Tag: sexual health

Contraception in Europe, why is it only free in some EU countries?

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Contraception is known to prevent unwanted pregnancies and, in the case of condoms, protect against sexually transmitted infections (STIs). When it comes to contraceptives, male and female condoms are the most effective barriers to STIs including HIV, according to the WHO and the European Centre for Disease Prevention and Control. 

So, on International Condom Day, 2023, why is there still such disparity in access to contraception around Europe? 

The European Parliament encourages safeguarding access to contraception. As recently as 2021, a parliamentary report on sexual and reproductive health stressed that all member states are encouraged to provide universal access to contraceptive methods and address any barriers.

Yet government policies across the European Union continue to vary.

Financial inequality between western and eastern member states is believed to be part of the problem. Neil Datta, Executive Director of the European Parliamentary Forum for Sexual and Reproductive Rights told Euronews: “In east European countries, up until the early 1990s, contraception was not very well known, it was not very accessible so, we are still dealing with the legacy of that even today.”

Recommendations

The AIDS Healthcare Foundation has designated 13 February as International Condom Day. It says the event was created to encourage safer sexual practices on an international scale and promote the use of contraception to prevent unintended pregnancies and STIs.

The EU mirrors this message and has also called on public authorities to ensure students in schools are given a rounded education on sexual health. It calls for professional counselling to be provided on a range of contraceptive methods in line with standards set by the World Health Organization.

But, these are recommendations and the 27 Member States are not obliged to act on them.

“Governments have not been very proactive in thinking about their policies in relation to contraception,” said Datta. He went on to explain that some countries are also against wider contraception policies, based on the idea that encouraging the use of contraception will have a negative impact on fertility rates.

‘Best accessibility’

The Contraception Policy Atlas, designed by the European Parliamentary Forum for Sexual and Reproductive Rights, breaks down contraception policies in 46 countries across Europe. Its findings suggest that France has the best access to contraception, counselling and the highest availability of online information services out of all EU Member States. Accessibility was rated at 93.2%. 

France announced its pharmacies would provide free condoms to people aged 18-25 from January 2023 after health authorities discovered that the number of STIs in France increased by 30% in both 2020 and 2021. A programme providing free STI testing and the emergency contraceptive pill has also been rolled out.

In Ireland, free condoms are available to people of all ages through sexual health clinics and some third-level colleges. In addition, from 1 September 2023, free contraception will be given to 16-year-old girls and to women between the ages of 26 and 30 as part of the national budget. The national health service has also announced it will spend €500,000 on condoms and lubricants as part of an ongoing campaign against “crisis pregnancies” and STIs – amounting to 1.5 million free condoms every year.

Germany also announced that it wants to follow France’s lead and finance condoms through its national health insurance. For now, though, contraception comes at a cost through the national health scheme, although special provisions cover birth control pills and emergency contraception for adolescents up to the age of 22.

‘Lowest accessibility’

The Contraception Policy Atlas puts Poland at the opposite end of the scale, with a rating of just 33.5% in terms of public access to contraception. Emergency contraceptive pills need to be prescribed by a doctor and are not available over the counter in pharmacies.

Meanwhile, in Hungary, there is no publicly-funded website for contraception services and a prescription is needed for all contraceptive supplies except condoms and emergency contraception.

Role of politics and religion

“Policies on contraception influence people’s behaviours in accessing contraception. One aspect is whether it is covered by the respective national health system. If it is not covered by the national health systems then it creates financial barriers for individuals who want to use it” said Datta.

Religion is also an important factor, “most religions, Christian religions specifically, do discourage the use of contraception, particularly in the world of Catholicism. 

“So where those religions are very strong, the narratives out there which do discourage the use of contraceptives and religious actors can have influence over public policies” he added.

The right kind of sex education

Yet, in Europe as a whole, the unintended pregnancy rate has declined by 53% over the past 30 years, according to the Guttmacher Institute.

