Joint Open Letter regarding current threats to reproductive rights

Námestie Alexandra Dubčeka 1

812 80 Bratislava 1

7 September 2020

Dear Members of the National Council of the SlovakRepublic,

We are writing on behalf of 111 organizations toexpress our deep concern regarding current threats to reproductive rights inSlovakia. At this time Parliament is debating draft legislation1 that if adopted would impose new barriers to accessing lawful abortion care, harm women’s2 health and well-being, and undermine their decision-making and privacy. It would also forcedoctors to act in conflict with their professional obligations to theirpatients. If enacted, the legislation will create dangerous chilling effects onthe provision of lawful abortion care in Slovakia, and increase the harmfulstigma surrounding abortion.

The draft legislation seeks to double the mandatorywaiting period currently required before accessing abortion on request andextend its application, impose a new layer of medical authorizationrequirements for abortion on health grounds, and introduce a requirementobliging women to state the reasons for seeking an abortion and to provideother private information when requesting an abortion. Such information wouldthen be transmitted to the National Health Information Center. The draftlegislation also seeks to restrict the information that medical professionalscan provide publicly about abortion services by prohibiting so-called“advertising” on abortion, and to strengthen the dissuasive nature of themandatory information doctors are required to provide to women seekingabortion.

Our organizations are deeply concerned by theseproposals. If adopted, they will harm women’s health and well-being andcontravene international public health guidelines, clinical best practices andSlovakia’s international human rights obligations.

The World Health Organization (WHO) has outlinedthat countries should ensure that women’s decisions to access lawful abortioncare are respected and that abortion care is “delivered in a way that respectsa woman’s dignity,guarantees her right to privacy and is sensitive to her needs andperspectives.”3 International human rights mechanisms have stressedthat states must ensure the availability, accessibility and quality of abortionservices in line with the WHO guidelines. They have called on states, includingSlovakia, to remove barriers to safe and lawful abortion, including mandatorywaiting periods, mandatory counseling and third-party authorization requirements4. In addition, the European Court of Human Rights has held that “[o]nce the legislature decides to allowabortion, it must not structure its legal framework in a way which would limitreal possibilities to obtain it”5 and has underscored that European states have “a positive obligation to create a procedural framework enabling apregnant woman to exercise her right of access to lawful abortion.” 6

Extending the mandatory waiting period: The proposed extension of themandatory waiting period from 48 to 96 hours and its proposed application toabortions on specific grounds would substantially increase delays in women’saccess to abortion care, thereby placing their health and lives at risk. TheWHO has outlined that “[m]andatory waiting periods can have the effect of delayingcare, which can jeopardize women’s ability to access safe, legal abortion services.”7 As the WHO has underlined, while abortion is a very safe medical procedure, risks ofcomplications, though still small when abortion is performed properly, increasewith the duration of pregnancy.8 The WHO has underlined that “[o]nce the decision [to have an abortion] is made by the woman, abortion should be provided as soon as is possible”9 and without delay. Besides jeopardizing women’s health and well-being,mandatory waiting periods also often lead to discrimination and socialinequities as they increase the financial and personal costs involved inobtaining lawful abortion by requiring at least one extra visit to a doctorprior to abortion.

Mandatory waiting periods also undermine women’sagency and decision-making capacity. The WHO has made it clear that mandatorywaiting periods “demean[] women as competent decision-makers” and specifiedthat medically unnecessary waiting periods should be eliminated to “ensure thatabortion care is delivered in a manner that respects women as decision-makers.”10

Imposing onerous authorization requirements: Introducing a new layer ofmedical authorization

requirements in situations where an abortion is necessaryfor health reasons will delay women’s access to lawful abortion and jeopardizetheir health in situations where it is already at risk. Requiring two doctorcertifications, instead of the single doctor certification now required in suchcases, will also increase the costs of accessing abortion care, createburdensome administrative procedures, and generate a chilling effect for theprovision of lawful abortion services. The WHO has specified that onerousauthorization procedures, including where multiple medical professionals arerequired to provide certification, should not be required for abortion care.11

