A country for (old) men?

So it (finally) happened. On June, 23rd, Polish Father’s Day, President Andrzej Duda signed the bill prohibiting the sale of ellaOne (the “morning after pill”) without a doctor’s prescription. By doing so, he added another brick to the current government’s mission aimed at limiting the sexual and reproductive rights of Polish women. According to European Commission recommendations, ellaOne has been available without prescription since 2015 and it will now remain so for less than one month. Access to ellaOne under new legislation will present multiple obstacles such as difficulties in finding nearby gynecologists (particularly those willing to give a prescription), short visiting hours (Nappi et al., 2013) and money issues (short-notice visits to gynecologists in Poland usually cost extra). In other words, many women, especially those who are young, from rural areas and not wealthy, will suffer under the new law tremendously.

The history of ellaOne in Europe begins in 2009 when this particular type of emergency contraception became available on prescription in several EU countries. In 2013 the producer of ellaOne submitted an application to change the legal character of the product and thus make it possible to sell it over the counter. The proposal was discussed by the Committee for Medicinal Products for Human Use (CHMP), as part of the European Union’s European Medicines Agency (EMA) (Caspers 2016). The proposal was finally accepted in 2015. As a result, today, ellaOne (or similar types of morning after pills) are available without prescription throughout Europe (subject to a variety of conditions depending on the country, such as age limitations or limitations on the number of pills a person can buy at once). Now emergency contraception is available without prescription in all European Union countries, except Poland and, surprise, surprise, Hungary.

As already mentioned, this decision by the Polish Parliament (authorised by the President), is part of a wider strategy aimed at limiting women’s rights in Poland. This particular decision follows attempts to introduce a total ban on abortion in Poland, which will probably  continue throughout autumn 2017. The official discourse behind the decision is based on a language of protecting women. The Minister of Health claims that emergency contraception is abused by women, and that they replace regular forms of contraception with the morning after pill. According to him, women, especially young women, “eat ellaOne like candy” and in doing so, threaten their own health and well-being. In reality, Poland has the lowest rate of ellaOne consumption in Europe. Only 3% of Polish women used the pill in 2015 and 2016 compared to the 6.4% EU average. Moreover, young women (under 18 years old) represent 2% of users. In other words, the language of women’s health protection does not reflect reality, and simply serves as a political tool aimed at limiting women’s rights. I have written this several times already, but in a situation like what we are dealing with in Poland, it is important to keep repeating this over and over again.

However, as scientists, we all have an obligation to look at both (or all) sides of those creating discourse. I am obviously on the side of the progressive political scene, and support pro-gender equality politics, and the feminist movement, but I usually at least try to understand the other side’s argument as well. One such attempt to understand “the other side” was my project on the character of the Polish pro-life/anti-choice movement that I conducted in 2010. After my research on this particular phenomenon I was able to understand the logic behind the movement’s actions, the motivations of activists and the ways in which activists construct their values, goals and strategies. I disagree, but I understand.  So I’ve tried to apply the same approach to this particular case. I have assumed that the Minister (as well as MPs and the President) are seriously worried about the health of Polish citizens and that the new law is simply a manifestation of their concern. This concern is based on incorrect evidence, obviously, but at least their intentions are good. I assumed that these decision-makers are unfamiliar with the real number of women using ellaOne and that when they get the right data (well, my pleasure ;)) they will simply change their mind. I could even believe this, but, as always, there are also men to consider.

In 2016 a pharmaceutical company was allowed to register a new medication in Poland containing sildenafil, the substance used to treat erectile dysfunction, and normally known as Viagra. This wouldn’t be interesting, except for the fact that the new medication is now available in Poland without prescription, unlike in any other (EU) country. In other words, unlike in the case of Polish women, the government is not interested in the protection of men’s health and well-being while, again, unlike in the women’s case , it definitely should be. According to research, the condition of men’s health (in general) in the EU (and the rest of the world) is rather poor (Scambor el al. 2013). Men die prematurely, with more than twice as many deaths per year as women, the life expectancy of men is lower than women in all EU countries, and finally, men go to the doctor and ask for medical help much less often than women. All of these facts are clearly rooted in male socialisation. “What makes a boy a ‘real’ boy and a man a ‘real’ man is still connected to ideals of hardness, toughness, physical strength and invulnerability which leads men to overestimate their health status and to refrain from accepting health services” (Scambor et al. 2013: 129). Moreover, men who suffer from erectile dysfunction go to the doctor even more rarely. According to Rubin, “[e]vidence from both the United States and the United Kingdom suggest that only a very small percentage with the problem are ever sent to a urologist, perhaps only 10% of the population who suffer” (2004: 22). In other words, the availability of Viagra-like medication without a doctor’s consultation may cause a situation where many men “eat the pills like candy”. This could lead to complications resulting from a) abuse of its usage, b) the interaction of the pill with other medication that (usually older) men take and, c) unexamined and unknown health conditions that are risk factors while using Viagra (Marshall 2006).

Therefore, every responsible government should be concerned about men’s health in the same manner as it cares for women’s well-being. The fact that the Polish government focuses on “women’s protection” and completely ignores care for men’s health shows that the well-being of citizens is not the goal of the new legislation. In the best case scenario, the new law is an exemplification of traditional ways of defining women as irrational, non-logical and emotional individuals who are not able to take rational and evidence-based decisions and thus need help in making such decisions. Men on the other hand are seen as logical and responsible, and therefore, don’t need assistance in making important decisions concerning their health, as they can do that by themselves. And as we known from the bulk of relevant studies, this is complete nonsense as both men and women as rational/emotional to the same extent (Hearn 1993; de Boise & Hearn 2017). The worst case scenario suggests that the new law has nothing to do with the protection of citizens and is instead aimed at limiting women’s rights, which is one of the main agendas of the current Polish government, I repeat again and again.

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