Some experts argue that one of the factors behind declining unintended pregnancy rates is the promotion of sex education in schools, which is widely encouraged by the European Parliament and the World Health Organization. 

“Comprehensive sexuality education teaches young people both about contraception and about respect and consent within relationships including sexual relationships. This has a very positive knock-on effect on people understanding how to prevent unintended pregnancies and how to protect their own health by being able to empower themselves to avoid sexually transmitted infections” said Datta.

Sex education remains a topical issue. In some countries, such as Ireland and France, it is a compulsory part of school education, but in Italy, for example, sex ed is optional.

Where available, education is often delivered through a variety of school subjects as part of a cross-curricular programme. Various aspects are taught through biology, home economics and social sciences.

Yet sex education does not necessarily provide students with information on contraception methods.

Natalie Picken, an analyst for the RAND Corporation, a non-profit specialising in improving policy and decision-making through research, told Euronews that education on contraception is only included in the sex education curriculum in some EU countries.

“It is likely that the content, nature and extent of these programmes varied considerably between regions, schools, and classes” she added.

Picken’s research found that most EU members have limited teacher training opportunities in sex education, despite its benefits. 

“There is strong evidence that sexuality education can lead to reduced risk-taking, delayed initiation of sexual intercourse, and more use of contraception and condoms and generally improves young people’s knowledge and attitudes around sexual health,” she said.

How can EU countries bridge the gap?

Implementing better access to contraception can be costly but there are ways authorities can get up to speed. 

“One easy quick fix that is accessible to any government would be to provide government supported information for example via a website which provides authentic, authoritative information… that is within the capacity of each government no matter how strapped it may be”, concluded Datta.

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Staying Healthy While Staying Open: The Polyamory Dilemma

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Jan. 5, 2023 – Angie Ebba, 42, of Portland, OR, has two local girlfriends, one long-distance partner, and a platonic life partner. 

Ebba is polyamorous, having multiple intimate romantic relationships at the same time. Her partners know about each other and have consented to the arrangement, she says. 

Polyamory is becoming more common in the United States. In 2021, one in nine Americans said they’d been in polyamorous relationships, and one in six said they wanted to try it, according to a study by researchers at the Kinsey Institute. 

While a high level of transparency is required to make polyamory work, those who practice it don’t always feel comfortable sharing their relationship status with health care professionals. The fear of disclosure is not unfounded. Of the those in the Kinsey study who said they weren’t and had never been interested in polyamory, fewer than 15% said they respect people who engage in the practice. 

“I hear all the time from patients who have sexual questions and issues but are uncomfortable talking to their doctors or even other therapists,” says Ian Kerner, PhD, a psychotherapist and sex therapist in New York City. “As polyamorous systems are still on the outskirts of the mainstream, some doctors may have implicit biases or explicit judgments, especially if they are lacking in experience.”

Roadblocks to Care

People who practice polyamory face unique health issues. These include a potentially higher risk of sexually transmitted infections (STIs) from having multiple sexual partners, and anxiety or depression stemming from managing multiple relationships. 

“It is of particular importance in OB/GYN given the risk of STI transmission, and its consequences such as infertility, vaginal discharge, and systemic illness,” says Cheruba Prabakar, MD, the CEO of Lamorinda Gynecology and Surgery in Lafayette, CA. “Disclosing information will allow the provider to think about the patient more holistically.”

Ebba does not tell her doctors about her personal life. She knows other people in these relationships who have felt judged in clinical encounters, and she avoids disclosure unless absolutely necessary. 

“Primarily, I don’t let my providers know because I’ve already in the past faced discrimination and awkwardness for being queer; I don’t want that for being poly as well,” she says. “If I can avoid it, I will.”

A study from 2019 of 20 people in consensual non-monogamous relationships – which can include polyamory – found most of them reported challenges in addressing their health care needs related to lack of provider knowledge, not enough preventive screenings, and stigmas that impacted their health and trust in the medical system.

