The violation of sexual and reproductive health and rights of refugee women from Ukraine, victims of CRSV, in Poland, Hungary, Slovakia and Romania

Since Russia’s invasion of Ukraine began in February 2022, more than 8 million people have left the country and sought refuge in neighbouring states such as Poland, Romania, Hungary and Slovakia (UNHCR, 2022). Most of the refugees spread across Europe are women and children, many of which are victims of human rights violations committed during the war, especially in the occupied areas. Recent reports, however, have revealed that such violations are also experienced once refugees have crossed the borders of Ukraine and reached the European Union. In particular, there are concerns regarding the victims of conflict-related sexual violence (CRSV) and how the laws in host countries actually exacerbate the gendered impact of this war and impose barriers on access to sexual and reproductive health services (Center for Reproductive Rights et al., 2023). 

Conflict-related Sexual Violence in the Russo-Ukrainian War

Official reports revealed that violations of human rights and international humanitarian law have been committed in Ukraine since the first months of the conflict (Gall & Boushnak, 2023; McKernan, 2022). More specifically, there is evidence that women of all ages have faced sexual violence, including rape and forced nudity, often in front of their children and other family members, in areas occupied by the Russian armed forces (OHCHR, 2022b). The Independent International Commission of Inquiry on Ukraine (2023) further mentioned that such acts were committed during house searches, at checkpoints, in confinement or in spaces where women sought refuge from the conflict—such as basements and bomb shelters—, in areas such as Kyiv, Kharkiv, Kherson or Chernihiv. These allegations are just some of the risks that girls and women are facing in the country, whether internally displaced or forced to cross the border. OHCHR (2022b) also raised concerns about sexual exploitation, human trafficking, domestic violence and other forms of gender-based discrimination which mainly affect women. 

Officials of the United Nations (Gans, 2022) and OSCE (2022) have officially claimed that the Russian Federation uses rape as a weapon of war. After all, the use of sexual violence in conflict as a tool of military strategy can be encountered in several conflicts around the world and it is currently deemed a war crime within the international humanitarian law framework. In Ukraine, whether as a form of punishment, humiliation or dehumanisation, this horrifying act affects mainly women and girls (Wamsley, 2022) and its consequences reveal the gendered impact of this armed conflict. It is also important to note that, while women are primarily the victims of these acts, boys, men and members of the LGBTQ+ community have also faced sexual violence (Berger, 2022; Kulick, 2022). Nevertheless, since women are usually more likely to remain in occupied zones due to their caregiving responsibilities towards children and elder family members (Horne, 2023), they are at higher risk of becoming victims of conflict-related sexual violence. At the same time, due to martial law being in place, they also represent the majority of people fleeing the country.

From the beginning of the Russian invasion until 31 October 2022, approximately 86 cases of conflict-related sexual violence were officially documented in different regions of Ukraine (HRMMU, 2022). The atrocities committed in Bucha, for example, which became known worldwide, included the rape of 25 girls, 9 of which became pregnant after these unspeakable acts (Limaye, 2022). However, it is difficult to know its real scale and the number of victims is predicted to be much higher than what is currently reported. Consequently, it is also almost impossible to know how many women, victims of sexual violence, crossed the border in the countries under discussion. As Ukraine’s prosecutor general mentioned last year (King, 2022), sexual violence is usually underreported due to stigma and the consequences towards victims. Many survivors are reluctant to share their experiences and suffer long-term trauma (Mannell, 2022), especially in the absence of effective services to support them. Moreover, in an active conflict and in occupied areas, it is even more difficult to ensure a thorough investigation and begin criminal proceedings against the perpetrators. 

In this context, women from Ukraine who are victims of CRSV should be able to have access to sexual and reproductive health services. These include emergency contraception, safe abortions or medical support for sexually transmitted diseases, among others. Within the Ukrainian borders, this may be limited due to the destruction of many health facilities and the shortage of medicines. Therefore, many seek help and hope to undertake time-sensitive procedures such as abortions in neighbouring countries. Moreover, they might be in need of psychological support and long-term care due to the trauma caused by war crimes. 

Poland, Hungary, Romania and Slovakia are all members of the European Union and as a consequence, they should follow the rules set by the Temporary Protection Directive adopted in March 2022. According to this protection mechanism, countries should ensure medical access to people coming from Ukraine. However, a recent report (Center for Reproductive Rights et al., 2023) has shown that the restrictive policies in place on emergency contraception and abortion make it almost impossible for refugees from Ukraine to access services regarding their sexual reproductive health and rights (SRHR). Moreover, the impact of gender-based violence in these countries creates an environment where such acts are tolerated and victims are often silenced and left unprotected.

