Proposition 54K3439

Projet de loi modifiant l'arrêté royal du 16 septembre 2013 fixant une intervention spécifique dans le coût des contraceptifs pour les femmes n'ayant pas atteint l'âge de 21 ans afin d'étendre les remboursements prévus pour les contraceptifs et la pilule du lendemain.

General information ¶

Authors

PS | SP Nawal Ben Hamou, André Frédéric, Karine Lalieux, Laurette Onkelinx, Daniel Senesael, Fabienne Winckel

Submission date

Dec. 20, 2018

Official page

Visit

Status

Adopted

Requirement

Simple

Subjects

redemption contraception health policy young person social security woman health insurance

Voting ¶

Voted to adopt

Groen CD&V Vooruit Ecolo LE PS | SP DéFI Open Vld MR PVDA | PTB PP

Voted to reject

N-VA

Abstained from voting

∉ VB

Party dissidents ¶

• Peter Luykx (CD&V) voted to reject.

Contact form ¶

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Discussion ¶

March 28, 2019 | Plenary session (Chamber of representatives)

Full source

I refer to the written report.

Mr. Speaker, dear colleagues, a new important step was taken last March 12 in the Public Health Committee to allow better access to female contraception and to strengthen the right of women to dispose of their bodies. Through the Socialist Bill, we will allow more women to have free access to contraception.

Our struggle is not from yesterday. As early as 2004, Rudy Demotte, then Minister of Health, allowed free contraception for girls under 21 if the doctor prescribed the cheapest contraceptive. Then, a new step was taken when Laurette Onkelinx, also Minister of Health, made sure that those under 21 years of age no longer have to renew the application annually to benefit from the free pill.

On March 12th, a new advance was made in the Health Commission. I would like to thank all my colleagues. We have indeed received the support of all the parties in this Parliament, with the notorious exception of the N-VA, which I regret. I will talk about it in a second. We have achieved that free access to contraception is extended to all women under 25 years of age. I don’t understand how you can be against this. This free access will also cover the morning afternoon pill, which will be extended to all women, regardless of their age.

The objectives pursued by this bill are the same as in 2004: improve access to contraception and emergency contraception, with the aim of reducing the number of unwanted pregnancies and guaranteeing women the right to freely dispose of their bodies.

For the PS group, access to contraception, and therefore the full coverage of health insurance, should be extended to all women. But for budgetary reasons, and because we are reasonable with the state budget, at first we extend the measure only to young women under 25 years old.

Why less than 25 years? There are two important reasons. On the one hand, it is the increase in poverty among young people. The latest Social Integration Barometer shows an increase in the number of young people under the age of 25 depending on social integration income. They and they were “only” 22,675 in January 2016, against more than 43,600 today. In two years, there has been an increase of ⁇ 20,000 young people under the age of 25 who have access to social inclusion income. We know that many of them are women.

On the other hand, although this is not directly related, according to the latest available figures, which unfortunately date back to 2011, it is found that approximately 40% of the 4,000 women aged 20 to 24 who used IVG did not use contraception.

You know how I regret – and there was again a negative vote in the Health Committee yesterday – that this country has still not completely and really decriminalized abortion. We have had long debates on this here. In these long debates, those who did not vote for the total decriminalization of abortion, i.e. the N-VA, the MR, the CD&V, the CDH and the Open Vld, all said that access to contraception and the morning afternoon pill should be strengthened to prevent abortions. I see that the N-VA says yes. I do not understand why he voted against this in the Health Committee.

But here, one does not replace the other. Indeed, we respond with this bill to those who voted against the actual decriminalization of abortion.

How much will it cost, Mrs. Minister? This will cost 6 million euros, according to INAMI figures. That’s a little compared to the 26 billion annual healthcare budget. Admit that 6 million, even for Van Rompuy, is not expensive! This is also very little, Mrs. Minister, in view of the gifts you regularly give to the pharmaceutical industry, since the money left to health care is 600 million euros.

This is also very little considering the significant savings you have made in relation to the healthcare budget: 2 billion euros during this legislature. There is therefore, Mrs. Minister, no reason to curb this bill, which, I recall, was widely voted in the committee.

