But will the birth control pill be free? No, yes, no
The decision to make the contraceptive pill free has been postponed. Here are reasons, numbers, comments and false myths, and how it works in the Italian regions where it is already a reality
It seemed like a done deal and instead the story of the free contraceptive pill will still go on for a long time. Yesterday, in fact, the board of directors of the Italian Medicines Agency (Aifa) chose not to pronounce itself, requesting further insights because "there are no elements to decide".
The news comes after the Aifa Price and Reimbursement Committee (CPR) last April 21 said it was in favor of free contraception – for women of all age groups – estimating a cost of around 140 million euros per year for the state.
WHY DID AIFA CHANGE MY MIND?
As reported by Aifa, the Board "acknowledged that the Agency's advisory commissions have not yet elaborated precise indications on the age groups to which the contraceptive pill can be granted free of charge, on the methods of distribution and on the costs for the National Health System in the various scenarios for the adoption of reimbursement”.
"For example – explains the press release – for all women of childbearing age, for women who are in financially disadvantaged conditions or for young women up to 19/26 years of age as happens in some European countries and in the six Italian regions that offer free birth control pill".
With these reasons, AIFA lets it be known that "the Board has therefore noted that the essential elements for deliberation do not exist" but is "ready to play its role and to fully express its opinion as soon as it has the adequate preliminary investigation request to the Advisory Commissions".
Finally, it is specified that as soon as the Board has the indications requested from the Commissions, "a consultation table will be set up with the supervisory Ministries and the Conference of the Regions".
THE ITALIAN REGIONS WHERE THE PILL IS FREE
The Italian regions, to which AIFA refers and where the contraceptive pill is distributed free of charge, are – with some differences – Puglia, Emilia-Romagna, Piedmont, Tuscany and Lazio, while the autonomous province of Trento is working on it with a proposal motion to the junta, advanced by Pd and Futura, to make hormonal, barrier, emergency contraceptives and the clinical services necessary for their use free of charge, as well as the systems for the prevention of sexually transmitted infections for people within the age of 25.
THE PUGLIA MODEL
With a resolution of 2008, Puglia was the first Italian region to give the possibility of free access to hormonal contraceptives based on income.
On the website of the ASL of Bari we read that the low-dose pills, the transdermal patch and the vaginal ring are distributed in all Family Consulting Centers in Bari and the province, according to the choice and prescription of the Consulting Gynecologist, to women belonging to families already exempt from pharmaceutical expenditure according to income.
Regardless of income, on the other hand, immigrant women without a residence permit in possession of the Stp code (Temporarily Present Foreigner) can access it; new EU women with or without Eni code (Unregistered European); women up to the age of 24; women who have already undergone a voluntary termination of pregnancy (IVG) and postpartum women who are breastfeeding.
As explained by the ASL, this facilitation is aimed at "reducing the use of voluntary abortion, and is based on the annual reports of the ISS to Parliament, in which it is demonstrated that one of the main determinants for the reduction of IVG is the use of methods rest assured of responsible procreation”.
THE EMILIA-ROMAGNA MODEL
In Emilia-Romagna, from 1 January 2018 , women and men under 26 and women aged between 26 and 45 with exemption from unemployment or affected workers can receive free contraception and advice from the doctor or midwife from the crisis or who are facing post-abortion within 24 months of the intervention and postpartum women, within the 12 months following the birth.
THE PIEDMONT MODEL
In Piedmont, the resolution of the Regional Council of 3 July 2018 provides for the free distribution of hormonal contraceptives (oral, transdermal and vaginally), subcutaneous implants, intrauterine devices, male or female condoms and emergency contraception at health clinics women up to 26 years of age, for unemployed women between 26 and 45 years of age, for female workers affected by crises or who are facing post-abortion within 24 months of the operation and postpartum women, over the 12 months after delivery.
THE TUSCANY MODEL
In the Tuscany region, the oestrogen-progestogen and progestogen pills – but also the transdermal patch, the vaginal ring, intrauterine devices with and without hormones (coils), subcutaneous devices and condoms – have been free, since 2018 , in counseling clinics when requesting first time. For subsequent times you will receive further instructions.
