics show only several hundred abortions are performed every year, but pro-choice campaigners say underground abortions are very common, Reuters reports.

‘We estimate… that on average 150,000 abortions are performed per year,’ Wanda Nowicka, head of the Polish Federation for Women and Family Planning, told the meeting. ‘Of this number, some 10-15 percent of abortions are performed abroad and this number is definitely growing.’

The doctors said women sought abortions abroad because they were illegal at home and often performed in poor conditions, and they fear social ostracism. An illegal abortion in Poland costs 2,000-4,000 zlotys ($640-$1,270), compared to 400-600 euros ($510-$760) in Germany, 280 euros in the Netherlands and 450-2,000 pounds ($700-$3,120) in Britain, they said.

The website of the Polish Federation for Women and Family Planning notes that most women go to Poland’s East and South neighbouring countries, for example Lvov (Ukraine), Druskienniki (Lithuania), Kaliningrad (Russia), Minsk (Bielorus), the Czech Republic and Slovakia. Fewer women can afford to seek abortion in Western countries, but those that do most frequently go to Holland, Germany, Belgium and Austria.

The British media has previously reported ‘abortion tourism’ from Poland in scandalised terms, claiming that women are frequently travelling to the UK to get abortions free on the National Health Service.

Ann Furedi, chief executive of BPAS, said:

‘In 2009 just 20 Polish women were included in the official statistics for the number of women from overseas who had abortions in Britain. However, this does not include the many Polish women who are able to claim free NHS care because they are registered to work or studying, are resident in Britain. Arrangements now exist for reciprocal health care between European countries.

‘Privately paid for abortions in Britain are relatively expensive; but Polish women are smart and who can blame them if they travel to get the care they need. No one knows exactly how many Polish women have abortions in Britain - it may be thousands. At BPAS we treat, without prejudice, anyone who wants our care and is lawfully able to receive it.’

Poland lost a case in the European Court of Human Rights in 2007 to Alicja Tysiac, who nearly went blind after giving birth to a third child following failed attempts to find a doctor who would perform a legal abortion for her.

More Polish women seen seeking abortions abroad. Reuters, 26 August 2010

Polish Parliament Hearing Held Regarding Women Traveling for Abortions. Ms magazine, 27 August 2010

Poland: ‘Abortion tourism’ ad causes reaction in UK. Abortion Review, 17 March 2010

Health ministers said they would look at what more could be done to increase young people’s awareness of risks.

The 482,696 new cases represent a 3% rise from the 2008 figures, continuing a ‘steady upward trend’ that the HPA said had been seen over the past decade.

Urban and deprived areas have the highest rates of STIs. Hotspots include Hackney and Lambeth in London, as well as Nottingham, Manchester and Blackpool.

The rise is in part due to more testing, and the use of tests which are more sensitive at picking up signs of an infection - but experts believe unsafe sexual behaviour is also part of the story, BBC News Online reports.

Dr Gwenda Hughes, an STI expert at the HPA, said:

‘These figures highlight the vulnerability of young women. Many studies have shown that young adults are more likely to have unsafe sex. Often they lack the skills and confidence to negotiate safer sex. Re-infection is also a worrying issue. Teenagers are repeatedly putting their own and others’ long-term health at risk.’

There were 217,570 diagnoses of chlamydia in 2009 - a 7% increase on the previous year. Cases of genital herpes went up by 5% to 30,126.

And diagnoses of gonorrhoea have gone up by 6% from 16,451 cases in 2008 to 17,385 last year.

The HPA says the bacteria which cause gonorrhoea are becoming more resistant to the most commonly used antibiotics.

Professor Cathy Ison, from the agency’s Centre for Infections, said:

‘We could see gonorrhoea becoming a very difficult infection to treat within the next five years. The infecting bacteria are very versatile. We’re trying to encourage companies to develop effective new antibiotics.’

Sexual health charities described the figures as ‘alarming’ and joined the HPA in urging people to use condoms, and to have a health check if they have had unsafe sex.

Health Minister Paul Burstow said:

‘Left untreated, STIs can lead to infertility. We’re going to look at what more can be done to increase young people’s awareness of risks, to prevent infection and to access screening and treatment.’

Sexually transmitted infections near 0.5m a year in UK. BBC News Online, 25 August 2010

Sexually transmitted infections reach almost half a million: Young women most at risk. Health Protection Agency, 25 August 2010

Overall, the number of teenage conceptions in Wales has fallen, with the figures for the first half of 2009, the most recent available, 8.65% lower than the year before.

