Spain’s Socialist Government Approves EC Without Prescription

Angela Castellanos

Regardless of age or province of residence, all Spanish women will have access to emergency contraception pill without a prescription. It will be in pharmacies by August.

Regardless of age or
province of residence, all Spanish women will have access to the emergency
contraception pill (EC) without a prescription. It will be in pharmacies by
August.

The morning-after pill was authorized in Spain in
2001, and it is distributed for free by public health centers in some regions,
while in others, it is more difficult to obtain due to the particular ways of
implementing the national norms by the regional administrators of the health
care system.

Socialists leaders argue that
the measure will contribute to eradicating the territorial inequality regarding
the access to family planning methods.

Currently, the pill is sold in pharmacies
for 20 euros (about 27 US Dollars) with prescription. But, according to Concha
Martín, director of the Family Planning Association of Madrid, women often have
to go to several doctors before finding one who will prescribe the EC.

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That is why, for the Socialists, the
announcement is part of a package of measures promoting "the development of the
fundamental right to sexual and reproductive health for all citizens."

"The aim
is to make it available to anyone who wants it without any difficulty," said
the Ministry of Health’s Trinidad Jimenez, who made the announcement May 11th.

Jimenez underscored that EC
use is aimed to "avoid unwanted pregnancies" and "unexpected sexual relations
without protection," therefore it cannot be regarded as routine method of
contraception.

Nevertheless,
the General Secretary of the Sociedad Española de Ginecología y Obstetricia (Gynecology
and Obstetric Spaniard Society), Luis T., called the governmental measure
"frivolous." Mercé Alberto argues that there is a risk, especially among young
women, of using EC as a regular contraceptive method for occasional sexual
intercourse.

Mercé Alberto added that the
generalization of its use as conventional contraceptive "could increase the
number of unwanted pregnancies and sexually transmission diseases as well."

In addition, this measure
did not address sexuality education, which is a problem to be solved by the
school system, Mercé Alberto pointed out.

"Emergency contraceptive
pills are for emergency use only and not appropriate for regular use as an
ongoing contraceptive method because of the higher possibility of failure
compared to modern contraceptives. In addition, frequent use of emergency
contraception results in more side-effects, such as menstrual irregularities.
However, their repeated use poses no known health risks,"

According to an
official document of the World
Health Organization
.

Some associations of consumers have asked
for more information in order to avoid the use of the morning-after-pill as a
conventional contraception method.

The
conservative forces, such as the Catholic Church and the conservative
opposition, the Popular Party, have reacted by arguing that the number of
abortions will increase as a result of its implementation.

Socialist leaders said statistics in
countries that have made the pill available over the counter, such as the United States and France, show it has helped reduce the
number of abortions significantly.

According to official data of the Ministry of Health, of the 112,000 women who had
abortions in Spain
in 2007, 6,000 were minors.

For many people, sexuality education and
access to contraception are the ways to diminish unwanted pregnancies and
abortions.

A Spanish blogger stated that this measure
will reinforce sexist behaviors. "Probably many men from their male condition
will say "Thanks." Once again, the consequences of a not thought-out act can be
stopped with just a pill. I am worried because day by day it is getting harder
to explain to a daughter that a woman is equal to a man, and she deserves
respect."

So far, pharmacies have
not expressed any objection. The Ministry of Health is confident that its
managers will not argue conscience objection, since the pill is not abortive.

According to the World Health Organization, "Levonorgestrel emergency contraceptive pills have
been shown to prevent ovulation and they did not have any detectable effect on
the endometrium (uterine lining) or progesterone levels when given after
ovulation. ECPs are not effective once the process of implantation has begun,
and will not cause abortion."

"Emergency contraceptive
pills prevent pregnancy. They should not be given to a woman who already has a
confirmed pregnancy. However, if a woman inadvertently takes the pills after
she became pregnant, the limited available evidence suggests that the pills
will not harm either the mother or her fetus."

