A white dress, a wedding and a boisterous wedding, and then a bunch of children - this is what a typical young girl dreamed about even in the decline of the era of communist Poland (PRL era). Then she more and more often declared: “of course I am planning a husband and children, but not yet - first I have to finish my studies, find some job, we'll see.” There were probably many who did not fit into this scheme, but rather did not flaunt it. Why expose yourself to the conclusions of the omniscient that “you will still be wise”?

And today? Z-gen, or women from generation Z*, are increasingly declaring: FOR NOTHING, NEVER. IT'S NOT FOR ME. Even if pressure is exerted, the threats: “you will regret”, sound convincing and decisive. Undoubtedly, there are also such women whose dreams are no different from the declarations of moms and grandmothers, but their voice is heard less and less. Reverse trend.

This year's CBOS survey shows that among young people (data for both sexes, regardless of age group, are very similar) of those who decide not to have children at all, there are more than 20%. One, a mountain of two children, is considered by the vast majority. At the same time, it has been maintained for years that more than half of the respondents, in each age group, end up having fewer children than they originally planned. Demographers are increasingly talking about a catastrophe that can no longer be stopped. The youngest women in the study Ipsos They said they didn't want children because they simply couldn't afford them. Women mature that they are afraid of losing their jobs. More and more voices are being raised in all age groups that pregnancy in Poland is one big risk. However, it seems that this aversion to motherhood, however, is something more. We asked Prof. Marzena Dębska how it looks from the perspective of the gynecological office, but also from personal experiences.

Eliza Dolecka, health.gazeta.pl:

My assistant told me that she couldn't keep up with ordering kits for long-term contraception because interest in her was growing at a rate that was hard to predict. It is used by patients of almost all ages.

Prof. Marzena Dębska:

- Indeed, women are increasingly choosing pregnancy protection methods that provide reliable contraception for at least a few years. They are supposed to be not only very effective, but also comfortable and safe. More and more young women are opting for long-term contraception in the form of IUDs and subcutaneous implants. A growing group of women do not see themselves in the role of mom at all. I say this, of course, from the perspective of a doctor working in a big city.

It used to be that young women who had not yet given birth were warned against long-term contraception because it was supposed to negatively affect fertility.

- Today, patients know that these warnings can be dismissed. The risk is practically nonexistent, and fertility returns very quickly after removing an IUD or contraceptive implant – it can be done at any time. An intrauterine device (IUD) is not the first-choice contraceptive method for women who haven't given birth, but this is mainly due to technical issues related to its insertion. Since the introduction of the 5-year IUD, which is smaller than the traditional ones, very young women also use it. Hormonal IUDs and implants are effective and comfortable contraceptive options, and they also alleviate menstrual discomfort. It’s very rare for a woman to want to stop using this form of contraception before its expiration date.

Do you often talk to young patients about motherhood?

- Of course. I have a “pro-family policy” in my office. I want women to make informed decisions about motherhood and not suffer the consequences of procrastinating and postponing decisions for too long. Very often I ask my patients the immortal question - and when are you planning a baby? I haven't seen a patient feel bad for me yet. Many times, however, women came to me with whom no one spoke about it and dealt with the topic too late. I respect all women's decisions. I often hear that a child is contemplated somewhere in the distant future or not at all. I do not criticize or press, because I know that the world of young women, especially between the ages of 20 and 30, does not revolve around motherhood. It is quite the opposite. We are talking almost exclusively about contraception. Thinking about having a baby starts just before thirty, but that does not mean that in fact that is when women stop contraception. Often they do not yet have a suitable partner, but they ask about fertility issues and possible risks. They plan a pregnancy, sometimes only theoretically, without trying at all for this baby yet. It seems to me that it is similar throughout Poland, although the age limit may be different. Childbirth centers in both small and large cities are increasingly shining with voids, maternity wards are closing. It must testify to something.

‍About what?

