Contraception in Europe: disparities in access to the pill. Italy between delays and criticalities

The contraceptive pill is the second most used method, particularly in the 20-29 age group. In addition, 39.7% of women stated that they had used emergency contraception at least once. Among adolescent girls, more than 63% regularly request medication for menstrual pain, a figure that demonstrates the need for a more structured approach to female reproductive health.

Access to the morning-after pill is formally guaranteed in pharmacies, without a prescription, for both formulations: levonorgestrel (to be taken within 72 hours) and ulipristal acetate, marketed under the name ellaOne (effective up to 120 hours). However, only some autonomous communities (including Catalonia, the Basque Country and Madrid) guarantee its free distribution in public health centres, while in other regions it remains a cost for women.

The recent report by the Federación de Planificación Familiar SEDRA denounces precisely this inhomogeneity, mapping regional differences in access to contraceptive methods. In particular, it points out that many rural or peripheral areas lack information centres and services for timely contraceptive counselling.

Finally, another major obstacle is misinformation. Many women, for example, do not know that there are two different types of morning-after pill or mistakenly think that it is only effective within 24 hours. The SEC therefore insists on the need to strengthen educational campaigns in schools and through digital channels to ensure not only material but also informed access to contraception.

In Austria, contraception is still regarded as an individual, predominantly female responsibility and the costs are almost entirely borne by the users. According to the report published by the Ministry of Health in June 2024, every second woman pays for her own contraceptive method out of her own pocket; only one in four shares the costs with her partner.

Prices vary between EUR 30 and EUR 230 per year depending on the method chosen. Austria ranks in the lower rungs of the European Contraception Policy Atlas, both in terms of public coverage and access to effective contraceptive counselling.

Despite this critical picture, there are signs of change: in October 2024, a pilot project was launched in the state of Vorarlberg (western region of the country), which will run until the end of 2026. Some 3,500 women will receive free counselling and contraceptives on demand, with the aim of measuring the impact on choices and well-being.

A study linked to the project has already found that 37% of women would use different methods if they were free - a sign that cost is still a major obstacle to sexual self-determination.

Romania represents one of the most problematic scenarios in Europe in terms of access to contraceptive methods. To date, no type of contraception is covered by the national health system. Neither the contraceptive pill, nor the morning-after pill, nor IUDs or other devices are reimbursed or distributed free of charge by the state.

Romanian women therefore have to bear all the costs alone, and often face cultural and informational barriers as well. Sex education in schools is almost absent, and family planning centres - a legacy of a more progressive past in the 1990s - have been progressively dismantled or underfunded.

Feminist organisations and NGOs active in the field of reproductive health have been denouncing this situation for years, which contributes to high rates of unwanted pregnancies and abortions among teenage girls. In the absence of clear political will, however, no structural reforms seem to be on the horizon.

Romania thus remains an emblematic case of European backwardness, where the right to contraception is in fact an economic privilege.

In the United Kingdom, contraception has historically been accessible thanks to the National Health Service (NHS), which provides all major contraceptive methods free of charge through advice centres and GPs.

But the real news came in March 2025, with the announcement that the morning-after pill will be free in all pharmacies in the country. Currently, emergency contraception is only available in some counselling centres or for a fee in pharmacies (between £10 and £30).

This measure - seen as a 'revolution for equitable access to reproductive health' - aims to remove one of the last economic and logistical barriers for British women. According to NHS data, one in three women between the ages of 16 and 30 has used the morning-after pill at least once, but many avoid doing so for economic reasons or stigmatisation.

Sex education in the UK is also compulsory and well structured, with up-to-date programmes including contraception, consent and prevention of sexually transmitted infections. However, territorial and cultural inequalities remain - for example in Northern Ireland, where some prescriptions remain more restrictive.

The 2025 reform therefore aims not only to improve access, but also to normalise emergency contraception as an essential element of public health.

* This article is part of the European collaborative journalism project "Pulse".