By Emilie van Outeren

Poland’s government has sought to combat population decline through incentives for women to have more children, so far with limited success. At the same time, it is using religious arguments to make a tried-and-tested method of boosting the birth rate, in vitro fertilisation, more difficult and expensive.

One of the few places where Kasia Wilk would find solace when her troubles got the better of her was her church in Gdańsk. She would drive the 35 kilometres from her rural village of Nowy Wiec to the Polish port city, partly on a dirt road, to pray in the spireless church with red roof tiles.

At least she did until a few years ago, when she confessed to her priest that, after years of futile hope and attempts at getting pregnant, she and her husband Kamil were trying in vitro fertilisation (IVF). “The priest said this sin could not be forgiven,” says Wilk. “He told me that IVF is the work of Satan.”

The desire to have children has dominated Kasia’s life for the last five years. The 34-year-old has undergone countless medical exams, tried multiple diets that would supposedly affect her fertility, and was prescribed several cures that messed up her hormones. She has tried artificial insemination and, until now, two failed IVF procedures. Kamil estimates the couple has spent at least 80,000 zloty (over 18,000 euros) on their unfulfilled dream. This is a huge sum for the couple, even though they that both work full time; he at the local sewerage company and she at a logistics firm.

But in today’s Poland, the social stigma attached to infertility and IVF is costing the couple more than their medical bills. Kasia avoids questions from neighbours and family members about when she will finally have children. And she has stopped going to church. She now sees the Roman Catholic Church and its influence on Polish politics as part of her problem. The church and the current national-conservative government in Poland are actively sabotaging the medical support she considers her last hope to conceive. The womb has become a battleground.

State natalism

Poland is one of several Central European countries that are trying to compensate for population decline, ageing and emigration by encouraging women to have more children.Hungarian Prime Minister Viktor Orbán wants to boost the country’s birth rate by promising to waive personal income tax for mothers of four or more.

Ahead of this year’s European and parliamentary elections, Poland’s ruling party Law and Justice (known by its acronym PiS) expanded its “Family 500 Plus” child-benefit programme. This subsidy of 500 zloty, or around 115 euros, per month, which since 2016 had already been given to parents for their second and each subsequent child, now also covers first-borns.

Although this programme has helped reduce poverty and advanced PiS’s popularity, it so far has had little effect on its main stated goal of boosting births. After a brief spike in the birth rate following the introduction of 500+, the figure began to fall again in 2018.

On average, Polish women have 1.36 children, sharing the EU’s bottom spot with Romania. At 1.45 children, Hungary, which already had special loans and donations in place before Orbán launched his last incentive, is not doing much better. The EU country with the highest fertility rate, 2.06 children per woman, is France.

Irena Kotowska, who heads the Centre for Demography at the Warsaw School of Economics, is very critical of the government’s programme. “Income is only a part of the reason why people have children or not. Investments in healthcare, education, day care and the possibility for both parents to work flexible hours have proven more effective than any financial reward.”

The number of people who choose to have a second or third child has increased slightly, says Kotowska. But the number of women who do not have any at all is rising faster.

“Political and ideological”

At the same time, the government in Poland has made medical assistance for infertility more expensive and more complicated. In 2016, PiS scrapped all coverage of test-tube fertilisation and the drugs this procedure requires from the country’s collective health insurance. Data from the Health Ministry show that in the three years prior, when this treatment was covered, 21,666 Polish children were born through subsidised IVF.

“The fact that the government has suspended this funding shows you that their policies to increase fertility are selected according to political and ideological criteria,” says Kotowska.

The previous government, headed by centrist Civic Platform (PO), did not fully cover IVF procedures either, and single mothers or same-sex couples were not helped at all. But treatments were thousands of zloty cheaper for patients than they are today – a crucial difference in a country where the average monthly disposable income per person is under 1,600 zloty, or 370 euros.

Those in Poland who aren’t actively looking for advice on in vitro, which has been available since 1978, seldom hear about it. If IVF does make headlines, it is mostly in a negative or even malicious sense. In 2013 Franciszek Longchamps de Berier, a prominent Polish priest and legal scholar, said in a newspaper interview that children born from IVF have on their face “a tangible furrow, characteristic of certain genetic defects”.

A group of conservative MPs last year backed new legislation to further curb in vitro, or at least its effectiveness. The plans would force doctors to reinsert just one fertilised egg into the womb per procedure and only allow direct IVF, prohibiting cells from being frozen. Freezing embryos “violates man’s dignity”, argued the authors of the legislation.

