In Poland, vasectomy is becoming an increasingly popular method of permanent contraception among men. In contrast, female tubal ligation is illegal on request.
Poland's population could more than double by 2100, according to figures from the United Nations.
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The youngest adults are even called the "end-of-the-world generation" or the "climate catastrophe generation".
The State of the Young 2025 report indicates that 15 percent of those born between 1995 and 2006 have no children and do not intend to have any.
Permanent forms of contraception, such as vasectomy among men, are gaining in popularity. However, it is only men because tubal ligation, a similar procedure for women, is prohibited in Poland.
Five thousand vasectomies a year
There is a lack of precise statistics from the National Health Fund, as most vasectomies in Poland are performed privately.
Meanwhile, it is estimated that around five thousand are carried out annually.They are commercialised, and their advertisements can be found online and on roadside billboards.
Mateusz Siwik, owner of one of the Warsaw vasectomy clinics, told Euronews Health that the procedures are noticeably gaining popularity.
"In recent years, we have seen a systematic increase in interest in vasectomy. The year-on-year dynamic is around 15 percent," he said.
In his opinion, the increase in interest is a gradual process and is mainly due to "the greater availability of information and the breaking down of social stereotypes."
According to Siwik's observation, the patient population is socially diverse.
"They are mostly men in stable relationships, with two or more children, who have consciously made the decision to end family enlargement," he assessed.
A very masculine decision
Just such an example is Kamil Pawelski, a psychologist and influencer on the subject of masculinity, who underwent the procedure in 2020, two years after the birth of his second child.
"It was a decision driven by the fact that I knew I didn't want my wife to have hormone therapy because we were aware that it didn't affect her functioning well, her health. At the same time, we were also aware that we did not want to have any more children," he says.
As a blogger who emphasises masculinity and responsibility, Pawelski is a popular figure in Poland, but when he publicly announced the procedure, he did not receive the support he expected.
"Paradoxically, the biggest hate came to me from the men's side. I got very much support from women instead," he said.
"I think this is a very masculine decision. Although, of course, I wouldn't recommend this procedure to people who are considering having children in the future."
Medical tourism
Unlike vasectomy, tubal ligation on request is prohibited in Poland.
The procedure is regulated by Article 156-1 of the Penal Code, which states that whoever causes grievous bodily harm, including permanent inability to conceive, is liable to imprisonment from 3 to 20 years.
"In most Western European countries, the procedure of tying up the fallopian tubes is legal. More often than not, gynaecologists from abroad are surprised that in our country this is the law, that the possibility of performing this procedure is so limited and only allowed for medical reasons," says Rafał Zadykowicz, a specialist in obstetrics and gynaecology.
He also has an extensive practice abroad. In an interview with Euronews, he explains that in other countries, the law is less restrictive in this regard.
The limited access to the procedure has led to the development of so-called medical tourism, especially to neighbouring countries such as Germany, Czechia, and Slovakia, where clinics offer packages in Polish, including transport and accommodation.
"As Polish patients know, they are educated, they no longer ask for it. They simply turn to the relevant institutions or go abroad," said Zadykowicz.
French men are open to the idea, Italians, not so much
Both methods of sterilisation are legal in Western Europe.
Although statistics show that vasectomy is increasingly the preferred method among couples, as it is considered simpler and less invasive than tubal ligation.
In France, the number of vasectomies has increased from 1,940 in 2010 to more than 30,000 in 2022, especially among men under 40. In other countries, such as Spain and Austria, interest is also slowly growing. Meanwhile, Italy remains low, around 1 percent of men in their reproductive ages.
According to The Lancet, vasectomy is widely used in North America at around 12 per cent, and 11 percent in Oceania and Northern Europe. In Canada, it is the most popular method, with 22 percent of women relying on their partner's vasectomy. High rates are also recorded in the UK, New Zealand, and South Korea, with 17-21 percent. In developing countries, the marginal rate is at least 0.7 percent.
There are no such figures for Poland.
Poland with third place from the end
The discussion on access to sterilisation is combined with the one on alarmingly low fertility rates.
Poland struggles with one of the lowest fertility rates in the world. According to the Central Statistical Office, by 2025, the population will have fallen to 37.3 million, and the number of children and adolescents will have decreased by another 140,000.
The fertility rate (TFR) in 2024 reached a record low, around 1.10-1.16 children per woman according to various CSO/Eurostat sources, with an estimated 1.10 in 2025.
In 2024, Poland ranked third from last among OECD countries in terms of fertility, ahead of only Chile and South Korea.
In the European Union, the average TFR in 2023 was 1.38 children per woman, with the highest in Bulgaria at 1.81 and the lowest in Malta at 1.06. The downward trend has continued for years, with short bounces, for example, a rate of 1.53 was recorded in 2021 during the pandemic. After that, however, it declined again.
In Poland, there is now a heated debate over how to reverse the dramatic decline in fertility rates. A social policy programme offering tax-free financial support for children has been in place since 2016.
However, it does not address one of the key questions: why do people who could have children ultimately decide not to?