Restricting medical providers’ provision ofinformation on abortion: Introducing the proposed prohibition on so-called “advertising” ofabortion would restrict doctors’ ability to provide evidence-based informationon abortion care and where women can access lawful abortion. The legislationwould have a chilling effect on the provision of such information by medicalproviders, which could jeopardize women’s health and safety. Internationalhuman rights mechanisms have underlined that legal restrictions on theavailability of evidence- based information on sexual and reproductive health,including safe and legal abortion, contradict states’ obligations to respect,protect, and fulfil women’s right to the highest attainable standard of health.They have made it clear that “[s]uch restrictions impede access to informationand services, and can fuel stigma and discrimination” and have called upon statesto “[e]nsure that accurate, evidence-based information concerning abortion and its legalavailability is publicly available.”12 Similarly, the WHO hasstressed the importance of ensuring access to evidence-based information onabortion and the entitlements to lawful reproductive health care.13

Reasons for abortion: Requiring women seeking anabortion to state the reasons for their decision, which is often a verypersonal and private matter, could deter women from seeking care within theformal health system.14 International human rightsmechanisms have already urged Slovakia to “[e]nsure the confidentiality of thepersonal data of women and girls seeking abortion, including by abolishing therequirement to report the personal details of such women and girls to theNational Health Information Centre.”15

If adopted, this legislation will wholly contradictinternational public health guidelines and clinical best practice. It willundermine Slovakia’s compliance with its obligations under international humanrights treaties to guarantee women’s rights to health, privacy, information, tobe free from inhuman or degrading treatment, and the principles ofnon-discrimination and equality in the enjoyment of rights. In addition, theadoption of these proposals will be contrary to the fundamental internationallegal principle of non-retrogression. In its 2019 review of Slovakia, the UNCommittee on Economic, Social and Cultural Rights explicitly urged thegovernment to avoid any retrogression in relation to women’s sexual andreproductive health rights.16

We call on all Members of Parliament to reject thisregressive and harmful legislative proposal and to refrain from furtherattempts to restrict women’s reproductive rights in Slovakia.

Yours sincerely,

Abortion Rights Campaign, Ireland

Abortion Support Network, UK

Accountability International Action for Choice,Ireland

Aid Access, Austria

AIDOS - Associazione Italiana Donne per loSviluppo, Italy

Albanian Center for Population and Development(ACPD), Albania

Alliance for Choice, Northern Ireland

AMICA (Association of Italian Doctors forContraception and Abortion), Italy

Amirat OBK Association, Hungary

Amnesty International

Arbeitskreis Frauengesundheit e.V., Germany

Associação para o Planeamento da Família (APF),Portugal

Association for Advancement of Gender Equality,Republic of North Macedonia

Association for Liberty and Gender Equality(A.L.E.G.), Romania

Association HERA-XXI, Georgia

ASTRA – Central and Eastern European Network forSexual and Reproductive Health and Rights

Aube Nouvelle pour la Femme et le Développement(ANFD), DR Congo

Austrian Family Planning Association (OGF), Austria

Catholics for Choice, USA

Center for Curricular Development and GenderStudies: FILIA, Romania

Center for Feminist Foreign Policy, Germany/UK

Center for Reproductive Rights

CESI - Center for Education, Counselling andResearch, Croatia

CHU Saint-Pierre, Belgium

Coalition Margins, Republic of North Macedonia

Coalition of African Lesbians, South Africa

Coalition to Repeal the Eighth Amendment, Ireland

Conseil des femmes francophones de Belgique,Belgium

Consell Nacional De Dones D’Espanya, Spain

Danish Family Planning Association, Denmark

DAWN (Development Alternatives with Women for a NewEra)

