From healthcare services and insurance to medical costs and more, we explain everything you need to know about women’s healthcare in Spain.
Fortunately for expats moving to Spain, the country’s healthcare system consistently ranks among the best in the world. In fact, the World Health Organization places it seventh worldwide. Bloomberg also ranked it as the fourth-most efficient healthcare system in the world prior to the COVID-19 pandemic. Women moving to Spain will also be happy to know that the country’s healthcare system includes a full range of services that cater to their needs. These range from gynecology and obstetrics to maternity care, sexual health, cancer screenings, and more.
Even with its glowing reputation, learning how to navigate women’s healthcare in Spain can feel overwhelming. Luckily, though, this guide is here to walk you through it, and includes the following information:
- Accessing women’s healthcare services in Spain
- Insurance for women’s healthcare in Spain
- Family planning and maternity services in Spain
- Abortion in Spain
- Cancer screenings in Spain
- Menopause in Spain
- Sexual health in Spain
- Availability and cost of feminine hygiene products
- Women’s clinics and health centers in Spain
- Women’s mental health services in Spain
- Services dealing with abuse and violence against women in Spain
- Useful resources
Accessing women’s healthcare services in Spain
Fortunately, all women living and working in Spain have access to the free state healthcare system, which is called the National Health System (Sistema Nacional de Salud or SNS). This is paid for by social security payments which are made by all employees and self-employed workers. Notably, spouses and children of workers also have coverage for this.
Women’s healthcare in Spain consists of both private and public services and both offer a high-quality level of care. Some hospitals (hospitales) and healthcare centers (centros de salud) offer both private (privado) and state healthcare services (asistencia sanitaria pública).
Generally speaking, local clinics are the first port of call for women in Spain. These are provided as part of the Spanish National Healthcare System, which you can read more about in our guide. By law, primary healthcare services in Spain are available to those who live within a 15-minute radius from any place of residence.
Insurance for women’s healthcare in Spain
Currently, around 90% of Spaniards use the public healthcare system. This provides public health insurance and coverage for emergency services and comprehensive healthcare, including prevention, treatment, and rehabilitation. Because social security payments fund the Spanish public healthcare system, most residents don’t require private insurance to access health services.
That said, many expats still choose to take out private health insurance in order to benefit from shorter waiting times, private rooms in private clinics, and other value-added services. Private health insurance in Spain usually costs between €50 and €200 a month, depending on the coverage plan.
Some of the largest private health insurance companies in Spain include:
You can compare private health insurance providers in Spain and get free quotes on our health insurance page and with the tools Acierto.com (in Spanish) and Rastreator.com (in Spanish). You can also find more information in our Guide to getting private health insurance in Spain.
Importantly, non-nationals living in Spain must be employed in order to benefit from the National Health System. Therefore, until you begin contributing social security payments through your paychecks, you may need to lean on your European Health Insurance Card (EHIC) to access women’s healthcare in Spain; if you are an EU citizen.
Family planning and maternity services in Spain
Gynecologists primarily manage family planning in Spain and thankfully, the country has high standards in this department. Women planning to have a baby in Spain should discuss their wishes with their GP. They will then provide a reference to the appropriate practitioner or specialist. However, if you have private insurance, you can skip the referral process and make an appointment directly with a gynecologist.
Spanish public healthcare covers a number of maternity services. The degree of medical contact with pregnant women is also reasonably high throughout the country. In fact, there are generally more antenatal tests, scans, and interventions during childbirth than in other countries. Spain is also one of the more inexpensive places to give birth. Even if you don’t have private health insurance, for instance, you will likely pay around €1,800, with any complications adding minimal costs.
In the larger cities, maternity facilities are very comprehensive, ranging from large hospitals to smaller clinics. Larger facilities are usually run under the social security system, while smaller providers are operated via private health insurance. With the public system, you’re likely to be in the care of a midwife for the duration of the birth. However, you may not always have the same midwife throughout your pregnancy. Furthermore, the doctor is only likely to come if there are complications or special procedures.
If you wish to give birth in a private facility in Spain, however, then you must have private health insurance. Ideally, you should aim to have a private health insurance policy in place for at least 6 to 12 months before becoming pregnant. It is also important to verify that the insurance policy will cover a newborn child. You can read more about this in our Guide to having a baby in Spain.
