Common cause, equal rights
November, 2020. For several weeks now, crowds of young Poles have been marching in the streets of many Polish cities almost every day. Despite the raging pandemic, government bans on gatherings, and unfavorable autumn weather, they leave their homes to protest the ruling of the Constitutional Tribunal.
On October 22, 2020, Constitutional Tribunal judges ruled that two sections of Article 4a of the 1993 Act on Family Planning, Protection of the Human Fetus and Conditions for the Admissibility of Termination of Pregnancy were unconstitutional. The Act permitted termination of pregnancy due to a high probability of severe and incurable impairment of the fetus or an incurable disease that threatens life.
The recognition of these sections as unconstitutional effectively banned abortion in such cases. By excluding the admissibility of one of the three grounds for legal abortion, Polish law, already considered one of the most restrictive in Europe, was pushed even further towards the extreme.
Even the most ardent pro-life activists must realize that this will not eliminate abortions. If anything, they will lead to an increase in abortion tourism or move abortions to the illegal underground, risking the health and lives of women, especially the poorest. So it is about more than just limiting freedom and penalizing the procedure; the goal is symbolic control over women, their sexual lives, and consequently, reproduction. After all, for many institutions in this country, the basic and most important purpose of the family is procreation, and sex itself cannot serve anything other than reproduction. This symbolic domination of women extends to many areas of life, making it difficult to take care of menstrual hygiene or burdening women with the responsibility for contraception. You don't have to look far for examples, and the problem is not unique to Poland. German law only this year stopped consideringtampons as luxury goods, reducing their taxation from 19% to 7%.
The unwritten consent to control women's freedom is particularly evident in yet another issue: the unequal access to surgical contraception, usually referred to as tubal ligation for women and spermatic cord ligation or vasectomy for men.
What does tubal ligation look like in practice?
The purpose of tubal ligation is to block the patency of the fallopian tubes, i.e. to stop the egg from moving from the ovaries to the uterus. In this way, sperm is prevented from reaching the mature egg, ready for fertilization. Several methods are currently used to achieve this. For example, a coil can be inserted into the fallopian tube, which, over three cycles, will close the patency by growing muscle tissue. Another method is to use a laparoscope. Through a small incision near the navel, the doctor can cut and tie the fallopian tubes or use titanium clips to tighten and thus block the patency of the tubes. Correctly performed, the procedure results in 99% contraceptive effectiveness, without affecting libido or menstrual cycle. Sex can be enjoyed as early as a week after the procedure, after prior consultation with a doctor.
How is a vasectomy performed?
The male sterilization procedure, or vasectomy, involves tying the spermatic cords. The doctor, similarly to the case of the fallopian tubes, can use titanium clips, thus preventing the appearance of sperm in the semen. In the world, this procedure is increasingly performed without a scalpel, i.e. cutting the skin and spermatic cords, opting for a less invasive, seamless puncture method. For some time after the procedure, sperm may still be present in the semen, which is why a test for their content is recommended after a few weeks. The effectiveness of vasectomy is almost 100%, without negative effects on erection or ejaculation.
My body, whose business?
Both procedures seem to be based on the fundamental right to freedom of decision about one's own body. The procedure itself looks similar in both cases, it does not differ much in effectiveness or effects. Both should be a conscious choice, which can be carried out in civilized conditions in the nearest hospital or clinic. However, the problem is Article 156 of the Penal Code. Its wording clearly implies that anyone who causes serious damage to health, including preventing procreation, is subject to a prison sentence of at least three years. This means that a doctor who causes permanent inability to conceive may be prosecuted ex officio. The only exception seems to be a situation in which there are clinical indications: a threat to life or health or a risk of serious fetal defects.
How did the abortion “compromise” contribute to the issue?
Things looked a bit different before the 1993 Act, commonly known as the abortion compromise, came into effect. In the Polish People's Republic, tubal ligation was often used on women who had had three caesarean sections. In such cases, there was a fear for the health and life of the mother, because in the event of another pregnancy, and therefore delivery, there was a very high risk of uterine rupture. After the abortion compromise was introduced, there were situations in which doctors, fearing the letter of the law, did not enter the fact of performing the procedure in their medical records, the purpose of which was nothing more than to care for the safety of women.
