Article was updated on: 27/06/2022
On June 3, 2022, the Minister of Health, Adam Niedzielski, signed a regulation that provides for the expansion of the catalog of data collected by medical personnel so that the system displays information about the pregnancy of a person using a medical service, even if this service is NOT a visit to a gynecologist. Mandatory reporting will come into effect on October 1.
The regulation raises many doubts – mainly because the Ministry of Health did not rule out the possibility of sharing data with prosecutors and courts: "(...) only selected medical personnel will have access to information in the system, and the rights of courts or prosecutors to information contained in the SIM cannot be used arbitrarily, but only in accordance with applicable legal provisions, as part of ongoing proceedings". In turn, Wojciech Andrusiewicz, spokesman for the Ministry of Health, put the matter as follows: "The catalog of data collected by medical personnel has been expanded to include allergies, foreign bodies, blood type and the fact of being pregnant. We do not create any registers (...). Only medical professionals will have access to the data" (in an interview for PAP, 03.06.2022). He also emphasized that this is the result of recommendations developed by a team appointed by the European Commission: "The Patient Summary (Patient Card – editor's note) is to be in force in the European Union from next year. Its implementation is obligatory for all EU countries".
So it's nothing to worry about?
The main fear that comes up in every discussion about the registry is that it will be used against women who may want to terminate their pregnancy, including legally outside the country.
The regulation itself would perhaps not be suspicious or disturbing if it were not for – firstly – the politicisation of the prosecutor's office and – secondly – the discrepancy in the ministry when it comes to access to data. "Although the ministry's justification is the desire to facilitate the work of doctors, in today's Poland every change concerning reproductive health, especially related to the collection of sensitive data, is met with suspicions of bad intentions. And it is no wonder" – these are the words of Krystyna Kacpura, president of the board of the Foundation for Women and Family Planning FEDERA.
The Left demanded that the provision on the "pregnancy register" be introduced by law, which would also include appropriate safeguards. As stated by MP Agnieszka Dziemianowicz-Bąk, many women already have doubts whether they can safely get pregnant, since the state forces them to give birth even when the pregnancy is fatal. The MP also points out that it is not the competence of the European Union to organize health care in the member states.
Joanna Mucha (Poland 2050) commented on the matter as follows: "This regulation is not bad in itself, and if it were introduced by authorities we trust , there would be no uproar. (...) Unfortunately, those in power have accustomed us to a lack of trust in their actions. Moreover, the very existence of the register is probably intended to have a chilling effect. And it will have the opposite effect - Polish women will not go to the doctor."
Meanwhile, the Patient Summary, i.e. the record of information about each and every one of us in the Medical Information System, cannot be introduced by the European Union otherwise than on the basis of recommendations and description of standards. It is also worth adding that among these recommendations there is also the right for each person to express an objection and demand that documentation about them not be kept.
Does this violate human rights?
According to some constitutionalists, registering a pregnancy in the event of using a service unrelated to pregnancy is a restriction of human rights that can only be regulated by law, not a regulation .
What hasn't changed?
The fact that a pregnant person cannot be punished for terminating their own pregnancy has not changed , and at the moment there are no signs of changes in this regard. The girls from the Abortion Dream Team remind us that regardless of the method of terminating a pregnancy, a woman cannot be held responsible for it. She is also not obliged to provide explanations in this matter. This is important because there are cases where medical personnel pressure women or feel obliged to notify state authorities. However, these actions have no legal basis, because the personnel are not obliged to notify the police or prosecutor's office. According to the provisions of the Penal Code, only people who terminate a woman's pregnancy with her consent must expect criminal liability (prison sentence of up to 3 years).
"(...) It is easy to imagine a situation in which a doctor during a visit, seeing a patient who is no longer pregnant, but according to the digital register was, for example, 3 weeks ago, will start asking questions about what happened to the pregnancy? However, one thing is certain - regardless of the answer, the doctor or anyone else cannot take any legal action against such a woman," the FEDERA Foundation emphasized.
And that is indeed comforting, but it is not only about the specter of being held criminally liable. If the pregnancy ends in failure, the patient will be forced to confess to a dentist, dermatologist or other doctor about the miscarriage, which is a traumatic experience for many and should always be a matter only for the parents and the doctor treating him.
So: how to live?
"In the matter of the so-called pregnancy registry, it is worth remaining calm, without giving up vigilance. The mere awareness that maintaining such a registry cannot lead to searching for a missing pregnancy or any legal consequences for the woman can be a protection if an uncomfortable question is suddenly asked in a gynecologist's office," the federation concluded.
End of update.