Commentary Sexual Health

Fewer Teens Are Having Sex, But Don’t Pop the Champagne Yet

Martha Kempner

The number of teens having sex may be less important than the number having protected sex. And according to recent data from the Centers for Disease Control and Prevention, condom use is dropping among young people.

Every two years, the Centers for Disease Control and Prevention’s Division of Adolescent and School Health (CDC-DASH) surveys high school students to gauge how often they engage in perceived risky behaviors. The national Youth Risk Behavior Surveillance (YRBS) is wide ranging: It asks about violence, guns, alcohol, drugs, seat belts, bicycle safety, and nutrition. It also asks questions about “sexual intercourse” (which it doesn’t define as a specific act) and sexual behaviors.

Started in 1991, this long-running study can provide both a picture of what high school students are doing right now and a historical perspective of how things have changed. But for more than a decade, the story it has told about sexual risk has been the virtually the same. Risk behaviors continually declined between 1991 and 2001, with fewer high school students having sex and more of them using condoms and contraception. But after the first 10 years, there has been little change in youth sexual risk behaviors. And, with each new release of almost unchanging data, I’ve reminded us that no news isn’t necessarily good news.

This year, there is news and it looks good—at least on the surface. The survey showed some significant changes between 2013 and 2015; fewer kids have ever had sex, are currently sexually active, or became sexually active at a young age. More teens are relying on IUDs and implants, which are virtually error-proof in preventing pregnancy.

In 2015, 41 percent of high school students reported ever having had sexual intercourse compared to 47 percent in 2013. The researchers say this is a statistically significant decrease, which adds to the decreases seen since 1991, when 54 percent of teens reported ever having had sexual intercourse.

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Another change is in the percentage of students who had sex for the first time before age 13. In 2015, 4 percent of high school students reported this compared to almost 6 percent in 2013. This is down from a full 10 percent in 1991. As for number of overall partners, that is down as well, with only 12 percent of students reporting four or more partners during their lifetime compared to 15 percent in 2013 and 19 percent in 1991. Finally, the percentage of students who are currently sexually active also decreased significantly between 2013 (34 percent) and 2015 (30 percent).

These are all positive developments. Delaying sex can often help prevent (at least temporarily) the risk of pregnancy or STIs. Having fewer partners, especially fewer concurrent partners, is frequently important for reducing STI risk. And those teens who are not currently having sex are not currently at risk for those things.

While I want to congratulate all teens who took fewer risks this year, I’m not ready to celebrate those statistics alone—because the number of teens having sex is less important to me than the percentage of teens having sex that is protected from both pregnancy and sexually transmitted infections. And that number is lower than it once was.

Among sexually active teens, there were no significant positive changes in measures of safer sex other than an increase in the number of sexually active high school students using the IUD or implant (up to 4 percent from 2 percent in 2013).

Moreover, some results indicate that today’s teens are using less protection than those who were teens a decade ago. The most telling finding might be the percentage of teens who used no method of contraception the last time they had sex. This decreased between 1991 and 2007 (from 17 percent to 12 percent), inched up to 14 percent in 2013, and stayed the same in 2015 (14 percent). There was also little to no change in the percentage of high school students who say that either they or their partner used birth control pills between 2013 (19 percent) and 2015 (18 percent) or those who say they used the contraceptive shot, patch, or ring (5 percent in 2013 and 2015).

For me, however, the most distressing finding is the backward progress we continue to see in condom use. The prevalence of high school students who used a condom at last sex went up from 45 percent in 1991 to 63 percent in 2003. But then it started to drop. In 2015, only 57 percent of sexually active high school students used condoms the last time they had sex, less than in 2013, when 59 percent said they used condoms.

