Slovakian health minister holds keys to unlocking abortion pill impasse

The political debate around access to abortion in Slovakia, Hungary, Poland and Malta – the EU countries in which medical abortion is prohibited – has dogged numerous election cycles and health ministers, with no major shifts.

The only legally recognised method of abortion in Slovakia remains surgical abortion under anaesthesia.

Last year, 11,526 end-of-pregnancy procedures were conducted, out of which 5,539 were induced terminations, followed by 5,382 spontaneous miscarriages, 424 ectopic pregnancies, and 181 cases of other types of abortions.

The data, however, provides an incomplete story. Not counted is “abortion tourism”, travelling to another country to access an abortion. While not as widespread for those in Slovakia as in Poland, some women still travel to bordering Austria, where the rules are more lenient.

Additionally, in some cases, people choose to get the abortion pill shipped from abroad, though this can come with increased risks for the patient.

In the health minister’s hands

Throughout the 2023 election campaign, Slovakia’s Health Minister Zuzana Dolinková said on multiple occasions that she is in favour of approving the abortion pill as the safest procedure for prematurely terminating a pregnancy.

When leaving office, the former health minister from the caretaker government, Michal Palkovič, moved along the procedure for the approval of a medical alternative to the surgical intervention for the new health minister.

Dolinková can introduce the new policy independently with a signed ordinance but has said she would like to initiate a debate with medical professionals first. Most of the medical community concurs that an abortion pill presents a less invasive and risky procedure for women than a surgical procedure.

However, her coalition partner, the Slovak National Party, strongly opposes the introduction of the abortion pill.

Dissatisfied conservatives and liberals

Currently, the termination of pregnancy is allowed within the first 12 weeks of gestation without a given justification. A mandatory 48-hour waiting period is imposed between the initial request and the procedure. Only a surgical intervention under anaesthesia is permitted.

Second-trimester abortions are allowed only for medical reasons, qualifying circumstances being that the woman’s life or health is endangered, if the healthy development of the fetus is threatened, or if the fetal development manifests genetic anomalies.

The conservatives have unsuccessfully attempted to amend the rules, repeatedly filing requests to amend the law at six-month intervals, the minimal limit for re-introducing a failed legislation.

The proposals include shortening the legal limit from 12 to eight weeks or allowing abortions only if there is a threat to health, incorrect genetic development of the embryo, or if the pregnancy is a result of a severe crime.

The liberal spectrum proposes the approval of the abortion pill as a less invasive option to the surgical procedure as a first step towards improved rules in reproductive rights.

The medicine’s registration expired years ago

The abortion pill consists of two tablets containing an active substance, Mifepristone, marketed under the commercial names Medabon and Mifegyne.

Medabon and Mifegyne were registered by the State Institute for Drug Control (ŠÚKL) at the end of 2012.

The use of the pill was prevented by a decree from the Health Ministry, restricting any form of abortion other than a surgical procedure. As a result, Medabon and Mifegyne were never brought to the Slovak market.

To clarify what it means for the current state of these two drugs, Euractiv contacted the State Institute for Drug Control.

“If a medicine is not put on the market for three consecutive years, its registration, under the sunset clause, is cancelled and cannot be extended. Based on this condition, the medicines’ registration expired,” Jana Matiašová, ŠÚKL’s spokesperson, told Euractiv.

Asked whether Mifepristone-containing drugs are currently considered for approval or new registration, Matiašová responded that ŠÚKL hasn’t received any new applications for the registration of these medicines.

The drug’s re-registration is conditional upon its arrival on the market, which can happen in two ways. “Either a pharmaceutical company submits a new application and ŠÚKL issues a new registration, or the Health Ministry issues a special approval for the use of an unregistered drug,” said Matiašová.

The buck stays with the health minister

Two weeks ago, the parliament approved the government’s official agenda for the next four years. It states that “health does not follow ideology”, which Dolinková has the chance to affirm.

With Slovakia remaining one of the last EU countries not to have the less invasive abortion pill method approved, eyes are on Dolinková to see if she will push access forward under her new mandate.

[By Filip Áč, Edited by Vasiliki Angouridi | Euractiv.com]

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