“We want at least two births per day in each ward – that is over seven hundred births per year,” announces Deputy Health Minister Tomasz Maciejewski. “No county hospital outside large cities practically reaches that number of births. This would mean the mass closure of maternity wards,” comments Krzysztof Żochowski, director of the county hospital in Garwolin, responding to the deputy minister’s announcement.
On an interactive map prepared by Janusz Cieszyński, based on hospital data, Poland is covered with red dots. According to Maciejewski’s assumptions, 199 out of 306 maternity wards would be closed. Women outside major cities would effectively be forced to give birth in hospital emergency departments.
In a Monday interview with Rzeczpospolita, Tomasz Maciejewski stated that it is necessary to reduce the number of maternity wards.
“We want at least two births per day in each ward – that is over seven hundred births per year,” Maciejewski says, explaining that such a threshold would ensure the safety of women in labor because obstetrics and gynecology staff would not lose their professional skills.
“No county hospital outside major cities reaches that number of births. This would mean the mass liquidation of maternity wards outside large cities,” Krzysztof Żochowski, director of the county hospital in Garwolin and board member of the National Association of County Hospital Employers, told Gazeta Polska Codziennie.
Poland in Red
The announcements by Deputy Minister Maciejewski were visualized by former Deputy Health Minister and Law and Justice (PiS) MP Janusz Cieszyński. Based on hospital data, he created an interactive map. Hospitals that do not exceed 730 births per year are marked in red, while those above that threshold are marked in green.
The map shows vast areas of Poland covered in red dots. In total, 199 out of 306 existing maternity wards would be shut down.
“Tusk’s government wants to close maternity wards. First, we had Minister Leszczyna’s proposal, with a threshold of 400 births. Now the deputy minister is talking about a threshold of over 700 births. The map shows what this means in practice,” says Janusz Cieszyński.
In practice, this means that the distance between maternity wards slated for closure (red dots) and those that would remain (green) would often exceed 100 kilometers. Entire regions such as Warmia-Masuria would effectively be left with a single maternity ward in Olsztyn. In Mazovia, Ostrołęka would depend on hospitals in Warsaw or Białystok. Similarly vast distances would affect the Subcarpathian and Łódź regions.
Forced into Emergency Rooms
The lack of maternity wards in county hospitals is also anticipated by regulations that have already entered into force, allowing the creation of so-called birth rooms within hospital emergency departments (EDs). Just two weeks ago, the ministry assured that this was not an incentive for hospitals to shut down maternity wards.
“Now we have clarity that this is exactly the intention,” hospital directors say.
“This is disregard for people living outside large cities. Why should they receive worse services?” Mariusz Trojanowski, director of the hospital in Aleksandrów Kujawski, told Gazeta Polska Codziennie.
Cieszyński’s map also shows that even the conditions for creating birth rooms within EDs would be violated if the threshold of over 700 births were adopted. The regulation stipulates that such a room may be established only if the distance to the nearest hospital with an obstetrics and gynecology ward is 30 kilometers – approximately 40 minutes by ambulance on public roads, usually the radius of a county. The map indicates that maintaining such distances would be impossible if so many maternity wards were closed.
Discrimination Against Women from “Poland B”
“Women do not want to give birth this way, and this change in smaller centers destroys a decades-old culture of childbirth in Poland. It is based on securing both mother and child in a maternity ward. The director from Leżajsk calculated that running such a birth room would require at least PLN 3.5 million per year. The National Health Fund (NFZ) wants to pay less than PLN 3.2 million. The ambulance alone costs PLN 2.9 million annually. Where are the funds for care in case of complications, pain management, anesthesia, and so on?” Waldemar Malinowski, president of the National Association of County Hospital Employers, told Gazeta Polska Codziennie.
According to Karina Bosak of the Confederation, chair of the parliamentary team for perinatal care, replacing maternity wards in smaller centers with births in so-called birth rooms – effectively within emergency departments – amounts to discrimination.
“Differentiating access to maternity wards depending on place of residence is a clear manifestation of discrimination. Women living in smaller towns do not have the same access to perinatal care as those in large cities, which means their safety and comfort during childbirth depend on where they live – and that is unacceptable,” says Bosak.
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