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To present the situation honestly, it would be necessary to start from the beginning. And it began with a motion authored by MP Bartłomiej Wróblewski (PiS), in which MPs asked about the constitutionality of abortion performed due to severe damage or disease of the fetus.
On 22 October 2020, the Constitutional Tribunal ruled that the provision of the 1993 Anti-Abortion Act permitting abortion in the event of severe and irreversible impairment of the fetus or an incurable disease that threatens its life is inconsistent with the Constitution.
Polish women felt the noose tightening around their necks, a wave of protests began. The last "loud" protest was a silent march for 30-year-old Iza from Pszczyna, who died of sepsis. The fetus in the woman's belly had no chance of survival, but doctors decided to wait for it to die, probably so as not to be accused of abortion. Organizations fighting for women's rights have no doubt that the doctors' decision was influenced by the tightening of abortion law.
Pregnancy registration – what kind of idea is that?
The Ministry of Health has issued a draft amendment to the regulation on data transferred to the Medical Information System. Until June 30, 2022, this data is to be transferred voluntarily, but then it will be mandatory. The change is to apply to all medical facilities, including non-public ones. The data to be reported includes allergies, implants, dates of hospitalization, blood type and pregnancy . It is around this last sub-item that the storm has broken out.
The idea was revealed by the Civic Coalition senator, Krzysztof Brejza, who decided to intervene as a senator. He asked the Ministry of Health what the mandatory registration of pregnancies is for, and who is the initiator of this idea.
If the aim of the project is – as Senator Brejza suggested – to facilitate the implementation of the Constitutional Tribunal's judgment on abortion, then the question naturally arises as to how realistic it is to introduce penalties for abortion performed outside the country. This raises the issue of access to the register, to which – according to information provided by the Ministry of Health – the prosecutor's office will not have direct access. The issue of expanding the catalogue of data by regulation, contrary to the Constitution and GDPR, is also worrying.
According to the Ministry of Health, the project (currently submitted for consultation) is intended to facilitate the work of medical personnel and improve the flow of medical documentation. Obtaining information about pregnancy is supposedly related to prescribing medications: "in the future, it will allow for avoiding the prescription of medications that are not recommended during pregnancy and in the event of providing life-saving services in the event of the inability to obtain information from the patient" - we can read in the statement of the Ministry of Health. "In addition, the use of information about pregnancy is necessary to verify additional entitlements, such as the entitlement of pregnant women to receive free medications or the right to access services out of turn," explains the Ministry.
Does it sound reasonable? Yes. And if it weren't for the circumstances, probably no one would pay attention to the requirement to report pregnancy. But considering the current tightening of abortion law and subsequent projects to tighten abortion (including punishing people involved in terminating pregnancy), it all looks suspicious and disturbing, to say the least.
Will our data be safe?
When we talk about pregnancy registration, I imagine women being prosecuted, summoned for questioning and medical checks of the contents of their uteruses. How likely is this vision?
The Ministry of Health provides a list of people on its website who may have access to information from the Medical Information System. The following are listed: medical staff who entered the data, a primary care physician, nurse and obstetrician who were selected by a given patient, and any medical staff in the event of saving the patient's life.
"The services, including the police, can already have access to some of this data," explains Marcin Kędzierski, an expert in new technologies and IT, former director of the Healthcare Information Systems Center. "However, this is not unconditional and unfounded access. It must be supported by a request and carried out in a specific case. In this respect, nothing changes (...)". It should also be remembered that access to the patient's data requires his individual consent - only the medical staff mentioned above do not need it.
What are they saying around town?
We have a simple transition from paper to digital files
– said Health Minister Adam Niedzielski when asked about the planned pregnancy registry.
Meanwhile, the opposition: "The state will gain a tool to track every pregnancy and possibly find out what happened to it," said KO senator Krzysztof Brejza.
In turn, Gabriela Morawska-Stanecka, deputy speaker of the Senate from the Left, commented on the planned amendment as follows: "They are going further, they want to eliminate the abortion underground, eliminate the possibility of abortion, even abroad, through such a register. A doctor who confirms the pregnancy will have to register it and the woman will be under surveillance."
MP of the Civic Coalition, Kamila Gasiuk-Pihowicz: "One may wonder whether it will be a pregnancy register or rather a register of information for the prosecutor's office (...)".
Lawyers also refer to the words about the prosecution of women by the prosecutor's office. They point out that the prosecutor's office does not automatically have access to the SIM card. It can obtain it after initiating proceedings in a case or against it. And this can happen as a result of, for example, a tip that a given person was pregnant but did not have a child, even though more than 9 months have passed.
