Is Pregnancy a Death Sentence in Poland? Interview with Obstetrician-Gynecologist Dr Maciej Jędrzejko

Dr Maciej Jędrzejko works daily in a gynecological practice and witnesses happy moments when two people learn that they are going to become parents. He also witnesses despair and terror, mainly among women, when he has to inform them that the pregnancy is embryopathological. In Poland, a woman with such a pregnancy must go through three traumas: when she learns that she has a sick child in her womb. The second moment comes when she realizes that she must continue carrying it and cannot do anything about it until it either dies on its own, her life is threatened, or it is eventually born or a cesarean section is performed. And the third trauma is the moment when she watches that child die.

Listen to the full interview with Dr Maciej Jędrzejko.

Transcript of the interview with gynecologist Maciej Jędrzejko

Grażyna Hanaf: – What do you think about the belief held by many women that pregnancy in Poland today can be a death sentence that, fortunately, is not always carried out?

Maciej Jędrzejko: – As an obstetrician-gynecologist, I mostly experience the joyful aspects associated with pregnancy, and my role is, of course, to protect women from complications, which usually succeeds. I have to say that pregnancy is generally associated in my mind with happy moments. I also believe that in most cases it is a dream situation for many women, a fulfilled dream. However, pregnancy can become an illness. It can become a torment, not because the woman did not want it, but because the pregnancy suddenly starts developing complications, for example. Sometimes pregnancy becomes a torment simply because it exists, because it happened, because someone simply did not want it. Then it is an especially great tragedy, because an unwanted pregnancy is burdened with a very particular stigma and the mark of rejection from the very beginning. It is simply sad, but such situations happen and are a social problem. We cannot just pass them by and not care about them; this is happening, it is our reality. For some, pregnancy will be the fulfillment of dreams and a long-awaited moment, something desired, something others will never be able to experience; on the other hand, there are people for whom it will be a misfortune, a complete change and, for example, destruction of their life plans.

– Today we will talk about a difficult situation, embryopathological pregnancy (deviating from the normal condition or altered by disease), and I know that you also support the educational project “This Is Not Talked About”. Because of this project, the film showing the situation of women after the Constitutional Tribunal ruling, Ordo Iuris took an interest in you. You wrote on your profile on January 22: “I just found out 20 minutes ago that Ordo Iuris is trying to find something on me.” What did this situation look like? What does Ordo Iuris want from you?

– The situation was that over the course of two days I received two phone calls from my direct supervisors, who told me that some people had reported me. Reports made by telephone, so ones that cannot be proven. After the first call, I thought it was indeed a difficult situation. But I also knew that my boss was firmly on my side, so I understood that the reports had essentially been rejected, although he informed me that the situation had occurred. When another supervisor called me the next day, I understood that someone was simply trying to intimidate me. I am not a particularly fearful person…

– If we may ask, what did these reports concern? Something specific?

– Specifically, they concerned the claim that I illegally terminate pregnancies, so they were clearly attempts to get me dismissed.

– And possible criminal consequences as well. Why do you think Ordo Iuris is behind it?

– I received that suggestion from the people I spoke with. I have no proof, and I cannot prove it, because it is one person's word against another's. The reports were made by telephone. Nothing was put in writing, so the situation is almost impossible to prove. However, I received clear signals, and then I consulted various lawyers, as well as fellow gynecologists, without suggesting to them where such an attack might have come from. These circles were fairly unanimous that it must have come from that side—because who else? The truth is, however, that I cannot unequivocally say that Ordo Iuris caused this situation. In fact, the president of Ordo Iuris commented on Twitter in a way that frightened me, saying that I was apparently trying to defame Ordo Iuris. I interpret that somewhat as threatening me with legal action. You know, this is a very unusual situation. I have never been in one like it. Often someone disagreed with me or expressed an opinion about what I think, often a critical one. I accepted that. Of course, everyone has the right to their opinion, but never before had anyone descended to the level of intimidating or attempting to intimidate me. In such situations, I had a choice: either remain silent, tell no one anything, and wait to see what would happen—effectively allowing myself to be intimidated—or say that this situation had occurred, that I had these suspicions and had received these signals from people around me, thereby exposing myself to various consequences, including legal ones. The truth is that I am accustomed to the consequences of my actions. I take full responsibility for all my words and all my public actions. Accordingly, I am accustomed to being held responsible for what I say. I state clearly and unequivocally that I have no conclusive evidence that this is Ordo Iuris. Therefore I cannot accuse them. I can only say that these suggestions were conveyed to me both by the people who informed me of the matter and by the circles with whom I shared the situation and asked what they thought about it.

