In Asturias, if you have had a risky sexual relationship and need the morning after pill – an emergency contraceptive method to prevent pregnancy – you can go to several of the health services in that community, where they provide it. free of charge and they also accompany the woman who is going to ask for it. If that happens in Murcia, the Canary Islands or Castilla-La Mancha, you will have to go to a pharmacy and pay around 20 euros, because it is not…
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In Asturias, if you have had a risky sexual relationship and need the morning after pill – an emergency contraceptive method to prevent pregnancy – you can go to several of the health services in that community, where they provide it. free of charge and they also accompany the woman who is going to ask for it. If this happens in Murcia, the Canary Islands or Castilla-La Mancha, you will have to go to a pharmacy and pay around 20 euros, because it does not occur in any of these public services unless you have suffered a sexual assault and go to to the emergency room of a hospital, despite the fact that free abortion is established by the latest reform of the abortion law. If there has not been an emergency but you do want a long-term contraceptive, such as a subcutaneous implant or an IUD—which is placed in the uterus and releases hormones—in Castilla y León it is free depending on the hospital you go to and the waiting list is around 10 months; and in Aragón, the IUD is also placed in the hospital, but you never have to pay and if you opt for another method such as the implant, it can be done in a health center, so the wait is reduced. And so, province by province, because in Spain, whether women can access all of the above—the so-called contraception, part of the right to sexual and reproductive health—depends, exactly, on where you live.
This care from the public health system has as many models “as there are regions, almost as many as there are municipalities, it almost depends on the zip code in which you live,” says Raquel Hurtado, the deputy director of Sedra, the State Family Planning Federation, and coordinator of the team. who carried out the research Unevenness on the route. The state of contraception care in the autonomous communities, presented this Tuesday. From this months-long analysis – with a review of the legislation of each region and public information, a questionnaire to health personnel who deal with this issue and interviews with specialists in this field – the result is “heterogeneity” and “ inequity” in the approaches and care models of each territory that has a lot to do “with political will”, because each autonomy, Hurtado recalls, “gives a different importance to contraception” and that “they suffer, in their daily lives, women.”
Something that also happens with the rest of sexual and reproductive rights, such as abortion, which is enormously unequal depending on the region. Despite the fact that there is specific legislation – the Law on sexual and reproductive health and voluntary interruption of pregnancy, last reformed last year – and that this law established that in order for it to be applied effectively it had to be elaborated A State Sexual and Reproductive Health Strategy has not yet been done. Thus, and as has been happening for around 40 years, it is the autonomies that have the health competencies in this area and each one has been working in a different way.
According to the Federation’s study, there are three important groups of autonomous communities according to how much they guarantee this right, which, in addition to the report, has been transferred to an interactive map in which you can explore the situation in which each autonomy is – excellent, optimal, improvable or very improvable—depending on issues such as the specialization of professionals or the free nature of contraceptives. Among those that are least guaranteed this right are “Castilla y León, Castilla-La Mancha and the Basque Country, which do not even have specific policies, nor are they guaranteeing access, nor are they training professionals, nor are they organizing the service,” he explains. Hurtado.
In contrast, “those that are best are Aragón and La Rioja, and Catalonia. Because? “They are the ones that have specific policies that regulate the circuit of access to these services.” Because although “it can be done well without specific policies, because the circuit can roll by inertia as happens in Galicia or Extremadura, policies are what allows continuity”, that is, that whatever happens in an autonomy, whoever governs governs. , those services will be able to continue working.
“The regions that do it well are not only because they have these policies, but because they have their circuit organized,” added the deputy director of Sedra. The circuit is where women access this contraception and there, as in everything else, there are also differences. In some, the gateway is the health centers, as is the case in Aragón; in others, specific services, such as sexual and reproductive health care units in Catalonia.
“Although specific centers alone are not an element of quality, they act as a catalyst. Aragon does not have one, but it works very well, and Catalonia works well because it relies on them,” says the deputy director of the Federation, who explains that “the issue is” at the first level of care, in how it works. “For example, those autonomies in which family counseling centers have been closed [que empezaron a abrirse en 1985], this access has been provided in primary care, but neither the circuit has been well established, nor have the professionals been well trained. In some it has already happened, like Andalusia, in others it is expected to happen and some professionals have told us that it is something they fear will happen,” he elaborates.
In any case, after this review throughout the territory, it is concluded that “those circuits that have an entry point in Primary Care and are supported there work better, because they avoid referral to specialized care. [a los hospitales] and therefore the waiting lists.” Hurtado gives a clear example: “Imagine that I want an IUD. If I have to wait 10 months for gynecology care in a hospital, I may get pregnant without planning it.”
Also, he added, “those that give more weight to the midwife work better”, as is the case in Aragon – with the midwife in health centers – or in Catalonia – in those specific units. A figure that Carlota San Julián, a nurse and sexologist who accompanied Hurtado in the presentation of the report, recalls that is more associated “with pregnancy and the puerperium”, but that is in reality an “essential profile” throughout the entire women’s sexual life. With one obstacle: “That there are areas in which there may not be enough specialists for the care burden that this would entail.”
There is room for improvement for all communities and “there is no single way to do it badly or to do it well, because there is no bad model, but only bad forms of management,” Hurtado clarifies, although there are issues that everyone should comply with. Among them being accessible to women throughout the territory – from large cities to small towns at any time of the day every day; the training of professionals with a “gender” perspective but also with “cultural competencies” to care for migrant, racialized women or “young people, without judging them.”
Also good information from the institutions, with dissemination campaigns and improvement of this information on websites and health applications “so that citizens know what the services are and where they have to go”; so that “attention is not given to the criteria of each area, or of each professional who cares, or their will or whether or not they have had training or training”; and, above all, so that “having this right guaranteed” “does not depend on where you reside.”