Contrary to many countries around the world - in Poland, contraception evokes strong emotions. It is not a purely medical issue for us, but also a sociological one. Unfortunately, too much depends on politics. With prof. Romuald Dębski, gynecologist, obstetrician, head of the Gynecology and Obstetrics Clinic of the CMKP at the Bielański Hospital in Warsaw, interviewed by Anna Jarosz.
Polish women start using provenmethods of contraceptionlater than most women in Europe. Anna Jarosz (monthly "Zdrowie") talks to prof. Romuald Dębski, head of the Gynecology and Obstetrics Clinic of the CMKP at the Bielański Hospital in Warsaw.
- Proven methods of contraception European starts to use around 18 years of age, and Polish around 25 years of age. Why is this happening?
Prof. Romuald Dębski : You might think that this is because most women in Poland begin sexual intercourse later than most women in Europe. However, in the light of research conducted by prof. Zbigniew Izdebski, it is not so. It turns out that women in Poland start intercourse in their teens, just like their peers in other European countries. It is true, however, that Polish girls do not use any protection against unplanned pregnancies during the first few years of intercourse. This is mainly due to the lack of sexual education and the simultaneous anti-promotion of hormonal agents, as well as the high price of contraceptive pills and the difficult access to them in various ways.
R.D. : The situation is very diverse. Effective contraception is most often used by young and studying women and women after giving birth to their first child and before the next one, and by those who do not want to give birth to any more. What is the knowledge of women? Well … A few days ago my mother came to my place with her sixteen-year-old daughter, 26 weeks pregnant. She found out about the pregnancy a few days earlier, because her daughter still hoped that she would get her period. Only when she clearly felt the baby's movement did she decide to tell her mother. ByOn occasion, it is worth saying that the time of getting pregnant depends very much on the cage in which you grow up or religion. In Arab countries, where women do not go to school and give birth to children, pregnant teenagers are not unusual. In Europe, in Poland, there is a different model of life. Women pass their high school diploma, go to university, make a career, children are thought of much later. These women are looking for effective methods of contraception. You mentioned the difficulty of getting a good contraceptive.
R.D. : I think that attempts to increase birthrate by restricting access to contraception will fail, because the lack of access to good contraception translates into the number of abortions. Telling the public that the contraceptive pill is behind negative birth rate is - to put it mildly - a great misunderstanding. 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 reimbursed, which appears in pharmacies under different trade names. The problem, however, is that it is not suitable for every woman. For example, it should not be used by girls who have acne, because the pill will aggravate it. But there is one more problem that needs to be mentioned here. Difficulties with obtaining a prescription for a contraceptive may result from philosophical reasons. If the doctor is against contraception, he sometimes tries to impose his point of view on the patients as well. It's unacceptable!
The code of medical ethics allows refusal to issue a prescription for a drug the use of which the doctor deems immoral. But such a refusal should be noted in the medical records. The doctor must show the woman a different place, an office, where she will receive appropriate help. Unfortunately, in Poland it is sometimes difficult not only to obtain a prescription from a doctor, but also to fulfill it. It is enough that the head of the ward is opposed to contraception, and his wife is the manager of the only pharmacy in the city to which such measures are not limited.
ImportantPostcoital pill or the "po" pill
Contraception "after" (the "after" pill) is used immediately after unprotected intercourse, eg when a condom has broken or slipped off, but also after a rape. There are three preparations available in Poland: Escapelle (PLN 55-60), Postinor duo (PLN 90-100)PLN) and, available without a prescription, ellaOne (cost 120-130 PLN). This contraception is still controversial because it has turned out that promoting it is not in line with the views of too many people and groups.
