January 23 will be the last day of work for Nicola Magrini, director general of the Italian Medicines Agency (Aifa). The Minister of Health Orazio Schillaci, thanks to the system of spoils system (which allows the new government to change the heads of ministries and agencies under the control of the ministries), has decided to bring forward the end of his mandate. Among the dossiers on Magrini’s table there is also the one on the free contraceptive pill, a process started some time ago which now risks being placed in a drawer.
The contraceptive pill does not fall within the current reimbursement criteria (it is classified in band C, therefore totally borne by the citizens) and making it free has technical and political implications: it means recognizing women’s universal right to sexual and reproductive health.
It is therefore an important choice, but not as futuristic as it seems. Access to contraception is free for all women or for some of them (such as adolescents or those who belong to vulnerable groups) already in thirteen European countries and, thanks to Title V of the constitution which allows autonomy in of healthcare, also in six Italian regions (Puglia, Emilia-Romagna, Piedmont, Tuscany, Lombardy, Marche and Lazio).
To understand the impact and significance of this measure, it is first of all necessary to understand who would benefit from it0. The data available are scarce and discontinuous, but they show that women from poorer backgrounds and with fewer social and cultural tools have less access to contraception. A situation that follows the social, economic and territorial differences of Italy: place of residence, income and cultural level also affect family planning and reproductive health.
The absence of national policies that guarantee accessibility to contraception, in addition to exacerbating social inequalities, causes a greater risk of abortion, unwanted, unplanned or adolescent pregnancies and abandonment of newborns. All phenomena that mainly concern the most vulnerable social groups.
“When we carried out our research on contraception in 2019 we noticed that access is uneven in Italy”, explains Serena Fiorletta, vice president of the Italian Association of Women for Development (Aidos) which has been dealing with sexual and reproductive health since 1981. “There are gaps between northern and southern regions, with some exceptions such as Puglia. But there is also an evident difficulty in finding the information”.
For Fiorletta, access is not only to contraceptives, but also to comprehensive sex education: “It is a key factor for gender equality and the emancipation of young people, especially girls. This is underlined in the various international conventions, platforms and action programs dedicated to women’s rights. Comprehensive sex education is necessary for health and well-being, to make healthy, informed and responsible choices, which guarantee women’s and girls’ freedom of choice and bodily autonomy”.
In the ten European countries with the greatest access to contraception, the most children are born
There is therefore an economic problem and one of access to information. According to the Higher Institute of Health, the main source of information for boys and girls on sexual and reproductive health is the internet. Almost all think that it is the school that has to take care of it, yet in the south only 33 percent of students have received some type of information on these issues in school (78 percent in the north).
Even if there are no sex education programs and the number of clinics is insufficient, girls are increasingly aware, also because they are the daughters of mothers who have extensively used contraception. But those who come from contexts with a more traditional and patriarchal culture or with fewer cultural tools to emancipate themselves fall behind. The lack of information can translate into teenage pregnancies, which in fact mainly concern girls with a low economic and educational level, and into an increase in abortions, as suggested by the abortion rate among foreign women which is significantly higher than that of Italian.
The Onda foundation reports that one in three women does not know that emergency contraception (also called the “morning after” or “five days after” pill) can be found in pharmacies and that a prescription is no longer necessary. According to Istat, the women who use it the most are graduates. In summary, those with money and the ability to find and interpret information – usually these two categories overlap – have full access to contraceptive drugs. Recognizing that contraception is everyone’s right would therefore be especially useful for those who are excluded from it today.
As Valeria Viola, an expert on drug approval pathways says, “if we recognize family planning and women’s sexual freedom as universal rights, the free pill becomes a priority as well as sustainable expense: if we take France as a parameter, the the national health service spends around seven euros a year for each woman who chooses this type of contraception, compared to the 160-230 euros that individual citizens would spend”.
In this context, the approval of the reimbursement of the pill (the inclusion in range A, and therefore paid by the National Health Service), would have an important social value and would mark a fundamental political point, but to be truly effective this decision should be supported from an efficient system of access to information on contraception in schools, and through the strengthening of territorial principals. As Cecilia D’Elia, a senator with a long history in women’s politics says, “sex education must be curricular, not delegated to the sensitivity of individual teachers or institutes, but a right guaranteed to all boys and girls” .
The right wing in government seems convinced that it can raise the birth rate by controlling women’s bodies and limiting their sexual and reproductive choices, but if politics really wanted to promote births it would offer free contraception. It seems like a paradox, but it’s not.
In the ten European countries with the greatest access to contraception, more children are born than in the ten countries with the least access. Because? Perhaps there is greater equality, care work is more distributed, family and parenting models are multiple, women work more and welfare is not based on women but on services.
There is now enough data to know that in the more conservative Western countries, where the state limits and does not promote access to contraception, where the model promoted by policies and permitted by legislation is the so-called traditional family, with a strong between care work and paid work, there are fewer and fewer children.