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Number of women using hormonal contraception has grown from 2% at the time of collapse of previous regime to almost 18% recently, e.g. nine fold. However, it is still quite low comparing to other EU countries. The number of women using any kind of modern contraception is about 42%; prevalence rate for any method is about 74%. Hormonal contraception is an object of medical prescription and is not covered by medical insurance at all. Emrgency contraception has since May 2005 the OTC status and can be purchace withouth presciption. However, Ministry of healt just relased a statement asking th Drug Agency to change their decision from May, so emergency contraception will be again an object of medical prescription.
In accordance with the current practice, contraception is fully covered by the patient. The consequence of this rather high price of contraception is that especially adolescent girls, young women and women from socially disadvantaged groups cannot freely choose the most adequate contraceptive method as their choice is limited by the price. In such way, contraception becomes unaffordable for many women particularly from the above mentioned groups. Similarly, other reproductive health services such as abortion and sterilization are at the price level of the minimum wage (app. 400 USD). If the performance of an abortion or sterilization is not conditioned by health reasons, these services are fully covered by the patient. High fees for these medical interventions make the access to these health care services particularly difficult for young women and women from socially disadvantaged groups as some Romani women living in marginalized settlements. The Committee on the Elimination of Discrimination against Women on its forty-first session urged „the State party to take measures to increase the access of women and adolescent girls to affordable health-care services, including reproductive health care, and to increase access to information and affordable means of family planning for women and men.“ [ii] However, no action has been adopted yet.
Slovakia belongs among the European countries with the most positive development in number of artificial abortions, which dropped down by 70% over last 15 years. There are 11,4 abortions per 1000 women in fertile age (e.g. 17.000 per year), which means approximately every fourth pregnancy. The biggest segments are women with two children (55% of all requirements). The main reasons for abortion are, aside with failure of contraception, economic reasons and the problem of conflict between nurturing the children and keeping the family against the employment of mother. The cost of abortion doubled in 2003 to EU 250 – 400 and has to be paid full by the women (the averange sallary in Slovakia is about 600 EU).
According to the current law, an adolescent girl under 18 needs the consent of the parent or other legal guardian for performance of abortion. This provision does not reflect the fact that some girls do not want, for various reasons, their parents to learn about the pregnancy or its termination. The requirement for the parental consent or notification on the termination of pregnancy can result in violation of the patient’s right to privacy and confidentiality. At the present time, the increasing emphasis on the evolving capacities of the child and its right to adequate attention paid to its interests should be reflected also in the provisions on the artificial termination of pregnancy.
Due the legal changes last year a mandatory counseling following by waiting period of 48 hours is required for performance of an abortion. According the law the gynecologists are obliged to mail the informed consent including personal data of all women considering abortion regardless of their decision to undertake it or not, to a state agency. The collection of personal data by state can be considered as a breach of protection of personal data and violation of private life of woman.
Within the framework of educational process and upbringing at schools, the state is responsible for the contents and implementation of education to sexual health as part of preparing children and youth for marriage and parenthood. In Slovakia, sexuality education is not a separate subject, but is a part of other school subjects, particularly the ethics, religious education and biology. More than ten years after the Ministry of Education approved a new curricula for sexuality education at the basic and primary schools, the level and quality of the education is still very low. It is common practice that adolescents do not receive relevant information on prevention of STIs including HIV/AIDS and unwanted pregnancy, let alone issues like sexual orientation and sexual and reproductive health rights. Despite the Committee on the Elimination of Discrimination against Women recommended to government to „ensure that sex education be widely promoted in schools and targeted at both girls and boys“[iv], the current situation after the reform of the education system is getting even worse since the sexuality education is not mandatory anymore.
The core of this preparation at basic and secondary schools is included in the curriculum of mandatory optional subjects of ethical and religious education, which shall give parents and pupils a choice in selecting education in accordance with their worldview. However, the sexual education performed on religious education is very conservative and subjective. The pupils do not get the objective information about family planning policy and modern contraceptives, the only method preferred is the sexual abstinence before marriage and natural family planning. The sexuality education on ethics is very depending on the teacher’s approach, there is no minimum standard on knowledge required. There are not avaiable modern and pupilsfrendly sexuality education materials.
HIV/AIDS and STI
HIV/AIDS occurrence in Slovakia is substaintionally lower then in the EU. According to reports of the National Reference Centre for HIV/AIDS, since 1985, 222 people in Slovakia have been infected with the virus and 23 have died of AIDS. Although experts claim the real numbers could be five to ten times higher, Slovakia is still registering low numbers when compared with other countries. The low prevalence of HIV/AIDS in Slovakia has more to do with the country’s isolation and fortunate location than public awareness and responsibility.
The occurrence of syphilis increased significantly in the last years. By 1990, the syphilis incidence in the Slovak Republic was lower then in EU. At present, the figures are approximately for times higher then EU level.
In Slovakia, there is still a low number of assisted reproduction interventions performed. Performing the assisted reproduction intervention is conditioned by intimate physical relationship between a man and a woman. This provision discriminates against single women who would like to get pregnant by means of assisted reproduction, as well as against women in homosexual relationships.
Problems and restrictions
In the area of reproductive health the main problem in Slovakia remains the ideological opposition to sexual and reproductive rights as well as economical and social restrictions in access to reproductive health services. No comprehensive national public health policy exists in this area despite of several trials beginning in year 2003 to introduce a National Program on Protection of Sexual and Reproductive Health in the Slovak Republic. The proposed program draws mainly upon the World Health Organization’s principles and the Program of Action of the UN International Conference on Population and Development (Cairo, 1994). Due the opposition of conservative forces the Program has been canceled twice, by previous and recent government. A new draft of National Program on Care for Women, Save Motherhood and Reproductive Health has been introduced beginning of year 2009. However, because of the strong opposition it has not been adopted yet (and probably will never be adopted).[i]
The access to sexual and reproductive health services in Slovakia is considerably restricted by exercising the conscientious objections to such services. The conscientious objections is exercised not only by the health care staff, but it is also often abused by the top management of hospitals, who frequently ban performance of some interventions (usually abortions or sterilizations) regardless of the opinion of the health care staff. These hospitals thus violate the very essence of the conscientious objection, which can be exercised only by a natural person. The Committee on the Elimination of Discrimination against Women recommended to government to „adequately regulate the invocation of conscientious objection by health professionals so as to ensure that women’s access to health and reproductive health is not limited… It recommends that, if health service providers refuse to perform such services based on conscientious objection, measures should be introduced to ensure that women are referred to alternative health providers.“[iii] Similar as in previous case, the state did not responded yet by adopting any regulation.
[i] Following text is mainly based on the Shadow Report to the Committee on the Elimination of Discrimination against Women for the Slovak Republic
[ii] Concluding observations of the Committee on the Elimination of Discrimination against Women: Slovakia. Committee on the Elimination of Discrimination against Women. Forty-first session. 30 June-18 July 2008. 7 CEDAW/C/SVK/CO/4