European Contraception Atlas 2020
- Access to modern, effective and affordable contraception remains a European challenge
- 7 countries introduced policies related to supplies and counselling and 4 countries improved online resources
- Belgium edges ahead of France, taking the lead for the first time in four years
- Poland remains at the bottom of the Atlas for being the only European country to increase restrictions to contraception in the past four years
European Parliament, Brussels, 12 November 2020
On 12 November 2020, MEPs for SRR co-chair MEP Sophie in ‘t Veld and MEP Terry Reintke co-hosted the launch of the fourth annual edition of the European Contraception Policy Atlas - a map that scores 46 countries throughout geographical Europe on access to modern contraception.
Since its debut in 2017, the Contraception Policy Atlas has become an acknowledged tool of reference for information on contraception in Europe and has also contributed to legislative changes in 9 countries as well as improved online resources in a handful of countries.
The Atlas stratifies countries by traffic light colours according to their access to contraceptive supplies, family planning counselling and online information. The red category indicates extremely poor performance and has been attributed to 8 countries this year, compared with 12 last year. Poland proved unable to relinquish its bottom place and specially created dark red category this year, following its policy change in 2019 to necessitate prescriptions for emergency contraception.
2020 highlights include policy changes to break down financial barriers to contraception in Belgium, Bulgaria, Finland, Iceland, the Netherlands, North Macedonia and Spain, particularly for young people and marginalised or vulnerable groups.
This year’s atlas reveals yet another uneven picture across Europe and demonstrates that inequitable reimbursement schemes and failure of governments to provide accessible and accurate information impedes access to the latest and widest choice of contraception.
“Although nearly 60% of European women of child-bearing age use a form of contraception[1], 35% of pregnancies in Europe are considered as unplanned[2]. There remains a disconnect between the preferred method of contraception for certain categories of women, their financial ability to access these methods and public authorities’ funding priorities. 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”, said Neil Datta, EPF Secretary.
“It’s important that we don’t see European countries regress on these matters, like Poland. Governments must take the cost-effective effort to provide accessible, reliable and authoritative online information in order to empower women to make informed decisions about the 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”, said MEP Sophie in ‘t Veld.
“Having access to affordable and accessible contraception is a right that has been fought for over centuries and the battle is not yet won. The pandemic has illuminated existing gaps and shortcomings in healthcare services, with some governments shifting resources away from basic sexual and reproductive services, others 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”, said MEP Terry Reintke.
Highlights
- EU countries Czech Republic, Lithuania, Slovakia, Hungary and Poland among the ten worst performing states.
- Better access to contraception does not negatively influence fertility rates - the top 10 countries have a higher fertility rate than the bottom 10 countries.
About the Atlas
Now in its fourth year, the Atlas has been produced by the European Parliamentary Forum for Sexual & Reproductive Rights (EPF) while experts in sexual and reproductive health and rights designed the methodology.
EPF benefitted from the financial support of MSD to undertake original and independent research which is presented in the Atlas. EPF is grateful to numerous expert national organisations and individuals who contributed to gathering the data presented in the Atlas. The scope and content of the European Contraception Atlas is the sole responsibility of EPF.
[1] https://www.un.org/development/desa/pd/sites/www.un.org.development.desa.pd/files/files/documents/2020/Jan/un_2019_contraceptiveusebymethod_databooklet.pdf
[2] https://www.guttmacher.org/news-release/2020/new-estimates-show-worldwide-decrease-unintended-pregnancies
Website discoverability
Content is King, but distribution is Queen.
There is little point in having great content if nobody knows about it. Effective websites containing information on contraception should be easily discoverable by citizens. Applying Search Engine Optimisation practices improves how a website ranks in search engines.
For the vast majority of Europeans, the internet is the primary source of information about contraception. And for young people in particular, the web is the first place they look for guidance.
It is therefore key that governments are present online to provide contraceptive information that is easy to find, authoritative, accurate, non-judgmental and easy to understand.
Web design
Accessible design is good design. Designing a site with vulnerable groups in mind improves the user experience for all.
The structure of the site should be intuitive with only as many menu items as is absolutely necessary. A good contraception site should contain two main sections: Types of Modern Contraception and Frequently Asked Questions (FAQs). Including a search function on the website helps with navigation. It also allows you as the site owner to see what are the most searched for terms. You can use this information to expand and improve the information provided on the most searched for topics. Page Design People tend to scan webpages rather than thoroughly reading all the content. Eyetracking research shows that the manner in which a person's eyes move across a page depends on the type of content before them.
Online information - regional or minority languages
Governments have a responsibility to provide all their citizens with online information to help plan their families, this includes people with disabilities, people with literacy problems and non-native speakers (including asylum seekers, refugees and migrants). Including translation in a regional or minority language ensures all citizens can access the information they need to make their own contraceptive choices. Language should be easy to read -- use simple words, short sentences and paragraphs. Text like this works best for read-aloud software and online translation tools.
Online information - where to get contraceptives
In providing accurate information on modern contraceptive methods, it's important to make the information relevant to the domestic audience by specifying: where the contraception can be obtained, price range, available reimbursement, whether a medical professional needs to be consulted beforehand (e.g. the pill) or needs to administer the contraception (e.g. implant). Informed citizens can choose which contraceptive suits their particular needs best.
Online information - costs of contraceptives
In providing accurate information on modern contraceptive methods, it's important to make the information relevant to the domestic audience by specifying: where the contraception can be obtained, price range, available reimbursement, whether a medical professional needs to be consulted beforehand (e.g. the pill) or needs to administer the contraception (e.g. implant). Informed citizens can choose which contraceptive suits their particular needs best.
Online information - number of contraceptives listed
In providing accurate information on modern contraceptive methods, it is important to include the full range of available contraceptives. Informed citizens can choose which contraceptive suits their particular needs best.
