Options for Contraception in Spain

From daily pills to surgical options, family planning and contraception in Spain have been revolutionized over the last two generations. It’s now affordable to choose the contraception method that best works for a couple, thanks to legislation and coverage in both the public and private sectors. Read on for a quick guide to contraception options in Spain.

How does anti-conception work?

At its most basic, an anti-conception method disrupts the natural cycle of reproduction; this could mean regulating hormones associated with conception, or creating a barrier in which the sperm cannot reach an egg.

How much do anti-conception measures cost in Spain?

Since becoming available for sale just 50 years ago, the Spanish healthcare system has begun to subsidize costs for most anti-conception methods. If you are in the public system, you can expect deep discounts for most non-surgical and surgical methods with a written prescription from a GP or gynecologist.

Those with private health insurance may have to spend more because their treatments are not subsidized through social security, though anticonception methods are typically cost-friendly in Spain.

Non-surgical options

El preservativo (condom)

Believe it or not, condoms are the most used contraceptive in Spain (nearly one-third of couples use them) and are available at any drug store, pharmacy or supermarket.

How it works: Condoms are made of a thin layer of latex and work as a barrier – that’s to say, the condom forms a barrier between the sperm and the egg so that healthy sperm won’t get the chance to fertilize an egg.

Benefits and disadvantages: One of the biggest advantages to using condoms over other contraceptive methods is that they also protect against sexually transmitted infections. However, they can be less effective than other methods if used improperly.

Costs: Costs will vary between brands and quantity purchased, but expect to pay between 0,50€ and 3€ per unit.

La píladora (anticonception pill)

One of the most common forms of birth control, la píladora, or the birth control pill, is used by about one-fifth of surveyed women in Spain.

There are two types of pills: those that combine estrogen and progestin, and the “mini-píladora” that contains only progestin. The latter is recommended for women with a history of blood clots or who are breastfeeding.

How it works: The pill, to be taken daily at or around the same time, helps regulate hormones associated with conception and pregnancy. This could mean stopping or reducing ovulation, thickening cervical mucus to prevent sperm from entering the gg or even thinning the uterine lining so that fertilized eggs cannot easily attach. When you stop taking the pill, you can become pregnant more easily, though you may have several cycles in which you do not release viable eggs; your hormone levels may take a few months to return.

Benefits and Disadvantages: There are also health benefits to the pill in women, like lighter menstruation, managing premenstrual symptoms, reducing migraines and even improving acne. Yet some women report side effects related to hormones, such as headaches, irritability, nausea and even spotting between cycles. More serious complications are blood clots and deep vein thrombosis, or even heart attack or stroke.

Cost: Taking the pill is quite cost-effective, as they are subsidized by the government since 2011, and they may be available over the counter. Expect to pay between 3€ if you have a prescription and up to 10€ monthly if you don’t.

El anillo vaginal (vaginal ring)

Though they were a big deal about a decade ago, vaginal rings are not as popular these days. The rings are a small, soft plastic ring that is placed into a vagina, releasing a continuous dose of estrogen and progesterone into the bloodstream.

How it works: Like a pill, ring provides contraceptive protection for a month but releasing hormones into the bloodstream. This prevents eggs from being released as well as thickening cervical mucus and thinning uterine lining.

Benefits and disadvantages: This sort of option is good for women who have trouble remembering to take a pill daily, and users report that they often have less sever menstrual cramps, bleeding and other symptoms. That said, there is more spotting during the first few months, and some medicines can make the ring less effective.

Costs: As of late 2019, the Spanish government subsidizes part of the cost of the vaginal ring; the cost per month is around 30€, though you can pay anywhere from 3€ to 18€ depending on your household income.

El parche (patch)

Though not commonly used in Spain upon their debut in 2003, the hormonal patch is another non-surgical antic-conception method.

How it works: Users wear a patch for three consecutive weeks before shedding it when their menstruation cycle starts. During the 21 days of use, hormones are released through the skin in the same way a pill or vaginal ring would work.

Benefits and disadvantages: Like this ring, this sort of contraceptive does not require the user to have a daily regiment, and it won’t fall off during bathing or swimming. What’s more, it’s been proven to help menstrual cramps, and there’s even evidence that it can protect against ovarian, womb and bowel cancer. That said, the patch is not recommended for smokers over 35, or for those over 90kg. Additionally, you may need to use another contraceptive method, such as a condom, for the first cycle.

Costs: Again, thanks to subventions, you may pay a heavily reduced cost. Packs of three (one month) or nine (three months) are the most typical format, and cost around 30€ per month.

Surgical options

Surgical options for contraceptives are not as common in Spain and typically require an outpatient procedure. In many cases, public healthcare will cover the entire cost; in the private sector, a prescription or doctor’s order can significantly reduce your costs.

La DIU cobre or hormonal (IUD)

IUD devices have become more popular in Spain in the last few years, allowing users to have a small plastic coil inserted into the womb.

How it works: The IUD comes in two forms – hormonal or copper – and is a small, T-shaped device that is inserted directly into the uterus by a doctor or nurse. This prevents pregnancy for three to five or even ten years from the moment it’s put in, and you can have the procedure done at any point in your cycle (but it’s recommendable to do it while menstruating). The hormonal IUD releases hormones, where as the copper one produces spermicide that kills sperm.

