Tài liệu Women’s Health and Postsocialist Healthcare Reforms: Lessons from Poland and Eastern Europe

Mishtal, CAGH

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Women’s Health and Postsocialist Healthcare Reforms:

Lessons from Poland and Eastern Europe

CAGH – Working Group on Health Insurance Reform

Position Paper, Joanna Mishtal

Current debates about healthcare reform in the US offer an opportunity for anthropologists and

feminist scholars to call attention to the urgent need to improve women’s health through access

to reproductive and sexual healthcare. While both men and women have reproductive and sexual

health needs, women are often more directly involved in prevention of unintended pregnancy,

accessing contraception, and are uniquely affected by pregnancy and childbirth as well as

sexually transmitted infections. Reproductive health has been shown to be a central determinant

of women’s overall health, and therefore universal healthcare coverage should include access to

comprehensive and affordable services that promote reproductive and sexual health (Chavkin et

al. 2010). But access to reproductive and sexual rights and healthcare is also highly politicized

and affected by other agendas, including religious and demographic, in addition to neoliberal.

Based on 21 months of fieldwork in Poland between 2000 and 2007 focusing on the politics of

reproductive health and rights, I briefly summarize here the effects of Polish neoliberal

restructuring on reproductive healthcare.

Lessons from Poland and Eastern Europe

After the fall of state socialism in 1989 Poland, similarly to other East European nations,

embraced neoliberal economic reforms dictated by the global pressures to adopt market solutions

in most areas of transition politics. This shift resulted in major cutbacks in social services and

state healthcare coverage, as well as privatization, decentralization, and deregulation. Formally,

Poland has a universal healthcare system via the National Health Fund, but cuts in coverage have

been substantial: subsidies of medicines dwindled from 100% before 1989 to 35% in 2004, the

lowest in the European Union, and many basic services were removed from universal coverage

known as the “health benefits basket,” resulting in increasing out-of-pocket payments for

patients (Maarse 2006; Tymowska 2001). Although the Polish Constitution explicitly guarantees

every citizen the right to protection of health and equal access to publicly-financed healthcare,

regardless of one’s material situation, the state determines which services are publicly funded.

Thus the constitutional guarantee to health is a right only to the extent that publicly funded

services are actually available.

Poland implemented some of the largest cuts in public health coverage. As of 2009, Poland’s

expenditure on healthcare was 9.8% of total state’s expenditure, the second lowest in the EU

after Latvia (WHO Report 2009). Private health insurance plans are only beginning to be

established and are available only to the wealthy, thus, most people rely on public healthcare and

private care is paid for by users. A national survey indicated that 59% of Poles rely solely on the

public system and never pursue healthcare privately, mainly due to high cost (Sawińska and

Adelt 2004). Some of the deepest cuts in state subsidies were implemented in the area of

reproductive and sexual health services. The situation in Poland is exacerbated by the political

role of the Catholic church, which was instrumental in the criminalization of abortion in 1993.

The ban has been funneling abortion to the clandestine underground where the service is widely

available but for a high fee (Mishtal 2010).