Access to SRHR in neighbouring countries

While Poland, Hungary, Slovakia and Romania are among the neighbouring countries where women from Ukraine first seek refuge, they are also some of the states with the most restrictive SRHR policies in Europe (Diamondstein, 2022). Particularly the three first countries have implemented laws which impose barriers to those seeking emergency contraception or abortion. What all the mentioned countries have in common is also the lack of effective policies against gender-based violence or victim support mechanisms. As a consequence, gender inequality, domestic violence, sexual harassment or rape are highly tolerated in society, which makes it even more difficult for victims of such acts to seek help. 

Poland is already known in Europe and worldwide as one of the countries with the most restrictive abortion and emergency contraception policies. More specifically, abortion on request is not legalised and is permitted only when the pregnancy poses a risk to a pregnant woman’s health and life, or when it is a result of rape or incest, until the 12th week of the pregnancy. In October 2020, the Constitutional Tribunal ruled that abortion on the grounds of “severe and irreversible foetal defect or incurable illness that threatens the fetus’ life” is unconstitutional, marking it one of the strictest policies in this domain (Amnesty International, 2022b). Moreover, anyone who assists women in performing an abortion or who provides them with emergency contraception can be prosecuted. Earlier this year, Justyna Wydrzyńska became the first person to be sentenced in Europe for helping another woman to terminate her pregnancy (Easton, 2023), under Polish law. 

Nevertheless, given these provisions, ending a pregnancy resulting from rape seems to be legal. However, what many organisations in the country report are the difficulties encountered in practice when someone requests such a procedure. More specifically, few abortions resulting from rape are actually carried out as the procedure is not always accessible to Polish women and others in their situation. To be eligible, authorities need to undertake criminal investigations and women have to provide official documentation as proof. Moreover, due to increased restrictions and the fear of being criminally prosecuted, many doctors refuse to perform this procedure (Biedron, 2022). Others choose to invoke the so-called “conscience clause” or state that performing an abortion is against their religious beliefs. These aspects were encountered in a recent case where two hospitals refused this procedure to an underage rape victim, although she had documents from the public prosecutor and all the grounds necessary for a legal abortion (Lepiarz, 2023).  

In Hungary, although abortion has been legal since 1953 (Cursino, 2022), the intention of the current government to raise the birth rate and its tendency to publicly support traditional family values have also impacted SRHR policies. In this regard, the Orban government’s Constitution from 2011 stated that it guarantees that “the life of a fetus will be protected from conception” (Strzyżyńska, 2022). Hungarian society is known for being pro-choice and as a consequence, abortion until the 12th week of pregnancy is allowed by law, on grounds similar to Poland such as the risk to women’s health, if it is a result of rape or, additionally, if the fetus has a serious health impairment. Moreover, it is also allowed in the case of “a serious crisis situation that causes physical or mental disruption or social impossibility” (Kafkadesk Budapest Office, 2021). 

In practice, while these grounds do not necessarily need to be proved, a woman seeking an abortion needs to do two compulsory appointments with a childcare/family worker, after the pregnancy is confirmed by a gynaecologist. During these visits, women usually receive counselling and information on adoption services or benefits provided by the state (Strzyżyńska, 2022). Such conditions are often used to convince them to change their minds or even to stigmatise women for the choices made. Furthermore, there is a ban on medical abortion (known also as abortion pills) and recently, the government introduced the mandatory condition for every pregnant woman to listen to the fetus’s heartbeat before undertaking the surgical procedure (Cursino, 2022). Similar to Poland, doctors can also refuse to conduct an abortion based on conscientious grounds and emergency contraception can only be accessed with a prescription after a medical visit. 

Refugee women from Ukraine also encounter difficulties in Slovakia, another country that has come to the aid of people fleeing from war. According to a law which has been in place since 1993, women can request to terminate a pregnancy within the 12 weeks timeframe without any justification. Similar to Hungary, they have to go through mandatory counselling appointments on possible alternatives to this procedure and the consequences of abortion and then wait approximately 48 hours before terminating the pregnancy (Center for Reproductive Rights et al., 2023). Similar to the countries analysed previously, surgical abortion is the only legalised form, and the costs are relatively high, especially for those women with low incomes. Moreover, doctors and hospitals can refuse to perform abortions on conscientious grounds, a practice that has been widely used in the country. 