Doctors for Choice Germany e.V

DSW (Deutsche Stiftung Weltbevölkerung), Germany

Enclave Feminista, Spain

Euroregional Center for Public Initiatives, Romania

European Roma Rights Centre, Belgium

Family Planning and Sexual Health Association,Lithuania

Family Planning Association of Moldova

Federación de Planificación Familiar Estatal,Spain

Fédération des Centres de Planning et deConsultations, Belgium

Fédération des Centres de Planning familial desFemmes prévoyantes socialistes, Belgium

édération des Centres Pluralistes de PlanningFamilial and Gacehpa, Belgium

Federation for Women and Family Planning, Poland

Fédération Laïque des Centres de planningfamilial, Belgium

FOKUS - Forum for Women and Development, Norway

Fondazione Pangea, Italy

French Ligue des droits de l’Homme, France

FRONT Association, Romania

Fundacja im. Kazimierza Łyszczyńskiego, Poland

Furia vzw, Belgium

Garance, Belgium

Gender-Centru, Moldova

HERA - Health Education and Research Association,Republic of North Macedonia

Human Rights Watch

ILGA-Europe
International Campaign for Women’s Right to Safe Abortion

International Commission of Jurists

International Planned Parenthood FederationEuropean Network

Ipas

Irish Family Planning Association, Ireland

Latvia’s Association for Family Planning and SexualHealth

Le Planning Familial, France

Lobby Europeo de Mujeres en España - LEM, Spain

Marie Stopes International

Medical Students for Choice, USA

Mujeres Supervivientes de Violencias de Género,Spain

NANE, Hungary

National Collective of Community Based Women’sNetworks (NCCWN), Ireland

National Network to End Violence Against Women andDomestic Violence, Republic of North Macedonia

National Women’s Council of Ireland, Ireland

OMCT - World Organisation Against Torture

rganisation Vishakha, India

Organization of Women of Municipality of SvetiNikole, Republic of North Macedonia

PATENT Association, Hungary

Plataforma catalana de Suport al lobby europeu dedones, Spain

Plural Association, Romania

Polish Women’s Strike, Poland

Pro-Choice. Rete italiana contraccezione aborto,Italy

pro familia Bundesverband, Germany

RadioAttive, Italy

Reactor - Research in Action, Republic of North Macedonia

Reproductive Health Training Center of the Republicof Moldova

Reproductive Rights Platform, Croatia

Romanian Women’s Lobby Network, Romania

Rutgers, Netherlands

Santé Sexuelle Suisse – Sexual Health Switzerland

Sensoa, Flemish expertise centre for sexual health,Belgium

Serbian Association for Sexual and ReproductiveHealth, Serbia

Sex og Politikk, Norway

SEX vs The STORK Association, Romania

Society for Education on Contraception andSexuality, Romania

Society for Feminist Analyses AnA, Romania

Society Without Violence, Armenia

Swedish Association for Sexuality Education (RSFU),Sweden

UK All Party Parliamentary Group on Population,Development & Reproductive Health, UK

Union Women Center, Georgia

Vrouwenraad, Belgium

VUB Dilemma, Belgium

Women’s Aid, Ireland

Women for Women’s Human Rights (WWHR) – New Ways,Turkey

Women Global Network for Reproductive Rights

Women’s Link Worldwide

Women on Waves, Netherlands

Women on Web, Canada

Women’s Resource Center, Armenia

Women’s Rights Center, Armenia

Women’s Room - Center for Sexual Rights, Croatia

Women Spaces Africa, Kenya

YouAct - European Youth Network on Sexual andReproductive Rights

Youth Coalition for Sexual and Reproductive Rights

1Draft Lawwhich Amends and Supplements Act No. 576/2004 Coll. of Laws on Healthcare,Healthcare-related Services, and on Amending and Supplementing Certain Acts AsAmended, and which Amends and Supplements Certain Acts (Print no. 154,19.06.2020), proposed by members of OĽANO - Ordinary People and IndependentPersonalities.
2 Althoughabortion relates mainly to the experience of cisgender women, we recognize thatabortion restrictions can have profoundly devastating impacts also on the livesof transgender men and nonbinary individuals who have the capacity to becomepregnant and may also require abortion care.

