Accessing long-term contraception or the free emergency pill can be easy or impossible. A report from the Family Planning Federation (SEDRA) shows the disparities that exist between autonomous communities in terms of attention paid to contraception, “a reality marked by heterogeneity and inequalities”. Three of them – Murcia, the Canary Islands and Castile-La Mancha – do not distribute the emergency contraceptive pill free of charge in any of their services, except in cases of sexual assault, although the law on sexual and reproductive health requires it. In Madrid, it is only possible to access it free of charge in municipal community health centers.
The report includes a map by autonomy in which it assesses the situation of each and classifies them into three categories of sexual health care: excellent, optimal, improvable or very improvable. To do this, it takes into account access to resources and their organization, the existence or not of specific strategies and plans, the training of professional staff or even free contraceptive methods.
Free distribution of the emergency pill, as well as the universal and free provision of long-term contraceptive methods, are, according to SEDRA, two of the “most powerful initiatives” that communities can implement to guarantee sexual rights of those who have the capacity. .reproductive. However, in both cases, the situation between territories is very unequal.
Although Murcia, the Canary Islands, Castile-La Mancha and, in part, Madrid do not include free emergency contraception, the report highlights that the rest not only provide it for free, but also offer “quality support” to users. These are Andalusia, Aragon, Asturias, Cantabria, Castile and León, Catalonia, Valencian Community, Euskadi, Extremadura, Galicia, Balearic Islands , La Rioja and Navarre. In addition to being free, the report highlights that the more opening hours and services offering this service, the better access to the pill will be.
The three communities in which the emergency pill is not freely available are violating the Sexual and Reproductive Health Law approved in February last year. “The free provision of emergency contraception will be guaranteed in health centers of the National Health System and in specialized care services, taking into account the organization of care of the health services of the autonomous communities and the managing entities of the National Health System,” he explains. the norm.
SEDRA emphasizes that long-term contraceptive methods – such as the IUD, hormonal injections or patches, or the ring – are the “most effective and cost-effective” for preventing unplanned pregnancies and reducing the abortion rate. “However, the reality is that there are various barriers that make access difficult for people who want to use these types of methods,” they argue. One of these obstacles is the cost, but also the waiting lists for the insertion and removal of IUDs or implants. These lists grow where this skill is exclusive to gynecology specialists.
In Aragon, all long-term methods are free and the placement and removal of the implant is carried out between primary care and gynecology services, a distribution that has reduced waiting lists and accelerated the placement processes . On the other hand, in Castile and León, free care depends on each center and placements and removals depend exclusively on gynecology, which means that the average waiting list reaches almost ten months. Castile-La Mancha offers intrauterine devices based on hormones and copper free of charge, but they depend on specialized care, “therefore, even if financial accessibility is partial, the waiting lists are relatively long.”
The Planned Parenthood Federation demands that there be universal access to all long-term methods, as well as expanding the profile of professionals who can place and remove them, except in complex cases, to reduce the lists of wait and ensure early access that avoids unplanned pregnancies. . The report highlights the relevance of midwives and calls for prioritizing their training given that “their professional profile is decisive in the contraceptive care circuit”.
Political commitment
Political will also contributes to “heterogeneity and inequalities” between communities. “The lack of coherence in public policies and the impact of political transitions are factors that make it difficult to develop uniform strategies across the entire territory,” the report states. Although contraception is included in the service portfolio of communities, not all communities have a specialized care strategy or program. Only Aragon, Asturias, Catalonia, the Canary Islands, Comunitat Valenciana, La Rioja and Murcia have one. SEDRA cites as an example Aragon and Catalonia, which “demonstrate that it is possible to improve accessibility and quality of care through the implementation of well-structured plans and the promotion of the figure of the wise -female “.
Political will was one of the “brakes” to the implementation of public policies on contraception that the Federation noted most during the interviews conducted to prepare this study. Also “political transition processes” carried out after the last regional elections in certain governments. “It appears that not only do professionals from communities where there is no plan or program perceive this as a hindering factor in the development of public policies on contraception; but also professionals from communities who have plans or programs consider that these political transitions endanger the achievements obtained so far,” they emphasize.
The existence of public policies is essential, they conclude, for attention to be given to “accessible and quality” contraception.
