To: Human Rights Committee

To: Human Rights Committee

8-14 Avenue de la Paix

CH-1211 Geneva 10

Switzerland

Updated information for the consideration to the Human Rights Committee regarding the review of the Third Periodical Report of the Republic of Macedonia under the International Covenant on Civil and Political Rights, 114nd Session, 29 June - 24 July, 2014

June, 2015

SUBMITTING ORGANISATIONS

H.E.R.A.-The Health Education and Research Association was established in January, 2000. The Association works to promote the inclusion of sexual and reproductive health and rights in national legislation and strategies. HERA annually provides health, social and legal services to 2,600 women, mostly Roma women, who are the most at risk community in the country. HERA is a member of the International Planned Parenthood Federation (IPPF).

The Helsinki Committee for Human Rights of the Republic of Macedonia (MHK) was formed on 23 October, 1994 as a non-governmental organization working for the promotion and protection of human rights, without any political and religious orientation. MHK’s objective is to raise awareness about the concept of human rights and freedoms based on international human rights documents. MHK monitors the situation with human rights, provides legal aid to citizens in cases of violation or limitation of their rights and freedoms and cooperates with other organizations and state bodies for the purpose of increasing the promotion, respect and protection of human rights and freedoms.

Reactor – Research in Action is an independent think-tank based in Skopje, Macedonia. Reactor is committed to facilitating Macedonia’s EU integration process by providing timely and relevant research, proposing evidence-based policy alternatives and actively working with citizens, civil society organizations and the policy community. Gender equality is one of the three areas where its research is focused, with specific attention on women’s participation, inclusion and economic integration, as well as violence against women.

The Coalition “Sexual and Health Rights of Marginalized Communities” (SHRMC) was formally established in 2010 as analliance of five different organization (HOPS, HERA, IZBOR, STAR-STAR and EGAL). SHRMC promotes the protection and respect of the fundamental human rights of marginalized communities such as sex workers, drug users, people living with HIV and LGBTI people. The main areas of its work are: increasing access to quality health, social and legal services; advocating for laws, policies and practices that prevent discrimination and other human rights violations of marginalized communities; and legal empowerment and stronger participation of marginalized communities in the struggle for the realization of their rights and freedoms.

I. SUMMARY

1.  We have jointly prepared this information to supplement the information available to the Human Rights Committee in the examination of Republic of Macedonia on its implementation of the International Covenant on Civil and Political Rights.

2.  The government’s response to the LOI (Question 7, paragraphs 30-34) makes reference to the changes in the law in relation to abortion; however, the response does not address the numerous concerns that civil society has raised about the ways in which the changes in the abortion law fall short of the requirements of the Covenant, in relation to Articles 2, 3, 4, 5, 6, 7, 17 and 26. The government has given no explanation of why the law was changed and has not been able to point to any improved health outcomes for women. It has neither addressed the fact that the change in the law was part of a widely disseminated anti-abortion government campaign, which was grounded in gender stereotypes that are contrary to the Covenant and to the Committee's previous recommendations to Macedonia.

3.  In this submission, we provide information and concrete case studies on the impacts, individually and cumulatively, of the measures included in the new law. We highlight that the new measures are designed to shame and stigmatise all women who access abortion services, to make access to abortion more difficult for many women, as well as that they are likely to worsen health outcomes or cause unnecessary physical and mental health harms to women.

