REPRODUCTIVE HEALTH WOMEN IN POLAND
REPORT - February 1997
REPRODUCTIVE HEALTH WOMEN IN POLANDREPORT - February 1997 |
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The poll serving as basis for this Report has been conducted on a non representative group of women, because to a large part they came from supporters of the Federation itself. Of the 5,000 polls posted (annexed to the Federation bulletin) we have been sent back as many as 1,223 filled in question sheets. This is regarded as great success, because post polls seldom yield such results. From the sounding carried out by the Federations one basic conclusion emerges:
The subject of reproductive health turned out to be extremely vital and topical, since so many women answered the poll. Many of the responding women added very interesting comments to it.
The poll was fairly long: it consisted of 62 questions organised into 10 modules, each of which covered a portion of issues falling under the general category of "reproductive health". The modules are as follows:
The educational pattern of the surveyed sample departs greatly from that of the population in general. Nearly 95 per cent of the surveyed women have received secondary and higher education, Poland's average being 35 per cent. The poll has been answered mostly by women living in towns, and in 10 per cent by women living in villages. So the surveyed women have a much higher awareness of health issues, including prevention, than the vast majority of Polish women. They also have a more comprehensive knowledge about and better access to health-care services. As many as 62 per cent of them were younger than 20 when visiting a gynecologist for the first time. More than 55 per cent say they visit a gynecologist not less than once a year. In 70 per cent of the cases the reason why the responding women's seek a gynecologist's counsel are follow-up visits and not health problems; in 17 per cent of the cases it is contraception. 63 per cent admit having taken measures to prevent or detect women-specific neoplasms at an early stage. A 21 per cent had reproductive organs disease and 8.8 per cent had breast problems; in 62 per cent of the cases the condition was detected at an early stage.
The obtained results have to be regarded, therefore, as an over optimistic picture. In reality, that is in relation to the whole population of Polish women, it presents itself in much darker tones.
Generally the responding women are critical of health-care services, especially of gynecologists, particularly in the area of information, pro-health education and prevention.
The largest percentage of the responding women paid their first visit to a gynecologist because of disturbing symptoms (35.6%). The first of the follow-up examinations was the reason for slightly over 22 per cent of the women. Only 4.4 per cent of them went to a gynecologist seeking counsel on contraception and nearly 12 percent - because of an unwanted pregnancy. It turns out that around 70 per cent of the women were left ignorant by the doctor about the nature of a gynecological examination or were informed about it insufficiently; 57 per cent say that during their first visit the gynecologist did not signal to them the need of making regular follow-up examinations or did this insufficiently.
Nearly one third of the responding women, when asked about the way the gynecologist had treated them, found that they had not been treated properly, i.e. in accordance with the principles of respect, professional secrecy and privacy and the like. More than 14 per cent admitted having suffered improper remarks concerning them (e.g. you are too young to be thinking of sex life, it's high time you had children). Nearly 4 per cent said they had experienced such behaviour of the gynecologist as may be regarded as sexual molestation, which makes a fairly large percentage. After all each and every incident of this type should be judicially penalised. It can even be said that a percentage of criminal behaviour in the gynecologist's consulting room amounting to 3.9 is downright alarming. Particularly because this is probably just "the tip of the iceberg": the group surveyed is by no means representative and such incidents may be much more acute in relation to women who are less aware of their rights.
Breast cancer prevention - breast cancer being the main death cause in women in Poland - is most severely neglected. According to nearly three fourth of the responding women the gynecologist does not examine their breasts at all or does it rarely; in only 21.9 per cent of the surveyed women gynecologists conduct this examination on a regular basis.
The promotion of family planning by gynecologists also looks grim. More than 52 per cent of them never recommend women to use contraceptives or do this seldom. This is the more surprising, as doctors should have improved contraception counselling since the anti-abortion statute is in power. According to as many as 61 per cent of the women, gynecologists do not inform about family planning means and methods and about their pros and cons at all or do so insufficiently. It is of interest that the contraceptive they are most ready to recommend, if at all, is IUD (as done by 58 per cent of the gynecologists); the pill is advised by a mere 27.7 per cent. It seems that one reason of this disparity may be the fact that inserting an IUD means extra money (the second largest source of income after abortion) for the doctor. An IUD insertion costs at least 250 z_oty (1 USD = 2.8 Polish Z_oty), at present. And this in a situation where gynecologists in public health service do not insert IUD, unless for a fee. The fact that non-medical concerns may affect the methods gynecologists recommend does not speak well for the professional ethics of this community. There are reasons enough to suspect that contraception counselling is deficient not only due to an insufficient proficiency in modern family planning means and methods among gynecologists, but also because many of them are biased against contraception on ideological grounds.