Notably, the Spanish aren’t big believers in home births and there are no regulations around the practice. Therefore, expectant mothers who are keen on keeping things as natural as possible should practice due diligence and ensure that backup is available in case of an emergency.
Breastfeeding in Spain
Medical practitioners in Spain encourage breastfeeding, and doing so in public places is commonplace and rarely, if ever, discouraged. Despite this, however, statistics show that the rate of breastfeeding in Spain is generally declining; from 72.4% at 6 weeks postpartum to 66.5% at 3 months postpartum and 47% at 6 months postpartum. Among the world’s high-income countries, Spain actually stands out for its low breastfeeding rate.
According to International Breastfeeding Journal, several factors are potentially responsible for this. These include shorter duration of maternity leave permissions, lower rates of part-time female employment, lower spending on family benefits as a percentage of the country’s GDP, and a lower percentage of baby-friendly hospitals. However, in recent years, no well-known policy initiatives have been implemented to promote breastfeeding in Spain.
Women’s contraception in Spain
Contraception is widely available throughout Spain and is either free of charge or sold at a reasonable price. Public insurance subsidizes surgical and non-surgical methods of contraception in the country. To access this, you typically need a prescription from your GP or gynecologist. Although expats who have private health insurance won’t get the same subsidized benefits, contraception costs are still fairly affordable.
Contraception options in Spain
- The condom (el preservativo): Spain’s most common form of contraception is favored by around one-third of couples. These are available without a prescription at most drug stores, supermarkets, and pharmacies for between €0.50 and €3 per unit; depending on the brand and quantity purchased.
- The birth control pill (la píladora): This is available over-the-counter or with a prescription for all women aged 15 and older. Two types of pill are available in Spain; one which contains oestrogen and progestin, and the mini-píladora which only contains progestin. Notably, the latter is recommended for women who are breastfeeding or who have a history of blood clots. This is one of the most cost-effective contraception methods in Spain: costing around €3 with a prescription or €10 without.
- The emergency contraception pill (la píladora del día despues): This is available as an over-the-counter drug at pharmacies and one pill costs €20. However, it is available for free in some regions; including Andalusia, Aragón, Asturias, Cantabria, Castilla y León, Navarra, Catalonia, Extremadura, Galicia, and the Balearic Islands.
Other non-surgical options include the vaginal ring (el anillo vaginal) and the contraception patch (el parche), but these are not as widely used. Depending on the household income, a one-month prescription for the vaginal ring costs between €3 and €18. The patch, on the other hand, is a bit more expensive, but still affordable, at €30 per month.
Other surgical contraception options in Spain include:
- Copper and hormonal IUDs: la DUI cobre, la DUI hormonal
- The contraceptive implant: el implante subcutáneo
- The vasectomy: la vasectomía
- Female sterilization: la ligadura de trompas
In Spain, public health insurance covers the cost of all surgical procedures except for the contraceptive implant. This costs around €60 to get implanted, or €150 without a prescription from a GP or gynecologist.
Fertility treatments in Spain
Fortunately for women seeking fertility treatment, Spain is a global leader in the industry. In fact, according to data from the European Society of Human Reproduction and Embryology (ESHRE), Spain is the leading European country for the number of fertility treatments performed each year; this is currently around 180,000.
The assisted reproductive technologies and legal framework in Spain mean that all residents are able to access fertility treatment; regardless of their marital status or sexual orientation. The majority of fertility clinics in the country are privately run and must abide by specific regulations to operate. They are also routinely inspected by their regional government, and many have additional accreditation for safety and quality.
Similar to other countries, the first step in beginning a fertility treatment in Spain is to take a fertility test. This will enable the patient and doctor to determine the appropriate course of action. The fertility test may be included in the cost of treatment, but if it isn’t, it will typically cost between €100 and €200. Fortunately, many fertility clinics offer free online consultations, no waiting lists, and other amenities to make prospective parents feel more comfortable.
Because Spain is a global destination for fertility and other reproductive treatments, some clinics in the larger cities also offer multilingual services.
