Access to abortion in Spain still depends on the postal code.

BarcelonaIn 2024, 106,172 voluntary terminations of pregnancy were reported to the State, a figure that represents a 3% increase compared to the previous year and a record in the history of this benefit, which this year celebrates forty years. In these four decades, there have been attempts to reduce the criteria, and in the 2011 PP reform, abortions for young people between the ages of sixteen and eighteen were conditioned by parental authorization. However, in 2023, the Spanish government of Pedro Sánchez passed a modification in which returned autonomy to minors Furthermore, it eliminated the imposed three days of reflection before abortion, which met the long-standing demand of feminists who criticized the measure for infantilizing women. However, none of the amendments have managed to end the territorial inequalities in access to abortion, a right guaranteed in the health services portfolio, nor the dependence on the private sector. Some regional governments also refuse to open the mandatory registry of objecting doctors, which is useful for planning teams and ensuring that no center is neglected due to a lack of professionals.

The latest abortion report prepared by the Ministry of Health shows that the availability of voluntary abortion depends on a woman's postal code of residence because, as Sílvia Aldavert of the Observatory of Sexual and Reproductive Rights points out, "there is a single state law, but each community has its own." Across the country, only one in five abortions (21%) were performed in a public center, although the regulation promoted by Minister Irene Montero two years ago requires this service to be guaranteed within the national health system.

Andalusia and Madrid, the large privatized territories

Between Catalonia, Andalusia, and Madrid, they account for more than half of the reported abortions. Andalusia, with 0.2%, and Madrid, with 0.47%, are the regions with the lowest average number of procedures in public centers, as almost all are performed in the private or state-subsidized sector. In the latter case, this means that women do not pay for the service and the corresponding regional government bears the costs, as is the case in Spain. Even worse, but with a lower proportion in the national total, are Extremadura and Ceuta and Melilla, where none of the abortions were performed in the public system.

In Catalonia, where the most abortions were performed, 55% of the procedures were performed in public centers, mainly thanks to the ASSIR (Sexual and Reproductive Health Care Centers) integrated into primary care. But in the remaining 45%, not all women covered the costs: two-thirds were referred to clinics authorized by the Department of Health and only a third went to a completely private center.

Cantabria (88%), Galicia (77%), La Rioja (76%) and Navarra (75%) lead the integration of abortions within the public health system, partly because they perform more medical abortions, a method less rejected by doctors and gynecologists5 than in Catalonia. Aldavert, who has promoted the Spanish version of the initiative Vullavortar.org, shares with the Minister of Health, Mónica García, the complaint about the limited options women find at her center to "choose" between pills and surgery based on their personal circumstances.

In the presentation of the report, Minister García warned that it is necessary to "avoid the double privatization of voluntary abortions" and to eliminate the practice of this right from the private and intimate sphere. She also pointed out the healthcare dysfunction that occurs in these communities with a high private presence: four out of five women receive information related to how the abortion will be performed in public centers, but end up in a private center. Only in Aragon and Asturias is the information now provided through the private network.

No registration

Two years after the latest reform came into effect, the registers of professionals who object to abortion remain blocked in four regions governed by the People's Party (PP), in some cases with the support of the far right. These are Aragon, Asturias, the Balearic Islands, and the Community of Madrid. Specifically, in the latter region, President Isabel Díaz Ayuso insisted on her refusal to open the register, which she described as a "blacklist" to distinguish professionals between those who want to perform abortions and those who refuse. "Go get an abortion somewhere else.", launched by the Popular Party leader in a speech in the regional parliament, addressing the left-wing opposition when they reproached her for not having implemented it yet. Specifically, activist Aldavert questions the fact that, given the "breach of the law" that the Madrid Popular Party is boasting about, there has been no strong "reaction" from the Spanish government to call for order and enforce the law.

The rebellion over registration, the failed initiative to make feel the fetal heartbeat or the proposal also breaks the false posture syndrome of José Luis Martínez Almeida's PP are part of "the same" ultraconservative and fundamentalist strategy to "take over the abortion law" and women's sexual rights, just as it is replicated in other Western countries and from there exported to Latin America and Africa, Aldavert indicates.