In Poland, access to contraception is decided by politicians, not by doctors or women interested in it. In some parts of our country, getting a prescription for pills is no mean feat, because many doctors are excused by the conscience clause. It also happens that when a woman obtains a prescription, there is nowhere to sell it, because pharmacies do not have such an "assortment". This sick situation is increasing the number of illegal abortions.
We talk to prof. Romuald Dębski, obstetrician gynecologist, head of the Gynecology and Obstetrics Clinic of the CMKP at the Bielański Hospital in Warsaw.
What do Polish women know about contraception?
Prof. Romuald Dębski:My experience shows that the average woman knows little about effective methods of preventing unwanted pregnancy. But it is also true that many women, especially young ones, cannot afford hormonal contraception because the packaging costs from 30 to 40 PLN.
In addition, currently only one tablet is partially refunded, which appears in pharmacies under different trade names. However, it is not suitable for every woman, e.g. it should not be used by girls who have acne because it will aggravate its symptoms. There are also difficulties in obtaining a prescription. If the doctor is against contraception, he tries to impose his point of view on the patients as well. Although the Code of Medical Ethics allows the refusal to issue a prescription for a drug the use of which the doctor deems immoral, such refusal should be recorded in the medical records. The doctor must also show the woman another place, an office where she will receive appropriate help.
The conscience clause works …
R.D.:If someone's conscience does not allow him to write out a prescription for a contraceptive pill or an IUD, he should inform the public about it, e.g. post a relevant notice on the door of the surgery. I propose: "Here he accepts the conscience, not the doctor." Same with pharmacies. If the pharmacist does not want to sell contraceptives, his customers should know about it - a sign used will solve the problem.
According to the Central Statistical Office of Poland, approx. 20 thousand teenager gives birthchildren
R.D.: It's not that much. There are countries in Europe where there are many more of them. Fortunately, the number of young women in Poland using effective contraception is growing. And this is not the merit of schools or doctors, but the media that take up this topic. The opening of borders also contributed to this. More and more often I meet patients who have implants under the skin and they did it in Great Britain, because it is a very popular method there. However, the methods of contraception recommended by medical societies are still used in Poland several times less frequently than in Western European countries.
What does our law allow?
R.D.:A minor may issue a prescription for a contraceptive pill, provided that she is over 15 years of age, and only with the written consent of her parents or legal guardians. If there is a he althy relationship between the daughter and the mother, the mother, out of concern for her daughter's safety, will come with her to the doctor to choose the right contraception. Fortunately, this is happening more and more. If the girl is younger and the mother agrees to use contraception, I should inform the prosecutor's office that a person under the age of 15 is beginning sexual intercourse, which is considered a crime in our country. When such a girl becomes pregnant and gives birth to a child, the case will go to the prosecutor's office anyway, because the registry office is obliged to inform about the fact that a child was born by a minor.
What about the after pill? Opponents call it the death pill, although it is not an early abortion measure
R.D.:It's not! The accusations made against postcoital contraception are absurd. This is not what there is undeniable scientific evidence for, an early morning pill, which has a different composition and must be taken over several days. The "po" tablet is taken once. How does it work? Simply put, if the intercourse took place before ovulation and the woman takes the pill, the ovulation process will be delayed by 5 days. The sperm will not be able to fertilize the egg because it will not be there. If intercourse has occurred after ovulation, pregnancy may not be prevented from taking the pill. It will develop normally. The active substance present in the pill "after" is also a component of the preparation treating fibroids. I have many patients who have been taking this drug for many weeks for their fibroids. When they got pregnant during the treatment, they stopped taking the drug and gave birth to he althy children. The "po" pill does not harm the fetus!
Time will tell what her fate will be. 200,000 have already been collected signatures on the appeal for its withdrawal
R.D.:If the pill disappears from pharmacies, there will be more unplanned pregnancies, it will bloomthe black market of early-abortion products and abortion tourism. I have always said that promoters of unreliable methods of contraception are advocates of abortion. A few weeks ago, the results of an experiment carried out in Sweden were published. In the years 2011-2012, all obstacles to access to contraception were removed in some areas. It has become not only widely available, but also free. Effect: 3 times fewer abortions. Swedish authorities intend to introduce free, easily accessible contraception nationwide.
Contraception - get to know the important facts
There is no doubt that the lack of access to effective contraception is an excellent breeding ground for the development of the abortion underground and abortion tourism in our country
R.D.:Yes, but we don't want to notice it. There are tons of adverts in the newspapers like "AAA for painless menstruation." It is very often a cover, a code informing that pregnancy can be terminated here. It is known that there are doctors who do this for money. For the last 10 years, no patient who had such expectations came to my office. Women know I don't. But after the scandal with prof. It happened with Chazan that an attempt was made by telephone to arrange an appointment with me for an abortion. I know the addresses in Warsaw and Poland where such treatments are performed. It is often done by very experienced people who have modern equipment at their disposal and guarantee the safety of women. But you also have to pay dearly for it.
There are other ways too
R.D.:Yes. Abortion tourism is flourishing here, especially in border regions. The most famous are the Silesian-Czech "expeditions". Every day buses depart from a specific point to take patients with an accompanying person. Immediately abroad, women "arrange" what they have to do and come back. It is similar at the German border. The third "way", in my opinion marginal, is the so-called pseudo-dead pregnancies. The patient is admitted to the hospital with an entry that the pregnancy is dead. A procedure is performed and it is not registered as a termination of pregnancy. The fact that many women undergo abortions, I find out in the clinic.
There are so many complications?
R.D.:Yes. Increasingly, pregnant women are diagnosed with a condition called cervical insufficiency. This, simplifying the problem, is a painless dilation of the cervix that can lead to a miscarriage or premature birth. This complication is typical after cleaning the uterus after spontaneous miscarriage, but also after termination of pregnancy. When abortion was legal in Poland, a pregnant woman told the doctor that she had terminated the pregnancy earlier. Thisit allowed to implement a procedure that would protect against the loss of a child. Currently, women do not reveal that they have had surgery because they do not know that admitting it is not punishable by law. We have patients with serological conflict who say they have never been pregnant, and we know that if she hadn't been pregnant, she wouldn't have had the antibodies.
Are they ashamed or are they replacing this traumatic experience?
R.D.:Both. Women who have had abortions fear stigma and fear. They decided to terminate the pregnancy because they had no support … Lack of access to good contraception means that the number of abortions is increasing.
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