Although abortion is legal in the Czech Republic, it is not accessible to everyone. Half of Czech hospitals would not provide the procedure to citizens of other EU Member States, according to a new survey. People living with disabilities or low incomes also face obstacles, says Rafał Szwajkowski of the A.S.A.P. (Abortion Support Alliance Prague) collective.
The Czech Republic is considered a country with a liberal approach to abortion and there is a general perception that abortion is available. You are trying to point out, though, that it is not necessarily accessible to everyone. Where do you see the biggest gaps?
RS: We see three biggest gaps here. The first is definitely accessibility for foreign nationals. People from outside the European Union who don’t have permanent residence in the EU have no access to abortion at all in Czechia – we’re talking about a normal medical procedure here, so to us this is a bit ridiculous. According to the Czech Health Ministry’s interpretation of the abortion law (there are other interpretations of this law as well) and to its interpretation of EU law, people from other Member States should be able to have an abortion here, but according to our research only about 50% of hospitals would provide such a procedure to an EU resident.
The second issue is the cost of an abortion - there is no law that regulates this issue, so each hospital can set the pricing for reasons known only to themselves. So we have a situation where the price for an abortion in a public hospital can reach, depending on the region, up to 1/5 or 1/4 of the minimum wage. In such a situation, in our opinion, we cannot say abortion is available to all citizens, as there may be cases where a person will not be able to afford it. There are also no support organizations offering help in such situations, and abortion up to the 12th week is not covered by health insurance.
The third important thing is the availability of abortion pills, which are a leading method of pregnancy termination worldwide, especially in developing countries, and also in countries where abortion is illegal - such as Poland. There are organizations, such as Women Help Women, where you can order a package of such pills and safely perform an abortion on your own at home. This is a method labeled as safe that has been tested up to 12 weeks of pregnancy and is recommended by the World Health Organization. Despite those recommendations and their widespread use worldwide, here pills are usually available just up to the seventh or eighth week of pregnancy. You can only get them in hospitals, where you have to appear twice and take the drugs each time in the presence of a doctor - then you are allowed to go home. During our years of work, we have repeatedly encountered doctors’ ignorance about performing abortion with such pills and often even their discouragement of this method. Last but not least, this method often costs as much as surgical abortion, even though it is not as expensive to perform.
For which groups in society is abortion difficult to access? What specific barriers did you uncover in your research?
RS: Here we see three main groups which are affected. The first is foreign nationals, including migrants, due to the unclear abortion law which excludes them. The second is low-income people, and the third is people living with disabilities. For the latter, making the simplest appointment can often be an obstacle, such as when the hospital only offers phone calls as a contact method, which will be an issue for the hearing impaired. Often such people, due to their exclusion from the job market, may also struggle financially. There is also the issue of properly training medical staff and adapting facilities to accommodate people living with different types of disabilities who seek this service.
What role do individual healthcare providers play in facilitating or hindering access to abortion services?
RS: In the case of private clinics, price plays a big role, such facilities charge much more* for their services than public hospitals. Also, we often encounter false information about abortion pills on the websites of private clinics, warning or openly advising against using them. In our eyes, this is obviously related to profit, as surgical abortion is more lucrative for the clinic.
However, we also see the positives here - with private facilities, access to abortion is certainly being increased, even if it may not be affordable for everyone. Private clinics are also much more willing to accept foreign nationals, especially in the Ostrava area, where many Polish citizens seek help. It is also often easier and quicker to get an appointment at a private facility, as time also plays a big role in the case of abortion.
*Around 12,000 CZK [475 EUR] for a surgical abortion up to 12 weeks of pregnancy, in comparison to around 4,700 CZK [185 EUR] in a public hospital
What should the Czech Government or other stakeholders do to make abortion truly accessible to everybody?
RS: We see a lot of opportunities for improvement here, but we will mention four main points.
1. The law should change. It dates back to 1986. It discriminates against non-EU citizens, de facto preventing access to abortion for them and making it very hard for foreign nationals even if they come from the EU. If it is not possible to change the law, then a protocol on abortion for foreign nationals should be created that would clearly describe when abortion is and is not possible for them here.
2. Abortion should be covered by health insurance for those who cannot afford it. If not, then there should be a law that regulates its price to prevent disproportionate price hikes.
3. Access to information about abortion should improve. The information on abortion available on the Health Ministry’s website lacks detail and does not address the situation comprehensively. We believe this should be improved. It does not seem like that’s going to happen anytime soon, which is why our website on accessible abortion is already in the making.
4. Extend the approved time limit for performing abortion with pills beyond eight weeks of pregnancy. Ideally, it would be best to follow the recommendations of the World Health Organization and allow abortion through medication until the 12th week of pregnancy.
When you look at the current political situation in Czechia, do you see any window of opportunity to move this issue forward?
RS: Unfortunately, no. We have heard from Government representatives and from the Czech Medical Association that there is no need to change the abortion law in the Czech Republic. They claim that the law is aligned with public opinion and that any attempt to change it, or even to open a public debate on the subject, could have the opposite of the desired effect.
In Europe, as well as globally, we are observing the attempts of the growing “anti-gender” movement to restrict women’s and LGBTQ+ rights. Where does Czechia stand in this respect?
RS: The “anti-gender” movement exists in Czechia and is doing well. Here I would mention organizations such as Hnutí pro život [Movement for the Family] or Aliance pro rodinu [Alliance for the Family], which are linked to similar organizations throughout Europe (on this subject, we recommend the excellent series of articles, “Mezi Bohem a ultrapravici” [Between God and the Ultra-Right] authored by Eliška Koldová and Magdalena Dušková in the Alarm journal). Those orgs even have lobbyists in the Czech Government and have considerable financial resources (see, for example: the “Nesoudíme, pomáháme” [We Don’t Judge, We Come To Your Aid] campaign). While the situation in Czechia so far is not so alarming, we do observe the activities of these organizations, and we know they are working hard to achieve their goals.
Also worth mentioning here is the Istanbul Convention and the resistance that its ratification has caused among Czech politicians. We think this speaks for itself in terms of the state of Czech politics and its approach toward women.
What are the biggest risks? What do we as a society need to watch out for?
RS: We certainly need to remember that no rights are ever given to us forever and that every freedom can be taken away from us at some point, even the right to have an abortion. It’s enough to look at what has happened in Poland, in the USA, or the attempt to restrict abortion in Slovakia, which has been underway for several years.
What’s alarming to us already now is the media hype that was created this year around the counter-demonstration to the “Pochod pro život” [March for Life] that took place in April 2024 in Prague. Counter-demonstrators blocked the Bridge of the Legions, which was part of the March for Life’s route, and the public then metaphorically lynched the counter-demonstrations for that online. Even the official social media accounts of the firefighters and the police in Prague joined in the vilification.
We think we need to pay attention to all manifestations of radicalism in public spaces and to support the initiatives that oppose them – the protests, the venues, the organizations. We also need to responsibly cast our votes in elections and always check whether our candidate supports the issues which are important to us.
The report “Reproductive justice and access to abortion in the Czech Republic” will be published in November.
A.S.A.P. (Abortion Support Alliance Prague) is a group of activists living in Czechia researching access to abortion in this country. They are also engaged in educational and awareness-raising activities and are in the process of creating the first website on accessible abortions in Czechia.