Benefits and disadvantages: Apart from its long-term effects against pregnancy, removing the IUD will allow you to get pregnant immediately. That said, women report a high degree of discomfort in the first few days after insertion, and longer effects included heavier and more painful menstrual cycles. IUDs are also a safe contraceptive measure while you’re breastfeeding.

Costs: Both IUD forms are covered by Spanish social security. If you don’t have Spanish social security, you can expect to pay up to 200€ for the device, and removal is an additional 50€.

La vasectomía (vasectomy)

A vasectomy is a major surgical undertaking and is practically permanent, and it is one of the options available to men.

How it works: A vasectomy effectively stops sperm from getting into a man’s semen by sealing or cutting the vas deferens tubes that carry sperm to the semen. Thus, ejaculation does not contain any sperm, preventing eggs from becoming fertilized. In most cases, it is outpatient surgery that has a speedy recovery time.

Benefits and disadvantages: As vasectomies are highly effective, this is an option for men who are sure they do not want any children or to have children in the first place. Additionally, your sex drive will not wane and complications are rare. That said, you will need to use other contraceptive measures for 8-12 weeks after the surgery, as there are still sperm in your tubes that must be ejaculated.

Costs: A vasectomy is covered by Spanish public health, though you may be asked to undergo counseling prior to the procedure.

La ligadura de trompas (female sterlization)

Like a vasectomy, getting one’s tubes tied is an effective yet surgical way to ensure that eggs are not released during a menstrual cycle. It does not, however, protect against STIs.

How it works: During surgery, your fallopian tubes will be blocked by applying a device like clips or tying and cutting. This is a straightforward procedure that is typically performed as outpatient surgery.

Benefits and disadvantages: Hormone levels will not be affected by sterilization, and a woman will continue to have periods. However, as it is surgical, there is a risk of failure, post-op complications or even a higher risk of an ectopic pregnancy if the surgery is not successful. What’s more, tubes can rejoin on their own.

Costs: This procedure is covered by Spanish public health, and can even be performed shortly after childbirth if a woman wishes.

El implante subcutáneo (contraceptive implant)

The implants are another surgical method, though it is one of the least popular options for contraceptives in Spain.

How it works: A small plastic rod is inserted into your upper arm just under the skin; it is effective for three years and considered highly effective for preventing pregnancy (99%). Like other methods, the implant releases progestogen into your bloodstream.

Benefits and disadvantages: The biggest benefit is, no doubt, the lack of estrogen in this method. Additionally, you can have the device put in at any time in your cycle, and your natural fertility will return quite quickly when removed. It’s also safe for breastfeeding and can be put in practically immediately after childbirth. A major drawback is that you will likely stop menstruating all together, or have heavier and more irregular periods.

Costs: The implant is 60€ after government subsidies (150€ without a prescription), and it lasts for three years (data from mid 2019).

Which contraception in Spain is best for me?

Anti-conception methods can be up to 99% effective at preventing pregnancy; the only form that is more fool proof is abstaining from intercourse. You should speak to your gynecologist before undergoing any treatment to determine the best course of action, and you should track any side effects during the first few cycles. If you can, take an appointment and get a prescription, as it will always be cheaper.

Family planning in Spain: public versus private

Spain’s top-notch healthcare system allows for continued support for expectant families, beginning with family planning. Your first move should be to speak to a gynecologist, who can help your body prepare by suggesting you remove an IUD or stop taking anti-conception pills; you should ask your doctor about how long it may take to become pregnant and consider getting a general health checkup, as well as inquiring about family history. There is no magic formula to getting pregnant but tracking your pH levels or your menstrual cycle can give you a better idea of when you’re the most fertile. Doctors will suggest an antenatal pill to be sure you’re getting the right nutrients into your body, as well as prescribe folic acid, which aids in healthy spinal cord formation.

It’s worth mentioning the differences between public and private healthcare with regards to family planning: if you’re part of Spain’s public scheme, you will be able to see your GP to ask to be referred to both a midwife and a gynecologist. The gynecologist will confirm your viable pregnancy – typically around five or six weeks - and explain the process for genetic and blood testing, your three scheduled scans and childbirth, as well as sign you up for prepartum classes.

If you choose to go through the private system, you can go straight to a gynecologist and schedule more scans. The antenatal classes are often an additional fee, and you may or may not have all your scans or tests included, depending on your level of coverage. That said, most private insurers require a wait time of between six months and one year before you can use the services related to pregnancy, fertility, childbirth and postpartum care.

Families planning ahead can add-on special services related to pregnancy and childbirth, such as fertility diagnosis, genetic testing, prepartum classes and even post-natal home visits, to private their healthcare plan. Caser offers several coverage options, providing a flexible way for families to choose the perks that best suit their needs.

Ultimately, deciding when and how to start a family – or not – is an individual choice for partners, and it’s often a decision that carries a lot of weight. Thanks to options and affordability, Spain is a country in which you have freedom to choose what works the best for you.