Madrid

Spain / Central Spain / Madrid

OVERVIEW

In Spain, contraception is legal and widely available, though a prescription is technically required. Emergency contraception, or the morning after pill, is available without a prescription and there are no age restrictions. You can find ellaOne in Spain, which is the longest lasting EC on the market. There are many clinics that offer accessible and potentially free STD/STI tests, and there are no known restrictions attached to HIV status. It is unclear if PrEP or PEP is widely available. Since 2010, abortion has been fully legal, with no restrictions or third party approval, in the first trimester of pregnancy. However, after the first trimester, abortion is only legal under specific circumstances.

In Spain, you can high-quality health care in both the public and private spheres. Private hospitals are more efficient (i.e. shorter queue) and they typically provide options regarding treatment and physicians. Yet public hospitals are generally good, as well, and provide adequate services for a number of treatments. In many cases, private hospitals even refer patients to public hospitals that may have better equipment or facilities. If you live in Barcelona, and if you are uninsured, you may want to consider purchasing an insurance plan. Check out our "Additional Resources" section for some insurance plans.

Contraception (Birth Control)

General Note: There are many types of contraceptives, also known as "birth control," including IUDs, oral contraceptives, patches, shots, and condoms, etc. If you would like to view a full list, click here.

Laws & Social Stigmas

Contraception is legal and widely available in Spain. If you would like to buy condoms, they can be found at most supermarkets and pharmacies, and there are even condom-dispensing machines in Spanish cities. However, if you would like hormonal birth control, a prescription is required. You will need to visit a doctor who will conduct a basic assessment and then issue the birth control prescription. Note that, while you legally need a prescription for birth control pills, it appears that some pharmacies may sell them over-the-counter without a prescription. Spanish pharmacies also tend to be rather liberal in dispensing hormonal birth control if you they know you have any prescription, past or present (including a foreign one), if you have a strong rapport with the pharmacist or if you bring an empty box of the birth control that you are seeking out.

What to Get & Where to Get It

If you're looking for hormonal birth control pills, you may come across brands like Dianette, Diane 35, etc. You should also be able to find contraceptive rings (like Nuvaring) at pharmacies. As for pharmacies, you'll be able to find them on almost every corner in Barcelona. But one recommendation for foreigners is Farmacia Central, as they speak English, French, German and Arabic. Address: C/Via Laietana, 40 - 08003 Barcelona - Spain - Tel. +34 932 68 45 54 - barcelonapharmacy@gmail.com.

Costs

For a month's supply of birth control pills, you can expect to pay 2.5-5 euro for a box.

Emergency Contraception (Morning After Pill)

Important Notes: Emergency contraception may prevent pregnancy for three days (72 hours) and sometimes five days (120 hours) after unprotected sex. Take EC as soon as possible after unprotected sex. If you don't have access to dedicated EC, oral contraceptives can be used as replacement EC, but remember the following: 1) Only some contraceptives work as EC 2) Different contraceptives require different dosages and time schedules to work as EC 3) You must only use the first 21 pills in 28-day packs and 4) They may be less effective than dedicated EC. For general information on emergency contraceptives, click here and here.

Laws & Social Stigmas

The morning after pill ("píldora del día después" in Spanish) is available without a prescription. There are no age restrictions. However, if you want to take ellaOne (see details below), you have needed a prescription, though it appears that ellaOne is now available in the EU without a prescription. According to one study, about 50% of women in Barcelona who purchase EC at pharmacies are between the ages of 15-20.

What to Get & Where to Get It

Note: The longest-lasting EC is currently ellaOne. It lasts up to 5 days (120 hours) after unprotected sex.. If your country doesn't carry ellaOne, copper IUDs may also prevent pregnancy up to 5 days after unprotected sex. If none of these options are available, and it's been over 3 days since you had unprotected sex, you can still take EC, which may work up to 5 days. Note that EC pills are not 100% effective and should be taken as soon as possible.

For dedicated anti-progestin, you can take ellaOne (take 1 pill within 120 hours after unprotected sex), but you may need a prescription. If you would like more information ellaOne, here's the website for Spain. For all other morning after pills, you don't need a prescription. If you are looking for dedicated, progestin-only EC, you can take NorLevo 1.5mg or Postinor 1500 (take 1 pill within 120 hours after unprotected sex). There's also Postinor (take 2 pills within 120 hours after unprotected sex). If you cannot access dedicated EC, you can use some hormonal birth control pills as EC. To do this, you can use Neogynona or Ovoplex (take 2 pills within 120 hours after unprotected sex and take 2 more pills 12 hours later). There's also Microgynon, Ovoplex 3 and Ovoplex 30/50 (take 4 pills within 120 hours after unprotected sex and take 4 more pills 12 hours later).

Costs

LNG: € 19, as of 2013; UPA: € 32, as of 2013. You can supposedly get EC pills for free at some ER and health centers.

Sexually Transmitted Infections (STIs/STDs)

Important Notes - Learn about PEP and PrEP: If you think that you've been recently exposed to HIV (i.e. within 72 hours), seek out PEP (Post-Exposure Prophylaxis). It's a month-long treatment to prevent HIV infection after exposure, and it may be available in your city. Take PEP as soon as possible. For more information, click here. If you are at risk of HIV exposure, seek out PrEP (Pre-Exposure Prophylaxis). It's a daily oral pill that can prevent HIV infection before exposure. To learn more about PrEP, click here.

What to Get & Where to Get It

To say STD in Spanish, say "Enfermedades de transmisión sexual."