Slovakia has also been known in the past decade for its attempts to impose more restrictions on SRHR policies. For example, in  2018, 19 proposals were discussed in this regard, and the most recent ones, in April 2022, raised serious concerns regarding the access of refugee women to terminate their pregnancies. More specifically, the proposals discussed in the Parliament considered banning abortion on request, except on grounds similar to Poland, and restricting these procedures for foreigners without a residence permit, to challenge the so-called “abortion tourism” (Nešťáková, 2022). While none of these proposals passed, they are just the latest attempts to restrict the access of women, including refugees, to emergency contraception and safe abortion (Amnesty International, 2022a). 

Romania has been known, especially during the Communist regime, for its restrictive policies in terms of abortion. After the fall of Communism, the tendency was to legalise such procedures and implement more SRHR policies for women. In the last three decades, abortion on request has been legal for up to 14 weeks, with no justification needed. Further, the laws in place have ensured free and direct access to ambulatory and specialised care for refugees, including for those coming from Ukraine (Center for Reproductive Rights et al., 2023). Nevertheless, in the last decade, the government cut the funding to contraceptive measures and the Parliament recently modified a law which previously introduced sex education in schools. In this context, Romania is the country with one of the highest percentages of underage pregnancies in Europe, especially due to the lack of education and inaccessible sexual and reproductive health services. 

The biggest concern in Romania at the moment is that many public hospitals refuse to terminate pregnancies, based on a conscientious objection clause in the Professional Code for Medics. During the Covid-19 pandemic, access to such procedures was especially heavily impacted since abortions were not considered emergency healthcare services. Following an investigation, FILIA Centre, a women’s rights organisation in Romania, revealed that during the pandemic, approximately 200 abortion procedures were performed at home, without any specialised help. Moreover, in the first six months of 2022, the number of abortions performed in the private healthcare system doubled and approximately 69 public hospitals declared that they do not conduct this procedure, due to religious beliefs and other moral and ethical grounds. Out of the Romanian hospitals contacted by FILIA Centre (2023), only 9 of them provided access to medical abortion.

In recent years, civil society has also been concerned about the rise of anti-choice actors in Romania (Schwartzburg, 2022). These organisations are often funded by donors from other European countries or the United States of America and have succeeded in opening support centres for pregnant women, where they often share false information about abortion and its consequences. One example is Heartbeat International, one of the largest anti-choice organisations in the world. In the context of the war in Ukraine, this organisation opened crisis pregnancy centres and provides counselling in both Ukrainian and Russian language to refugee women who come to Romania regarding the consequences of terminating a pregnancy (Cilibiu, 2022). Many of these actors have also reached the level of political representation and managed to influence laws on children’s rights or education which indirectly have an impact on SRHR policies.

The impact of such restrictions on refugees from Ukraine, victims of CRSV

For victims of CRSV, the laws imposed in host countries regarding SRHR can aggravate the impact of such crimes. Many would seek access to emergency contraception and abortion because continuing a pregnancy resulting from rape can prolong the already-lived trauma and stigma within their own community. This is often linked with a high occurrence of gender-based violence and exclusion, which can indefinitely affect women. Moreover, other issues might occur, such as sexually transmitted diseases, genital trauma, miscarriage or mortality, determining the need for immediate access to sexual and reproductive health services. CRSV causes not only long-term physical harm but also psychological wounds, including post-traumatic stress, depression, anxiety and suicide (Stark et al., 2022). Therefore, it is important to analyse how the barriers imposed to SRHR in each of the countries under this discussion impact refugee women. 

In the case of Polish law, refugees from Ukraine who are victims of rape during the conflict have to go through a criminal investigation and provide official documents to request an abortion within a 12-week timeframe. In most cases, as previously mentioned, such investigations are almost impossible to conduct, especially in areas with active conflict. As a consequence, many Ukrainian women resort to abortions in unsafe conditions or to medicine which is often procured illegally. Since the state imposed additional restrictive policies, FEDERA, an organisation that works in Poland, estimates that approximately 150,000 procedures are performed illegally (Lepiarz, 2023), which could heavily impact the safety of women. 

Others seek support in neighbouring countries. However, pursuing an abortion abroad could prove very costly for refugee women coming from Ukraine, due to their vulnerable position and limited financial resources (Amnesty International, 2022b; Schwartzburg, 2022). The recent practice of prosecuting those who aid women seeking abortion and emergency contraception also causes fear among refugees who are reluctant to ask for support from their friends or host communities (Center for Reproductive Rights et al., 2023). While abortion resulting from rape is legal, Poland fails to offer support to women victims of CRSV in Ukraine by imposing barriers in practice which do not consider their particular position. 