In particular, we provide additional information on the following issues:

1.  Introduction of new legislation on abortion - the Law on Termination of Pregnancy - which raises concerns about State compliance with the Covenant in that: (1) the Law was adopted in a short and non-transparent procedure, without consulting experts and without any public debate; (2) the legislation includes provisions that were not contained in previous legislation; these new barriers (i.e. mandatory request, mandatory counselling and mandatory waiting period) create significant new and discriminatory legal barriers to women's access to legal abortion and thereby have serious consequences for women’s health, and are humiliating and degrading to women, contrary to human dignity and the fundamental rights to privacy and confidentiality;

2.  A Government campaign against abortion that aimed to stigmatise and discriminate against women who choose abortion and that illustrated State attitudes based on gender stereotypes;

4.  The actions taken by the State and described here are retrogressive and are not in compliance with the Covenant. The 2013 Law is more restrictive than the previous (1976) Law and introduces new legal barriers in Macedonia. The Law was introduced through a non-consultative and accelerated process that ignored the recommendations of international and Macedonian health expert bodies. The new provisions introduced have no health related rationale, and indeed have significant potential to endanger women’s physical and mental health. The Law was introduced in conjunction with a widespread anti-abortion government campaign. Notwithstanding the clear intention of the law to make women’s access to lawful abortion more difficult, contrary to the impression given in the state's response to the list of issues, no measures to enhance access to contraception have been introduced. In a context of low access to information on family planning, the Law would negatively affect the health and life of women in general, and in particular those who due to reasons related to poverty, gender inequality or family violence will be forced to seek unsafe abortion services. It should be noted that unlike other medical procedures abortion is not covered under national health insurance, so that women must incur the costs of the procedure. Four case studies illustrate the harmful impact of the new law on women’s health:

Case study 1

On 05.09.2013, due to injuries caused by a fall from a height, a woman with physical and mental disabilities was received in the emergency ward of the Clinical Centre in Skopje. During the examination and provision of health services by the medical staff it was established that the patient was pregnant, after which she was transferred to the Gynaecology and Obstetrics Clinic. The next day, during the gynaecological examination, the pregnancy was confirmed, while during the ultrasound exam it was established that the foetus was dead. That same day the woman was released from the Gynaecology Clinic with the explanation that she is not bleeding and that this did not represent an emergency situation, while also recommending monitoring of the situation. On 09.09.2013 the woman reported back to the Gynaecology Clinic for the purpose of having an abortion, but according to the statements of the staff she was informed that three days have to pass before an abortion can be performed. Following an intervention by an NGO, the abortion was performed on 11.09.2013 or 5 days after the day when it was established that the woman was carrying a dead foetus.

Case study 2

“I was bleeding for three weeks already and I didn’t know what was wrong with me. On 12.09.2013, with a regular referral from my family physician, I went to the Gynaecology Clinic to have an abortion because I had a hematoma and I couldn’t keep the foetus. I was not hospitalized after the examination at the Gynaecology Clinic. The doctor told me that I should have gone back to my family physician so he can explain to me the new abortion law. His exact words were “Don’t you follow the media, don’t you watch the news.” I came back home. The following day I went back because I was in a lot of pain. After several attempts and another examination I was referred to a social worker and a psychologist to receive counselling on the abortion procedure. After I signed the consent form I was not accepted in the hospital, but I was turned back and told I will have the intervention after 3 days. I had the abortion on 16.09.2013“ – testimony from October 2013.

Case study 3

In October 2014, a woman who was carrying a foetus diagnosed with serious malformations was not allowed to choose an abortion as her health was not judged to be directly under threat. “During the humiliating process of counselling, a counsellor tried to persuade me to keep the baby by saying that it “may not be beautiful, but it will be intelligent”. The procedure for terminating the pregnancy was not being properly and fairly implemented. When the pregnant woman wanted to file her request for the termination, she was told that the form did not exist and that she had to create her own because the hospital had not received by –law guidance on the form and content from the Ministry of Health, as laid down in the law. The time was a serious consideration because it was a case of pregnancy after the 10thweek.

After the woman managed to file a request on her own, the primary commission (expert committee) made no official decision and simply forwarded it to a secondary commission. She was also asked to file a new request for the secondary commission. This represents a significant breach of the law because the secondary commission can process only cases referred from the primary commission. In this example the secondary commission functioned on the primary level. The secondary commission should be appointed by the Minister of Health and the bureaucratic process took a long time. Eventually, the secondary commission and the Minister of Health himself decided that the legal terms for abortion were not met and refused to allow the termination of the pregnancy, even though the woman still legally had the right to access the procedure. At the end, the women filed a plea to the Administrative Court and had no other option but to keep the pregnancy.

