In Macedonia, only 14% of women that are in relationship or married use contraception, which is guaranteed to protect them against unintended pregnancy,
and the Government has been consistently promising ever since 2017 to expand the Positive List of Medicines with at least one modern contraceptive.
26 September 2022 – In our country, only 14% of women aged between 15 and 49 that are either in relationship or married use modern contraceptives, and the most widely used contraceptive method is the “pull out” method (ending the unprotected sexual intercourse before ejaculation). In the period between 2011 and 2018, the use of modern contraceptives in our country, including oral contraceptives and IUD, dropped: in 2018, male condoms were used by only 10% of the couples. These were just a fragment of the alarming finds presented at today’s national conference “Contraceptives on the Positive List! Why aren’t we ready yet?”, organised by HERA – Health Education and Research Association.
In stark contrast to this reality, which poses a direct threat to the reproductive freedoms of all citizens, remains the fact that, despite the Government’s promise of 2017, not a single contraceptive method has become available yet under the coverage scheme of the Health Insurance Fund. Even though in 2020 the Law on Health Insurance was amended towards facilitating the revision of the Positive List of Medicines, the Government of the Republic of North Macedonia and the Ministry of Health have not yet formed the required Commission, nor have they adopted the Rulebook on the Positive List of Medicines. As a consequence from this, the citizens of Macedonia pay 42% of the total cost of medicines and 100% of the total costs of modern contraceptive methods available in the country.
“Despite this information, the budgets and the programmes through which the Government provides oral contraceptives, IUDs and condoms, and this only for an exceptionally limited number of women from the socially vulnerable categories and women having repeat abortions, keep shrinking. For example, from 150 women in 2018, the number of women who have received free contraceptives has dropped to only 50 in 2020 and 2021, and even this was only available in health facilities at the secondary and tertiary level”, was pointed out by Dragana Karovska-Čemerska, HERA’s Programme Manager.
According to Prof. Dr. Ana Daneva-Markova, President of the Safe Motherhood Committee, many research conducted worldwide have confirmed that the access to modern contraceptives can reduce the maternal mortality rate by 25%, and that of newborns by 20%. “Certain contraceptive methods can reduce the incidence of HIV and of sexually transmitted infections, and the proper level of information and use of contraceptives can prevent unintended pregnancies”, she added.
Irina Lučeska, MSc, pointed out that Macedonia’s index expressing the family planning needs satisfied with modern methods, as part of the general national “Universal Health Coverage Index”, has scored 25, and across the globe it is only Albania, South Sudan, Somalia and Chad that have worse indices. This devastating fact can be illustrated with the data coming from the Institute for Mothers and Children of the Skopje Health Centre, according to which the number of family planning counselling sessions provided in the primary healthcare system was halved.
“The analysis of the relevant MPs’ perceptions of the availability and use of modern contraceptive methods has shown that decision makers agree that sexual and reproductive health counselling should continue to be provided, including on contraceptive methods”, was pointed out by Dr. Marija Risteska, the Executive Director of CRPM – Centre for Research and Policy Making and author of this analysis. “Decision makers agree that condoms should be free and available to everyone through health facilities, and that contraceptive pills should be listed on the Positive List of Medicines”.
Even though the country took the obligation as long ago as in 2010, in its National Strategy on Sexual and Reproductive Health 2010-2020, to introduce the modern contraceptives on the Positive List of Medicines, we can regrettably conclude that, 12 years later, the Government has failed in improving the access to contraception. Therefore, our Government and all the responsible institutions should as soon as possible proceed with realising the many promises that were made when signing the international documents, and also the tasks they had set for themselves within the national strategies. This includes initiating the process of revising the Positive List of Medicines towards expanding it with at least one modern contraceptive method, which will improve the universal health coverage, especially for the most vulnerable citizens who have no access to family planning services.