The View from Poland

Family counseling and teaching methods of natural family planning and responsible parenthood began in Poland in 1956 when the National Family Pastoral Care was established. However, the scope of family counseling centers and social education in this area was limited or even banned by the State. The Communist Government of Poland was hostile to the Catholic Church, whose values were contrary to the ideas of communism and later to socialism.

The Polish State adopted a law in 1956 allowing the termination of pregnancy for social reasons, e.g. lack of work, poor living conditions, etc. Only a few doctors had the courage to oppose the procedures. One of them was Dr. Włodzimierz Fijałkowski from Łódź. Most gynecologists, even if they did not fully agree with the law and the right of women to abortion, performed these procedures for fear of losing their job or other serious consequences. Others changed specialties to avoid the need to perform abortions. Professor W. Fijałkowski lost his job at the Medical Clinic and started working on the Polish Model of Prenatal Classes and the Program of Ecological Procreation free from contraception and abortion. The proposal promoted natural childbirth in the hospital, rooming in system after delivery, breastfeeding and NFP. The result was the 1980s social movement called “Human Birth” which led to profound and positive family oriented changes in Polish obstetrics and midwifery.

At that time, in Poland, knowledge of NFP methods was limited, as was knowledge of contraception. Our country, lying behind the Iron Curtain, had difficulty accessing information from Western countries, and the State limited the opportunity for education in NFP. According to the research of Dr. Michalina Wisłocka, Polish sexologist, gynecologist and well known author of the 1970s book Art of Love, as a method of birth control Poles often used the intermittent sex relationship, condoms and marriage calendars. For the “selected” and to a very limited extent, an IUD was available. In the 1960s and 1970s Polish doctors referred for hormonal contraception cautiously, fearful of serious side effects, especially since the high-dose East German Ovosiston was the only available pill, providing a lot of thromboembolic complications. Access to more modern preparations with lower hormone content from Western European markets was very limited due to a shortage of primary necessities, and because the state delayed their importation, preferring abortion as a cheap method of family planning. According to various estimates, the number of abortions in the fifties and sixties could have reached 800,000 per year in Poland! Their number decreased over time, to 20,000 a year in 1993. It was not until 1993 that the law on family planning, protection of the human fetus (embryo), and restrictions on abortion was introduced in Poland, resulting in forbidding the interruption of pregnancy for social reasons. Today in Poland, there are about 1,000 abortions, primarily for eugenic reasons (the prenatal diagnosis of severe incurable disease), and very rarely due to pregnancy after rape or a life threatening condition for the mother. Parliament has considered a total ban on abortion for several years now, but there is much opposition, especially from feminist and LGBT groups.

Amidst these difficult conditions, some doctors dared to say NO to abortion, contraception, and artificial procreation procedures (IVF). Most of them were people with a deep faith in God, for whom Christian values were their point of reference, personally and professionally. Professor Michał Troszyński, a well-known Polish gynecologist and national consultant for obstetrics and gynecology, recalled that the support in these times for doctors opposed to the general anti-life trend was the Catholic Church and parish family counseling centers, where it was possible to conduct classes and lectures on responsible parenthood.

The author of the first method of NFP taught in Poland was the gynecologist Teresa Kramarek from Poznań. Dr. Kramarek promoted the Polish sympto-thermal method through the Society called “Love and Responsibility”. In addition, written material on the natural methods of family planning was published, mainly by the Catholic Church, including ones written by Dr. Elżbieta Wójcik, Dr. Włodzimierz Fijałkowski and many others. There were also translations of books on NFP written by the Drs. Billings, Mercedes Wilson, the Kippleys, and Teresa Capella.

In the communist era, the Catholic Church in Poland became a center of resistance in the struggle for the independence of the nation and defense of the right to life of the human being from the moment of conception. Priest Karol Wojtyła, later Pope John Paul II, Dr. Wanda Półtawska, Teresa Strzembosz, Dr. Emilia Paderewska Chróścicka, Father Karol Meissner, Father Leon Mońko, Father Kazimierz Kurek and many others were very active in this effort. According to Dr. Archbishop Henryk Hoser, the 1968 encyclical of Paul VI, Humanae Vitae, became the turning point, and the manifesto for people of conscience in the face of growing threats related to the spread of contraception, abortion and in a short time also IVF, euthanasia and embryo production on an industrial scale. It turned out that the modern evolution of science and technology was accompanied by the involution of morality. HV for many scientists and doctors in Poland was a call to action to oppose the dehumanization of medicine. HV together with the subsequent “Theology of the Body” of John Paul II constitute a guide for the promotion of the integrity of life.