3WorldHealth Organization (WHO), SAFE ABORTION: TECHNICAL AND POLICY GUIDANCE FORHEALTH SYSTEMS (2d ed. 2012), at 64. 4 See, e.g., Committee on Economic, Social andCultural Rights (CESCR), General Comment No. 22 on the right to sexual andreproductive health (article 12 of the International Covenant on Economic,Social and Cultural Rights), para. 41, E/C.12/GC/22 (2016); Committee on theElimination of Discrimination against Women (CEDAW), Concluding Observations:Hungary, para. 31(c), CEDAW/C/HUN/CO/7-8 (2013); Slovakia, para. 31(c),CEDAW/C/SVK/CO/5-6 (2015); Russian Federation, paras. 35(b), 36(a),CEDAW/C/RUS/CO/8 (2015); Macedonia, para. 38(d), CEDAW/C/MKD/CO/6 (2018);Committee on the Rights of the Child,

6 Concluding Observations: Slovakia, para. 41(d),CRC/C/SVK/CO/3-5 (2016); Commissioner for Human Rights of the Council ofEurope, Women’s Sexual and Reproductive Health and Rights in Europe (2017), at11.
5 Tysiącv. Poland, No. 5410/03 Eur. Ct. H.R., para. 116 (2007).

6R.R. v.Poland, No. 27617/04 Eur. Ct. H.R., para. 200 (2011).

7WHO, SAFEABORTION: TECHNICAL AND POLICY GUIDANCE FOR HEALTH SYSTEMS (2d ed. 2012), at96.
8 WHO,SAFE ABORTION: TECHNICAL AND POLICY GUIDANCE FOR HEALTH SYSTEMS (2d ed. 2012),at 21, 32.

9WHO, SAFEABORTION: TECHNICAL AND POLICY GUIDANCE FOR HEALTH SYSTEMS (2d ed. 2012), at36, 64.

10WHO, SAFEABORTION: TECHNICAL AND POLICY GUIDANCE FOR HEALTH SYSTEMS (2d ed. 2012), at96-97.
11 WHO,SAFE ABORTION: TECHNICAL AND POLICY GUIDANCE FOR HEALTH SYSTEMS (2d ed. 2012),at 94-95. See also CESCR, General Comment No. 22, supra note 4, para. 41;CEDAW, General Recommendation No. 24: Article 12 of the Convention (women andhealth), (20th Sess.,1999), para. 14, HRI/GEN/1/Rev.9 (Vol. II) (2008).
12 CESCR,General Comment No. 22, supra note 4, para. 41; Special Rapporteur on the Rightof Everyone to the Enjoyment of the Highest Attainable Standard of Physical andMental Health, Interim Report of the Special Rapporteur on the right ofeveryone to the highest attainable standard of physical and mental health,para. 65(l), A/66/254 (Aug. 3, 2011).

13WHO, SAFEABORTION: TECHNICAL AND POLICY GUIDANCE FOR HEALTH SYSTEMS (2d ed. 2012), at95.
14 Whilethe draft legislation states that this information would be collected forstatistical purposes, it would still be a breach of women’s privacy to requirethem to fill in this information and provide reasons for abortion prior toreceiving abortion care.

15CEDAW,Concluding Observations: Slovakia, para. 31(f), CEDAW/C/SVK/CO/5-6 (2015). Seealso CESCR, Concluding Observations: Slovakia, para. 42(d), E/C.12/SVK/CO/3(2019).

16CESCR,Concluding Observations: Slovakia, para. 42(e), E/C.12/SVK/CO/3 (2019).