“Polyamorous people often have trouble seeking out health care because they fear being judged by their doctor or other clinicians who don’t understand or respect their lifestyle choices,” says Akos Antwi, a psychiatric mental health nurse practitioner and co-owner of Revive Therapeutic Services in Rhode Island and Massachusetts. “They may also be reluctant to share information about their relationships with providers who aren’t familiar with the complexities of polyamory.” 

Sharon Flicker, PhD, a clinical psychologist and assistant professor of psychology at California State University-Sacramento, says she understands why people are worried about discussing the topic of multiple relationships with their health provider.

“Health care providers’ interactions with patients are often shaped by their mono-normative assumptions, that monogamy is ideal and deviations from that ideal is pathological,” she says. “Non-disclosure presents a barrier to sensitive care that meets the individualized needs of the patient.” 

Flicker says health care professionals can seek training to reduce their biases, and to better understand and address the unique needs of people involved in consensually non-monogamous relationships. In addition, offering to answer any questions that a doctor might have after disclosure can open the door to dialogue, according to Prabakar. 

“They may be simply embarrassed to ask, as many may not be familiar with” polyamory, Prabakar says.

People in polyamorous relationships also can look for affirming language on the websites of health providers, which may mention welcoming patients of all sexual orientations or gender identities. A first appointment can serve as an interview to find out what kind of terms a provider uses when referring to non-monogamy. 

Safely Navigating Sexy Time With Multiple Partners

Prabakar says sexual health and safety is at the forefront for her patients in polyamorous relationships because they are engaging with multiple partners. 

She recommends anyone who has multiple partners use condoms and dental dams for the prevention of STIs, like herpes and gonorrhea, in addition to receiving regular screening tests for the diseases. 

Tikva Wolf, from Asheville, NC, says she’s been in polyamorous relationships for 20 years. She says she has strict boundaries for engaging in new romantic relationships to protect her sexual health: She has sex only with people who know their current STI status, are clear communicators, and use protection. 

“If the conversation feels awkward, or they don’t seem to know what they’ve been tested for, I don’t engage in sex with them,” she says. “I don’t start romantic partnerships with people unless they’re on the same page about relationships, and I don’t have casual sex.” 

Wolf says her actions toward transparency mirror the greater community of people who engage in polyamorous relationships.

“Monogamy is the default setting, so there’s a tendency to be more transparent about specific preferences upfront in any relationship that doesn’t quite fit into that standard box,” she says. 

Some research backs up Wolf’s hypothesis. A 2015 study in The Journal of Sexual Medicine found that polyamorous people reported more lifetime sexual partners than people in monogamous relationships, but were more likely to report using condoms and be tested for STIs. About one-quarter of monogamous partners reported having sex outside of their primary relationship but not informing their primary partner. 

Kerner explains that each partner in a polyamorous relationship may have different ideas about sexual activity; some partners may be interested in casual sex, while others are interested in maintaining steady primary and secondary relationships. 

“These systems are always different, and without clear boundaries, honesty, and communication – for example around the use of protection – the potential to contract an STI within the system increases,” and the potential for the polyamorous relationship to not work increases, he says. 

Taking Care of Mental Health

Not only does a polyamorous lifestyle require talking about sexual health and romantic boundaries, it demands an openness with feelings as they come up. 

“Couples in a polyamorous relationship don’t fully anticipate the emotional response they might have to their partner being with another person,” says David Helfand, PsyD, a therapist in St. Johnsbury, VT, who has worked with many polyamorous couples.

People may have feelings of insecurity or jealousy, which can lead to anxiety in navigating the complexity of multiple relationships. 

“The first time your spouse goes on a date with another person, or you hear them in the bedroom with someone else, it can create an intense emotion that you might not know how to process or have been prepared for,” Helfand says.

Seeing a therapist can help with processing emotions raised by dating multiple people. Ebba says she sees a therapist regularly, in part for help setting boundaries on how much time to spend with different partners. 

“Poly relationships can be great because you have more support people in your life,” she says. “But you’re also giving more of your time and energy away too.”

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