Research has shown that in Spain, the average number of children per woman was 1.18 and the average maternal age reached 31.2 years for the year 2020 (1). That makes Spain, the second country with the lowest fertility rate of Europe (2). Moreover, Spain, together with Italy, are the European Union countries with the highest maternal age at first birth (3).
Different factors have been related to delay parenthood, such as high unemployment rates among youth or the rising levels of education among women and their participation in the labour market (4). Besides, the increasing secularisation of society has also been pointed out as one of the factors which influence the declining trend on fertility rates (4). Although Catholicism is the dominant belief in Spain, with around 60% of the population defining themselves as Catholics, this figure decreased to roughly 35% among young people from 18 to 34 years old (5).
The first Spanish legislation on ART was published in 1988, although the last revision of the law was in 2006 (6). This legislation has been defined as one of the most liberal regulations in assisted reproduction in Europe, considering that the law does not define age limit for ART users, and married and not married couples can access to it, as well as single and lesbian women and transexual individuals with gestational capacity. High accessibility and delayed pregnancy have created an ideal breeding ground for an increasing trend in the use of ART, being Spain the largest European ART provider and the European country with the largest treatment numbers and the higher rate of ART infants per national births . In 2018, nearly the 10% of the children born in Spain were the result of ART (7).
ART services are provided at public hospitals and private clinics, with 493 clinics in Spain, most of them private. The Spanish National Health System includes free treatment for healthy heterosexual couples and single women, as long as women are under 40 and men under 55 years old, and heterosexual couples have experienced a lack of conception following one year of unprotected sexual intercourse. However, some techniques are excluded from the Spanish National Health System, such as oocyte donation and preimplantation genetic diagnosis, and waiting lists of public centres can be as long as 24 months. Therefore, close to 75% of treatments are carried out in private clinics, which are also responsible for nearly all donor eggs and preimplantation genetic diagnosis (9). Due to the expensiveness of the treatments, people with high socioeconomic status or high educational level are more likely to access private clinics. In addition, private clinics reported higher success rates than public hospitals (10). The reality for lesbian couples is different, in fact, directed egg donation between lesbian couples (ROPA method: Recepción de Ovocitos en PAreja, for its acronym in Spanish) is not allowed (or prohibited) by ART law. There is a legal gap. In theory, the National Commission for Assisted Reproduction should consider these applications on a case-by-case basis, since the general principle to be respected is the anonymity of gamete donation.
In practice, there is a climate of tolerance on the part of the Administration regarding the implementation of ROPA, allowing this application for lesbian couples. However, legal uncertainty remains, as there is no regulation in this respect.
Moreover, people from other countries come to Spain to undergo ART treatments, mostly in private clinics, largely because of the greater accessibility to ART in Spain and the legal restrictions in their original countries (11,12).
B2-InF interviewed a sample of 15 young people in Spain. Their sociodemographic characteristics are described in table 1. The average age was 24 years old (standard deviation=3.8).
| Table 1. Sociodemographic characteristics of the sample in Spain | ||
| Participants (n=15) | ||
| n | % | |
| Age in years | ||
| 18 – 22 | 6 | 40 |
| 23 – 26 | 2 | 13 |
| 27 – 30 | 7 | 47 |
| Gender | ||
| Male | 7 | 47 |
| Female | 7 | 47 |
| Transgender male to female | 0 | 0 |
| Transgender female to male | 1 | 6 |
| Other | 0 | 0 |
| Sexual Orientation | ||
| Heterosexual | 7 | 46 |
| Homosexual | 4 | 27 |
| Bisexual | 4 | 27 |
| Other | 0 | 0 |
| Occupation | ||
| Student | 6 | 40 |
| Self-employed | 0 | 0 |
| Employed for wages | 6 | 40 |
| Homemaker | 0 | 0 |
| Unemployed | 3 | 20 |
| Unable to work | 0 | 0 |
| Highest educational level achieved | ||
| No schooling completed | 0 | 0 |
| School | 0 | 0 |
| High school | 3 | 20 |
| Bachelor’s degree | 11 | 73 |
| Doctorate degree | 1 | 7 |
| Residence | ||
| Urban area | 13 | 86 |
| Semi-urban area | 1 | 7 |
| Rural area | 1 | 7 |
| Relationship | ||
| Yes | 7 | 47 |
| No | 8 | 53 |
| Marital status | ||
| Single | 12 | 80 |
| Married or domestic partnership | 3 | 20 |
| Widow | 0 | 0 |
| Divorced | 0 | 0 |
| Separated | 0 | 0 |
| Religious beliefs | ||
| Christian | 4 | 27 |
| Muslim | 0 | 0 |
| Jewish | 0 | 0 |
| Orthodox | 0 | 0 |
| Other | 0 | 0 |
| None | 11 | 73 |
The recruitment process was carried out by the research team of APLICA (B2-InF partner) through its own panel and networks, contacting potential participants by email or telephone to be included in the sample and ensuring that they met the inclusion/exclusion criteria.
15 interviews were carried out from March to July 2021, all of them in Spanish language. Eight interviews were done face-to-face in Madrid and seven were conducted by Zoom because of the COVID-19 pandemic or because the participant was based in a different city such as Bilbao, Barcelona, or Huesca. Although in general the interviews conducted online did not face connectivity issues, in some of them, minor problems occurred without jeopardizing the engagement and discourses of participants.
Interviews were conducted by male or female researchers, in concordance with the interviewee’s gender. Participants were willing to cooperate and spoke openly.
REFERENCES
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- Geyter C De, Calhaz-Jorge C, Kupka MS, Wyns C, Mocanu E, Motrenko T, et al. ART in Europe, 2015: results generated from European registries by ESHRE. Hum Reprod Open [Internet]. 2020 Jan 1 [cited 2021 Jul 15];2020(1). Available from: /pmc/articles/PMC7038942/
- Ministerio de Sanidad Consumo y Bienestar Social. Notas de Prensa [Internet]. 2020. [cited 2021 Jul 15]. Available from: https://www.mscbs.gob.es/gabinete/notasPrensa.do?id=5067
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