Most Polish women learn about contraception from the press and their friends. The doctor is named in third place.
Intermittent intercourseandcalendarmarital intercourse is still the most popular in our country methods of protection against pregnancy by women who remain in permanent relationships. Teenagers mostly usecondoms . The method can be ineffective, but at least it protects against sexually transmitted infections.
Read: Contraception: natural, mechanical, hormonal methods
Polish women choose ineffective methods of contraception. What are the consequences?
Prof. Romuald Dębski, head of the Obstetrics and Gynecology Clinic of the CMKP at the Bielany Hospital in Warsaw: Underground and abortion tourism … It is also abandoned children and the stress experienced by many women who are afraid of another and unexpected pregnancy. But there is a change in behavior in this area. More and more women do not want to rely on chance and choose safe contraception. 12 percent women who have regular intercourse and do not want to be pregnant, use hormonal contraception, but it is still much less than in Western European countries. IUDs are used by about 3%, while in Europe more than 8%. The picture is completed by data collected by the Central Statistical Office: almost 60 percent. marriages in Poland are concluded because of pregnancy. Only a dozen or so percent of them last longer than 1-2 years.
Is it easy to get a prescription for a contraceptive?
R.D .: Basically yes. But it happens that the gynecologist refuses to issue such a prescription. In large cities, where many doctors practice, it is possible to go to another. It is worse in small towns where there is only one doctor. If he refuses, the woman has a problem, because she cannot always go to another city.
The doctor has the right to refuse to issue a prescription for contraception?
R.D.:Could do that. But then it should indicate a place where a woman can get it. Moreover, he should make an appointment with the patient himself. However, I believe that refusing contraception is not a good practice. Of course, we are free people and we have the right to make our choices. I understand and respect it. However, the doctor's worldview is his private matter and should not affect his professional activities. If the doctor did not want to provide such services, he couldchoose another specialization, where you do not have to deal with such dilemmas.
ProblemWe are far from Europe
Less than 40 percent Polish women are protected against unwanted pregnancies - this is the result of research conducted in 15 European countries. We also start using contraceptives at the latest. The average European reaches for them at the age of 18, while a Polish woman only after the age of 25. This does not mean, however, that we remain abstinent for so long. We start having sex around the age of 17, but until our 25th birthday we use methods with a high risk of getting pregnant.
It's a theory. What is the practice?
R.D .: It can be different. Teenagers are in the most difficult situation, even those who come to visit their mother. A 17-year-old girl who asks for birth control is often scolded and, discouraged, leaves the office. The doctor thinks he took care of her morale, but he doesn't think it won't stop the girl from having sex.
After such an interview, the girl often comes to the next visit to the gynecologist with an unwanted pregnancy. Aggressive opponents of any type of contraception, or those who accept only natural methods, do not think about the consequences of their actions. And there is no shortage of tragedy.
The so-called tablet after …
R.D .: Many doctors do not accept this pill as they believe it has an abortion effect. It is also not accepted by the Church, and thus also by those doctors who do not prescribe contraceptives. The emergency pill taken before ovulation is contraceptive. Swallowed after intercourse during ovulation also prevents pregnancy, because it does not allow the egg to implant in the uterus. Personally, I always consider the lesser evil. What is more beneficial to the he alth of a woman:
Read: Contraception for the forgetful
swallowing a pill or termination of pregnancy? From a medical point of view, taking a pill is a hundred times safer than surgery. In some European countries, such funds are available at gas stations. The authorities of these countries have concluded that it will be safer for women when the tablet becomes readily available. It cannot be overdosed, because even swallowing many lozenges will end up in vomiting and diarrhea. Not a single case of death has been reported in the medical literature after taking such a tablet. There are, however, many reports of damage and deaths caused by painkillers and acetylsalicylic acid medications that can be purchased at any grocery store. Of coursepostcoital pillscannot replace contraception, but a woman who does not have a regular partneror uses uncertain methods, she should have her at home. As the saying goes - just in case. In my opinion, there is nothing blameworthy about it. Another argument in favor of this is that in the USA, where the tablet is widely available, the number of abortions has dropped by 1/5.
Do women mentally react similarly to termination of pregnancy and taking the pill?