They openly, you secretly
Meanwhile, in Poland, in 2020, tubal ligation is widely considered an illegal procedure. Unlike vasectomy, we will not find information about tubal ligation on the websites of many private clinics scattered throughout Poland. No one will openly offer us a painless, 15-30 minute procedure for PLN 1999, as is done in the case of spermatic cord ligation. On the other hand, we will easily see a large billboard with the words MALE CONTRACEPTION, catching the eye of drivers on one of the main Polish highways and tempting with the 100% effectiveness of vasectomy. In turn, when looking for advice on tubal ligation, the first thing we will read is that it is an illegal procedure in Poland. We will learn that in addition to abortion tourism, there is such a thing as sterilization tourism, and the hottest destinations each season are the Czech Republic, Slovakia or Germany. Then we will read the story of a woman who is the only one on the entire coach of a quasi-legal tour who does not want to have an abortion, but merely tie her fallopian tubes. And she will be forced to pay more for it than a man for a similar sterilization procedure. Prices in private German clinics range from 600 to even 800 euros, excluding travel and accommodation. Isn't it true that one can get the impression that for some reason someone wants to make someone's life very difficult? No wonder phrases such as "tubal ligation Germany" or "tubal ligation Czech Republic" are Googled about 300 times a month in Poland.
Since when does reversible equal permanent?
The drastic difference in standards seems to have no rational explanation. The problem in this case is the interpretation of Article 156 of the Penal Code, which refers to permanent bodily harm. In the case of vasectomy, it is estimated that the chance of restoring fertility ranges, according to various sources, from 30% to even 80%, a year after the re-vasectomy. The probability of success depends on many factors, including the condition of the spermatic cord after the first procedure or the time that has passed since the vasectomy. The chances are lower the more time has passed. The reversibility of the vasectomy procedure seems to protect it from the sanctions of Article 156 of the Penal Code. Why, on the other hand, cannot a woman undergo the same procedure? Why can a doctor refuse if the decision to sterilize oneself is autonomous and fully conscious? Does the argument about reversibility not apply in the case of tubal ligation?
Have you taken away your ability to plan a family forever?
It is commonly believed that vasectomy is reversible, while tubal ligation is not. However, it turns out that despite the relatively greater chance of success of vasectomy reversal, tubal ligation can also be reversed. The operation does not guarantee success, is more complicated and therefore often more expensive. In Great Britain, the price of such a procedure ranges between 15 and 25 thousand pounds and is rarely reimbursed by the British National Health Service. The procedure itself involves stitching and unblocking the fallopian tubes or, in more difficult cases, a fallopian tube transplant. The less damaged the organs during ligation, the higher the chance of successfully restoring fertility. If the procedure goes without any complications, the probability of getting pregnant in the future can reach up to 70%, depending on the woman's age.
Why don't we know why?
It is difficult to indicate a rational and justified basis for the fact that tubal ligation is not performed in Poland, but vasectomy is. This state of affairs is largely due to vague legal regulations, which do not even attempt to specify where the boundary between permanent damage to health and a conscious procedure for the sake of oneself is drawn in this case. In practice, the law formulated in this way does not allow us to make decisions about our own bodies. It is also impossible to indicate to what extent the belief in the irreversibility of tubal ligation is responsible for this situation, when in reality there is a chance to reverse this step. Apart from surgical solutions, there is always the possibility of in vitro fertilization, which is not excluded by prior tubal ligation. Despite the fact that in theory both procedures, according to Article 156, are not legal in Poland on request, performing one of them is much simpler and more accessible.
Also read our other articles about contraception:All contraceptive methods , Hormonal contraception and The morning-after pill - we present the facts, debunk the myths .
I think, I feel, I decide
What shapes this particular approach to surgical contraception in Poland seems to be exactly the same thing that brought hundreds of thousands of young people to the streets in recent weeks. As with abortion, here too the desire to control women by restricting their freedom to decide about themselves and their bodies is evident. Thousands of slogans on sheets and cardboard show that we know exactly where this desire for control comes from. It doesn’t matter whether it comes from the habits of a crumbling patriarchy, the oppressive, conservative doctrine of the Catholic Church or cynical political interests. In the end, it’s always about dominating a woman’s position and reducing her role in the family, but also outside it, to procreation. Different forces have used different means to achieve their goal, such as shifting the responsibility for contraception onto women. How many men contribute to the cost of contraceptive pills? How many of them would dare to take this burden off a woman? How many of them would take advantage of the possibility of pharmacological contraception? Promising research results from work on such a measure appeared already in 2018. If such things are to rest on women's shoulders, how can you simultaneously take away their right to decide about themselves and their bodies, including in an issue such as surgical contraception? Fortunately, it is enough to read a few slogans from protests to know that this is not possible.
My body, my business.
Created at: 06/08/2022
Updated at: 15/08/2022
