Contraceptives
in Europe, accessibility and availability
Medard M. Lech
School of Public
Health, National Postgraduate Center of Medical
Education,
Warsaw, Poland
It is important that couples have ready
access to a vast range of methods of birth control so they can freely exercise
their choice in the matter of procreation. There are two ways to exercise the
freedom of choice; effective contraception or abortion. Abortion due to various
reasons should stay as a last resort method of births control. In the countries of central and eastern
Europe and in the newly independent states induced abortion was commonly used
as contraceptive method due to lack of modern contraceptives. In these
countries in 1994, 43% of women aged 15-44 years used no contraceptive method,
27% relied on withdrawal and 6% the rhythm method, and in 1996 the
contraceptive prevalence rate was still only 35%. As a consequence of such
situation, the number of induced abortions was usually much higher than in
western European countries. The increase of use modern contraceptives is
strictly correlated with decline of abortion rates, for example the annual
number of abortions in the Czech Republic declined by 65% from 107,100 in 1990
to 37,200 in 1999 as the modern
contraceptives use increased seven folds in the same period of time.
The teenagers abortion and birth rates in
Norway decreased consecutively by 34% and 24% in the period 1999-2000 (in
comparison with the period 1997-1998) only by single implementation of
contraceptive counseling and OC prescription by public health nurses in youth
clinics.
Prevalence of contraception
in Europe (in women aged 15-49 year) vary from 20-23% in Lithuania, Moldova,
Ukraine to 74-78% in Denmark, France, Norway and Sweden. In some of countries
modern methods of contraception are even less popular (Romania; all method –
57%, but modern methods only – 14%). Total fertility rates all over Europe – in
recent years – have fallen down, and in the most countries have reached the
value of <1.9 (excluding Albania, Iceland, Cyprus, UK and Turkey) and it is difficult to think that this have happened due to decreasing of sexual activity of people living in Europe, it happen due to increase in use of birth control methods, especially in use of modern contraception. Full range of modern contraceptives is available in the most of
European countries, but in the eastern and central part of the Continent access to contraceptive
implants is very limited. Level of the
accessibility of modern contraceptives depends of various factors, in a poorer
settings (especially for adolescents) the price of contraceptive pills packet
may be the barrier difficult to overcome. There is no universal European policy
regarding the reimbursement of contraceptives costs. In some countries – for
youngsters – oral contraceptives are disposed free of charge (f.e. France, UK),
in many other countries (f.e. Poland) is hard to find even one oral
contraceptive brand name on a list of for
refund (even partial) from the
government or social security accounts.