Author: Delila Hasanbegović Vukas, Programme Coordinator at Sarajevo Open Centre, for SAAF website

Abortion is available on request up to 10 weeks of pregnancy in Bosnia and Herzegovina (B&H). After 10 weeks it is available with the approval of a committee. However, we recently carried out research which shows that access to abortion services in the country is limited in a number of ways.

Our research shows that abortion care is inconsistent. 

I work for Sarajevo Open Centre (SOC) – an organisation dedicated to human rights in B&H, particularly the rights of women and those belonging to the LGBTI community.

We already knew from our work that abortion care in the country is lacking, but we wanted to carry out this piece of research to find out more about actual practice across the country. Unfortunately, abortion data in B&H is unreliable, incomplete, and not kept at a national level.

So, in 2023, my team and I interviewed and surveyed staff at health institutions and health care facilities, as well as 163 people who have had abortions. This research reveals a number of problems with access.

For example:

• Abortion for non-medical reasons is not covered by health insurance and prices vary wildly in different areas;
• Misoprostol is not registered, so medication abortion is rare;
• Some clinics have a lack of resources/staff and very few people are offered counselling support (only 3% of those surveyed);
• Doctors can (and do) refuse to provide abortions, and the rules on ‘conscientious objection’ are not consistent across the different areas of the country.

Doctors are refusing care and stigmatising those seeking abortions. 

The law guarantees that every woman has the right to decide independently whether to terminate her pregnancy up to the tenth week of pregnancy, but in practice women face situations in which the doctor can refuse to perform an abortion citing ‘conscientious objection’. If the doctor decides that the procedure is against their moral beliefs, some hospitals provide the patient with another doctor, and some hospitals do not, so it is up to women to fend for themselves.

Conscientious objection is not a rare phenomenon in B&H, it is unregulated and there are no mechanisms for punishing those who do not do their job.

Many of those we interviewed shared examples of judgemental treatment from health professionals:

“The doctor was unkind, she tried to talk me into pregnancy. She kept showing me the heart. Hands. Legs. Foetus. Even though I said it was an abusive relationship.“

“A medical doctor in a public health care facility refused to perform an abortion and made a conscientious objection, despite the fact that abortion is free in my area and covered by my insurance.”

Health insurance cannot be used to cover the costs of an abortion performed on request. 

Although abortion on request (where there are no medical issues) is legal, it is not covered by health insurance. Abortion is therefore hard to access or unavailable to many women because of high costs. The cost of an abortion depends on the procedure and the healthcare facility so can range from 100 to 500 BAM ($55-$280 USD).

So, a person who has money will still somehow be able to find their way through the administrative and conscientious objection labyrinth, but what happens to those who are not able, for various reasons, to go to another area of the country, who are exposed to demonization in their environment because they want to terminate the pregnancy?

Abortion is a feminist issue, as well as a class issue. 

The reasons why a woman wants to have an abortion should be of no interest to the state.

Around the world, abortion remains a topic that will immediately create a fierce debate in the public space, but the wider conditions women are facing when making decisions about pregnancy are rarely acknowledged. In B&H there is a lack of sex education, too few public kindergartens, high levels of unemployment, and patchy access to contraception.

It turns out that it is easier to deprive women of the right to make decisions about their own bodies than to deal with these wider issues. Abortion will always exist, and it’s the poorest women who suffer the most – who may have to turn to dangerous methods of abortion.

How to improve access to abortion services. 

We know that abortion is safe and can change women’s lives. However, so much stigma and misunderstanding still remains. Our ultimate goal with this work is to influence a broader understanding of abortion as basic health care and a human right and for it to be made available to all persons who need it.

It was encouraging to see that many of the women we interviewed also agreed:

“The right to abortion is a basic women’s human right, as is the right to make choices, the right to a dignified and free life. The national framework must be based on international legislation on abortion. Medical staff must continuously have gender-sensitive trainings in order to overcome personal frustrations and dominant patriarchal patterns of behaviour.”

To find out more view the full research report here.