Some of these clinics include:
- IVI Fertility in Alicante, Barcelona, Bilbao, Las Palmas, Madrid, Málaga, Mallorca, Murcia, San Sebastián, Sevilla, and Valencia
- Instituto Bernabeu in Albacete, Alicante, Benidorm, Cartagena, Elche, and Madrid
- Tambre Madrid
- Reproclinic in Barcelona
- Barcelona IVF in Barcelona
- URE Centro Gutenberg in Málaga
- Institut Marquès in Barcelona
Abortion in Spain
Since 1985, abortion has been legal in Spain in the first 14 weeks of a woman’s pregnancy. After this point, the permissible circumstances for abortion are if the pregnancy is a serious risk to the mother’s life or to the fetus itself. In 2010, the law was broadened to allow abortion up to 22 weeks in cases of fetal deformities which are deemed “incompatible with life”, or incurable diseases. This is in accordance with the country’s Organic Law 2/2010. You can read the full terms of the law here.
In 2015, Spain’s abortion law changed once again to make parental consent for those aged between 16 and 18 mandatory. Generally speaking, Spain’s abortion law is similar to other liberalized EU countries. Notably, some private clinics also welcome patients seeking to end their pregnancy who are unable to do so in their own country of residence.
Getting an abortion in Spain
In Spain, abortions are either performed in public hospitals, where they are heavily subsidized or free of charge, or in private hospitals where they cost upward of €300. There are two methods of pregnancy termination: medical abortion by prescribed drugs, or surgical abortion at a clinic or hospital. The most common method is a medical abortion, which is typically a prescription of mifepristone and misoprostol. Notably, physicians are legally obligated to inform a patient seeking an abortion of the rights, benefits, and public aid available to them. The patient must then wait three days before they can have the abortion.
In theory, abortion is available to anyone in Spain on request during the first 14 weeks of pregnancy. In practice, however, access to the procedure is diminished by the right of medical professionals to make a conscientious objection; i.e., the refusal to participate in certain activities because of moral or religious reasons. There is no public register in Spain of physicians who object to assisting in abortions. However, in some regions, such as La Rioja and Lleida and the Pyrenees in Catalonia, those seeking abortions are actually referred to other provinces due to objections from medical staff.
Cancer screenings in Spain
Remarkably, Spain has one of the lowest rates of cancer among women in Europe. In fact, the World Cancer Research Fund ranks it 40th in the world; with an incidence of 227.1 per 100,000 women. Screening for cancer has proven to be effective in prevention and prognosis throughout the country; especially for breast, cervical, and colorectal cancers. Pap smears remain the best way to screen for cervical cancer and getting one is as easy as making an appointment with your GP.
The government invites women aged between 50 and 65 to have a mammogram every two years. These screenings usually happen at local clinics. In some cases, however, a smaller clinic may send patients to a larger regional clinic. If a mammogram reveals irregularities, you will be contacted for treatment or additional studies at the nearest hospital. If you are younger than 50 and have a family history of breast cancer, it’s a good idea to talk to your GP about entering the screening program.
The Spanish Association Against Cancer (Asociación Española Contra el Cáncer) is a country-wide non-profit organization that offers resources to help people searching for support if they or a loved one have been diagnosed with cancer.
Menopause in Spain
According to the Spanish Menopause Society, around 20% of women in the country find their quality of life affected by perimenopause (or the menopausal transition) “in a meaningful way”. Even though hormone replacement therapies (HRT) (la terapia hormonal sustitutiva or la terapia de reemplazo hormonal in Spanish) can be bought at pharmacies without a prescription, you should first check with your GP or gynecologist to determine what, if any, HRT is best for you and how long you should take it. In Spain, the cost of HRT is free with a prescription, and upwards of €20 per month when you buy it over the counter.
Sexual health in Spain
Sexually Transmitted Infection (STI) transmission has soared among young people living in Spain in recent years, with chlamydia being especially high among women between the ages of 20 and 24. While not all STIs have symptoms, all can cause damage if not detected.
In Spain, testing for STIs may be as simple as phoning your GP for an appointment or seeking a referral to see a specialist. If you are still settling in and don’t have a GP or health insurance coverage just yet, your European Health Insurance Card (EHIC) will grant you access to see a temporary doctor who can assist you with getting a test in a timely manner. The Open House Medical Center in Madrid also offers consultations in English over the phone, as well as several options for STI testing in-person at their clinic or by yourself at home.
The EU and the Spanish government have approved branded and generic HIV prevention drugs (PrEP), and an estimated 2,500 to 3,000 people in Spain currently use them. Although the Spanish government funds PrEP at a federal level, the distribution and availability of the drugs at the regional level are uneven. Therefore, you should check with your trusted healthcare provider about securing access to one of the PrEP regimens.