Case study 4

In September 2014, a 30-year- old women in the 7th month of pregnancy, found, during a regular medical check–up, that the pregnancy might be life threatening, and she was advised for abortion. After a second opinion from other gynaecologists, she was admitted at the State Gynaecological Clinic. She was informed that because it was a case of pregnancy after the 10th week she needed a decision from the primary commission. But the commission meets only once a week, and she was forced to wait for its next meeting. The women had to wait for 4 days before meeting the Commission that consisted of a gynaecologist, a psychologist and a social worker. “Though I had the knowledge that I was carrying a ticking bomb inside me, I had to run between desks and commissions and to wait several days in order to obtain consent for terminating the pregnancy.” After going through the documents and medical evidence showing that the chances of having a healthy child were very low and that the mother’s health was in danger, the primary commission insisted on another medical examination and the woman was told that there might be a need for confirmation from the secondary commission. The woman and her husband stated that they would initiate legal proceedings against the members of the commission if they unnecessarily and unlawfully prolonged the process by referring the case to the secondary commission. Finally, the woman was granted a permit to terminate the pregnancy. The gynaecologist who performed the abortion told her “If you waited a minute longer I am afraid we couldn’t have saved you!”

II. BACKGROUND

5.  The Republic of Macedonia in its Third Periodic Report on the International Covenant on Civil and Political Rights[1](Paragraphs 150 and 152) reports on the progress of sexual and reproductive health services and the improvement of protocols. However, the report does not cite any reasons for the changes in the legislation regulating abortion. The number of abortions in the country has been steadily decreasing: the abortion rate in Macedonia in 2000 was 38.9 per 100 live births[2]; by 2012, the rate had fallen to 23[3].

6.  It should also be mentioned that abortion can only be performed in gynaecological-obstetrics hospitals and not in primary health care institutions. Those women particularly affected by this restriction are women who have to travel a long distance to the health institution, women who do not have access to reliable forms of transportation, women who cannot take leaves of absence to visit the institution due to work or child care duties or fear of stigma, women from marginalized groups, women who live in rural areas and poor women.

7.  As confirmed by the information on the low number of prescribed contraceptives on an annual level in the state's response to the list of issues, the access to modern methods of contraception in Macedonia is very limited.[4] The most recent Multiple Indicator Cluster Survey (2013) conducted by UNICEF shows that the usage rate of any type of modern method of contraception in women between 15 to 49 years of age is just 12.8%[5].

8.  Although in 2011, the Government of the Republic of Macedonia adopted the National Strategy for Sexual and Reproductive Health 2010-2020, it has not adopted action plans for its implementation, neither has it allocated resources for its implementation. The main reason cited for this was the decision not to provide oral hormonal contraception as part of the health insurance. The national laws are guaranteeing health insurance covering different medical services and medicines for all citizens, but still oral or other modern forms of contraception are not enlisted in the “positive list” of medicines that is covered by the insurance fund.

9.  Access to information on sexual and reproductive health in the state curricula is limited. While the state’s response to the list of issues is indicating that “lectures are also held in schools about contraception and planned pregnancy”, in fact, the reality is different and a recent research[6] among high schools students shows that 21% of them stated they had received information on family planning, 22% on condom use and only 8.5% on oral contraception during the biology classes. Contrary to the impression given in the state's response about the Counselling offices for family planning and contraception throughout the country, the State Public Health Institute report in 2014[7] is underlining many challenges. The evaluation has found that in these offices there are no appropriate premises, no definition of working hours, absence of trained personnel and gynaecologists, low number of clients. The main reason for this is that there was no state funding secured after the internationally supported project was finished.