About 50 per cent of the women visit a gynecologist who has a private practice and more or less as many visit public doctors. One fifth of the responding women go to public gynecologists, because the visits are free. What the women value in their gynecologist is the confidence they inspire (67.1%). More than one fifth of the women make their choice of the gynecologist considering the high quality service, there. The responding women are most satisfied with such gynecologists, whose competence becomes manifest in informing them, talking with them and directing them for specialised examinations. The women also appreciate it, if the gynecologist examines their breasts and leaves the choice of treatment methods, including contraceptives, open to them.
A 25 per cent of the responding women have never used any contraceptives. Such as do or did use some, admit that they are most fond of the pill (nearly 45%), condoms (58%) and IUD (nearly 24%); 49 percent admitted using the calendar. It is characteristic that the most common reason for part of the women against using contraception was concern over side-effects (over 28%). The Polish community still seems to cling to the conviction that hormonal methods are harmful, though pills of the new generation contain a small amount of hormones and the side-effects they may cause are only minor. 4.5 per cent of the responding women did not use contraceptives for religious concerns. Such persons are likely to be much more numerous in the general population.
The question whether medical care had been satisfactory during childbirth was answered in the negative or judged as insufficient by 43 per cent of the responding women. Nearly one forth of those women, who were content with the quality of care during and after delivery, had to pay some extra fees; 5.7 per cent of the responding woman complained about the unfriendliness and unhelpfulness of the personnel. The standards according to which the personnel's behaviour was evaluated remain an open question, though: would what used to comprise the image of routine help in the 60's or 70's meet the expectations of women giving birth in late 90's? More than half of the women pointed to an absence or neglect of respect, care and interest on the personnel's side. Over 35 per cent were not informed about the need to breast-feed at all or only to an insufficient extent. More than 65 per cent were not taught how to take care of the infant or were instructed roughly. Nearly 60 per cent complained about the hygienic and living conditions at the ward (change of shirts and sheets and blankets, assistance in breast care).
In summing up the answers to questions concerning childbirth it can be said that health-care service does not function too well in this respect (an additional circumstance being that most of the responding women are inhabitants of large and very large towns; in small towns and villages the situation is probably much worse). However, obstetrics is undergoing major changes in Poland, at present. On the one hand the women demand ever higher service standards, on the other hand many institutions have witnessed a distinct change for the better. Consequently, the evaluation criteria of maternity ward functioning evolve and this in turn may render the interpretation of the answers to these questions more difficult. No doubt Poland has a long way to go before high quality maternity care is universally available.
More than 83 per cent of the responding women are of the opinion that abortion should be permitted on the woman's demand. The simple question: abortion on demand - yes or no - is obvious to nearly all the women, inviting a clear answer. This may indicate that the women take on the responsibility for their choices and do not deem it necessary that the lawmaker provide a multitude of detailed regulations. It may be that the 5.4 per cent of women who refrained from answering this question were persons ready to accept abortion for reasons other than "on the woman's demand"; this percentage is too small, however, to significantly disturb the implication of the other answers.
Sterilization as a contraception method is accepted by nearly 74% of the women. Although it is carried out very seldom, nearly three forth of the women would like to see it as a contraception method in Poland. This result makes one stop and think deeply, because the status holding in Poland so far is incompatible with such opinions. Such a high rate of accepting sterilization as a contraception method invites the guess that Polish women would welcome a change in the respective laws towards the standards of the European Union and of many other countries.
In the opinion of as many as 95 per cent of the women sexual education should be taught at school. The answers to the relevant question are salient, because they manifest the conviction of nearly all of the surveyed woman, regardless of the differences between them, that sexual education should be taught at school. This result is of prime significance, even with the correction that the surveyed sample is not representative. A large number of educated women being so unanimous in this respect indicates an important and distinct tendency and also a social demand for sexual education.