Unfortunately, there was no reason to submit an amendment, signed by MR, Vld and CD&V, who wanted to condition the implementation of this measure to the adoption of a royal decree. In the meantime, Mrs. Minister, and I am sorry, you said that you would not take this in this legislature. Mr. Reynders does not understand why.

Because, Mr. Reynders, even in ordinary affairs, one can take this kind of royal arrest! Because, Mrs. Minister, you did it, for another policy, which we support. You have unlocked 5 million euros from the healthcare budget to fight obesity. But what you can do for the fight against obesity, you can also do for access to female contraception.

Mr. Minister, I will ask you only one question. Do you plan to take this decision before the end of the legislature?

It’s a stop, it’s done very quickly and you can do it. I ask you to do so, otherwise this vote will not be a reality for women for a long time.

In terms of women’s rights, certain rights believed to have been acquired are always questioned. I think we missed the opportunity for a real decriminalization of abortion in this legislature. For my group, it is obvious that every woman should be able to dispose of her body. It is an inalienable and imprescriptible fundamental right.

We are making a step forward today and I ask the Minister of Health to take this step with us and without waiting.

Mr. Speaker, colleagues, as Ms. Lalieux has already mentioned, the N-VA is against this bill. I will try to explain our attitude, with all the nuances this dossier deserves.

The N-VA considers prevention important, but we also consider the division of powers in this country important. It is clear to us that this bill has been made on the basis of the Wallonian centers for family planning. Please note, I welcome the growing understanding, in Wallonia, that prevention is important and an indispensable part of good health care. It only annoys me a little that, as soon as it comes to prevention, cherrypicking is done. The French Community is usually the worst student in the class when it comes to prevention. Think about vaccinations, including against HPV, but not only against HPV. On the contrary, there is a great zeal for prevention if the account can be transferred to the federal treasury. Repayment of medicines is a federal authority. Therefore, this prevention is diligently carried out in the French-speaking part of the country.

No matter how you turn it or turn it, both contraceptive pills and the morning after pill are medicines. And medicines have side effects. Hormonal preparations are not sweets. For example, there is an increased risk of cluster formation, especially when hormonal preparations are taken in combination with smoking. It is therefore not responsible for us to distribute those resources without medical guidance, without the guidance of a central figure who knows and follows the patient’s dossier, such as a general physician.

Our group also does not believe in a free story. Someone has to pay the bill. Let this bill that account now have just been forgotten. In addition, it annoys me that it is a free story for everyone. Most women in this age group do not need this intervention at all. The budget would be much better spent if only the weakest of society were taken into account.

I am surprised that the former coalition partners have taken part in this. They used a small trick. They submitted an amendment to determine the date of implementation by a royal decree. The law becomes an empty box. Their execution is thus likely to wait until Sint-Juttemis.

The N-VA faction is suitable for a symbolic free story, a month before the elections, as a fun extra and a certain form of clientelism. We will not approve the bill.

We will support this proposal. We are obviously quite in favour of better accessibility of contraception for girls and the morning afternoon pill.

It is true that the cost of contraception and the afternoon pill should in no way be a brake for our young girls. On the other hand, I insisted heavily on the concepts of education and prevention. We find that young girls are not always aware of the different methods of contraception. They do not always apply them in the right way. These are elements that really need to be taken into account. I even pointed out that it might be interesting, in the context of school education, to consider creating additional courses or information that would undoubtedly limit the use of the morning afternoon pill.

In the current situation and in the perspective of such complementary courses, we will support this proposal very constructively.

This proposal extends the free provision of contraceptives to all women up to 25 years of age. Until now, this was only applicable to women under the age of 21. The hope in the longer term is, of course, the return for all women. In addition to the contraceptives, all women, regardless of their age, would be given free access to the morning after pill. Especially low-income women benefit from this measure. This way we improve equal access to contraceptives a little more and make young women less dependent and more in control of their own bodies. We cordially welcome this from our group. This is, in our view, primarily a social measure, and in that sense he enjoys our full support.

Sexual and reproductive rights are human rights that all women should enjoy. However, as with many rights, some women benefit from them and others do not. This is due to reasons related to their education or their socio-economic situation. Access to contraception is an integral part of this. It is, however, about allowing every woman to freely dispose of her body, that is to say, to plan her pregnancy, to decide if and when she wants a child.