Starting in the late seventies nonprofit Polish associations gradually introduced a variety of NFP methods, including:

• Billings Method (Australia) taught since 1981 by the Polish Society for Responsible Parenthood
• Józef Rötzer (Austria) taught by Iner Polska since 1993
• Double check or so-called English method from the Center for Natural Family Planning (Dr. Anna Flynn Birmingham, UK) taught since 1989 by the Polish Association of Natural Family Planning Teachers (PSNNPR)
• CCL (USA) -LMM Polska since 1992.
• Creighton Model FertilityCare (Dr. Thomas Hilgers, USA) taught by FCCP-Polska.

The majority of NFP methods recognized around the world are taught in Poland, a country of 40 million people. Over the years, 5,000 well educated NFP teachers have provided counseling at the parishes. Unfortunately this large group of professionals remain on the margins of professional health services. The Ministry of Health does not recognize these professionals to provide services at any health clinics, even those whose training and materials meet required standards and are certified by European Institute of Family Education, primarily because the majority are not medically educated. It is a great waste of potential capacity to help overworked health professionals to educate on fertility care and promote parenthood.

Polish demographic data shows that mothers are on average almost 30 years old at the birth of their first child. There is a negative fertility rate and aging population in Poland, resulting in a lack of replacement of generations. The 2016 National Health Program from the Ministry of Health underlined the great need of fertility care and promotion among young Poles. Unfortunately, so far, this action is not enough to restore what has been neglected over so many years.

Despite political changes since 1980, there is still a widespread belief that NFP are “church methods” and have no scientific basis. According to the announcement of Polish Society of Obstetricians & Gynecologists (PTG) in 2011, NFP cannot be recommended as an effective method for postponing conception. Due to the perceived unreliability of the natural methods, NFP may only be recommended to women who are unwilling or unable (due to contraindications) to use hormonal agents, or women who will accept pregnancy if it occurs. According to PTG, the disadvantage of NFP is the need for sexual abstinence and limited satisfaction and spontaneity of intercourse. The PTG expert team recommends computer analyzers as the most effective NFP method, and do not recommend self-observation. Nor do they recognize NaPro as an infertility treatment.

In 2019, the Contraception Atlas (UN) published an annual report of the European Parliamentary Forum which identified Poland as among the countries with limited access to contraception (only about 43%), while in most European countries, contraception is cheap and available without prescription (especially postcoital/emergency). This propaganda denies the reality, for contraception is readily available and Polish doctors are knowledgeable. There is, however, a lack of good pro-health and pro-fertility education among medical staff, especially in the field of Fertility Awareness Methods (FAM). The subject of reproductive health promotion is marginalized and the medical community is dominated by contraception, not only for birth control but also for non-contraceptive reasons such as dysmenorrhea, dyspareunia, menorrhagia, irregular cycles, PCOS, and endometriosis.

Since 2011 PSNNPR, together with other NFP organizations, and in cooperation with the University of Warsaw, has organized annual conferences, addressing the prevention of procreative health disorders. The 8th and most recent, held May 19, 2019 at the Cardinal Stefan Wyszynski University in Warsaw, focused on “Fertility as a Sign of Health”* The 30th anniversary of the Polish Association of Teachers of Natural Family Planning (PSNNPR) was celebrated during the symposium. In addition, FAM faculties have been introduced at Warsaw University since 2011. Both initiatives are intended to educate young doctors, midwives and nurses in fertility awareness.

Despite such efforts and the passage of years, health services remain divided and generally not conducive to the promotion of NFP. However, there is a small group (250+) of Catholic Obstetrician/Gynecologists in Poland who recommend NFP. These doctors are opposed to prescribing contraception, and are protected from being forced to prescribe emergency contraception or do abortions by a conscience clause passed in 1996. In addition, these physicians are involved in the development and promotion of the revolutionary Restorative Reproductive Medicine (RRM), which works exclusively to support/restore/optimize natural reproductive function. For women in their reproductive years, this often means using scientific based forms of cycle charting (NFP). RRM though encompasses the entire depth of reproductive medicine, throughout an individual’s lifecycle, and includes areas such as Restorative Andrology, Sexuality and more. Most of these doctors are certified NFP Medical Consultants through Omaha’s Pope Paul VI Institute. There is great hope that working together, doctors and NFP teachers will increase availability and acceptance of this much needed ethical and humane approach to medicine.