Why is IVF still up for debate in Poland?

Infertility is estimated to affect over one in six couples of reproductive age worldwide according to the WHO, with 25 million individuals affected in the EU alone. Poland is no exception with up to one in five couples being affected, which has led many city councils to provide funding for IVF from their own local budgets. And why have the city councils been stepping up to this task?

The Polish National Health Fund (NFZ) is very similar to the NHS in the UK. Normally, all citizens and residents who pay national insurance contributions, either through their employers, or individually, if self-employed, are eligible to receive NFZ-funded health treatments. Since the healthcare is generally centrally-funded, the local councils' initiatives to fund IVF is not the usual method of funding health treatments. Yet, this means that access to treatments is restricted to several selected towns and cities that have budgeted for it.

Although the first children conceived via IVF are reported to have been born in Poland in 1987, treatment of infertility had remained unregulated, and mostly unfunded, in the country for over two more decades. Discussions on a reproductive health bill began in 2010, but were unsuccessful, and a state-funded IVF programme was ordered by a ministerial decree in May 2013 and offered to 15,000 couples, resulting in over 22,000 live births, according to Oko.press. Following this success, the government, then led by the Civic Platform party, passed a bill in June 2015 to fund IVF for couples requiring the treatment.

However, in November 2015 a new government was elected, led by the socially conservative Law and Justice party, which has close ties to the Catholic Church, and by 2016 the bill was scrapped and the IVF funding withdrawn. Instead, the Polish government has been funding infertility diagnostic clinics, and hormonal and surgical treatments aiming to improve fertility. This is reported to have resulted in 70 births out of 1289 treated couples in one year, Gazeta Prawna reported.

The government has introduced a number of divisive reforms over its two terms in power, with a reform of the judicial system being among its most controversial, along with restrictions for the press, resulting in Poland's position in the World Free Press index falling consistently since 2015. In January this year again the government added to its debatable collection of reforms, when they passed a bill intended to 'protect children from moral corruption' in schools, according to Notes from Poland. The Ministry of Education and Science subsequently capitalised on this and introduced a new school subject, History and the Present, for which a new textbook has been written. The subject and the textbook have been criticised by academic institutions and historians, eg, the Council of the History Department at University of Warsaw, as being insufficiently researched and inaccurate, and caused substantial uproar on social media.

A parent of a child born thanks to IVF is even filing a lawsuit against the Polish Minister of Education and Science and the author of a new textbook, (see BioNews 1156), because a fragment of the textbook, even though it does not mention IVF explicitly, implies that children conceived in vitro could not be loved: 'Increasingly sophisticated methods of separating sex from love and fertility lead to treating the sphere of sex as entertainment and the sphere of fertility as human production, one might say breeding. This prompts the fundamental question: who will love the children produced in this way?'

The problematic passage has since been removed from the textbook by its publisher, euronews reported recently. However, in the meantime, Kamil Mieszczankowski had raised more than ten times his original target in a crowdfunding campaign for financing the lawsuit. Independently, Poland's Association for Infertility Treatment and Adoption Support – Nasz Bocian  – has filed an application to initiate the procedure for annulment of the Ministry's decision to allow the textbook to be used and is also preparing to sue Professor Wojciech Roszkowski the author of the textbook. Meanwhile, minority party members of the parliament have been proposing new legislation to guarantee state funding of IVF.

Poland is a majority Roman Catholic country and the Church is very active politically, as analysed in the Journal of Religion and Health. To a certain extent this stems from the fact that the Church had played a major role in Poland’s struggle against communism, as analysed in the Journal of International Affairs. The iconic Polish Pope John Paul II is claimed by historians (such as in the Polish Review) and older generations of Poles to have built the foundation for change, if only by offering moral support to his compatriots in Poland during communism.

Hence many people who grew up in the communist era, associate the Church with progressive values and treat it as an expert authority on a number of matters. This has been contributing to opposition from the more religious and traditionally conservative members of the society to passing bills that would allow for the reinstatement of state-funding of IVF treatments in Poland, and instead has been providing fertile ground for new questionable educational reforms. On the other hand, the continued involvement of the Church in the secular aspects of society has been pushing many Poles, including one of the country’s first 'IVF babies', to turn away from it, Notes from Poland reported.

The tensions over IVF and the new school subject and textbook are expected to continue, and will likely be fuelled by clashes between the major competing political parties in the runup to the upcoming parliamentary elections due in 2023. It is close to impossible to reliably predict which political parties will form the government next year. Based on a recent public opinion poll, the Law and Justice party will get the highest number of votes, but it will not be high enough for this party to lead on its own. In that case the poll analysis suggests that the opposition parties may be more likely to form a coalition, and then a government. If these predictions come true, this will potentially mean a reinstatement of a state-funded IVF programme