There will be no reimbursement. Dispute at the Health Committee meeting: "Vulgar manipulation"
- The Ministry of Health decided not to reimburse separate lactation consultations after hearing the negative recommendation in this matter from the president of the Agency for Health Technology Assessment and Tariff System
- Deputy Minister of Health Wojciech Konieczny emphasized that the opinion of the AOTMiT and the decision of the Ministry of Health refer to the provision of separate lactation advice, and not breastfeeding itself.
- During the meeting of the Parliamentary Health Committee, a quarrel almost broke out between MP Janusz Cieszyński and the Deputy Minister of Health.
- Babies aged 2–6 months are breastfed by fewer than 50% of women , but 97% of women begin breastfeeding in the hospital. Mothers want to breastfeed, but they need support, said Kinga Osuch, a midwife at St. Sophia Hospital and Clinic in Warsaw.
- MP Marcelina Zawisza, referring to the lack of evidence for the effectiveness of lactation counseling , proposed to the Ministry of Health to introduce a pilot program
- Members of the Parliamentary Health Committee accepted the request on this matter to the Ministry of Health
During the meeting of the Parliamentary Health Committee on Tuesday, July 8, the topic of introducing specialist lactation advice by midwives and obstetricians almost became the subject of a dispute between MP Janusz Cieszyński (PiS) and Secretary of State in the Ministry of Health Wojciech Konieczny (senator, Coalition Parliamentary Club of the Left).
At the committee meeting, Deputy Minister Wojciech Konieczny presented "information on the results of the work of the Team for Improving the Quality of Perinatal Care in the Field of Lactation Counseling at the Minister of Health regarding reimbursed specialist lactation counseling, including in particular the possibility of conducting a pilot program for such a solution, and on the results of the ministry's activities aimed at improving lactation care in Poland."
The Deputy Minister explained that the Ministry of Health did not decide to reimburse separate lactation consultations after reviewing the negative recommendation in this matter issued by the President of the Agency for Health Technology Assessment and Tariff System.
One of the expert arguments for "no" - cited by Deputy Minister Wojciech Konieczny - was the opinion of the Transparency Council and the opinion of experts about the low or moderate quality of evidence contained in the scientific literature on the effectiveness of lactation advice provided by additionally trained midwives or obstetricians.
Polemicising with the ministry's position, MP Janusz Cieszyński went so far as to point out that there had been "vulgar manipulation" in the matter of opinions on the effectiveness of lactation advice, because "the fact that someone has the title of professor in another field of medicine does not affect their competence to make such assessments."
"The Ministry of Health is not opposed to breastfeeding and absolutely does not question the knowledge about the benefits of natural feeding of a newborn," replied Deputy Minister Wojciech Konieczny, emphasizing that the AOTMiT opinion referred to the provision of separate lactation advice, not breastfeeding itself. He was also clearly outraged by MP Cieszyński's opinion questioning the AOTMiT's competence.
The debate during the meeting of the Parliamentary Health Committee referred to the Ministry of Health's decision of May 8, 2025, not to introduce specialist lactation consultations by a physician and midwife as a guaranteed service within the scope of outpatient specialist care. A ministerial working group appointed by the previous Minister of Health reviewed the service. The Agency for Occupational Health and Therapy (AOTMiT) issued a negative recommendation regarding the service in June 2024.
The AOTMiT President justified his position, among other things, by stating that currently, basic lactation care for pregnant women, including preparation for breastfeeding and for lactating women, is available within the framework of services provided by midwives and specialists in obstetrics and gynecology, neonatology, and outpatient and inpatient care, as well as by midwives and primary care physicians. The AOTMiT President also pointed out that the proposed separately financed specialist lactation consultation by a midwife and physician does not add any new specialized quality to the current guaranteed services in this area.
The budget impact analysis carried out showed that the projected two-year expenditure of the public payer related to financing the service will amount to approximately PLN 3-4 million in the first year and PLN 3 million in the second year in the case of a doctor's consultation, and PLN 10-13 million in the first year and PLN 9-12 million in the second year in the case of a midwife's consultation.
As Kinga Osuch, a midwife working daily at St. Sophia Hospital and Clinic in Warsaw, argued, specialist lactation advice does exist.
"I and many of my friends have been practicing it for years. It's just that it's provided outside the public health care system. Women pay for it," she said.
According to ad hoc information provided during the committee meeting, the price of private lactation consultation is PLN 300 for the first visit and PLN 180 for the subsequent visit in private offices in Warsaw.
- There is a wide bibliography and research indicating that breastfeeding is an important preventive measure that reduces the risk of lifestyle diseases such as obesity, diabetes, cardiovascular diseases, asthma, and some cancers in children - said Kinga Osuch.
She also cited a 2023 report from the e-Health Center, which found that fewer than 50% of women breastfeed children aged 2-6 months. "Other studies, however, show that 97% of women begin breastfeeding in the hospital. This means that mothers want to breastfeed, but at some point they experience failure and give up," she emphasized.
She argued that professional lactation counseling requires attention and time. "Research has shown that effective counseling can take 60-90 minutes," she said.