Young people aged between 14 and 25, adults aged between 26 and 45 with exemption code: E02 and E90 are eligible for access, unemployed and with dependent family members; E91 in layoffs or in a defensive solidarity contract with dependent family members; E92 mobile workers and dependent family members registered in the mobility lists; E93 asylum seekers; X01 foreigners not belonging to the European Union with Stp card without sufficient economic resources to share the health care costs; and, finally, Uk22, i.e. people from Ukraine who have arrived in Italy since 24 February.
Furthermore, the service can also be used by women between 26 and 45 years of age within 12 months of giving birth or within 24 months of an abortion, and students enrolled at the universities of Florence, Pisa, Siena and at the University for Foreigners of Siena, up to the age of 25 and in possession of the single university student card.
Those who do not fall into the categories indicated above, by contacting the Consultorio, can in any case have free counseling, a gynecological visit, the prescription of contraceptives and the insertion of intrauterine or subcutaneous devices, which will be available at a discounted rate.
THE LAZIO MODEL
Last in chronological order is the Lazio region, which last February approved the resolution that fully implements the free administration of hormonal contraception in family counseling centers for adolescents and young women between 14 and 21 years of age.
Lazio was also among the first regions in Italy to adopt a protocol on the free distribution of the RU48 abortion pill in counseling centers and at home.
The cost of the operation was 10 million euros.
A POLITICAL ISSUE
“All of this – declared in January Laura Anelli, gynecologist, head of the network of consultants of the ASL Roma 1 and member of the regional technical table on contraception – takes place while at AIFA, the decision on the reimbursement of oral contraceptives has stalled. Officially due to a problem of financial coverage (in 2021 the expenditure on the pill was 272 million in Italy), but in reality due to the political resistance implemented in the Commission on prices and reimbursements by the representatives of the regions led by the centre-right. The decision has been postponed, but it is not possible to know when, since the leaders of AIFA will soon be revolutionized ”.
And effectively it cannot be denied that it is not a political question, as well as an economic one. From the Senator of the Brothers of Italy, Lavinia Mennuni, who recalled that the government's priority "is that every available resource of the State be specifically designed to promote the birth rate and support the family" to thePro Vita & Famiglia and Moige-Movimento Italiano associations parents, who consider the possibility of making the contraceptive pill "serious and dangerous" and a "discrimination for those who have children".
DATA ON CONTRACEPTION IN ITALY
According to what was stated by the Piedmont Regional Council , in Italy only 59.3% of couples use methods of contraception. "Weighing – we read – is above all the lack of information on possible contraceptive choices, the almost total absence of educational programs on the subject which limits access to contraception and its conscious use, while the use of contraception is increasing emergency which already in 2018 led 548,684 women to use them".
It is no coincidence that Italy, as revealed by the latest European Atlas of Contraception drawn up by the European Parliamentary Forum for Sexual & Reproductive Rights (Epf), ranks only 22nd in Europe for access to and information on this issue.
And according to Sole24Ore , "out of 1,438 clinics in Italy that carry out activities on the subject of contraception (out of a total of 1,800 clinics in our country), 510 (equal to 35.5%) are those that offer contraceptives free of charge".
BUT IS IT TRUE THAT IF THE PILL WERE FREE THEY WOULD HAVE LESS CHILDREN?
Finally, if on the one hand the detractors of the cause claim that the free pill would lead to fewer children, on the other the supporters cite the example of France, where from 1 January 2022 the age was raised from 18 to 25. within which the State bears all the costs of contraception for women.
Indeed, as Rings recalled: "In France the pill is free and there is a higher birth rate than in Italy". And a lot too. According to Eurostat data , "with 1.86 children per woman, in 2019 France clearly exceeded the EU average of 1.53 and even more than the Italian one, which stands at 1.27". And it is not an exception, but a trend that has been going on since 2012, thanks to political choices and trust.
This is a machine translation from Italian language of a post published on Start Magazine at the URL https://www.startmag.it/sanita/ma-quindi-la-pillola-anticoncezionale-sara-gratuita-no-si-ni/ on Thu, 25 May 2023 09:51:22 +0000.