– We will watch a fragment of the film being made, which you support. We can consider whether Ordo Iuris would like such a film. Let us watch the excerpt.

– Do you encounter such situations in your practice? Have you seen such despair in your practice? That trailer is difficult to watch.

– Unfortunately, I know such situations very well. I knew them even before the Constitutional Tribunal ruling, back when we could legally terminate such pregnancies involving severely ill fetuses. These women suffered unimaginably. I have said in many interviews that all of us gynecologists who manage pregnancies in which embryopathological conditions occur have to confront the suffering of women. When a woman comes to an appointment smiling with her husband and we have to tell her, “I am very sorry, but unfortunately something is wrong with the pregnancy; there is a problem, I can see some abnormalities here on the ultrasound.” These are words no woman wants to hear. They are the very words women tremble at the prospect of hearing. In nearly 20 years of work, I have never seen a woman feel relieved because I told her that her pregnancy was severely affected and would most likely require termination—or rather, not that it required it, but that she was legally entitled to such a termination. I should also say that very few women chose to continue such pregnancies, because when there were severe genetic defects, most decided to terminate them. Two or three months later they became pregnant again, with healthy pregnancies, and the situation completely changed; there was joy. There was always some fear and anxiety at the beginning, of course, but once prenatal tests showed that everything was fine, the joy of being pregnant and then becoming a mother remained undisturbed. However, when we cannot terminate such a severely affected pregnancy and allow the situation to continue until the threat to the mother's life reaches some maximum level before we can make such decisions, or when the pregnancy reaches full term and a cesarean section must often be performed simply to deliver the fetus, the consequences are severe. A cesarean section is a serious, major operation. We perform it well and complications are uncommon, but it is a serious operation on a woman's body. It is disfiguring, permanently leaving scars and adhesions, and above all means that a woman cannot become pregnant again for the next 18 months. Thus, when we cannot remove a fetus that is 6 centimeters long and weighs 20, perhaps at most 30 grams, which could pass through a 1.5-centimeter-wide birth canal without damaging a woman's reproductive tract in any way, we cannot do it. We must wait until the fetus weighs kilograms, cut open her body, and mutilate her in order to bring into the world a severely ill, dying human being who will die moments later. We create a situation of double trauma—or rather, triple trauma. The first trauma is when a woman learns that she has a sick child in her womb. The second is when she realizes that she must continue carrying it and cannot do anything about it until it either dies on its own, her life is threatened, or it is eventually born or a cesarean section is performed. The third trauma is the moment when she watches that child die. Some women with deeply held religious beliefs find peace and solace in their faith. They experience it differently. But not everyone receives “sanctifying grace” and faith in one God or another. Many people are simply non-believers; I would even say that, in my observation, there are increasingly more non-believers than believers. In any case, even if believers do not practice their faith, they do not find strength in it because that faith is far, far away from them. They clearly say that they want this. They do not want it this way. Thus the law, in an absolutely coercive manner, prevents them from acting in accordance with themselves, with science, and with medical knowledge. This is simply profoundly wrong. It cannot be this way. I understand and deeply respect people who find peace in their faith and decide to make it through this very difficult process, but we cannot force women into heroism. Anyone. Neither women nor men. No one should ever be forced into heroism. If someone feels strong enough to get through it and survive, and will have support from their religious community, family, and partner, then that is fine. But if someone knows that they do not want to go through it, they must have the right to withdraw. They must have the right to make a different decision. That is all we are really asking for. Neither this film nor our entire campaign aims to promote abortion as such, because most of us simply do not agree with terminating a healthy pregnancy. In other words, we are not advocates of it in any way. We understand instead that nothing in the world can deter a woman who has decided to terminate a healthy pregnancy. Nothing that forces her to make a different decision. A woman who wants to terminate a pregnancy will always do so. At most, we can fail to see it, close our eyes, close our ears, stop talking about it. But it will happen anyway. And here we are talking about thousands; you probably know the statistics. In the case of embryopathological pregnancies, we are still talking about a thousand pregnancies a year. A thousand pregnancies a year out of roughly 320,000–350,000 healthy births is not even one percent. It is a very small scale, but at the same time the effect is real.