Website provided by
“All persons have the right to full information as to the relative benefits, risks and effectiveness of all methods of fertility regulation and the prevention of unplanned pregnancies”
Official government websites with information about contraceptive types, where to get them, and reimbursement information are a small expense for governments, but can make a big difference to citizens seeking advice.
Public authorities are primarily responsible for providing evidence-based information in order to enable people to fulfil their right to full information. Hence, the Atlas looks into whether online information supported by a public authority (Ministry of Health, etc.) exists across the different European countries. When it does not exist, or is very difficult to find, we examine whether there is a private-supported (by NGO, or commercial) easy-to find website, filling up the information gap.
Prescription requirements
The Atlas investigates whether contraceptives other than the barrier ones (condoms, diaphragms), such as the ring, the patch, the pill, and injectables, are accessible without prescription (officially, or de facto), or not. In countries with prescription requirements for contraception, it is important to ensure that they are clear and concise and are implemented effectively.
Legal status should not be a barrier to contraception access
Access to a full range of sexual and reproductive health services is critical to the well-being of individuals, families, and communities. Contraceptive use helps women realize their own reproductive goals, which in turn helps them achieve their educational, employment, and financial ambitions. Many women face structural barriers to obtaining contraception based solely on their legal status. This includes women who are lawfully present and those who are undocumented. When immigrant women are unable to obtain basic care, their health, well-being, and economic security are jeopardised, as well as the well-being and stability of their families and communities. Schemes for reimbursement of contraceptive supplies should be extended to all people of reproductive age, more particularly to those highlighted as having restricted access to contraception (young people and vulnerable groups).
Need for third-party consent
Requiring third-party consent for access to certain services presents additional barriers to contraception access and violates women’s rights. The Committee on Economic Social and Cultural Rights has held that States are required to repeal “third-party authorization requirements, such as parental, spousal and judicial authorisation requirements for access to sexual and reproductive health services and information, including for contraception.”
Counselling
“Counselling is a process of communication by which a person is helped to identify her or his sexual and reproductive health needs and to make the most appropriate decisions about how to meet them. Counselling is characterised by an exchange of information and ideas, discussion and deliberation”.
Building on quality of care dimensions, the Atlas investigates whether counselling is accessible by looking into whether consultation for contraception available; affordable, and accessible?
Special reimbursement for vulnerable groups
Long-acting, reversible contraception (LARCs), or subdermal contraceptive implants and intrauterine devices (IUDs) are less prone to failure and have higher satisfaction rates than other contraceptive methods. LARCs may be a more appropriate and effective form of contraception for certain categories of women (for example, women who are sexually active but do not have any medium-term child-bearing aspirations). However, they often represent a greater one-time cost which makes them less accessible to certain women, particularly those who may benefit the most from them such as low-income women, younger women like students, and women in vulnerable situations, such as asylum seekers and refugees. There is thus a disconnect between the preferred method of contraception for certain categories of women, their financial ability to access these methods and public authorities’ funding priorities. In times of budgetary constraints, LARCs are not only the most effective contraceptive option, but also the most cost-effective for the health systems in the long-term. Research shows that for every dollar the public sector spends on LARCs, five dollars is saved in unintended pregnancy costs.
Special reimbursement for young people
Cost is a significant barrier to using contraception for young people. Many must pay out-of-pocket because they have no pharmaceutical insurance, their insurance does not cover the contraceptives they desire, or they wish to obtain contraceptives without their parents’ knowledge. To address these barriers and reduce rates of unintended pregnancy, all young people should have confidential access to contraception, at no cost.
“All persons have the right to full information as to the relative benefits, risks and effectiveness of all methods of fertility regulation and the prevention of unplanned pregnancies”
Public authorities are primarily responsible for providing evidence-based information in order to enable people to fulfil their right to full information. Hence, this criterion looks into:
- Whether online information supported by a public authority (Ministry of Health, etc.) exists across the different European countries. When it does not exist, or is very difficult to find, we examine whether there is a private-supported (by NGO, or commercial) easy-to find website, filling up the information gap.
- Information coverage, including the different types of contraception covered on the website (WHO list), information on the cost of contraceptive options and reimbursement, logistical information given in terms of where/how to get the contraceptives, who can issue prescription, where to get additional information.
- User friendliness of the website.
Regrettably, in a few countries, the only online information on contraception comes from journalistic articles.
Read our Government website toolkit for more information
Prescription requirements
Prescriptions present an additional barrier to contraception access. This sub-criterion looks into whether at least one type of Emergency Contraception is available, and if so whether it needs to be prescribed or it is accessible without prescription. A time-sensitive family planning supply, emergency contraception should be available over the counter and without prescription.
Reimbursement
Reimbursement is the process whereby patients/clients receive payment for services used, most often through health insurance. The Atlas investigates whether a general reimbursement for different types of modern contraception, including at least one LARC, exists, and at what level. The cost of contraception can be an important barrier, particularly for certain population groups. Thus, aside to the existence or not of a general reimbursement, the Atlas looks separately into the existence of special reimbursement for young people, and vulnerable groups like unemployed and low-income women.
Access to contraceptive supplies and counselling
This is the dominant criterion of the Atlas. It consists of three main sub criteria, which in turn are made up of several others as follows:
- Reimbursement, including level of reimbursement, special reimbursement for adolescents, and special reimbursement for vulnerable groups such as unemployed, and low-income.
- Counselling, including whether a consultation for contraception is available, accessible, and affordable, whether a third-party consent is needed, and whether a certain legal status (marital, citizenship), can act as a barrier
- Prescription requirements for Emergency Contraception, as well as for other non-barrier hormonal contraceptives, such as pills, patch, ring, and injectables.