Lily* has gotten used to being in the wrong place at the wrong time. Since the start of the war, over a million Ukrainians have fled across the border into neighbouring Hungary and Lily was among them. Once there, she got pregnant and wanted an abortion but ran up against the complexities of the Hungarian healthcare system.
“When she found out how long she had to wait and what the conditions were, she wanted to go back to Ukraine,” explains her field worker from EMMA Association, a Hungarian organisation focusing on women’s rights and access to reproductive healthcare. Lily was not alone.
A study which interviewed 80 refugees between July 2022 and April this year has found Ukrainian women in Hungary, Poland, Romania and Slovakia opting to return home to access reproductive healthcare. The report – compiled by the Center for Reproductive Rights and co-authored by eight human rights organisations, including the EMMA Association – reveals that the women have faced long delays, financial hardship, institutional racism, and anxiety-inducing inadequate care. The refugees concluded that while dangerous, accessing reproductive-based healthcare was “easier” in war-torn Ukraine.
“The healthcare system is even difficult to navigate for Hungarian women. It’s not women-centred at all,” sighs Ezster Kallay, communications officer at EMMA Association. Surgical abortions are legal up until 12 weeks in Hungary, but in reality, women are subjected to a series of loopholes designed to make the legislation redundant.
The process of obtaining an abortion begins with an appointment to confirm the pregnancy which includes “listening to the fetal heart rate” explains a field worker from EMMA Association. By law, women are then required to attend two mandatory meetings with a state healthcare provider, the first one informs them of their other options, including adoption, while the second’s purpose informs them of the surgery’s dangers. The abortion then costs 45.312 HUF (approximately £95), although the government have waived this fee for Ukrainian refugees.
It’s an elongated and emotionally strategic system, targetting women’s 12-week legal window and, according to a report from Euronews, one that causes 10-15 Hungarian women a week to now travel to Austria for abortions. Subject to a doctor’s prescription and not subsided by national health insurance, the European Contraception Policy Atlas also ranks Hungary’s access to contraception as one of the worst in the continent, scoring only better than Poland, Belarus and Russia.
Ultimately, fearing leaving or making the journey with her two young children, Lily remained in Hungary to have an abortion. However, another client of Lily’s field worker decided to go back to Ukraine to gain access. “She didn’t want to go through the several-week procedure,” they said.
“In Ukraine, you just go in, pay and get it done. There is no required screening or check-ups, you just pay and have the abortion. This process has its own set of risks, but it is much faster and emotionally less demanding,” another EMMA Association field worker shared, they had worked with one young girl who returned to Ukraine for an abortion, where her mother arranged everything back home. In another one of her cases, a 14-year-old girl, who fled with her mother, needed an abortion, only when she explained to the pair the steps required in Hungary, the mother told the field worker that they would rather go home for the procedure. Both mother and daughter did and then they once again fled to Hungary.
When the news of the invasion first broke, EMMA Association’s field workers “jumped in their cars and went to the border”, pausing to pick up a few things that they felt would be needed for the women who fled. Soon, the organisation launched its humanitarian programme, supported by CARE International, offering specific social work for female refugees. “Although, what we thought would be the most important issues were not,” explains Anna Iványi, head of international relations and advocacy for EMMA Association.
In those opening days of the conflict, the eight field workers arrived with first aid kits, sanitary towels and nappies and, while this was helpful, their team soon realised that they would be required to offer more practical help, such as organising temporary protection status and arranging and transporting women to hospital appointments for those who have dual citizenship. “This is how it all evolved into this more complex case management,” she explains.
“Just by the field workers being there, they get much more attention, and they get the treatment that they have the right to receive,” explains Kallay. An announcement by the Hungarian government said that Ukrainian refugees should have the same access to national healthcare as Hungarian citizens and therefore should receive equal treatment but, in practice, this was not always welcomed by healthcare professionals. “A lot of the field workers print out certain paragraphs from announcements or new legal documents that prove that they have this right because otherwise, they wouldn’t necessarily get this treatment,” she adds.
To date, EMMA Association has helped approximately 1,000 Ukrainian women, at least 20% of whom were minors, and provided longer case management to between 200 and 400 women. Eventually, women who had the financial resources to do so moved on to other countries or were able to source their accommodation, rather than wait for the Hungarian system. “This is how we ended up with mostly Roma people, they did not have the ability,” explains Iványi. Now, 80-90% of the women EMMA Association works with are Roma.
“This is also important because it shows that they get the least support and there’s also a huge bias against them in many areas in Hungary. In the job market but also the healthcare system,” argues Kallay. When women arrived at the border, EMMA Association field workers found that Roma women were not being passed the correct information about where they could go or securing documentation. “The women discriminated against from the very beginning,” adds Iványi and 17-year-old Ruby* was one of them.
When the war broke out, while Ruby’s* parents stayed in Transcarpathia in Western Ukraine, she fled to Germany with her partner and his family, where his partner’s grandmother became her legal guardian. When her partner was then able to secure work in Gyál in Hungary, he and Ruby moved once more and EMMA Association workers officially translated this guardianship authority to Hungarian.
In Ukraine, there is less healthcare bureaucracy surrounding pregnancy as, if a woman is age 16 or over when she gives birth, she will not be assigned a guardian. In Hungary, however, anyone under the age of 18 needs a guardian before accessing healthcare, even if you do not need one in another country. This has meant, as was the case for Ruby, EMMA field workers needed to secure minors’ guardianship before assisting with their healthcare needs, adding to the piles of bureaucracy women had to wade through.