– Exactly, the effect of terror.

– Exactly. It has a chilling effect not only on doctors, but above all on women who, in their thirties, simply decide not to become pregnant at all. The situation is truly tragic. Women over 30 who want to become pregnant now tell me that they probably will not decide to do so.

– Are you afraid as a gynecologist? Are you now, after the ruling, afraid to make more decisive choices? As a doctor, when a woman comes to you and you tell her that it is an embryopathological pregnancy, what do you do now?

– I am generally not a fearful person, so I do not feel afraid in this case. I simply give her telephone numbers for clinics abroad. I refer her to websites where she can order abortion pills and obtain full information on how to perform an abortion herself, at home, for example.

– As a Polish doctor, do you not feel troubled that a Polish citizen cannot obtain professional advice, help, and treatment from you? Instead, you send her…

– Of course I do; I am furious about it. It is a moral burden as well. I am simply furious because I absolutely disagree with it. I cannot break the law, and that is a total obstacle. I cannot simply make decisions above the law, and I cannot break the law. I can only fight to change the law and act according to my conviction that these women have the right to information. But as a doctor, I cannot break the law. Everyone must understand that in Poland no doctor will currently terminate even an embryopathological pregnancy unless it genuinely poses a threat to the woman's life. But when we ask at what point there is a threat to life, that is where room emerges for various dilemmas, abuses, and disputed issues. The boundary is by no means clear or distinct. In fact, we already have two examples of women simply dying. When we wrote the letter from Polish gynecologists, signed by thousands of gynecologists, we predicted this. We wrote about it precisely, and predicted even more situations. The letter is available online. Please look it up: letter from Polish gynecologists.

– Did it receive any response, or was it sent off to Berdychiv?

– It was completely ignored. It was ignored both by the governing camp and, in reality, also ignored and not promoted in any way by the opposition. This surprised me greatly, because I had the impression that the opposition should nevertheless care about promoting this issue. Only recently have I begun to see the opposition slowly starting to take the side of women in any way. But I have the impression that it is still some kind of calculation between what pays off in the polls and what does not. I strongly dislike that. I am furious because I believe there are moments when one can deliberate, but there are also moments when one must unequivocally stand on the side of women. Simply, full stop. This is an issue beyond politics, because abortion in the case of a sick pregnancy is beyond politics.

– It is only a medical matter, a decision for each woman. I would ask that we look at what reality looks like, so that politicians do not become detached from it. Abortion Without Borders after a year of activity and following the Constitutional Tribunal ruling (presided over by Ms Przyłębska) says that 32,000 women used its access assistance. These are certainly not small numbers, as you will surely agree. Look at the scale. People aged 13 to 48 need abortions and use them. We send four people a day somewhere to a foreign clinic. There is also information that around 40% of those who traveled had fetal abnormalities identified. However, the exact number is not known because Abortion Without Borders does not ask about it. How do you assess the scale of this phenomenon? This is something neither the government nor the opposition deals with.

– It will always be the case that if we push a social problem to the margins, if we push it into the realm of social unawareness, we lose access to any scientific data on it. This is one of the greatest dangers of outlawing certain activities and social problems. If a problem is simply swept under the rug, it has consequences not only for how that problem continues to unfold in the country, but also means that we have no insight into what it really looks like. I have information that the data presented here are significantly understated. I know from patients who traveled abroad for abortions that from some cities, including Kraków, a bus full of women sometimes leaves every three or four hours for abortion procedures in Czechia or Germany. We are talking about a situation on such a scale that a bus carrying women who have abortions leaves one city every few hours because they know that no one in Poland will help them. Of course, we can continue living in denial. If someone wants to live in a country that lives in denial and believes that this problem does not exist, that is exactly what is happening in Poland right now. I do not want to live in a country ruled by denial. I do not want to live in a country where it is impossible to legally undergo a medical procedure recognized throughout the world and consistent with medical knowledge and practice, psychology, and sociological knowledge. It is an extreme absurdity that those who govern, who make the laws—I do not want to place myself on that side at all—completely ignore the views of scientists. Scientists from various fields: they might ignore gynecologists, but they also ignore sociologists, psychologists, and social psychologists. It is simply absurd. Therapists' offices are full of women experiencing trauma connected with this. These people do not realize one important thing, and I would very much like to warn against it. There is such a thing as the sense of happiness of living in a given country. Some countries have a high sense-of-happiness index, while in others it is very low. If we live in a country where women—half our population—are afraid, I cannot imagine building happy families there. I cannot imagine building happy relationships between men and women in such a country. I cannot imagine people being happy and satisfied with sex in a country without sex education and access to contraception. I am becoming increasingly sad, somewhat frightened…