Regarding the laws in place in Hungary and Slovakia, while abortion is officially legal, the conditions imposed for this procedure can become a bureaucratic and inaccessible process for refugee women. For many victims of sexual violence in conflict, the additional appointments, waiting times and documents necessary for requesting an abortion can become very challenging. In a context where many women from Hungary travel to neighbouring countries, such as Austria, refugee women from Ukraine find it difficult to access such sexual and reproductive health services under the public system and are forced to rely on personal financial resources. Similarly, in Slovakia, emergency contraception is explicitly left out of the officially reimbursed medical services under the public health system and, just as an abortion, can prove very costly to women. Besides the cost barriers, there are also issues regarding the language, since women from Ukraine have to attend different appointments necessary for receiving a prescription or requesting an abortion which are not that often conducted in Ukrainian (Center for Reproductive Rights et al., 2023). 

While in Romania the laws are less restrictive and both surgical and medical abortion can be requested in some hospitals, the refusal of doctors to perform such procedures can prove devastating for refugee women, similar to the other countries. In practice, not many public hospitals offer access to free sexual and reproductive healthcare. As a consequence, women from poor backgrounds and refugees, victims of CRSV, cannot afford to terminate their pregnancies in private hospitals or access contraception without the support of civil society organisations. Particularly in the case of women coming from Ukraine, despite the laws in place, many of them have to register with a family doctor and undertake a bureaucratic process and numerous appointments to access the services needed (Center for Reproductive Rights et al., 2023, OHCHR, 2022b).

In addition to these legal, cost and language barriers, a recent study carried in the countries under discussion revealed that there is a stigma surrounding SRHR and gender-based violence (Center for Reproductive Rights et al., 2023). As a consequence, many refugee women face harmful stereotypes and humiliation when requesting an abortion or contraceptive measures in countries where such services are legally provided (Center for Reproductive Rights et al., 2023). Moreover, what is available for victims of gender-based violence is not as effective as in the rest of Europe, and Poland, Hungary, Slovakia and Romania still lack the services, protocols and training necessary to support women. Discriminative gender norms and stereotypes which still persist in these four countries have an impact on the experience of refugee women, who are often faced with big discrepancies in terms of SRHR services compared to Ukraine. 

Furthermore, it is also relevant to mention that certain groups of refugee women, victims of CRSV, are also at risk of intersectional discrimination. These countries are widely known for their discriminative attitude towards the LGBTQ+ and Roma communities, among others. Consequently, Ukrainian refugee women who belong to such groups often face discrimination not only in terms of the restrictive SRHR policies but also because of their ethnic, sexual, racial or financial background. In this context, many refugees from Ukraine have travelled back to their country temporarily to access SRHR services which are not provided in Poland, Hungary, Slovakia or Romania (Center for Reproductive Rights et al., 2023). Such practice, however, raises important safety concerns, and financial and administrative barriers, which aggravate the trauma suffered by victims of conflict-related sexual violence and their vulnerable position within society (Center for Reproductive Rights et al., 2023). 

Conclusions

Overall, Poland, Hungary, Slovakia and Romania fail to provide the necessary sexual and reproductive health services for refugee women from Ukraine, who are victims of CRSV. While in theory terminating a pregnancy resulting from rape is legal and should be provided by public hospitals, in practice there are numerous barriers that women face to access such procedures. Even in countries where medical abortion or emergency contraception is legal, the bureaucratic process of receiving such support is making it almost impossible to benefit from it. Similar to women living in these countries, refugees coming from Ukraine face numerous legal, administrative, cost and language obstacles when accessing services which could save their life. They are often faced with restrictive policies on performing abortions, the refusal of medical personnel, costly procedures and time-consuming mandatory appointments, which contribute to prolonging the trauma suffered by sexual violence in conflict. 

The states under discussion should reconsider the SRHR policies in place and analyse how such services restrict the access of refugee women to life-saving practices. More procedures should be covered by the public health system and the governments of these countries must ensure that the legislation in place does not discriminate against women coming from vulnerable backgrounds. Given the particular situation of refugee women victims of CRSV, they should dedicate more resources and effort to implement victim-centred support services available to those suffering from both physical and psychological harm caused by such acts. Moreover, Poland, Hungary, Slovakia and Romania have to take measures in eradicating in their countries gender-based discrimination and violence, in order to create a safer environment for women. 

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