During a care visit, if any problems arise, there's no time for detailed instruction and explanation. "This service isn't paid extra, so midwives do what they need to do and what they can manage, and then refer the patient to a private lactation clinic," said Kinga Osuch.
"It's not always the case that a woman will receive lactation advice from a doctor. Unfortunately, doctors often lack lactation knowledge. Such knowledge comprises over 80 hours of training, while during medical studies , doctors acquire lactation knowledge during two hours of classes. Doctors simply specialize in different areas," said Dorota Ćwiek, a regional consultant in obstetrics and gynecology nursing from the West Pomeranian Voivodeship.
MP Joanna Wicha, a nurse and sociologist, said that a woman cannot—as was once possible—simply return to the hospital where she gave birth to see an obstetrician if she had trouble breastfeeding. "Midwife care, meaning two visits from the local area, is absolutely insufficient in cases of difficult lactation, because just because a woman wants to breastfeed doesn't mean she can, " she argued, citing her own experience with her daughter's delivery.
MP Marcelina Zawisza (New Left) pointed out that postpartum women are not returning – as they once did – to multigenerational families, where they could count on the help of many more experienced women who would show them how to breastfeed when their baby refuses to eat. "Women don't need to be encouraged to breastfeed, because very often they want to, but they just can't cope," she said.
The MP bravely publicly cited her own example.
"I had patronage visits, I had a community midwife, but it didn't work. My milk supply was improved thanks to a lactation consultation, which in my case lasted over three hours. They patiently searched for the causes, one of which was the issue of the baby's frenulum. Throughout my motherhood, I've met many women like me who simply wanted to breastfeed, but it didn't work out because they lacked the proper support," she explained.
Marcelina Zawisza, referring to the lack of evidence for the effectiveness of lactation counseling as a service, proposed to the Ministry of Health to introduce a pilot program.
- Then the data could be collected and checked - she argued.
She proposed that, as part of the pilot program, women be allowed to stay in maternity wards during the day for lactation consultations.
The call for separate lactation consultations for midwives and obstetricians was shared by all MPs present at the committee meeting, regardless of political affiliation. MP Czesław Hoc (PiS) even cited the release of oxytocin, the hormone of "attachment and love," during breastfeeding to justify the need for lactation consultations.
The same argument was used by MP Marta Golbik (KO), reminding that cuddling has a positive psychological impact on the child.
- The launch of the pilot project can be financed from funds for preventive programs that are at the disposal of the Minister of Health - suggested MP Józefa Szczurek-Żelazko (PiS), former deputy minister of health.
During the committee meeting, MP Janusz Cieszyński, together with MP Joanna Wicha, submitted a formal motion in the form of a desideratum. In the desideratum, they asked Minister of Health Izabela Leszczyna to launch a pilot program for specialized lactation consultations with midwives. The desideratum was approved without objection.
MP Cieszyński cited a fragment of the AOTMiT report with the opinions of clinical experts: the national consultant in the field of gynecological and obstetrics nursing, the provincial consultant in the same field and the national consultant in the field of pediatric nursing.
Experts indicate the expected health effects of lactation counseling as follows:
- reducing morbidity and mortality from infectious diseases,
- reducing the risk of sepsis, diarrhea, and respiratory infections in newborns,
- reducing the risk of rotavirus infections.
He assessed that the recommendation "is negative in the context of economic analysis."
- Clinical experts say it's good, but AOTMiT officials say it's not profitable - he said critically.
Deputy Minister Wojciech Konieczny, in his response, emphasized that the Ministry of Health is absolutely not against breastfeeding.
- We also do not believe that artificial milk is better than natural milk - said the deputy minister, emphasizing that he does not agree with the opinions expressed by the Ministry of Health during the discussion, which seem to be in contradiction to the generally accepted knowledge about breastfeeding.
The Minister pointed out that the AOTMiT (AOTMiT) did not consider piloting a separate lactation consultation performed by additionally trained, certified midwives. "This means the Agency did not even consider a conditional decision. It would have issued one if certain data had been obtained indicating that such a service was effective. But such data was not found," he emphasized.
He said that the pilot study should assume the expected results. "If we want to confirm that lactation counseling reduces the risk of diabetes, obesity, hypertension, or mental health problems, the pilot study should be conducted for 5, 10, or 15 years," he considered.
According to the minister, this goal can be achieved through other methods. "After this discussion, we will, of course, take another look at the problem," he declared. He emphasized, however, that lactation counseling should be provided to a higher standard. "An amendment to the standards for perinatal care will most likely be published in July, which will also address this issue," he added.
The desideratum adopted by the Sejm Health Committee will be forwarded to the Speaker of the Sejm.
The body against which the desideratum of the Sejm committee was passed is obliged to respond to it and notify the Speaker of the Sejm in writing of the position taken within 30 days of receiving the desideratum.
If the response is not received within the deadline or if the response received is deemed unsatisfactory, the committee may renew its request, submit to the Speaker of the Sejm a motion to return the response as unsatisfactory or submit to the Sejm a draft of an appropriate resolution or resolution.
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