Aser Garcia Rada: Ideological limits to public assisted reproduction in Spain

Aser Garcia Rada Since the conservative government of Mariano Rajoy´s People´s Party (PP) took office with an absolute majority on November 2011, healthcare has repeatedly been the setting for implementing ideological decisions that often contradict scientific evidence, social reality, or both.

With the PP collapsing in the polls due to its cooperation with the austericide imposed by the international authorities and the daily news on the  several corruption scandals affecting his party or other national institutions, this trend to cover the relevant issues affecting the PP or the government with measures that are more ideological than technical may probably continue till the end of  Rajoy’s mandate.

The first of those moves was the exclusion of undocumented migrants from public healthcare, a measure whose opportunism and lack of evidence was discussed  in a previous blog. The next ongoing polemic has been the debate initiated months ago by the ministry of justice – not the ministry of health – to change legislation on abortion, passed by the previous socialist government in 2010 and working perfectly well to date, back to a similar one from 1985, when abortion was still a crime and only legal in specific circumstances.

The latest one, in one of the first countries that accepted and legalized gay marriage, has been the exclusion of lesbians and single women from public funded fertility treatments. The decision was taken on July 23 in the periodic meeting between the national and regional health authorities, most of them also conservative. Though the first draft, that stated that funded therapies would be only available to couples “formed by a man and a woman,” was finally modified, the final legislation limits them to sterile people. Current legislation dating from 2006 allowed access to people with sterility but also in cases of an ambiguous “clinical established indication.” In practice this enabled some hospitals in certain regions to offer care to lesbians or single mothers.

According to the government, sterility is understood to mean after one year of unsuccessful sexual relations without contraception. I cannot imagine how this can be proven.  Some lesbians stated they may fulfil that criterion. In one of her few interventions, Ana Mato, from the Ministry of Health, Social Services and Equality – has said now that “the lack of a male [partner] is not a medical issue”, a revealing statement that will be long remembered in the annals of healthcare.

On the one hand, the budgetary saving may be small. According to the Spanish Society of Fertility (Sociedad Española de Fertilidad), only 10.000 assisted reproduction interventions were performed last year by the public sector, as  80% of therapies are performed in private clinics. Lesbians and single mothers demanding them are usually not infertile, so they seldom need more than the cheapest intervention – artificial insemination with donor sperm, which costs around 1000 euros. However, if austerity is compulsory, why not invite lesbians or single women to find a male partner, as some doctors have already done, or invite infertile couples to find a fertile partner. This will obviously solve their issue at quite a low cost.

On the other hand and most importantly, this decision is discriminatory.  A ruling by the Superior Court of Justice in the autonomous community of Asturias based on discrimination arguments, states that the regional socialist government has to pay back money spent by Silvia García, a lesbian, on fertilization therapies after she was denied treatment in her public center. García told a national radio station that when first visiting her doctor with her partner, he asked them if they were lesbians in line with regional health department policy.  He then told them he could not assist them. “The most important thing is that [the ruling] acknowledges my right,” she has said.

Opposition parties and civil groups have also denounced the new regulation for going against the Constitution, which states in section 14 that no citizen can be discriminated for, among others, reasons of gender, or any personal or social condition or circumstance. “It is a discrimination against all other models of families different from the heterosexual one,” said Mariluz Vázquez, spokesperson from the association of Single Mothers by Choice.

But apart of neglecting section 14, with these and other actions taken under the umbrella of austerity, Rajoy is being systematically negligent with the more relevant section 9.2. This  one states that “it is the responsibility of the public authorities to promote conditions ensuring that freedom and equality of individuals and of the groups to which they belong are real and effective, to remove the obstacles preventing or hindering their full enjoyment, and to facilitate the participation of all citizens in political, economic, cultural and social life.”

This is just the opposite of what they are doing.

Aser García Rada is a paediatrician at the Hospital Infantil Universitario Niño Jesús in Madrid, Spain, and a freelance journalist.