Economic discrepancies for contraception in Europe
Ines Thonke (Germany)
Pro Familia Bundesverband, Germany
Implementation. A survey was carried out among IPPF Europe (International Planned Parenthood Federation) member organisations. It was carried out 17 sovereign nations of Europe with the emphasis on the situation in the European Union concerning costs and access of contraception. The evaluation of contraceptive costs undertaken here focuses also on the situation in Germany.
Results. This comparison of contraceptive costs and access in Europe demonstrates the great divergence in absolute price. Prices tend to be aligned with the economic situation in the respective countries; however they highlight the arbitrariness in price-setting, particularly as a number of the richest countries even supply contraceptives free of charge.
Germany always takes second place and for hormonal IUDs is the most expensive of the countries in the survey, while the country in first place is different every time.
In terms of relative prices, shown here as a percentage of income per head, no universal tendencies whatsoever can be identified
Free access to contraceptives for all or for specific groups is offered almost exclusively by countries with high income per head rates and most comprehensively in France and the UK, for example, but all – even the poorest countries in the survey – provide all their citizens free access to medical consultation – which only in Germany is no longer the case.
The fact that Germany is expensive is primarily due to the recently introduction of medical consultancy fees. It is in this respect a new finding, as this last reform catapulted Germany out of the middle ground. The special provision for under-18s and under-20s should also be noted At the same time however it must be pointed out that cancelling free provision of contraceptives to those on social welfare benefits has reduced their access to contraceptives significantly in Germany compared to price levels in the rest of Europe.
Conclusion. It has been shown that it is useful to compile a comparison of contraceptive costs in Europe. Only by making specific comparisons does the particular situation in individual countries (here, the German situation is outlined in greater detail) become comprehensible. It has been substantiated that in the case of Germany the price for contraceptives is in the upper range in terms of an absolute as well as a relative comparison and that the introduction of the Gesundheitsmodernisierungsgesetz (GMG or Healthcare Modernisation Act) in 2003 has created a huge financial burden for clients when compared to the rest of Europe.
The survey should be made available to all European member organisations in the form of a useful and up-to-date factual report on the situation.
Proposals for subsequent work will be worked out.
Experiences with prescription-only access
Ines Thonke (Germany)
Pro Familia Bundesverband, Germany
In contrast to many European countries, the “morning after pill” is as we know only available on prescription in Germany. pro familia’s National Association has established in a survey among counceling offices that prescription-only availability is the main but not the only obstacle that girls and women are confronted with when they need the “morning after pill”. The information gained from practical experience could prove to be useful in objective discussions and sharing experience as to how to improve the provision of safe post-coital contraception to women in Germany.
New data show that about 12 % of women in the age of 20 to 44 have used emergency contraception at least once in their life. The observed frequency of application shows differences in age and marital status, in urban and rural areas and is also depending on educational background.
Our survey shows that the need to see a doctor to obtain a prescription leads to different obstacles.
At weekends and overnight medical care is provided by medical walk-in centres and hospital outpatient clinics.
Hospital provision. A refusal of EC was by no means the exception. This practice is evident among catholic hospitals. A further reason which is cited is that the hospital cannot issue this type of prescription for reasons of cost and as a third reason that duty doctors refuse on moral grounds or justify their refusal by claiming that it is not an emergency. Women who need the “morning after pill” also find that they are charged for gynaecological investigations, pregnancy tests and ultra-sound scans. Additionally girls and women are burdened by the fact that they have to present their private worries several times in the clinic and in some cases they have to endure very lengthy waiting times (up to 3 hours)
Walk-in centre provision. Our survey shows that similar problems are experienced at medical walk-in centres. For girls under the age of 16, often parental agreement is required.
Pharmacy provision. Sometimes women face even more problems in obtaining the medication. Not all pharmacies have the “morning after pill” in stock or their stocks are minimal. In rural areas and with no car, this can quickly result in a lengthy delay before it can be taken.
General problems from everyday practice. Girls and women tell about the high cost which is an obstacle for them and also of their fear of gynaecologists and the difficulty of booking an appointment at short notice.
Conclusion and the need for action. Problems in provision are still being reported in various parts of the country. The shortfall in provision described above represent obstacles which still delay and prevent the "morning after pill" from being taken. The information in medical training and development about the current standard of quality and provision for hormonal emergency provision must be considered a central task in the current options for action. In order to tackle moral and ethical concerns, it is important to provide clearer information about the current findings on effectiveness as EC is still cited in the context of abortion and/or equated with it. Many of the other obstacles mentioned here can be overcome with in-depth training and development of doctors and clear rules for charging in hospitals. Instead of blaming couples for contraceptive use failure they should be encouraged to act responsible when asking for EC.