Over 28 per cent of the responding women said they had had an abortion before the abortion statute was revised outlawing abortion. Nearly 3 per cent admitted having undergone abortion already after the revision. Since abortion is a taboo subject in Poland, heavily burdened by a feeling of guilt, the number of such women is likely to be much higher, but for various reasons they chose not to admit it.
There is not full availability of women-specific examinations in Poland. Some are available to a higher, some to a much lesser degree.
Interpretation difficulties with analysing the answers to the relevant questions are due to the fact that some of the examinations may be inaccessible either "objectively" (no equipment in a given township) or "subjectively" (no information that such an examination is possible at all). Particularly as concerns antenatal examinations, intravaginal ultrasonography and cytohormonal examinations it is likely that quite a percentage of the surveyed women are not aware of the possibility to carry out such examinations at all. The situation is better in respect to the availability of cytological examinations and ultrasonography and to the women's knowledge about the necessity to conduct these examinations. Only 8 per cent of them complain about a lack or poor availability of cytological services. The availability of ultrasonography, however, is not so good. Nearly one fifth of the women inform that it is either completely unavailable or available to an insufficient degree.
What comes to attention is a relatively small ratio of affirmative answers in examinations used for diagnosing diseases that are women-specific and at the same time frequent and dangerous. Breast cancer for instance, being one of the most common death causes in women, is diagnosed through mammography. This examination is either not available or available to an insufficient extent for over 37 per cent of the responding women (most of them live in towns!). Less than half of the women have full access to this examination, whereas, according to the standards of highly developed countries, it should embrace all women over a specified age. Similarly, over 23 per cent and over 36 per cent of the responding women have no access to cytohormonal examinations and to specialist doctors respectively, particularly to endocrinologists and ontologists. Add to this the considerable percentage of the "I do not know" category, which shows a significant lack of knowledge about these services and ignorance of their importance especially in diagnosing women-specific diseases.
Also the women's answers to questions dealing with the availability of antenatal examinations come to notice: as much as 42.4 per cent of the category "I do not know" and 6 per cent of the category "no answer" reveals an immense information shortage in this respect, most likely not only among the women, but also among health service workers, who themselves do not know what services there are available. The supposition can be ventured that the issue of antenatal examinations has to some extent become a "political" issue. This would partly explain such a severe lack of knowledge on the women's part and the unavailability of these examinations, as declared by over 25 per cent of them. Only 25 per cent state that antenatal examinations are fully available. It is probable that gynecologists avoid prescribing antenatal examinations for extra-medical concerns sometimes.
Over 60 per cent of the responding women answered "no" or "to an unsatisfactory degree" to the question whether the gynecologist had informed them about the methods of alleviating menopause effects. It does not seem to be the gynecologists?tm) common practice to discuss the treatment of menopause, a women-specific problem, with their patients, and to regard it of equal importance with other life and health saving procedures, although the conditions related to menopause, if left untreated, may cause serious diseases.
Nearly 60 per cent of the women gave a negative answer to the question whether the gynecologist had recommended substitutive hormonal therapy or other methods of alleviating menopause effects. Moreover, some of the patients may not know anything about the kinds of substitutive therapy nor of its importance (as indicated by the high percentage of "no answers").
As many as 63.7 per cent of the responding women did not take up any prophylactic therapy, compared with the 22 per cent who did. The high ratio of "no answers" is significant here, as well; it may illustrate a high level of information want and therapy unavailability. In this field, too, the health service leaves much to be desired in respect of disseminating information and rendering actual service.
The concern over hormonal drugs is intense enough to keep one fifth of the responding women from using a prophylactic hormonal therapy during menopause. Once again it is manifest that social knowledge about hormonal treatment is far from satisfactory, even among educated inhabitants of large and very large towns. It is significant, moreover, that for over 13 per cent of the responding women an impediment to using hormonal therapy are financial concerns. This can also partly be blamed on state policy concerning women health care (e.g. most hormonal drugs are not refunded).
For 5.3 per cent of the women, the reason for not using substitutive hormonal therapy is the gynecologist's negative attitude to it. This may reflect the doctor's insufficient competence in this respect.
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