Only for the happy few

In the south-western city of Wrocław, the product of successful IVF happily frolics around his parents’ living room in a black romper suit. Antoni, just over two years old, has no furrows or other health issues. But his mother, Kasia Politańska, 36, does: she suffers from endometriosis, a painful disorder that hinders natural conception. “I have some kind of scars on my ovaries and just having my period hurts so much it drives me up the wall,” she says.

Politańska is from a progressive family where the church and social pressure play a marginal role. And she has been lucky to have undergone the procedure when the state still covered part of the cost. Since central funding was suspended, the city of Wrocław, which is ruled by the opposition to the national government, has stepped in to cover part of it.

Kasia and her husband are torn between wanting other people to have the opportunity, and feeling that health care should not come at the expense of the municipal treasury. “In vitro has become a political tool for both sides,” says Marcin.

Kasia, who runs her own lawyer’s office, does not need the state to cover her health care. “For me, one procedure costs me the equivalent of a single case, but other people may have to spend their annual salary on it.” The PiS government has not banned in vitro, unlike abortion, which is illegal in all but a few cases in Poland. But it has made it a luxury item only the privileged can afford.

What Politańska finds even more scandalous is that instead of funding in vitro, the government has set up a pseudo-scientific programme called naprotechnology. This philosophy of ‘natural procreative technology’ adopted from the US, advertises itself as “consistent with Catholic moral principles,” meaning no test tube may be used.

“Women are treated by nuns, who tell them that they have to watch their cycle and eat healthily. They never see a doctor,” Politanska says. This causes women to lose valuable months or years, during which their fertility might completely run out. The religiously inspired programme was reported to have resulted in 70 births by late 2018 since its launch in 2016, a bleak number compared to the almost 22,000 born as a result of the government’s in vitro programme in the period 2013-16.

No oversight in private clinics

There are no recent figures on IVF in Poland. Private clinics that perform it are not obliged to report the number of procedures or their success rate. Aside from ending state funding, the national government has also stepped away from regulating in vitro. This has allowed some private clinics to let their financial interests prevail over the care and concern for their patients.

Despite her happiness with the result of her IVF – who is knocking two spoons together to distract his mother’s attention away from the interview – Kasia Politańska looks back on her treatment with disgust. She describes the clinic she visited as beautifully decorated but with staff that were “totally lacking respect”. There was no privacy, and patients would be told in public corridors that their procedure had failed, or even the verdict that they would never conceive.

When Marcin came in to get a cup to collect his sperm in, he was greeted by young women who ridiculed him with their giggling. Even the gynaecologist in the public hospital where Kasia gave birth wrote in his report that the birth had been difficult “because the child was conceived through IVF”.

“Part of me really wants to have another child”, Politańska says. “But given my endometriosis, another caesarean could prove fatal. And also, I never want to undergo the humiliation of an in vitro procedure in Poland again.”

Emotionally and financially drained

Kasia and Kamil Wilk also have their doubts about undergoing another procedure. Virtually all of their money, plus some from her parents, has been spent on medical bills. Receiving financial support from one’s parents is not uncommon for Polish thirty-somethings who work full time, the couple says. Kamil: “It is difficult in this country to be financially independent.” Kasia: “My folks say we should keep trying to have another baby, but I feel drained both emotionally and financially.”

With the church no longer being a place to go when they feel down, the Wilks often retreat to the forest behind their small, purple-painted house. “Sometimes I feel so frustrated I scream at the trees,” says Kamil. Which is exactly what he did last spring, when he saw on television that the Polish government would spend more money on child benefits, while the couple has to pay through the nose for even a chance of conceiving.

Their government, Kasia believes, is not really interested in boosting the country’s birth rate, only in its alliance with the church and in political gain “by handing out gifts to people who don’t work,” she says.

In a clinic 200 kilometres from their house, one frozen embryo is still waiting for the couple. A possibility that symbolises both hope and fear. “I am afraid to try again”, Kasia says, because miscarrying could mean the final failure.

In all the dreams and plans for the child they might one day have, the Wilks are sure of one thing. “I will never have my child baptised,” says Kamil. He has completely rejected his faith. But despite the incident with the priest, Kasia still believes in God. “I don’t think IVF is the work of Satan. It is the work of God, he has given us the knowledge and technology to make it happen.”

Main image credit:  Oocyte with Zona pellucida, Flickr/ZEISS Microscopy (under CC BY-SA 2.0)

Emilie van Outeren is a Warsaw-based Central Europe correspondent, born in Amsterdam and educated in New York. She writes mainly for NRC, the Netherlands’ paper of record, and has appeared as an analyst on BBC World. This article was originally published in NRC in March 2019. You can find the Dutch version here.

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