The Association for Civil Rights in Israel (ACRI), together with the Feminist organization, Kayan, the Adva Center, and Physicians for Human Rights – Israel, submitted a petition to the Supreme Court to demand the inclusion of contraception in the basket of health services provided by national health insurance. The petition, that was submitted by ACRI Attorney Sonia Boulos, explains that the failure to subsidize contraceptives violates the health, liberty, and dignity of women in general, and women of limited financial means in particular, discriminates against a woman’s ability to access health services, and violates the right to social equality.
The use of contraceptives represents a daily health requirement for women of childbearing age, and is designed to help women have desired births only, and control their fertility in accordance with their own personal needs. In the absence of cheap contraceptive options, voluntary terminations are used as an alternative form of contraception that has severe implications on the physical and psychological well-being of the woman. In addition to which, multiple pregnancies in a relatively short period of time also endangers the health of women. Unwanted pregnancies undermine a woman’s control of her life and body, as well as her right to plan the number of pregnancies, and when to give birth. The non-financing of health services that only women require, results in discrimination against women in comparison to their male peers by placing the financial burden of purchasing contraceptives in order to ensure their physical well-being, on women (according to a survey carried out in the U.S., women are forced to pay 68% more than men on their health to finance effective means of contraception). This gap, explains Attorney Boulos, blatantly violates women’s constitutional right to equality. Moreover, the non-funding of contraception also discriminates against women as multiple unwanted pregnancies – that result from this policy – make it extremely difficult for women to integrate into the employment market, or institutes of higher education, and thus further exacerbates existing discrimination in the employment market and educational institutions, and violates the right of women of limited financial means to choose. As if that were not enough, the petitioning organizations stress, the non-inclusion of contraceptives in the basket of health services, is not a result of budget constraints, but rather results from demographic considerations designed to encourage births. This is further elucidated by the disparity between the financial resources allocated to fertility treatment, and the only partial funding of voluntary abortions. Israel is considered to be one of the fertility centers of the world. An average of 3,400 fertility treatments are carried out a year for every million residents. In France, for example, the rate is only 900 for every million residents, and in England only 300.
Attorney Boulos notes that different studies have shown that an average women tries to prevent or delay pregnancy for three quarters of her childbearing years. On average, a fertile woman should be able to have 12 births between the ages of 20-44. In practice, a woman who wants a relatively small family has to use contraceptive devices to prevent pregnancy for many years. Thus, for example, a woman who decides to have 2-4 children needs to use contraception for a period of 16-20 years of the 25 years that she is capable of bearing children. As a result of the high cost of contraceptive devices, many women of limited financial means are unable to afford them, which, in turn, results in a high number of unwanted pregnancies and voluntary terminations. About only half the women of childbearing age use contraception, and their use or non-use is linked directly to their monthly income. The use of contraception in the group of women who earn up to 7,000 NIS is only 50% of those who earn twice as much. Furthermore, other studies also indicate a clear link between the socio-economic position of a woman and the effectiveness of the preventative methods she uses (if at all). The studies revealed that a number of women who used an intra uterine device became pregnant because the device was the cheapest possible and its effectiveness limited.
Attorney Boulos further emphasizes that Israel is one of the only countries in the world in which there is almost universal coverage of medical services on the one hand, but on the other hand does not subsidize contraception. As a result, the estimated number of voluntary terminations in Israel is estimated to be 12.7 for every 1000 women of childbearing age (according to 2001 statistics), in comparison to 7 terminations for every 1000 women in Holland, for example, where family planning services and contraception are subsidized by the state (it should also be noted that in addition to abortions that are carried out in state-funded hospitals with the authorization of a state-appointed medical committee, private abortions are also available at the rate of, according to various estimates, between 25-50% of all terminations carried out in Israel). The petition also notes that the majority of state authorized terminations are not the result of medical considerations, and it can therefore be assumed that the pregnancies are a result of failed contraceptive methods. The petitioning organizations further emphasize that the trials in other countries of introducing subsidized contraception and the increased usage of them, led to a dramatic decrease in the number of unwanted pregnancies and the number of voluntary terminations.
Attorney Boulos also stresses that the petitioning organizations recognize the fact that the inclusion of medication in the health basket is subject to budgetary constraints and that the organizations do not oppose the stipulated criteria for the inclusion of new forms of medications in the basket of services. However, she emphasizes, these criteria do not justify in any way the imposition of an unbearable and discriminatory burden on the female population of Israel. If the Ministry of Health is committed to canceling the subsidy of some medication and medical equipment (the intention, of course, concerns equipment that is not defined as life-saving), it cannot choose medication and services whose non-subsidy will place a significant and discriminatory burden on one sector of the population.
In light of the aforementioned, the petitioning organizations ask that the Supreme Court order the Minister of Health to exercise his authority and include contraception in the health basket, which will include contraceptive pills, (to be supplied to women over 20 who are not entitled to them currently as part of the existing package of services provided by state health insurance) and intra-uterine devices. The Supreme Court is also asked to order the Minister of Finance and the government to authorize the addition of these preventative means to the health basket.
last updated : 25/07/05
