The postcode lottery of publicly-funded assisted reproduction in Spain

Many autonomous communities are not providing the bare minimum of provision in Spain’s health service and are using stripped back services, age limits and imposing fees in order to avoid providing the service.

The postcode lottery of publicly-funded assisted reproduction in Spain_62cca37c15e88.jpeg
The postcode lottery of publicly-funded assisted reproduction in Spain_62cca37c15e88.jpeg

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The postcode lottery of publicly-funded assisted reproduction in Spain

Many autonomous communities are not providing the bare minimum of provision in Spain’s health service and are using stripped back services, age limits and imposing fees in order to avoid providing the service.

For women like Izaskun Gamen, the decision taken only a week ago to include single women, same-sex couples and trans people capable of pregnancy among those eligible for publicly-funded assisted reproduction “is very welcome because it’s been a long time coming”. Although she is pleased for those who will receive treatment in the future, she cannot help but look back and remember that, for years, she was unable to access in vitro fertilization on account of her single status.

In 2014, the Partido Popular government excluded single women from assisted reproduction services on the national health service. Little by little, however, most autonomous communities modified their laws to offer them treatment. Almost all were offering it to single women. But there were a few exceptions: Ceuta and Melilla did not have the appropriate services available, while Navarra offered single women the option of artificial insemination (cheaper yet less effective than in vitro). It was in vitro that Izaskun Gamen needed. The activist, a member of Madres Solteras por Eleccion (MSPE, Single Mothers by Choice), lives in Navarra. For years, she fought against this discrimination. “The injustice of ‘yes to them, no to others’ hurt me deeply. It made me depressed”, she says. It provided a further injustice to women suffering from illnesses such as endometriosis , which greatly limits the possibility of pregnancy without in vitro fertilisation, as described in the case brought to the ombudsman in Navarre in 2019. 

The measure has now been approved, but was announced in 2018 and it never came to pass. “It’s now possible, but no one remembers the bad times” she laments. That is because, as she turns forty in January (the age limit for publicly accessing in vitro fertilization), the decision has been made too late. Along the way, she wasted €20,000 made from second jobs in three years of attempts through private healthcare, on top of numerous attempts at artificial insemination, an inadequate technique – though the only one she could access through the state.

Now she finds herself in Valencia, far from Tudela, where she lives, giving it one last go at becoming a mother. She laments the fact that the government only found out about their organisation – which had been campaigning for years – through the press. She also points out that another form of discrimination that was present in the previous law has not been changed: public healthcare does not cover in vitro fertilisation for mothers or couples who already have a healthy child. This means that a single woman who has had a child with a previous partner cannot access this treatment, but can if she attempts treatment with a new partner. 

With its latest decision, the Government has levelled the playing field for women’s access to publicly-funded in vitro fertilisation. As there is only a law of minimum provision across the country, though, some autonomous communities implement it restrictively, imposing age limits, a maximum number of attempts, and restrictions on the physical state that a woman must be in in order to receive treatment.