– And there probably will not be the birth rate that Ordo Iuris would like, either, right? So it would be in Ordo Iuris's interest to have legal abortion up to, say, eight weeks of pregnancy. I think they would be happy then. Should we advise them that?

– First of all, the mathematics is clear. If Ordo Iuris can prove to us that more children with Down syndrome were actually born during the past year than in the previous year, that would mean that this law really protects children with Down syndrome. But if it turns out that the same number or fewer were born, it means that the law is ineffective. This is one of the simplest examples, because the law was primarily supposed to protect children with Down syndrome, right? If significantly more of them are actually born, I could believe that some protective effect for these children had occurred. However, I am strangely confident that the statistics will not improve, because my information is that among all patients diagnosed, among other things, with Down syndrome, 80% decide to terminate the pregnancy. And this is not only information from me; I also called various genetic counseling centers, since we work with geneticists as well. I always ask geneticists what statistical data they have on the decisions women make when they learn from a geneticist—a specialist—about the prognosis and further management in such cases, including the prospects for survival and the course of the diseases these children carry. They are all unequivocal: more than 80% of women chose abortion. Nothing has changed now.

– Mr Jędrzejko, we cannot end this interview optimistically, but we can say that people should donate to the educational project “This Is Not Talked About,” and we will provide a link. And that people should support women who make their own personal decision about whether to become mothers, together with their partners.

– In every situation I generally try to look for something positive. There are no positive aspects to this one, of course, but there is something else: it also encourages us to try to propose an alternative. If we do not accept this law, what kind of law would we want? Obviously, no extreme will produce a good result here. That is why we proposed a bill of a particular kind, which I presented to opposition MPs, because PiS MPs are not interested in it at all. It is a bill to create a support system for women in an abortion crisis. This is an idea for saving tens of thousands of healthy pregnancies. I have no idea—no wild idea—of banning abortion in the case of an embryopathological pregnancy in any way. The right to terminate such pregnancies must be restored, and there is no doubt about that. There is no room for debate on this point. If a woman wants to continue such a pregnancy, we must do everything to help her continue it. If she does not want to continue it, we must do everything to enable her to miscarry safely. At the same time, there is an idea for saving 50,000 healthy children. But this idea must be non-coercive. It must not be achieved through force or by imposing a situation on a woman in which she must do something, but by giving her support. This means creating provincial centers and a round-the-clock facility where a woman who has learned that she is pregnant and panicked could go instead of making immediate decisions in panic. There she could receive medical advice, psychological counseling, and advice from a social welfare professional…

– A priest, for example, if she is a believer…

– Or a priest, for example, if she needs one, of course. The point is that she should be able to obtain information about what to do next. These women most often decide to terminate a healthy pregnancy in great fear. Of course, there is a group of women who have thought it through very carefully, but in my view they are a definite minority. The overwhelming majority make the decision in a state of panic, despair, and confusion, not knowing what to do next. So if the state wants these children to be born, it must provide the woman with support. It must give her a chance and provide social assistance in such situations, because these are often people with serious financial problems. If the state truly cares about life, that is where there is room and an opportunity to save it. Where the pregnancy is severely affected, that is not the state's domain; it is the domain of doctors and mothers. That is all.

– And that is where the state should withdraw. With that message, thank you very much. It is indeed important that such projects and ideas are created at all. We hope they will find their place in Poland. Once again, thank you very much for your time. Thank you for this project, and I wish you success in everything you do.

– Thank you very much. My warm regards to you all, to the women, and to everyone who cares about the fate of women in Poland. Warm regards!