A report by IGAS provides ways to improve access to contraception for minors. By focusing on freedom and confidentiality.
Free and confidential. These are the two key principles that govern minors’ access to contraception. The Social Security financing laws of 2013 and 2014 enshrined these measures.
First, by making the delivery of contraceptives reimbursed by the Health Insurance free for all young girls aged 15 to 17; then the following year, by introducing third-party payment for gynecological consultations and biological analyses, on the part covered by the Compulsory Health Insurance (AMO).
However, a Mission of the IGAS, mandated last December by Marisol Touraine, notes that these provisions are still very badly understood by doctors and pharmacists, and especially very badly applied.
Only 1% of contraceptives issued to minors use free and confidential measures.
Principles undermined
There are several reasons for these poor results. According to the report submitted last Thursday to the Minister of Health, pharmacists are, for example, often hesitant to embark on the procedure of anonymizing the identifiers of the minor, because of its complexity.
As for free, they do not understand the interest of the measure given that minors often benefit from the complementary health of their “openers” (often the parents), and that free is therefore assured. But if young girls use this supplement, the principle of confidentiality is undermined.
Simplify and harmonize
To improve the record in terms of free access and accessibility, the IGAS proposes measures centered on the simplification of the fee advancement and confidentiality systems.
Several avenues for financing free access are mentioned, but it is above all at the level of procedures that the IGAS wishes to innovate. One of these measures consists in automating, in pharmacists’ billing software, the payment exemption and confidentiality procedure to allow them to practice them much more easily. This requires upstream work with the publishers of this software.
The IGAS report also highlights the need to extend these measures to under 15s and 18-24s. In the first case, even if they are rarer, sexually active young girls are very disadvantaged because they are not entitled to free access to contraceptives. As they depend on the mutuals of the rights holders, the secrecy is therefore not respected.
In the second, young women are adults, but often not financially independent. Not getting free can be a problem. The IGAS wants harmonized measures for all these age groups.
Strengthen education
The situation has nevertheless improved in recent years, with the number of abortions falling. While in 2006 there were 16,000 abortions in France, the year 2013 ended with 12,000 abortions recorded by the authorities. More than 99% of sexually active women in the 15-17 age group who do not want children say they use the pill.
However, contraceptive failures are still too numerous: 70% of minors who undergo an abortion were on the pill. Poor observance and ignorance of reproduction explain this phenomenon.
Beyond free access and confidentiality, the IGAS report considers that the main obstacle to effective contraception lies in the lack of sex education and in access to erroneous information. He therefore recommends reviewing the law of July 4, 2001 which imposed education sessions on the subject, three times a year in schools and in secondary schools, and which is still very little implemented.
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