An Assembly Government spokeswoman said:

‘We are continuing to work towards decreasing rates of conception for women under 18 in Wales as many of these pregnancies are unplanned. An abortion is an extremely difficult decision for women, whatever their age. It is the role of the Assembly Government and the NHS in Wales to ensure appropriate access to help, information and support to women considering this option and safe care and treatment if required.’

The Assembly Government is soon to publish its Sexual Health and Wellbeing Action Plan for Wales 2010-2015, which will set out how it intends to improve sexual health in Wales, the Western Mail reports.

A key component of the document is the need for an integrated response to tackle teenage pregnancies that will focus on those most vulnerable and address the wider issues such as the reduction of child poverty, raising the standard of education and the provision of good quality youth services. This will follow work under way in schools and be supported by school nurses in secondary schools.

A spokeswoman for abortion advice charity BPAS said teenagers were now more likely to be aware of how to access abortions than in the past, with most now carried out on the NHS.

Teenagers and those in their twenties are far more likely to choose to have abortions than older women – 11.4% of pregnancies among 30 to 34-year-olds end in abortion. Overall, 20.5% of pregnancies in Wales end in a termination.

The rate of teenage conceptions varies between local authority areas, with some seeing large increases while others see continued falls.

In Rhondda Cynon Taf the number of teenage pregnancies has dropped by a third year on year to the lowest in 12 years. But the Vale of Glamorgan saw a year-on-year increase of 61.9% to its highest numbers since June 2002.

Most teen pregnancies end with abortions. By Claire Miller, Western Mail, 25 August 2010

They found more searches in states and countries with more restrictive policies or less access to abortion and lower abortion rates.

‘In places where abortion access is readily available, people can go to their mainstream health care providers,’ Reis suggested. In areas with more abortion searches, he said, ‘people may be going on the Internet to find alternate routes.’

He said the pattern was found in every state and country studied, the Boston Herald reports.

‘We were actually very surprised. There is a very consistant, strong relationship,’ Reis said.

The study was published in the medical journal BMC Public Health.

‘Abortion’ Googled more in conservative areas. Boston Herald, 25 August 2010

Measuring the impact of health policies using Internet search patterns: the case of abortion. Ben Y Reis and John S Brownstein. BMC Public Health 2010, 10:514doi:10.1186/1471-2458-10-514

Many fertility clinics have long waiting lists, driving some childless couples abroad.

A spokesperson for the Human Fertilisation and Embryology Authority (HFEA) told the BBC: ‘We will be looking at a number of issues related to donation policies, one of which will be compensation given to donors. We haven’t decided on a figure.’

The HFEA is holding a three-month public consultation into its donation policies, starting in January 2011. No decision will be made until the end of the consultation.

It follows concern over the number of Britons travelling to countries such as Spain to receive IVF because of shortages of donated eggs and sperm in the UK.

In the UK, egg and sperm donors cannot be paid but can claim ‘reasonable expenses’ for travel and loss of earnings. This is limited to a maximum of £250 per cycle of egg donation or course of sperm donation. Some fertility experts say this is too low to attract donors, and they should be paid more for their time and efforts.

Susan Seenan of the support group Infertility Network UK said it was right to look at all the policies surrounding egg and sperm donation.

She said: ‘We know that many patients are travelling abroad for treatment, often because of the severe lack of sperm and egg donors in the UK. Although many patients do receive a high standard care abroad, this is not ideal and the rules and regulations in other countries can be totally different from that in the UK.’

Seenan said patients deserved access to safe, regulated treatment in their own country, and there was a need to find some way of increasing the number of both sperm and egg donors in the UK.

At a debate organised by Progress Educational Trust and the Royal Society of Medicine in 2009, experts suggested that one of the key reasons for the shortage of donor gametes in the UK was the removal of donor anonymity in 2005. 

Egg donor expenses ‘under review’. BBC News Online, 23 August 2010

Banking Crisis: What should be done about the sperm donor shortage? Abortion Review, 1 July 2009

This news digest is sent by email to those who have signed up to the Abortion Review Online mailing list. To join the mailing list for free, see here.

A quarterly news digest is provided in the print edition of Abortion Review. You can download the print edition for free here.

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- 1. UK: JUDGE CONDEMNS FORCED CONTRACEPTION PLAN

A council’s plan to force contraception upon a woman with a low IQ was ‘essentially a horrendous prospect’ that has ‘shades of social engineering’, a judge has said.

