La Rioja and Aragón are the autonomous communities that offer the best contraceptive care to the population, while Castilla-La Mancha, Castilla y León and the Basque Country are those that must improve this section, according to a report prepared by SEDRA-Family Planning Federation. According to the document, each autonomous community gives sexual health, and specifically contraception, “a very unequal importance, and applies a diversity of management models that produce inequalities suffered by women.” Therefore, the situation of contraceptive care in Spain can be defined “as heterogeneous and inequitable.” The information collected has been organized by autonomous community and based on the following indicators/categories: existence of contraception care policies; specific contraceptive care services; organization and operation of the contraceptive care circuit; accessibility of information on contraception; elimination of the cost of contraceptive methods; free provision of emergency contraception; continued training on contraception aimed at professionals; instruments for improving healthcare practice. In this sense, SEDRA highlights the role of Catalonia and Aragon, which constitute “two good examples in terms of structuring and dissemination of their care models, which have different entry doors to their circuit.” In the case of Aragón, the gateway to the contraceptive circuit is the Primary Care midwife’s office. “Those circuits that have their entry point in Primary Care, and that support contraceptive care in that circuit, work better. Simply because they avoid referrals to specialized care and therefore long waiting lists, which in occasions also affect unplanned pregnancies,” explained the deputy director of SEDRA and coordinator of the study ‘DISPENSE ON THE ROUTE. The state of attention to contraception in the autonomous communities’, Raquel Hurtado. For its part, Catalonia has placed the consultation of the midwife of the sexual and reproductive health care unit (ASSIR) as the gateway to the contraception circuit. “In addition, the circuits that give weight to the Primary Care midwife also work better. This is because midwives have specific training to care for preconception,” Hurtado added. At this point, the report highlights that Catalonia and Aragon also stand out for the excellent dissemination of information about the circuit that these communities have carried out through their web platforms and their service centers. As for the rest of the regions, the Valencia Community, Murcia, the Balearic Islands, the Canary Islands, Asturias and Navarra have an ‘optimal level’ in terms of contraceptive care. After the analysis: Andalusia, Extremadura, Galicia, Madrid and Cantabria have a ‘level that can be improved’. Finally, Castilla-La Mancha, Castilla y León and the Basque Country provide a ‘very improvable’ service. “To the absence of policies, we must add that the quality of services depends on the will of the professionals and that the lack of organization of the care circuit causes referrals to occur that congest specialized care consultations,” the authors emphasize. In general, the study indicates that the autonomous communities lack instruments to improve the quality of care. “The absence, in general, of continued and adequate training on contraception for professionals, and of information on contraception aimed at users, is especially notable,” they point out. THE IMPORTANCE OF UNIVERSAL FREE CONTRACEPTION Specialists highlight that universal free long-term contraceptive methods (LARC) are, along with the free provision of emergency contraception, two of the most powerful initiatives for protection and guarantee of the sexual rights of users. In relation to LARCs, SEDRA assures that these are the most effective and cost-effective reversible methods to avoid unplanned pregnancies and reduce the rate of pregnancy terminations. However, “the reality is that there are various barriers that make access difficult for people who want to use this type of contraceptive methods,” the NGO indicates. “In addition to the cost of the method, one of the barriers most repeated by the people participating in this research is related to the waiting lists for the placement and removal of IUDs and implants in those territories where the competition for placement and removal of “These methods are exclusive to doctors specializing in Gynecology in specialized care,” state the authors. After the analysis, the authors consider that there is great heterogeneity at the level of comprehensive accessibility of LARC methods within the Spanish context. Regarding emergency contraception, the autonomous communities that, in addition to providing this method free of charge in several of their services, provide quality support to the user are: Andalusia, Aragon, Asturias, Cantabria, Castilla y León, Catalonia, the Valencian Community, Euskadi, Extremadura, Galicia, Balearic Islands, La Rioja and Navarra. On the contrary, in the Region of Murcia, the Canary Islands and Castilla La Mancha, emergency contraception is not provided free of charge in any of the services of the national health system, with the exception of hospital emergencies in cases of sexual assault. Finally, in the Community of Madrid, emergency contraception is only provided free of charge in the Municipal Community Health Centers (CMSc) of the municipality of Madrid.