Yes, yes. This is the reality we are talking about. The obligation to have a good reputation "in the neighborhood" so that a neighbor does not report you in the event of a possible abortion.
Dr. Aneta Sieradzka from the Sieradzka & Partners law firm, specializing in GDPR in healthcare, also presented her opinion: "The draft does not provide for the right to delete data in the event of loss or termination of pregnancy (...); the draft regulation is an encroachment of the executive power on the sphere of individual freedoms and rights, and violates GDPR and constitutional standards."
According to the judgment of the Constitutional Tribunal of 18 December 2014 (ref. K 33/13), the scope of data that may be collected in medical registers must result from the statute.
Criticism of the idea
The Federation for Women and Family Planning has responded to the matter, firmly opposing the obligation to register patients' pregnancies, calling the whole idea anti-women and anti-family. It has issued a position on the draft regulation , which reads, among other things:
"(...) The Law and Justice government declares its willingness to take action to increase the birth rate in the country - but this is not the way. It is not the oppressive control that is the incentive to make the decision to have children, but the provision of stable employment, a place to live, decent pay, parental leave, and a number of other solutions in the field of pro-family policy, successfully used in Western European countries."
Pregnancy registration and what next?
Pregnancy registration = official reporting of the fact of pregnancy.
If a pregnancy is reported, could a person travel abroad to have an abortion? Would they have to register the termination of pregnancy? Maybe it would be easier to avoid doctors_rek so that information about the pregnancy does not end up in the registry at all?
Considering the government's previous actions (introducing a prescription for emergency contraception, removing the premise of severe fetal defects from the anti-abortion law, brutal treatment of participants in the Women's Strike, allowing for the consideration of further bills tightening the anti-abortion law), the bill raises concerns. It seems to be another attempt to control Polish women in terms of potential miscarriages or abortions, and thus an attack on women's rights: to decide about themselves, their lives.
In the crosshairs
In fact, this project is downright counterproductive and only deters pregnant women from regular doctor visits. Limited possibilities for prenatal tests (free only for women over 35, and their results cannot be the basis for a safe and legal abortion), lack of government support for the in vitro procedure (the program was planned until June 30, 2016; it was extended by the previous government in its final days in office - from July 1, 2016 to December 31, 2019, which was criticized by PiS). This, combined with the tightening of abortion regulations, looks like hell for people who have been considering parenthood.
To see what others think about it, I dove into the comments under articles about the pregnancy registry. “Today a pregnancy registry, tomorrow a registry for non-heteronormative people, the day after tomorrow a registry for masturbation.” – that’s close to what went through my mind when I first heard about the government’s latest idea. Someone else wrote: "The plan to create such a register should be considered in connection not only with what is happening around abortion (the Constitutional Tribunal's ruling, the case of Ms. Iza from Pszczyna, etc.), but also with two documents: the draft Demographic Strategy 2040 announced in June, which establishes as its main strategic goal an exit from the low fertility trap and approaching the fertility level that guarantees generational replacement, and the draft bill on the establishment of the Institute of Family and Demography submitted to the Sejm on November 5 by a group of PiS MPs, headed by Bartłomiej Wróblewski (the author of the known motion to the Constitutional Tribunal) . According to the draft, the most important tasks of the institute include, among others, collecting, developing and making available to public authorities information on demographic, social and cultural phenomena and processes. And the president of this Institute is to have prosecutorial powers."
Abortion reminder
It is worth recalling that for now (as of November 29, 2021), performing your own abortion is legal . As the abortion Dream Team reminds :
- Terminating your own pregnancy is not a crime (however, you should not order from Polish websites, because selling medications outside of pharmacies is illegal).
- Inducing a miscarriage by taking pills is legal (up to the 22nd week of pregnancy it is considered a natural or induced miscarriage, there is no possibility of criminal liability).
- It is legal to travel abroad to terminate a pregnancy. It is legal to accompany someone on such a trip.
"I kindly inform you: I am not pregnant!"
It is not easy to refrain from reacting when the government makes decisions that look like another "attack on the uterus". The Abortion Dream Team, Dziewuchy Dziewuchom and the March for Safe Abortion invited menstruating people to take part in an unusual campaign of sending photos of used sanitary products (pads, tampons, menstrual cups) to the Ministry of Health to report on the lack of pregnancy.
Why is it worth protesting?
The "Stop Abortion" bill is pending in the Sejm , banning termination of pregnancy even in the case of pregnancy resulting from rape or incest, pregnancy with a fetus with a severely damaged fetus, and one that endangers the woman's health. What else? How much more?