Since 2004, an INAMI intervention has been planned to ensure the free use of the contraceptive pill for girls and girls under the age of 21, provided that the doctor prescribes the cheapest contraceptive. For others, a specific intervention is also planned, but they still have a personal share to pay. In 2013, this intervention was extended to other means of contraception, oral pills combining estrogen and progestin, intravaginal rings, sterils, afternoon pills, with the exception of condoms.

If this advance was necessary, the current law does not respond to the reality. First, the cheapest contraceptive method is not necessarily the most effective or most suited to the needs and body of the woman who uses it. Secondly, the age of 21 is well below the average age where the most abortions are performed. At the time, this 21 year limit was justified with regard to the proportion of teenage girls who did not have contraception and used abortion. Today, statistics show that the average age of women using abortion is 27 years old and relatively stable. That is why my party supports this bill raising this age to 25 years, while stressing that this must be a first step towards free contraception at 27 years old.

It also shows that more than 40 percent of women who use IVG did not use a contraceptive during the month preceding pregnancy. This situation is explained by a lack of information but also by an increasing precariousness among women, so that it is necessary to remove the ⁇ financial barriers to access to effective contraception.

The age limit set for the refund of the afternoon pill is no longer justified as the cost of a medicinal IVG is almost entirely covered by INAMI, regardless of the age of the patient.

It is also a method of contraception adopted in a very exceptional manner and which allows women facing an unwanted pregnancy to interrupt it urgently, in accordance with their right to freely dispose of their bodies.

In fact, free contraception alone will not solve the problem of unwanted pregnancies. In addition to this, it is necessary to encourage federal entities to continue their prevention and information work, by implementing these activities with the general public, target audiences but also professionals, mainly with generalists, with regard to the various means of contraception.

Research, development and information on male contraceptives should also be promoted in order to ensure equality between women and men in the use of contraceptive methods. I hope all the members here will agree.

As the European Parliament has stressed in its resolution, already dated 6 June 2002, access to contraceptives must be continued at different levels in a comprehensive manner. This involves the obligation for States to provide comprehensive information on effective and responsible methods of birth control, to provide contraceptives and sexual health services free of charge to disadvantaged groups, and to promote the use of emergency contraception at affordable prices and without formalities.

In this perspective, this bill deserves our support, even though we regret that the majority amendment leaves the government to decide on its entry into force. I doubt, in fact, that the current government in ordinary affairs considers the freedom of women to dispose of their bodies as a budgetary priority, especially after ⁇ ining criminal sanctions against women who abort out of date.

Certainly, the expansion of the refund of contraceptives and the morning afternoon pill has a cost. However, it should be understood that this cost is ridiculous compared to the societal cost of unwanted pregnancies and abortions that could have been avoided if, in advance, care had been taken to remove the financial and educational barriers to access to contraception.

Mr. Speaker, colleagues, many Members of the Chamber agree that contraception is an essential prerequisite for the sexual freedom of women. Indeed, the committee accepted a draft that provides for the extension of the refund of certain contraceptives until the age of 25 and of the emergency pill regardless of age. I am happier with one than with the other. In fact, I would like to point out that an effective contraception will make the emergency pill little necessary. There is a lot to say about this; Mrs. Capoen has already alluded to this.

I can answer Mrs. Lalieux that I can only issue the royal decree if the procedure is followed, which means that the budget must be available. On my question, RIZIV calculated the budgetary impact immediately when the proposal was submitted. At the moment, the necessary budget is not available. The healthcare budget follows a different circuit. The post will therefore have to be registered in the pharmaceutical budget of the RIZIV before the royal decree can be issued for entry into force. Such a royal decree, which falls outside the budgetary framework approved by the General Council, must also be discussed in the Insurance Committee and shall be so. Only after that is done can the royal decree be published.

Meanwhile, we have also taken measures to make it easier for patients to obtain intrauterine implants while in the hospital. It is important that the hospital pharmacies that can deliver implants, so that the patient does not have to go home first and then come again for consultation in the hospital. The number of consultations in this regard would also be limited by that measure. That decision will be published.

The Belgian contraception policy is followed by Sensoa. The organization congratulated us last month with our strong general and structural repayment measures and special arrangements for very young people and vulnerable groups. The proposed measures are a good thing.