R.D. : The problem is serious. It is necessary to explain what the average age of initiation is. Since it falls on the age of 17, it means that half of the girls started intercourse before (maybe at the age of 12-14), and half after the age of 17, e.g. at the age of 20-25. years. Pursuant to Polish legislation of minors, it is not possible to issue a prescription for the contraceptive pill. Until the age of 16, consent to any medical procedure, including issuing a prescription for a contraceptive pill, must be given by parents or legal guardians. If the girl comes with her mother for an appointment, I have the right to issue a prescription, provided that the woman concerned is over 15 years of age. If she is younger and the mother wants her daughter to use contraception, I should inform the prosecution that a person under 15 is starting sexual intercourse, which is considered a criminal offense at that age. If I do not notify the authorities, the case will end up there anyway when the girl becomes pregnant and gives birth to a child. The registry office is required to notify the prosecutor's office of the birth of a child by a minor. Between the ages of 16 and 17, a prescription for contraceptive pills can be written out for the so-called mutual consent, i.e. the girl and her legal guardian must consent in writing to the use of such a medical procedure. If there is a he althy relationship between the daughter and the mother, the mother comes to the doctor with her in the interests of her daughter's he alth and future, and together they choose the right contraception. Unfortunately, it is still the case that young girls can only talk to their friends about contraception, or they look for information on the Internet, which is also not a good solution.
R.D. : Recommending only sexual abstinence leads to a greater interest in sex. This is the rule of the forbidden fruit. As for the methods. Young girls have intercourse intermittently, but also change partners from time to time. Each new contact is at risk of contracting sexually transmitted diseases. Therefore, in such unstable relationships, I would recommend the use of condoms as the primary method. In general, contraception is a good option for young girlshormones to protect against pregnancy and condoms to protect against infections.
ImportantThe truth about the calendar and intermittent intercourse
The marriage calendar is no longer promoted even in premarital teachings in the church, which probably shows the value of this method. Intermittent intercourse is also a very unreliable method of contraception. Besides, many women do not accept this behavior of their partner. One more thing: no woman intentionally becomes pregnant unplanned. Unwanted pregnancies result from the use of very insecure contraceptive methods.
R.D. : This "technical" name is the science of getting pregnant, which is based on an in-depth knowledge of one's own body. It can also be said that it is a form of natural regpiation of conceptions. It is a method that has its place in contraceptive counseling. There are women who, jokingly speaking, don't want to get pregnant a bit. If they do, there will be no misfortunes, but they would prefer it if it happened, for example, in a year's time. For such ladies, natural family planning methods are ideal. Anyway, learning your own cycle, understanding the changes taking place in your body, and finding out when you can get pregnant is very valuable. But you also need to know that natural methods limit the possibility of intercourse. And it must be added that in many women fertile days coincide with an increase in libido, i.e. greater desire for sexual intercourse. This is our biology, because intercourse is supposed to serve the purpose of procreation. It is worth adding that the most effective of the natural contraceptive methods is intercourse only in the second half of the cycle, a few days after ovation, which is actually when the woman's body is getting ready for the next menstruation and she herself does not want sex, because her breasts often hurt. Women who suffer from PMS are craving things, but sex is usually rejected by them. A recommended natural method is the assessment of cervical mucus, which we call the Billings method. This method allows you to determine the moment of fertility in advance, that is, to know the time when the woman will not be able to get pregnant yet.
R.D. : Of course, there are many factors that determine our fertility. Therefore, I believe that promoting such methods of conception regpation among people who cannot implement them well is a serious mistake. A misunderstandingis the recommendation of such methods to girls who are going on vacation alone for the first time in their life. If a woman gets to know her body, gains experience, has a permanent partner - she can be recommended this method. As a curiosity, I would like to add that every year parents of children conceived using the Billings method meet near Paris. Based on the experiences of these people, it is known that if a woman becomes pregnant twice using the Billings method, the third pregnancy will not occur.
ImportantImportant conversation with the doctor
Contraception should be selected individually for each woman. Therefore, before recommending one form of contraception, the doctor should take a detailed interview and find out about the patient's expectations. It doesn't always have to be hormonal contraception. After all, there are many other effective methods, the choice of which should depend on the he alth condition, menstrual cycle, preferences, lifestyle, and even the nature of the woman, because the method that requires regular taking of pills will not work for a distracted person. It is not true that every woman should undergo a lot of tests before choosing contraception. But they must be done when a woman is at risk of thromboembolism (she has inherited high blood clotting). This is the only contraindication to using hormonal contraception.