Mr Justice Bodey said he could not see how it could be acceptable for the court to impose contraception ‘by way of physical coercion’. He said the local authority’s plan, to stop the 29-year-old woman having more children, ‘would raise profound questions about State intervention in private and family life’.

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- 2. MOTHERHOOD, ABORTION AND PARENTING CULTURE

At a recent conference, supported by BPAS, academics from the UK and USA discussed new challenges to women’s autonomy:

-- Abortion and reproductive decision-making in a culture of ‘intensive parenting’;
-- Assisted conception and the limits of choice;
-- The pregnant woman’s autonomy in an era of increasing lifestyle surveillance and sensitivity to fetal harm;
-- Changing ideas about motherhood and fatherhood.

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- 3. UK: GPs TO GAIN COMMISSIONING POWERS

GP practices are set to be handed responsibility for most health services under ministerial plans for a radical shake-up of the National Health Service in England.

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- 4. USA: ‘ELLA’ EMERGENCY CONTRACEPTIVE PILL WINS FDA APPROVAL

A next-generation emergency contraceptive pill that can prevent unwanted pregnancy up to five days after unprotected sex has gained final approval from the Food and Drug Administration.

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- 5. UK: MAJOR PHARMACY PLANS TO SELL EMERGENCY CONTRACEPTION ONLINE

Boots has launched a website enabling customers to purchase certain treatments online without the need of a prescription.

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- 6. USA: IMMEDIATE POSTABORTAL INSERTION OF INTRAUTERINE DEVICES

In this study, from the Cochrane Database of Systematic Reviews, the authors concluded that insertion of an IUD immediately after abortion is safe and practical. IUD expulsion rates appear higher than after interval insertions. However, IUD use is higher at six months with immediate than with interval insertion.

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- 7. UK: GOVERNMENT CONSULTATION ON FAMILY PLANNING IN THE DEVELOPING WORLD

The UK Government is to ‘put family planning at the heart of its approach to women’s health in the developing world’ in an attempt to reduce the persistently high number of women who die in pregnancy and childbirth, the Secretary of State for International Development has announced.

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- 8. ‘CHOOSING TOMORROW’S CHILDREN’

John Gillott reviews Stephen Wilkinson’s new book on the ethics of selective reproduction. 

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- 9. ‘ALWAYS GLAD TO RECEIVE IT’: RESULTS OF THE ABORTION REVIEW READERS’ SURVEY

Many thanks to those of you who took part in our 2010 survey. We received dozens of responses from readers around the world.

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ABORTION REVIEW UPDATES

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For news updates from the UK, see here.

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For news updates from around the world, see here.

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For updates from the medical press, see here.

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He said the local authority’s plan, to stop the 29-year-old woman having more children, ‘would raise profound questions about State intervention in private and family life’.

The judge’s decision was published by the Court of Protection, which has jurisdiction over the property, financial affairs and personal welfare of people who lack the mental capacity to make decisions for themselves, last month.

The council, which also cannot be named, originally wanted to force contraception on a married woman who has an IQ of 53. Fears that she would not be able to look after her children have already led to social services putting the two children she already has up for adoption, the court heard.

But her husband, a man with an IQ of 65, was accused of using ‘violent and bullying behaviour’ to stop her taking contraception because he wanted a baby, so the council began court proceedings to ‘protect her interests’.

Mrs A’s social worker said the pair would not co-operate with anything involving coercion and admitted ‘there would need to be police involvement’ for her to be ‘physically removed from the family home and taken to have contraception under restraint and anaesthesia’.

The judge said:

‘It is obvious, on the facts of this case, that any step towards long-term court-imposed contraception by way of physical coercion, with its affinity to enforced sterilisation and shades of social engineering, would raise profound questions about State intervention in private and family life. Whilst the issue of the use of force has not been argued out at this hearing I cannot, on these facts, presently see how it could be acceptable.’

Forced contraception plan condemned. PA, 20 August 2010

Mother speaks out against council over forced contraception bid on daughter. Daily Telegraph, 20 August 2010

Mental disability, state power and the capacity to decide, by Wayne Martin. Guardian, 20 August 2010

In fact the study, published in the Journal of Public Health, found no association between heavy drinking and using emergency contraception or accessing abortion. In their paper, the authors write:

‘The drinking behaviours we measured increased between 1990/91 and 2000/01 in the British population, with the proportion of heavy drinkers tripling over this time. Both surveys observed greater numbers of partners and some sexual risk behaviours among those drinking in excess of the recommended limits.