As is the case in Hungary, there is also no need to secure multiple trips with a family doctor or midwifery service and each woman ordinarily is looked after by one gynaecologist for the duration of their pregnancy. “I often see women being shocked by the number of healthcare professionals they have to deal with during pregnancy care in Hungary,” her field worker explains.
Moving to Gyál was not “a free choice” for Ruby and her partner, her field worker tells me. “Ruby was constantly in need of someone driving her to the tests. A paediatrician was also not readily available if needed,” her field worker explains, adding that their assigned accommodation was on the outskirts of the town, surrounded by highways. Even if Ruby wanted to, she could not make the journey on foot – it was an hour and a half from the centre of Gyál. The assigned nurse did not do house calls that far out of town and, once Ruby had given birth, the house would not have been a suitable sterile environment for the baby’s mandatory vaccinations.
“This is what happens to many Ukrainian refugees. They try to take on a job through which their accommodation is secured. These are often factory jobs where they live in mass housing. It is not comfortable and it is an unsuitable environment for a new mother or baby, about eight people sleep in iron beds. However, other housing options are not available to them,” they say. Accommodation provided by the Hungarian state usually resides in the countryside, where employment options are low. Civil organisations’ resources are exhausted as while they can provide housing in the short term, long-term housing is not common.
“We [EMMA Association] took her to the most important examinations, although I missed one or two,” explains the field worker. These small absences were enough for one of Ruby’s doctors to write “uncared for pregnancy” in her appointment booklet, a piece of documentation that must be shown at all appointments with healthcare professionals during pregnancy. While another doctor later reversed the judgement, her field worker suspects Ruby faced this treatment as she was Roma. Her field worker explained that when she was pregnant and had also missed appointments, she was not subjected to the same discrimination.
“The biggest issue for her was the inaccessibility of hospitals and paediatricians in the outskirts of Gyál. EMMA [Association] would have tried to solve it. We would have taken Ruby to the nurse or the hospital every week for an examination, but this was a problem for Ruby personally, that she would not be able to take care of herself and get care on her own. The Hungarian care system is also much more complicated that it causes women from Ukraine anxiety and they don’t understand why it must be this way,” concludes her field worker.
After hearing of her daughter’s struggles, Ruby’s mother suggested she should come back to Ukraine to have the birth and, despite the ongoing war and being heavily pregnant, Ruby opted to return. Her baby was born last month in Ukraine.
But Hungary’s healthcare system is also pushing women back to Ukraine for more routine medical issues, even those as minor as filling prescriptions. When some of EMMA Association’s clients tried to get their usual prescriptions, doctors instead tried to rediagnose their conditions and prescribe alternative medications as opposed to the ones they were accustomed to. “We understand, it is much easier to get prescriptions in Ukraine and also medicines are available without prescriptions there. There’s also no waiting list, like in Hungary,” says Iványi.
Then there are the more emotively driven motivations for returning: homesickness. “But then they return and realise that there is no home left. There is not always electricity and you cannot predict what will be open. Everything is very expensive in Hungary but even more so at the moment in Ukraine,” she sighs.
Travelling back to Ukraine is dangerous, complicated and starts with red tape. “Small children should have an ID with a photo when they cross the border. Sometimes, they just go through the border without official documents, but then they cannot come back and when they try and return to Hungary they get turned away. This is why our field workers have women get birth certificates and passports for their babies”, explains Iványi.
“Of course, it’s not reasonable to leave a one-week-old baby here. But there can be complications at passport offices meaning that sometimes children might be separated from their mothers during these travels back and forth,” she adds. Then, there is the danger of traffickers. “Yes,” she says, “we have heard about cases when these traffickers approach the refugees. They are looking for unaccompanied minors and children making this journey. They want to take these women to different parts of Europe for sex work.”
In March, Thomson Reuters researchers found that Ukrainian refugees were at a heightened risk of traffickers since the invasion. Their analysis of internet search trends found that views of pornographic videos claiming to show Ukrainian refugees had soared in the past six months. Most soberingly, in January alone they found that 13 of such videos were viewed 275,000 times.
Since the 2015 refugee crisis, Viktor Orban’s government has been ramping up its anti-immigration rhetoric. “There was this kind of xenophobic propaganda going on,” remembers Kallay, adding that it was interesting to see the shift in dialogue when the war started.
“This official communication was altered and it was said that we should be helping those in need. But still, the system itself was weak. There wasn’t a built-out plan for what happens to refugees who arrive in Hungary and it was very chaotic. I think that in countries that are more open towards refugees, for example, in Germany, there are more obvious ways to have someone to integrate into society,” she says.
In this atmosphere, refugees have struggled to find their footing. According to data from the UN High Commissioner for Refugees, by April only 35,000 had applied for the EU’s temporary protection status in Hungary, fewer than in almost every other EU country per capita.
Nearly two years into the conflict, Kallay and Iványi are trying to envision a future for these women, concerned about the lack of any long-term strategy from their government. “I would say one of the biggest issues is long-term housing because I think it’s the basis of everything. Then employment,” explains Iványi. There is also, they tell me, a lack of Ukrainian language resources in Hungarian schools for the minors who have fled the war and face a childhood in a foreign country.
“Donors have also lost interest and there’s always a new crisis,” surmises Iványi, as the Israel-Hamas war rages on, her words ring perhaps more true now than ever. Nonetheless, while Hungarian women are at war with their healthcare system, the country is no haven for women fleeing Ukraine.
*These names have been changed to protect anonymity