No one will fight for our rights for us. Civil rebellion is the only chance for any change in the scope of control over women. Yes, limiting reproductive rights is a form of violence against women and a form of exercising control in a society dominated by men who, for some reason, claim the right to decide about our bodies, health and lives.
What else should everyone know?
About possibilities. In this case – about the citizens' bill "Legal Abortion. Without Compromise" as a response to the tightening of abortion law in Poland.
Because everyone should have the right to legal, free, safe abortion and to a life of dignity and respect – EVERYONE, regardless of gender. You can read more about it here .
According to the information provided on the website, the bill provides for:
- the possibility of terminating a pregnancy on the National Health Fund up to the 12th week of its duration without asking for the reason;
- possibility of terminating pregnancy on the National Health Fund after the 12th week if foetal defects are detected, when the pregnancy is the result of a prohibited act or when the life/health of the pregnant person is at risk;
- strict deadlines for providing the service of termination of pregnancy and sanctions for medical entities for unjustified refusal or failure to provide it;
- the obligation of hospital directors to employ subcontractors in the event of a refusal to perform an abortion due to the conscience clause by all doctors working in the facility;
- decriminalisation of abortion, i.e. repealing criminal provisions providing for the liability of doctors and third parties for performing abortions / assisting in extra-statutory abortions;
- simplification and acceleration of the patient’s objection procedure against a doctor’s refusal/opinion (24 hours for the Medical Commission to consider an objection to the refusal of abortion);
- expansion of the prenatal testing program to include PAPPa testing;
- the termination of pregnancy service is to be provided in accordance with the current state of medical knowledge, taking into account all available methods, including pharmacological methods.
In order for the bill to be submitted to the Sejm for consideration, the citizens' committee must collect at least 100,000 signatures by the end of the year. Any adult citizen with active voting rights can sign. On its Facebook profile, the Citizens' Legislative Initiative Committee "Legal Abortion. Without Compromise" (LABK) reported that as of November 26, 2021, 75,893 people had signed the bill (number of votes counted). More signature cards are still being submitted.
Why legal abortion?
Human suffering has not been erased by law. Dramas have "gone underground". And the fact is that only legal abortion is safe. If we want to protect women, we must enable them to terminate their pregnancies in dignified conditions, under the supervision of specialists.
The right to health care is guaranteed in the Constitution. Abortion is a basic medical procedure that saves physical and mental health. It saves life.
What is also worth emphasizing is the fact that there is no abortion without a reason. The fact that we are unable to understand something does not mean that it is meaningless to someone else.
Poland, another El Salvador?
As reported by Amnesty International, El Salvador is one of the few countries with a restrictive law that completely prohibits termination of pregnancy (even in cases where the woman's life is at risk). So, as Salil Shetty, Secretary General of Amnesty International, put it, in a critical situation pregnant women must make a choice: terminate the pregnancy and go to prison, or continue it and die.
For terminating a pregnancy, the penalty for a female doctor is 6 to 12 years in prison, and for a woman: 2 to 8 years. There are also cases of women convicted of intentional murder, subject to a penalty of 30 to 50 years in prison. An example is the case of Maria Teresa Riviera, who was sentenced to 40 years in prison for a miscarriage.
"Maria already had one child when she became pregnant. She worked in a sewing factory. One day she felt sick. Her mother-in-law found her bleeding on the bathroom floor. When she woke up in the hospital, she found police around her, who began to interrogate her without a lawyer present. In 2012, she was convicted of murder, despite there being no evidence to contradict Maria's claims that she had had a miscarriage. Her son will be 45 when she is released."
Pregnancy cannot be terminated, even if it is the result of rape. And these are common, even among minors. The AI report quotes one of the doctors there:
"In the last six months, we have had four cases of girls between 10 and 14 years of age. They were pregnant, the children were developing without kidneys. These children die at birth. And it's not just that we forced them to carry the pregnancies to term, but they were also told that it was their fault that they got pregnant."
These are the effects of repressive anti-abortion laws, lack of access to sex education and contraception, and a patriarchal society in which even women's testimonies are questioned.
I can't promise...
Is this text objective? Not really. It's hard to contain your emotions when you have two daughters and - with each passing year - an ever-increasing amount of fear for their future.
Recently, after meeting her pregnant aunt, my 5-year-old daughter asked me, “Mom, when I grow up, will I be pregnant?” I told her, “If you want to, then yes.” What I didn’t say out loud: “I wish I could promise you that you won’t be pregnant if you just don’t want to.”
Created at: 14/08/2022
Updated at: 14/08/2022