Availability and cost of feminine hygiene products
Although they share the pharmacy shelf with tampons, sanitary towels reign supreme in Spain. In June 2021, the average cost of a 32-item box of tampons is €4.15. Since 2018, the Spanish government has discussed lowering the VAT for feminine hygiene products – the so-called “tampon tax” – from 10% to 4%. However, so far, they have taken no action. Because of a unique tax structure, the Canary Islands (las Islas Canarias) are able to sell feminine hygiene products tax-free.
Some organizations in Spain have observed an increase in the demand for hygiene products during the COVID-19 pandemic and have taken action. Among them is the non-profit Mensajeros de la Paz, which now includes menstrual pads in its aid packages. The University of Vigo in Galicia is also providing free feminine hygiene products on its campuses in Vigo, Ourense, and Pontevedra.
If you are keen on buying sustainable menstrual products in Spain, you can visit these shops either in-person or online:
Women’s clinics and health centers in Spain
If you participate in Spain’s public health insurance scheme, then most gynecology and other general services relating to women’s healthcare in Spain are available at a public health center or public hospital. Occasionally, however, public-run healthcare is outsourced to private practitioners, but the costs will remain low.
Several private women’s health centers offer multidisciplinary approaches; from gynecology and obstetrics to physiotherapy and general wellness. If you have private health insurance, you should contact your insurer to discuss the clinics in your area that will best meet your needs.
Women’s mental health services in Spain
When it comes to mental healthcare, women have unique needs, such as treatment for post-partum anxiety or depression. While post-partum disorders have no direct cause and can happen to any pregnant or post-natal person, there is some evidence that links them to other mental health issues.
Despite its high standing in global healthcare rankings, mental healthcare in Spain has ample room for improvement. Similar to most areas of healthcare, people seeking treatment for mental health issues will first consult their GP or closest primary health clinic. They will then provide a special reference if you require additional treatment. You can read more about seeking mental health services in our Guide to healthcare in Spain.
Services dealing with eating disorders in Spain
Eating disorders such as bulimia, anorexia, and binge eating may be difficult to identify in others, especially early on. These may also be tied to other problems such as addiction or other mental health issues. Getting proper support to cure an eating disorder is important, as well as for caretakers of those with one.
Since 2011, the number of total cases registered in Spain’s National Health System has increased almost year-on-year, spiking to more than 60,000 in 2015. In recent years, the Spanish government has launched a public campaign aimed at educating the populace about the risks of eating disorders and how they can seek help.
Spanish-speaking expats who require holistic support to cure an eating disorder can visit Centro ITEM in Madrid or Bilbao. They can also learn about general resources, patients’ rights, support groups, and more with the non-profit ADANER.
However, English-speaking treatment for eating disorders tends to focus more on luxury rehabilitation, such as Villa Paradiso in Marbella and Ibiza Calm, which also has an office in London. The Camino Recovery treatment center in Vélez-Málaga also offers workshops for family members as well as services in English, Dutch, Swedish, and Finnish.
Services dealing with abuse and violence against women in Spain
Gender-based violence remains a human rights violation all over the world. In 2004, Spain implemented a new law that specifically cracks down on gender-based violence. The law called for the creation of special courts and integral rehabilitation centers, improved assistance to victims, and a series of procedures aimed at protecting women under threat. However, while Spain has made strides in supporting and protecting victims of abuse throughout the country, other forms of gender-based violence, such as forced marriage and sexual violence, have not received as much attention.
The Ministry of Equality (Ministerio de Igualdad) offers a centralized website that is available in Spanish, English, Catalan, Basque, Galician, Valencian, and French. It provides information about victims’ rights, resources, ways to contact law enforcement and the legal system, and associations that the government collaborates with on this matter.
If you are in Spain and need urgent assistance, you can dial 016 to reach the government’s abuse hotline, or send a WhatsApp message to 600 000 016.
- English Speaking Healthcare Association Spain – a non-profit connecting English speakers with healthcare professionals
- Ministry of Equality (Ministerio de Igualdad) – a government clearinghouse which provides information and initiatives for social equality among different sexes, genders, ethnicities, and sexual orientations
- La Leche League International – offers breastfeeding support and information
- IVF-Spain – provides information about clinics and treatments for in vitro fertilization