It’s not surprising that teens use condoms less frequently than they did a decade ago. In the 1990s, the HIV epidemic was still front and center, and condoms were heavily promoted as a way to avoid infection. As this threat waned—thanks to treatment advances that now also serve as prevention—discussions of the importance of condoms diminished as well. The rise of abstinence-only-until-marriage programs may have also affected condom use, because these programs often include misinformation suggesting condoms are unreliable at best.

Unfortunately, some of the negative messages about condoms inadvertently came from public health experts themselves, whether they were promoting emergency contraception with ads that said “oops, the condom broke”; encouraging the development of new condoms with articles suggesting that current condoms are no fun; or focusing on teen pregnancy and the use of highly effective contraceptive methods such as long-acting reversible contraceptives (LARC). The end result is that condoms have been undersold to today’s teenagers.

We have to turn these condom trends around, because despite the decreases in sexual activity, young people continue to contract STIs at an alarming rate. In 2014, for example, there were nearly 950,000 reported cases of chlamydia among young people ages 15 to 24. In fact, young people in this age group represented 66 percent of all reported chlamydia cases. Similarly, in 2014, young women ages 15 to 19 had the second-highest rate of gonorrhea infection of any age group (400 cases per 100,000 women in the age group), exceeded only by those 20 to 24 (489 cases per 100,000 women).

While we can be pleased that fewer young people are having sex right now, we can’t fool ourselves into believing that this is enough or that our prevention messages are truly working. We should certainly praise teens for taking fewer risks and use this survey as a reminder that teens can and do make good decisions. But while we’re shaking a young person’s hand, we should be slipping a condom into it. Because someday soon (before high school ends, for more than half of them), that teenager will have sex—and when they do, they need to protect themselves from both pregnancy and STIs.

News Contraception

New Hawaii Law Requires Insurers to Cover a Year’s Supply of Birth Control

Nicole Knight Shine

Insurance companies typically cover only a 30-to-90-day supply of birth control, posing a logistical hurdle for individuals who may live miles away from the nearest pharmacy, and potentially causing some using oral contraceptives to skip pills.

Private and public health insurance must cover up to a year’s supply of birth control under a new Hawaii law that advocates called the nation’s “strongest.”

The measuresigned by state Gov. David Ige (D) on Tuesday, applies to all FDA-approved contraceptive medications and devices.

Hawaii joins Washington, D.C., which also requires public and private insurers to cover up to 12 months of birth control at a time.

Oregon passed a similar measure in 2015, but that law requires patients to obtain an initial three-month supply of contraception before individuals can receive the full 12-month supply—which the Hawaii policy does not.

“At a time when politicians nationwide are chipping away at reproductive health care access, Hawaii is bucking the trend and setting a confident example of what states can do to actually improve access,” Laurie Field, Hawaii legislative director for Planned Parenthood Votes Northwest and Hawaii, said in a statement.

Insurance companies typically cover only a 30-to-90-day supply of birth control, posing a logistical hurdle for individuals who may live miles away from the nearest pharmacy, and potentially causing some using oral contraceptives to skip pills. Both the American Congress of Obstetricians and Gynecologists (ACOG) and the U.S. Centers for Disease Control and Prevention recommend supplying up to one year of oral contraceptives at a time, as the Hawaii Senate Committee on Commerce, Consumer Protection, and Health noted in a 2016 conference report.

Fifty-sex percent of pregnancies in Hawaii are unintended, compared to the national average of 45 percent, according to figures from the Guttmacher Institute.

Women who received a year’s supply of birth control were about a third less likely to experience an unplanned pregnancy and were 46 percent less likely to have an abortion, compared to those receiving a one- or three-month supply, according to a 2011 study of 84,401 California women published in Obstetrics and Gynecology.

Reproductive rights advocates had championed the legislation, which was also backed by ACOG–Hawaii Section, the Hawaii Medical Association, and the Hawaii Public Health Association, among other medical groups.

“Everyone deserves affordable and accessible birth control that works for us, regardless of income or type of insurance,” Planned Parenthood’s Field said in her statement.