- There are probably a lot of reasons. Times have changed and so have people. One of the reasons, in my opinion, is a great need for development, self-realization, passion. People want to explore the world. They are more focused on themselves. Perhaps the child seems to interfere with this, at least until a certain point. Every day I have several patients who come forward because after years of using contraception, they suddenly discover that they cannot get pregnant. They are usually around 35 years old and older. Although this “I can't happen” usually lasts quite a short time, for example, half a year, they are already very worried. Suddenly they are in a hurry. And rightly so, because once you start planning a family at this age, yes, you can have one child, sometimes two, but there is usually not enough time for three.

But it's not that only “convenience” or “selfishness” discourages motherhood. There are young women who, fully consciously, do not want to bring their children into a world that is on the verge of extinction. Climate depression, manifested by a seemingly excessive responsibility for the unborn, is not at all as rare as it seems. And the Polish perspective of recent years is already a nail in the coffin for procreation plans. A Polish woman is simply afraid of getting pregnant.

‍Why?

- Modern women want to be in control of their lives - this also applies to procreation. Unfortunately, pregnancy and childbirth is a period when in our country women do not have this control. They can make virtually no decisions. They are afraid that they will be forced to give birth to a sick child, which will ruin their professional career, personal and family life. They are afraid that they will die during pregnancy and childbirth, since they will not be provided with professional medical assistance for worldview reasons. They are afraid that they will be forced to give birth naturally when they do not want to - usually mainly out of fear for the baby. Added to this are financial issues. Many people, aware of the costs of maintaining and raising a child, come to the conclusion that they simply cannot afford it. I hear such voices many times in my office.

Socially, women are blamed for this lack of children.

- It is customary to talk about women, but it is obvious that there are usually partners behind them who share their views and concerns. Well, unless there are no partners or they are the brake in matters of motherhood. I have three sons. They are still learning, studying. This is not yet the time for children, but they do not even think about fatherhood at all in the long term. On the list of priorities, if they put the family, then at the very, very distant end and that too exclusively under the influence of their girlfriends. On the other hand, women who declare that they want children, often looking around, simply do not see a suitable partner. Over time, it turns out that even lowering the bar of requirements for the chosen one does not help, because it is difficult for anyone who would like to be a father. Women first look for that ideal candidate for a father, and if they do not find one, they are ready to decide even for sperm from an anonymous donor.

Are we witnessing a crisis of masculinity? Backrests?

- I think so. There are more and more single women. Single or “independent” motherhood is becoming more and more common, and it is really a huge challenge. On the one hand, it seems that employers look more and more favorably on mothers, as if there is a life-work balance on top, and yet in practice. even if the partner is, first of all, the woman is out of the labor market for long months. If misfortune befalls her and the child is born sick, she may never return to this job. This is something that women are very afraid of and I understand them perfectly.

You have three children, and yet you have managed to achieve professional success, so maybe children are not such an obstacle?

- This can be reconciled, because motherhood can also give motivation to work and life in general. For me, it was a constant compromise and remorse. I worked too hard and constantly felt like I was doing too little either at home or at work. In the hospital, it is impossible to work half a whistle, and important moments with children do not want to wait. I have never regretted my decision to become a mother. My children are the most beautiful thing that has happened to me in my life and I consider them my greatest achievement. Among my patients, there are those who regret not having decided to have a baby. At the same time, I personally do not know women who would be unhappy when these children are already there. Somehow we spin it all, we fight, we manage it, often at the expense of ourselves. I see that many modern young women apparently do not want that anymore. First they want to arrange a career, see something, experience. I understand this, but I always urge them to include children in their life business plan. Medicine comes to the rescue here - some do it by freezing eggs.

Why do we need these kids? For health?

