Revisiting Polish Abortion Law: Doctors and Institutions in a Restrictive Regime
| Date | 01 June 2022 |
| Published date | 01 June 2022 |
| Author | Atina Krajewska |
| DOI | 10.1177/09646639211040171 |
| Subject Matter | Articles |
Revisiting Polish Abortion
Law: Doctors and
Institutions in a Restrictive
Regime
Atina Krajewska
Birmingham Law School, University of Birmingham,
UK
Abstract
This article examines the motivations of doctors operating in restrictive abortion
regimes, and it takes Poland as a case study. It places in the foreground institutional
and intra-professional factors that determine abortion healthcare, which to date have
been accorded little attention. The article compares the impact that criminal, profes-
sional, and social sanctions have upon the provision of abortion services. In so doing,
its purpose is to refocus debate in this area. It aims to move the emphasis away from
legal and political factors, including the criminalisation of abortion, and to place it on
medical agency. The Polish case study is examined to test out, in the context of a late-tran-
sitional polity, the sustainability of neo-institutionalist approaches to the study of law and
organisations and the sociology of professions. The analysis is particularly important and
urgent in light of the recent retrenchment of reproductive rights in Poland, and beyond.
Keywords
Abortion law, reproductive rights, medical profession, medical autonomy, Poland, neo-
institutionalism, law and organisation studies, transitional society
Corresponding author:
Atina Krajewska, Birmingham Law School, University of Birmingham, Law Building, Edgbaston B15 2TT, UK.
Email: a.krajewska.1@bham.ac.uk
Article
Social & Legal Studies
2022, Vol. 31(3) 409–438
© The Author(s) 2021
Article reuse guidelines:
sagepub.com/journals-permissions
DOI: 10.1177/09646639211040171
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Introduction
Writing over 20 years ago about the history of abortion law in the USA, Reagan (1997: 3)
noted that ‘[i]t would have been virtually impossible for the state to enforce the criminal
abortion laws without the cooperation of physicians’. The studies of abortion in different
regional and socio-political contexts have confirmed that (a) historically, official medical
bodies provided strong support for the criminalisation of abortion (Keown, 1988; Luker,
1984; Mohr, 1978; Sheldon, 1997; Solinger, 1998); (b) many physicians are, at least offi-
cially, inclined to interpret abortion laws narrowly, limiting or denying access to abortion
services (Bentancur Pérez and Rocha-Carpiuc, 2020; Bergallo, 2014; De Zordo and
Mishtal, 2011); and (c) the medical profession is generally reticent to support liberal abor-
tion reforms (Freedman, 2010; Joffe, 1995; Joffe et al., 1998). Yet, far less is known
about the reasons and mechanisms that shape the collective and individual behaviour
of the medical profession and its members
1
in relation to abortion in states with restrictive
abortion regimes. Much social science literature to date has emphasised the impact of
conservative legal and political actors, at both national and international levels, on abor-
tion practices (Enright and De Londras, 2018; Petchesky, 1984; Solinger, 1998; Yamin
et al., 2017). Criminalisation and the so called ‘chilling effect’of the law are often
seen as primary factors constraining access to lawful abortion services (Nowicka,
2011). Researchers have attempted to account for physicians’behaviour on historical
and cultural grounds, including deeply rooted patriarchal structures, pervading paternal-
ism and the importance of religious organisations in society (De Zordo, 2018; Hoff, 1994;
Jankowska, 1991). However, these studies often omit important aspects of abortion law
and healthcare.
This article gives prominence to institutional factors determining the collective and
individual behaviour of medical professionals, which to date have been accorded little
attention (Freedman, 2010; Halfmann, 2011; Joffe, 1995). It combines insights from
the sociology of professions and (neo-)institutional theory to argue that questions con-
cerning the behaviour of the medical profession regarding abortion cannot be comprehen-
sively addressed without the analysis of professional organisations and employment
structures. Such studies have generated important insights by analysing the impact of
law, organisational practices and processes of professionalisation on the development
of institutions (Chiarello, 2019; DiMaggio and Powell, 1983; Edelman et al., 2010).
2
This article extends this research by examining the legal, professional, and employment
frameworks shaping the relationships and power dynamics within the medical profession,
addressing, in turn, how these affect the development and operation of abortion law. In
particular, it considers the factors determining physicians’professional autonomy in rela-
tion to abortion, that is, their regulatory independence from the state and their decision-
making power in every-day medical practice (Freidson, 1993). On this basis, the article
assesses the role that criminal law, professional regulation and institutional and organisa-
tional relationships play in restricting professional autonomy, and it investigates how
these restrictions impact upon the provision of abortion services. As such, the study
adds an important layer of analysis to scholarship concerning attitudes and behaviour
of healthcare professionals in relation to abortion. Existing studies have shown how emo-
tionally driven attitudes, in particular the fear of negative legal, professional and personal
410 Social & Legal Studies 31(3)
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