R.D .: Oh no! Termination of pregnancy is always a traumatic experience for a woman. This is the worst possible way to prevent unwanted pregnancy. When taking the pill, most women believe that they have used a contraceptive, not that they have had an abortion. This is a fundamental difference.
How do you assess the level of knowledge of Polish women about contraception?
R.D .: It can be different. There are women who don't have the slightest idea about it, and some who know a lot. In my opinion, the basic knowledge about contraception should be passed on to parents. Mother to daughter and father to son. Later, the school has to get involved in the process of broadening and consolidating this knowledge. Anyway, the whole process of sex education should start very early, maybe even in kindergarten, so that the children learn about the differences between the sexes, what behaviors they can afford and what to protect themselves from. Of course, it's not about teaching sex techniques or contraception. It is important to talk about sexuality at all, the need to go to the gynecologist, how to prepare for the first visit, that it is better, for example, to wear a skirt than pants, because you don't have to go to the chair without covering. I also believe that parents should teach their children about their family's medical and he alth past. It's good to know why Grandma died. I often hear from my patients: "Grandma died of old age". How old was she? "A, 52". If I heard that she died of a heart attack or breast cancer, I would know what to look for, what tests to order, what and whether to choose contraception at all. Going back to school: instead of talking about bees, it's better to talk about things that matter to everyone's future.
Is it true that a woman should do a lot of testing before starting contraception?
R.D .: There is no point in doing all possible research. If a woman was pregnant, gave birth to a he althy child, and the pregnancy was uneventful, i.e. she had no problems with the liver (cholestasis) - according to the recommendations of the Polish Gynecological Society - it can be assumed that there are no contraindications to using hormonal contraception. The risk, or rather the burden on the body associated with taking hormonal substances, is highsmaller than in the case of the pregnancy itself.
What about women who have not given birth?
R.D .: The so-called Leiden mutation. It is a factor V mutation of the coagulation system which, if present (5% of women), increases the risk of developing thromboembolism. The disease is rare, but it is extremely dangerous. It manifests itself as deep vein thrombosis, which must not be confused with varicose veins. It can lead to pulmonary embolism and strokes. These serious diseases are more common in women who use oral contraception.
So how should you choose this contraceptive method that is perfect for a particular woman?
R.D .: First of all, taking into account the state of he alth, but also taking into account the needs and preferences. In Poland, the method of contraception or the type of tablet is recommended under the influence of advertising, fashion, and the wave of seasonal popularity of a preparation. It shouldn't be like that! The correct selection of the contraceptive pill must be based on the knowledge of its composition, the content of individual hormones and their effect on the body. If I do not know that there is, for example, gestagen in the pill, which works anyway, and in the other, drospirenone, which works differently - then I cannot choose the right pill. When choosing contraception to suit a woman's needs and preferences, a doctor must base their knowledge on all her he alth problems and the properties of the ingredients in a given pill. I clearly want to say that there is no such set of hormonal or laboratory tests that will clearly show that we are to propose an X or Y pill.
What harm can badly chosen contraception bring to a woman?
R.D .: The patient may not tolerate an incorrectly selected contraception. It may report frequent headaches, prolonged spotting, depressed mood or libido. Complications such as venous thrombosis may occur when a patient's medical conditions are not taken into account or the history of her immediate family is not accurately collected.
So all hope in highly qualified gynecologists, their inquisitiveness and friendly attitude towards women …
R.D .: I hope that there are already many such doctors, and there will be more and more. Gynecologists are in a special, privileged position because they can influence many he alth behaviors of women. This applies not only to the care for the proper functioning of the reproductive system. If a pregnant woman has diabetes or circulatory problems, she should hear from the gynecologist - and usually hears - how she should proceed, what diet to keep, etc. When leaving the office, the woman should have her breasts examined. The doctor must encourage her todo cytology, breast ultrasound or mammography, remind about the necessity to perform a colonoscopy every 10 years and ask about the he alth of … her partner. Of course, I am not an idealist, and I know that this is not always the case. Some behaviors of doctors should be forced by the women themselves. A visit to the gynecologist cannot be limited to examining the patient and drawing up a prescription for contraceptives.