Second trimester abortions: a preventable crisis in global abortion care

Kamila had dearly wanted to have a child. The 27 year old was happily engaged to be married and was 17 weeks pregnant when a scan showed that her fetus was developing without a skull and wouldn’t survive to birth. She was refused an abortion in her home country of Poland, where abortions in the case of fetal abnormality are prohibited.

On her way to the Netherlands, where an abortion had been arranged by the charity Abortion Without Borders, Kamila (not her real name) started bleeding heavily in a petrol station toilet. Distraught and weak, she had to be transported to a German hospital, where she gave birth to a dead fetus in the emergency room. Kamila returned to Poland after a four day hospital stay, with a bill for her medical treatment from the German state.

Poland has some of Europe’s most restrictive abortion laws (fig 1). The law that forced Kamila to travel had been in place since 2020, introduced to Poland’s Constitutional Tribunal (the national court that supervises compliance of statutory law with the country’s constitution) by the Polish Law and Justice Party, which was voted out of power on 19 October 2023. In those three years the ruling has effectively shuttered Polish abortion provision: both medical and surgical abortions are inaccessible in Poland, even in cases where they’re technically legally permitted, such as when there’s a threat to the life or health of the parent.

To date, four women have died of sepsis and other complications after being denied abortions in …