‘As the magnitude of these relationships has remained the constant, this suggests that the interrelated public health issues of sexual risk-taking and heavy drinking increased in scale during the 1990s. For example, we found that those who usually drank in excess of recommended limits at the time of the interview were more likely to report unprotected sex with multiple partners and poor contraceptive choices.

‘Female heavy drinkers were more likely to report using emergency contraception in the year prior to interview, although not after adjusting for partner numbers and sociodemographics, and no association was observed with reporting an abortion in the previous 5 years. However, non-use of reliable contraception at first intercourse was reported more often by respondents who gave being drunk as their main reason for sex.’

Ann Furedi, chief executive of BPAS, said:

‘Women can have unintended pregnancies for a number of reasons, which is why it is important that emergency contraception and abortion are available to those who need it. If women are less likely to use contraception when they are drunk, surely it is good news that they are able to access the morning after pill when they sober up?’

Legacy of the ladette: Now alarming rise in teenage promiscuity and abortions is linked to women’s binge drinking, by Sophie Borland. Daily Mail, 21 August 2010

Alcohol misuse, sexual risk behaviour and adverse sexual health outcomes: evidence from Britain’s national probability sexual behaviour surveys. Aicken CR, Nardone A, Mercer CH. Journal of Public Health (Oxf). 2010 Aug 12.

‘At the center of the battle was the school’s mandate that all students must be covered by some form of medical insurance - a rule that occurs at most public and private universities.  Should the student not have insurance, either their own personal policy of coverage via their parents’ policies, they would be required to purchase insurance through the school at a cost of about $350 or $375 per semester, or $700 to $750 a year.

‘Most people would be excited to have such affordable insurance with the skyrocketing costs of healthcare.  Students, especially, rely on preventive healthcare to keep serious illness at bay, when complications could not only cost them lost time in the classroom but also lost money on tuition.

‘But the anti-choice students on campus discovered that among the many benefits being provided in their affordable plans was one they simply could not accept - coverage for elective abortions...’

Read the full article here:

Student Insurance and Abortion: A Battle at University of North Carolina, by Robin Marty. RH Reality Check, 18 August 2010

Watson Pharmaceuticals, Inc., of Morristown, N.J., will begin preparations to commercialise the novel type of emergency contraception pill from French pharmaceutical company HRA Pharma of Paris in the fourth quarter this year, under an exclusive distribution agreement, according to US tabloid reports.

Developed in government laboratories, Ella will be dispensed as a single dose and women will need a prescription but could keep a supply at home. The pill prevents pregnancy from occurring when taken within 120 hours (5 days) of unprotected intercourse or contraceptive failure.

Approved last year in Europe, Ella is now available in at least 22 countries under the brand name ellaOne. Formulated as a 30-mg tablet, the pill is a progesterone agonist/antagonist that inhibits or delays ovulation.

In June 2010, Ella was unanimously endorsed by the Reproductive Health Drugs Advisory Committee of the FDA, agreeing that the drug was safe and found no evidence it was capable of terminating an existing pregnancy. Ella was proved effective and safe in two phase 3 clinical trials.

On 13 August, the FDA granted approval for the marketing of the pill in the United States, where it will compete with Teva Pharmaceutical Industries Ltd.’s Plan B, the morning-after pill now available over the counter to women 17 and older. The Plan B pill is only effective in the first 72 hours, while Ella can be taken within 120 hours, or five days, of unprotected intercourse or failure of some other contraceptive method.

The FDA said that women who are pregnant, or suspect that they are pregnant, and those who are breastfeeding should not use this product.

‘As a pioneer and a leader in the field of emergency contraception, HRA Pharma is committed to providing women and their health care providers highly effective contraceptive options,’ said Erin Gainer, CEO of HRA Pharma. ‘Ella, an effective and well-tolerated new generation emergency contraceptive, fulfills a significant and previously unmet need in this field by reducing pregnancy risk up to five days after intercourse.’

5-day-after Ella contraceptive pill wins FDA approval. The Money Times, 14 August 2010

Also read:

Is Ella Birth Control or Abortion? By Sarah Elizabeth Richards. Slate, 17 August 2010

Ulipristal acetate versus levonorgestrel for emergency contraception. Abortion Review, 29 January 2010