Amid the public debate surrounding the treatment of Mrs. Mirela Čavajda by Sv. Duh Hospital and other Zagreb hospitals – and the healthcare system as a whole – the Ombudswoman supports the position publicly stated by the Gender Equality Ombudswoman, who has jurisdiction over this matter.

At the same time, as the institution responsible for promoting and protecting human rights and freedoms, and as the central body for combating discrimination, we emphasize a series of legally defined answers to key questions raised in recent days. This is essential in the context of the rule of law and patient rights, considering both the scope of the issue in this case and the underlying systemic problems.

We also urge all those participating in the public debate to do so respectfully, acknowledging the dignity and rights of Mrs. Čavajda and her family, who are experiencing extraordinarily difficult moments, both due to the medical situation and because of Mrs. Čavajda’s brave decision to raise public awareness about a systemic issue in Croatia through her personal experience.

Implementation of current law on pregnancy termination in exceptional circumstances

In Croatia, the Law on Health Measures for the Realization of the Right to Freely Decide on Childbirth (Official Gazette nos. 18/78, 31/86, 47/89, and 88/09) is in force and must be implemented.

Although abortion regulation is a multidisciplinary issue and the medical profession plays a key role in the procedure itself, interpreting existing regulations is primarily a legal matter. Therefore, it’s important to reiterate the provisions of the law currently in effect, which must be applied.

The law is based on the right to freely decide on childbirth, which can only be limited for health protection purposes under conditions and procedures prescribed by the law (Article 2).

  • Article 15 defines abortion as a medical procedure that can be carried out up to 10 weeks after conception, and beyond that only with the approval of a commission, under conditions and procedures established by the law.
  • Article 22 allows the first-level commission to approve abortion after 10 weeks of conception, with the pregnant woman’s consent or at her request, in the following cases:
    • when medical indications show that no other method can save the woman’s life or prevent harm to her health during pregnancy, childbirth, or postpartum;
    • when medical indications and scientific knowledge suggest the child is likely to be born with severe congenital physical or mental defects;
    • when conception occurred due to a criminal act such as rape, sexual abuse of an incapacitated person, abuse of authority, sexual activity with a child, or incest.
  • Article 25 further states that, regardless of the legal conditions and procedures, abortion must be carried out or completed if there is an immediate danger to the life or health of the pregnant woman, or if the abortion has already begun.

However, reliable media reports indicate that these legal provisions are often not implemented in Croatia, and that women face significant obstacles. Consequently, many women in similar situations travel to Slovenia for an abortion, as confirmed by Slovenian doctors.

 

Timely action, informed decisions, and consistent criteria in line with the law

According to the law, the first-level commission can approve abortion based on the woman’s request, and contrary to some public claims, the key factor is not whether the child would be born alive, but whether the child is expected to be born with severe congenital physical or mental defects.

The public discourse often frames abortions before the 22nd week as “miscarriages,” and those after as “induced labor” or “feticide.” However, the law does not define any gestational limits in exceptional circumstances covered by Articles 22 and 25, and uniformly refers to these situations as “pregnancy termination,” regardless of gestational age.

The medical profession is responsible for making the appropriate diagnosis. If a diagnosis indicates the expected outcome mentioned above, and after the woman has been fully informed, she has the right to choose: she may give birth or request a termination. It is the duty of healthcare providers to inform her of her rights, options, deadlines, and procedures.

Moreover, the law allows for termination after 10 weeks not only based on fetal diagnosis but also for reasons concerning the woman’s health. Therefore, even when a woman cites fetal issues, decision-making must also consider her overall health, including mental health, as recognized by the World Health Organization.

If a woman applies for a termination after the 10th week due to exceptional circumstances, the rule of law requires that commissions act promptly, apply consistent criteria, and are law-abiding. These commissions should also include not only doctors but psychologists and legal experts.

 

Right to conscientious objection

The Gender Equality Ombudswoman has previously warned about the Sveti Duh Clinical Hospital, which has not provided abortions on request for over 10 years due to all staff invoking conscientious objection. The hospital recently stated it is seeking external collaborators from other hospitals to perform such procedures.

Even though in this specific case the hospital claimed conscientious objection was not the reason for the refusal, this issue is clearly part of the broader problem in implementing the law.

Conscientious objection stems from the right to freedom of thought, conscience, and religion, and is permitted under various healthcare laws in Croatia. Article 20 of the Medical Profession Act (Official Gazette 121/03 and 117/08) allows a doctor to refuse treatment based on ethical, religious, or moral beliefs, provided that:

  • it does not conflict with professional standards,
  • it does not cause permanent harm or endanger the patient’s life,
  • and the doctor informs the patient in a timely manner and refers them to another doctor, while also informing their superior or employer.

In recent years, conscientious objection has mainly been discussed in the context of abortion refusals, especially where all gynecologists in a facility refuse to perform abortions. In such cases, the institution itself is responsible for ensuring that the procedure is available, potentially by hiring external doctors.

Given the number of doctors claiming conscientious objection, this issue may reflect a broader ideological shift, not just isolated personal beliefs.

 

Patient rights and communication

In this case, the Ombudswoman agrees with the Gender Equality Ombudswoman that Mrs. Čavajda was not adequately informed of her rights. As a patient, she was entitled to timely and clear information about procedures, timelines, and what to expect.

The Ombudswoman receives many complaints from across Croatia indicating a widespread problem of patients not being properly informed about their rights, medical procedures, or legal protections. This information should be publicly available on ministry and hospital websites.

In her 2021 annual report, the Ombudswoman recommended that all public bodies, including healthcare institutions, list their services, procedures, and legal remedies clearly on their websites and in public spaces, along with brochures detailing necessary steps and timelines.

The Ombudswoman also notes that poor communication is a broader systemic issue in healthcare, where patients often face disrespectful or inappropriate behavior, particularly in emotionally traumatic situations like Mrs. Čavajda’s.

Such experiences undermine public trust in the healthcare system and fuel harmful stereotypes about healthcare workers, which in turn demotivates those who conscientiously do their jobs under challenging conditions.

 

Speaking out in public

In recent years, many systemic issues in gynecology and obstetrics have been publicly revealed. It’s important to support women who speak out, like Mrs. Čavajda or earlier, MP Ninčević-Lesandrić, as well as those who participated in the #BreakTheSilence campaign by the Roda association. These voices have raised awareness of systemic issues in reproductive healthcare in Croatia.

One major issue is how the system responds publicly when such issues are exposed. It’s essential that healthcare stakeholders demonstrate greater accountability, empathy, and understanding, both publicly and individually.

Mrs. Čavajda’s trauma is immense. Her decision to go public was not only to highlight her situation but to help others, hoping her story would drive systemic change. In doing so, her privacy has been exposed to public scrutiny, with debates over her diagnosis, fetus, and moral choices – instead of focusing on her legal right to request termination in exceptional circumstances.

What needs to be done systemically?

  • Implement the current law, including procedures for approving abortion requests in exceptional situations;
  • Inform patients promptly, fully, and clearly about their rights;
  • Improve doctor-patient communication, respecting patients’ dignity and legal rights;
  • Ensure healthcare institutions provide legally permitted procedures, even when staff invoke conscientious objection.