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Revealed: Contraception inequality in Europe is widening

UK tops league in Contraception Policy Atlas, but access to birth control in other parts of Europe is worsening

Lucy Martirosyan
9 February 2023, 12.16pm

A gynaecologist explaining the diaphragm method of contraception and birth control


Andriy Popov / Alamy Stock Photo

Access to contraceptives in Europe remains “very uneven”, according to a new report from the European Parliamentary Forum for Sexual and Reproductive Rights (EPF), launched on 8 February at the European Parliament in Brussels, ahead of Valentine’s Day.

The sixth edition of EPF’s Contraception Policy Atlas, which rates 46 countries throughout Europe, shows that the best-performing countries include the United Kingdom, France and Belgium. Countries at the bottom of the ranking are Poland, Bosnia-Herzegovina and Hungary.

“The Contraception Policy Atlas reveals who is improving and who is backsliding in providing women the means to make decisions over their own bodies,” said Sophie in ’t Veld, a Dutch member of the European parliament. “With this Atlas, we can see that we are far from that goal.”

‘An uneven picture’

At first glance, the map paints a divided picture between a green Europe on the left and a red Europe on the right.

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“There’s a polarisation between East and West of Europe,” said Neil Datta, the executive director of EPF. “West Europe has been improving. On the other side of the continent, unfortunately, the countries have not been progressing away from dark red, red and orange.”

The colour green is attributed to countries with ‘great performance’, while the countries in red indicate ‘poor performance’. Countries are ranked depending on how European public authorities perform across access to contraception, counselling, and online information. Eight countries in 2023 were red, compared to 12 last year.

“57% of women in Europe use modern contraception, which shows an increase compared to last year’s edition,” Datta said. “35% of pregnancies in Europe are unintended and this represents the lowest rate in the world.”

The countries in green

The UK scored the highest (96.9%) on the map, thanks to the country’s expanded access to a full range of modern contraceptive methods as featured on the NHS website, Datta said. This includes long-acting reversible contraception (LARCs), such as IUDs and hormonal implants.

In the UK, contraception services are free and confidential, including for people under the age of 16.

France came in a close second (93.2%) behind the UK. Condoms became free of charge in French pharmacies for people aged 16 to 25 as of 1 January. Emergency contraception also became available free without a prescription.

Ireland got a special mention in the forum for its strides in improving access to contraception. Starting from 1 September, the age range for free contraception will be extended to include those aged 16 and 26 to 30. It’s a motion that was spearheaded by Pauline O’Reilly, a member of the Irish Green Party.

The conservative, Catholic country has long struggled with adopting legislation meant to empower women’s bodily autonomy, “but it has really shifted in a short space of time,” explained O’Reilly, mentioning Ireland’s adoption of abortion and same-sex marriage legislation in the past decade.

“I do think politics is key,” said O’Reilly. “It’s also about saying: ‘How can we push a human rights movement that’s not just led by women but where women’s rights are at the forefront?’”

The countries in red

Poland (33.5%) is the only European country to remain dark red, indicating its ‘extremely poor performance’. In 2017, the Polish government made access to the morning-after pill available only by prescription. Datta said he would be presenting the Atlas’s findings to the Polish parliament this week.

Attitudes toward contraception and access to public health in general differ culturally in Eastern and Western Europe because of shrinking demographics and income inequality, said Rositsa Kratunkova of Médicins du Monde in Bulgaria.

Out of 46 countries, 11 were downgraded, according to Datta. Armenia, Türkiye and Ukraine dropped a few points because non-governmental websites with information about access to contraceptives disappeared.

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In addition to financial and economic barriers, access to contraception can be undermined due to the spread of prejudice and misinformation.

“From my point of view as a clinician, I think fighting misinformation and lies is our utmost goal,” said Jan Greguš, a gynaecologist at the Czech Republic’s Centre of Outpatient Gynecology.

The report also found 41 countries (89%) covered counselling within their national health systems. Only 14 countries in Europe (30%) cover contraceptives in their national health systems for people above the age of 25, and 19 countries (41%) provide good or exceptional governmental websites.

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