Support

Regarding HIV treatment, check out this link for hospitals that specialize in HIV treatment in Madrid. According to HIVTravel: "Treatment is provided exclusively through the pharmaceutical services in hospitals. Care is provided by large hospitals through the specific service called "Unidad de enfermedades infecciosas" (infectious diseases unit); in smaller hospitals by the internal medicine service. Access to Spanish healthcare system is universal and free of charge for all citizens. Foreigners are also entitled to healthcare under the same conditions as any other citizen. All residents must be registered in the City council (municipality) irrespective of their migratory status in the country. This is a quick and easy process which can be done at no cost."

Regarding hepatitis treatment, Spain has one of the highest rates of hepatitis treatment in the world.

• UNAPRO (Unión para la ayuda y protección de los afectados por el SIDA): "Offers legal assistance, an HIV/AIDS information hotline, support groups, home and hospital accompaniment, social work, psychological care, temporary emergency housing, technical training for volunteers, education and prevention, a library of newspapers, books and movies, massages, food distribution and medicine for HIV-positive people in Santa Cruz de Tenerife."
• VIH y SIDA: "Online information on HIV/AIDS: the viruses, detection, help for HIV-positive people, prevention, statistics, HIV-positive people's rights, clinical demonstrations and treatment."

Medications & Vaccines

What to Get & Where to Get It

If you have a yeast infection, ask a pharmacist for a local version of Fluconazole. If you have a urinary tract infection, you can say that you have a "infección en las vías urinarias."

Menstruation

Note: In addition to pads and tampons, you can also use menstrual cups and menstrual underwear for your period. To learn more about menstrual cups, click here. To learn more about menstrual underwear, click here.

What to Get & Where to Get It

You'll be able to find pads and tampons (with or without applicator) in supermarkets. As for menstrual cups, there is one registered seller of DivaCup in Spain: Crianza Natural S.L., Tel:, +34936452369, Contact: Rosa Sorribas, info@crianzanatural.com). You can purchase LadyCup through LadyTeen or Copas Menstruales. It's unclear if there are any registered MoonCup sellers.

Gynecological Exams

What to Get & Where to Get It

It's usual to go to a private clinic to get a gynecological exam. You can also go to a public one, but first you will need to get a referral from your family doctor, which takes more time. The most of the private clinics have a gynecologist, and if it's not cover in your medical insurance, you can pay in cash. Once in the gynecologist's office, the standard procedure consists in examination, internal sonogram/ultrasound, cytology and blood test.

Abortion

Important Note: There are two main types of abortions: medical (also known as the "abortion pill") and surgical (also known as "in-clinic"). For medical abortions, you take a pill to induce abortion. For surgical abortions, a procedure is performed to induce abortion. For general information about medical and surgical abortions, click here.

Laws & Social Stigmas

Abortion is legal in Spain during the first trimester (14 weeks) of pregnancy, according to Organic Law (2010). However, once the woman reaches the second trimester, it is only available under certain scenarios, which are: to save the life of the woman, to preserve physical health, to preserve mental health, rape or incest, risk of fetal impairment. After 22 weeks of pregnancy, abortion is only allowed in cases of "serious risks to life or health of the mother or fetus." From the twenty-third week of pregnancy, a legal abortion may only be performed if the "fetal anomalies incompatible with life are detected" or "an extremely serious and incurable disease is detected within the fetus at the time of diagnosis and is confirmed by a clinical committee."

From 1800-1985, abortion was practically illegal in Spain. Beginning in 1983 and continuing into 1985, Spain began introducing laws that liberalized abortion restrictions. Under these new laws, women could receive abortions under special circumstances, including endangerment to life of woman, endangerment to the fetus, or cases of rape or incest. It also specified the criteria under which abortion clinics must operate, including number of staff and the creation of a commission that oversaw all clinics. In 1986, it was ruled that all voluntary abortions must be reported to the national health authorities by the Ministry of Health of each Autonomous Community, which was done after receiving proper paperwork from relevant physicians. Furthermore, all hospitals and clinics that performed abortions, as stipulated in 1986, must keep confidential records of these abortions, including forms authorizing the woman's consent.

In 1991, the Spanish Supreme Court first sanctioned abortion on social grounds after throwing out a case against a married couple who had sought out and received an abortion. However, at that time, the court's decision did not change the laws. Here's an article about abortion in Barcelona in the early 2000s, before additional restrictions were lifted.

In 2010, the Organic Law 2/2010 was passed in Spain. This law aligned Spain with the sexual and reproductive rights established by the World Health Organization (WHO). Under these changes, a woman is free to receive abortion during her first 14 weeks of pregnancy, and no third party involvement is required. After the first trimester, she may receive an abortion under special circumstances (see first paragraph of this section for details). In 2013, Spanish lawmakers challenged abortion law when the cabinet approved a draft law that prohibited abortion, except in cases of rape. This was struck down in September 2014 due to lack of government consensus.

Today, both medical and surgical abortion are available in Spain. However, statistics point to surgical abortion being much more popular with only 4% of induced abortions being done medically (i.e. with pills or medications).

List of Additional Resources

• Health Care Information for Expats in Spain
• Allianz Spain: "Allianz Seguros offers a wide range of financial and insurance products throughout its agent/broker network. Allianz Seguros is also present in the direct channel through its subsidiary Fenix Directo (specializing in direct insurance)." Address: Paseo de la Castellana 95, Planta 14, Edificio Torre Europa, 28046 Madrid, Spain, Tel: +34.91.4177767, Fax +34.91.4177999.