- For health that's not necessarily the case. According to UNICEF data, every year in the world dying about 2.8 million pregnant women and newborns, or 1 every 11 seconds. Of course, this applies mainly to the poorest countries, where medical care is at a very low level, but this reflects the fact that pregnancy and childbirth pose a real risk for a woman. Increasingly, the quality of care during pregnancy and childbirth also in our country raises concerns for women. It is said that pregnancy is not a disease, but nevertheless it is a kind of fitness test for the body. Not all women pass it - in many healthy or seemingly healthy women, various diseases are revealed, such as hypertension, diabetes, thromboembolic complications, problems with the spine, by the kidneys and others. The later we decide to have a baby, the greater the risk of various complications. Although pregnancy reduces the risk of uterine cancer and breastfeeding reduces the risk of breast cancer, multiple births, in turn, are associated with the risk of incontinence, uterine prolapse, varicose veins or cervical cancer. Although pregnancy by its very nature puts a strain on our body and can bring on us diseases, at the same time it has been shown that having offspring can prolong life. A few years ago, it was scientifically proven that there is a relationship between motherhood and the chance of experiencing late old age. It turns out that women who have given birth to several children have the best chance of having a 90th birthday. The same is true when it comes to married men who live longer than their single counterparts.

Thrombosis is what scares women who are thinking about hormonal contraception, and not potential pregnant women.

- Venous thromboembolism is one of the main causes of death in pregnant women and is even more common in the postpartum period. It competes for the infamous first place with hemorrhages and infections. The risk of deep vein thrombosis and pulmonary embolism during pregnancy is several times higher than when using birth control pills. Hardly anyone knows about it.

They say pregnancy rejuvenates us?

- Physically? As long as we are under the influence of hormones produced by the placenta, it can be so anyway. The hydration and blood supply of the skin improves, many women improve their complexion, hair, they enjoy large, firm breasts, a surge of energy. And then? The skin becomes flabby, stretch marks remain, problems with the spine, urinary incontinence. There is fatigue, lack of sleep, stress - all this does not add beauty. Young women usually deal with it quickly and get back into shape, but women in their 40s are already much slower. A small child can and does rejuvenate mentally. But what about when the strength is no longer enough to run after him. Meanwhile, 40 is increasingly the age of a young mother.

So what age is the right one?

- There was once such a trend among gynecologists to say that before thirty you need to give birth to the first child. All in all, right, because biologically the age range of 20-30 years is the best time for motherhood. If you manage to get pregnant and give birth without problems during this period, then we assume that with the next pregnancies you can wait, because you can see that the woman is unlikely to have health problems. 35 years is already the cut-off age for a decision. In general, more and more people believe that they have much more time, because in case it is in vitro. Meanwhile, this method will not help when the eggs are already weak and there are few of them. In vitro, it helps to overcome the barrier of obstructed fallopian tubes or poor sperm motility, but not age. Stopping the biological clock allows you to freeze the embryos, because they can be transferred to the uterus at basically any age of the woman, of course, within the limits of common sense. A woman who reports to an infertility clinic in her 40s often gets an offer right away to use a donor egg, and this is really a shock that is better avoided. This is due to the age of the ovum and usually a very low chance of fertilization and the normal development of the embryo. After the age of 45, a woman can forget about a natural pregnancy at all, although, of course, exceptions do happen. Men also have no reason to rejoice, because the parameters of male sperm systematically decrease over the years and it often turns out that the problem of getting pregnant lies on both sides.

We regularly hear about pregnancies and their happy solutions in celebrities even around the age of 50.

- Maybe we look better than our grandmothers and mothers, having at our disposal a whole arsenal of aesthetic medicine, but biologically we are no different from them. Late pregnancies have always happened infrequently and have usually aroused more or less sensation. Currently, the scale of interest in late motherhood has increased enormously. Such pregnancies today also happen naturally, maybe sometimes you manage to use your own previously frozen cells, but usually these are pregnancies from an egg cell coming from a donor. Dramas related to the absence of children usually take place in the comfort of home. This is talked about less willingly.

Do women really regret not having children?

- In my opinion, for most women, motherhood is a fulfillment, a great happiness, something that gives meaning to life. I'm talking about the majority because there are certainly women who think differently and find that happiness elsewhere. Unfortunately, sometimes they realize the need for motherhood too late. In a successful relationship, realized professionally and materially, they discover that they are missing something. Those who, even at a late age, finally manage to get pregnant, are often ready to quit their careers and devote themselves to motherhood. They say more than once that in the end this child turned out to be the most valuable in their lives. Even when the relationship with the partner has sprinkled, and the environment envies them of completely different successes. It used to sound like a cliché and a truism, but today I don't think so.