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

aromatherapy as extras during deliveries. The Polish Federation for Women and Family
Planning argued in an open letter to the Minister of Health, to no avail, that this excludes many
women from otherwise available advances in maternity healthcare and constitutes a patient’s
rights and human rights violation (Nowicka 2010; Zielińska and Nowicka 2009).

The significance of greater out-of-pocket cost of women’s healthcare should also be understood
in the context of women’s economic position after 1989. East European nations are experiencing
“feminization of poverty” as women are fast becoming the new economic “underclass”: they
have greater likelihood of falling below the poverty line as compared to men and constitute the
majority of the unemployed since 1989 (Domanski 2002).

Hospitals are also becoming privatized, although this trend is gradual. As newly-privatized
hospitals are only nominally regulated and not required by the state to provide a full range of
services, gynecological care is not always included. Yet, Poland has one of the highest rates of
cervical cancer and the highest mortality rate due to this illness in the EU, mainly because less
than 20% of cervical cancers in Poland are detected in the premalignant stage. Despite the
epidemic levels of cervical cancer, the Polish state fails to dedicate state resources to population-
wide screenings.

Moreover, because of cuts in healthcare expenditures, doctors’ and nurses’ wages are frozen,
which drives providers to emigrate—since 2004 thousands have been registering to work in the
UK’s National Health Service (McLaughlin and Smith 2005). This exodus has depleted
Poland’s health system, leaving only 203 doctors per 100,000 population—a dismal ratio ranking
Poland near the bottom in Europe, and only surpassed by Romania, Bosnia and Herzegovina, and
Albania, all of which have a far lower GDP per capital than Poland (WHO 2009).

Some conclusions and directions
According to the World Bank’s assessment of the post-Soviet region, “the transition from
planned to market economy has witnessed one of the biggest and fastest increases in inequality
ever recorded” (Milanovic 1998:1). The effects of market reforms in healthcare tell part of this

Berer, Marge. (2010). “Who has responsibility for health in a privatised healthcare system?”
Reproductive Health Matters 18(36):4–12.

Chavkin, Wendy, Sara Rosenbaum, Judith Jones, and Allan Rosenfield. (2010). “Women’s
Health and Healthcare Reform: The Key Role of Comprehensive Reproductive Healthcare.” At:
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Domanski, Henryk. (2002). “Is the East European ‘underclass’ feminized?” Communist and
Post-Communist Studies 35(4):383-394.

Maarse, Hans. (2006). “The privatization of healthcare in Europe: an eight-country analysis.”
Journal of Health Politics, Policy and Law 31(5): 981-1014.

McLaughlin, Daniel, and David Smith. (2005). “Doctors go west in Polish brain drain.” The
Guardian 15:21.

Milanovic, Branco. (1998). “Explaining the increase in inequality during the transition.” Policy
Research Working Paper. Washington, DC: World Bank, 1998. Report #WPS1935, Vol.1.

Mishtal, Joanna. (2010). “The Challenges of Reproductive Healthcare: Neoliberal Reforms and
Privatisation in Poland.” Reproductive Health Matters 18(36):56–66.

Nowicka, Wanda. (2010). “List otwarty o bezpłatne znieczulenie farmakologiczne przy
porodzie.” Federation for Women and Family Planning, 16 February 2010. At:
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/>bezpatne-znieczulenie&catid=11:centrum-prasowe&Itemid=17 Accessed: 10-9-2011.