Contraceptive Atlas 2020: Empowerment, rights and autonomy

Access to modern, effective and affordable contraception remains a challenge for many women across Europe, reports Brian Johnson.

By Brian Johnson

Brian Johnson is Managing Editor of The Parliament Magazine

23 Dec 2020

There’s a strong disconnection between the preferred method of contraception for certain categories of women, and their ability to afford and access those methods. That was one of the key messages from the recent online launch of the 2020 Contraception Atlas.

The Atlas, now in its fourth year, is published by the European Parliamentary Forum for Sexual and Reproductive Rights (EPF) and provides a European country-by-country ranking based on access to contraceptive supplies, family planning counselling and online information.

Opening the webinar discussion on 12 November, MEP co-host Terry Reintke said, “Having access to affordable and accessible contraception is a right that has been fought for over centuries, but the battle is not yet won”.

The Greens/EFA deputy told participants that many people are still under the impression that issues around access to contraception have long been resolved. “Yet when you look at the findings of the Contraception Atlas, you can see that this is actually not the case”.

Covering 46 countries throughout geographical Europe, the Atlas also stratifi es countries using traffic light colours, with red indicating an extremely poor provision of contraceptive services.

Several EU Member States - Czechia, Lithuania, Slovakia, Hungary and Poland - are among the 10 worst performing countries, with Poland again firmly stuck in last place - using a specially created dark red category - following its controversial 2019 policy change, requiring prescriptions for emergency contraception.

“Having access to affordable and accessible contraception is a right that has been fought for over centuries, but the battle is not yet won” MEPs Terry Reintke and Sophie in’t Veld

Reintke’s MEP colleague and cohost, Sophie in’t Veld, warned that there was a “full-blown global attack” on women’s rights and autonomy, adding that there were Conservative forces, such as those in Poland, that were looking to “roll back all the achievements in terms of sexual and reproductive rights”.

The Renew Europe Group deputy said, “It’s important that we don’t see European countries regress on these matters, like Poland has. Governments must take the cost-effective effort to provide accessible, reliable and authoritative online information to empower women to make informed decisions about the contraceptive method most appropriate for them.

This is all the more important during these times of COVID-19, when access to contraception is under pressure across Europe”, she added.

Her comments were echoed by Reintke, who argued that the pandemic had illuminated existing gaps and shortcomings in healthcare services. “Some governments are shifting resources away from basic sexual and reproductive services, others are deliberately manipulating the situation to pass through laws further restricting these fundamental rights. All countries must ensure and facilitate access to contraception, also during challenging crisis situations.”

On a more positive note, Belgium has edged ahead of France, taking the top spot in this year’s atlas. Belgium, Bulgaria, Finland, Iceland, the Netherlands, North Macedonia and Spain were all praised for introducing national policy changes aimed at breaking down financial barriers to contraception, particularly for young people and marginalised or vulnerable groups.

However, across Europe as a whole, the Atlas revealed an uneven picture, highlighting inequitable reimbursement schemes and widespread government failure to provide accessible and accurate information.

This in turn was impeding access to the latest contraception choices. Although nearly 60 percent of European women of child-bearing age use some form of contraception, 35 percent of pregnancies in Europe are considered as unplanned.

EPF Secretary Neil Datta explained that the Contraception Atlas, “highlighted the often strong disconnect between the preferred method of contraception for certain categories of women, their financial ability to access these methods, and national funding priorities.”

“Long-lasting reversible contraception (LARCs) often represent a greater one-time cost, which makes them less accessible to certain women, but they have higher satisfaction rates and research shows that for every dollar the public sector spends on LARCs, five dollars is saved in unintended pregnancy costs”.

Datta argued that there was really “no excuse” for the governments of those five EU Member States that are among the 10 worst performing countries in Europe to not be providing access to modern, affordable and effective contraception.

Effective contraception contributes to fewer unintended pregnancies. This then leads to fewer induced abortions. We’ve done very well as a European region in the past. But there’s still a lot of uneven progress. However, this is essentially a question of political will. We have all the contraception technologies we need; it’s really simply a question of political will in different countries”.

Guest speakers included Karine Lalieux, currently serving as Belgian Federal Minister for Pensions, Social Integration, Poverty Alleviation and Disabled Persons, who spoke about her work bringing Belgium to the top of the Atlas. Lalieux was behind two major changes in Belgian legislation in 2019; making emergency contraception free of charge and increasing the age of contraception reimbursement for young people from 21 to 25.

Antonina Lewandowska, a coordinator for ASTRA, the biggest Central and Eastern European Network for Sexual and Reproductive Health and Rights, outlined some of the issues that have led to Poland’s bottom place in the Atlas.

She explained that a combination of factors, such as a government that is “strongly against sexual and reproductive health and rights”, scarce provision and access to nationally funded services and “the nonexistence of theoretically refunded procedures” such as IUD insertion.

“Long-lasting reversible contraception (LARCs) often represent a greater onetime cost which makes them less accessible to certain women, but they have higher satisfaction rates and research shows that for every dollar the public sector spends on LARCs, five dollars is saved in unintended pregnancy costs” EPF Secretary Neil Datta

Lewandowska explained that Poland has one of the lowest birth rates in Europe, because women are terrified of becoming pregnant. “We do not have access to contraception. We do not have access to legal abortion. Several governments have tried to address the issue, but this has never occurred to any of them that maybe investing in access to contraception and national health funding could be an answer.”

Another guest speaker, Austrian MP Petra Bayr, spoke about the challenges she encountered as Rapporteur on the Council of Europe Parliamentary Assembly (PACE) resolution on promoting access to contraception in Europe, adopted earlier this year.

Bayr, who is also EPF interim President, said that access to contraceptives aids women’s empowerment, decision making power and autonomy. “Access should also be regardless of your economic and financial situation, which makes it so important that you have some reimbursement schemes. And there should also be equal access regardless of age and social surrounding”.

Concluding the event, Terry Reintke thanked the speakers and the EPF team and called for more MEPs to take up the baton of sexual and reproductive health and rights. “These are fundamental rights. We can see in countries like Poland that there is a fully-fledged attack on the independence of the judiciary."

"That political control of the judiciary is then used to undermine sexual and reproductive health and rights. So let’s put pressure on the European Commission, so that they actually act on the very dire situation in Poland.” 

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