A Human Rights-Based Approach to Health in Assisted Reproductive Care in Spain
,
Abstract
Objective: Assisted reproductive techniques (ART) have evolved significantly since the early 20th century, driven by biomedical advances and profound socio-cultural shifts worldwide, particularly in Spain. This expansion has enabled access to parenthood in previously inaccessible situations, such as infertility and diverse family structures, yet it also poses risks of human rights violations.
Materials and methods: A reflective analysis is conducted on the practices in Spanish healthcare related to assisted reproduction, based on national legislation and its alignment with international human rights legislation. The review of international standards was carried out using normative sources from the United Nations (UN), the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), the World Health Organization (WHO), the Universal Declaration on Bioethics and Human Rights of UNESCO, and those adopted in the European regional context by the Council of Europe, particularly the Convention on Human Rights and Biomedicine.
Results: This article examines potential human rights violations within Spain's ART healthcare framework, identifying gaps in international human rights compliance. Despite Spain's progressive legislation on ART, discrepancies remain with evolving European standards, especially concerning oocyte donation and donor anonymity.
Conclusion: The goal is to promote reflection, improve the quality of care, and protect the health and rights of women, children, and families using ART, while ensuring that clinical practices align with human rights principles.
1. Flores J. Evolution of assisted reproduction technologies: A biomedical perspective. Inter disciplina. 2022;10(28):355-368.
2. Ortiz Movilla R, Acevedo Martín B. Assisted reproduction and child health. Pediatr Aten Primaria. 2010;12(48):651-671.
3. World Health Organization. Infertility. https://www.who.int/news-room/fact-sheets/detail/infertility/, 2020.
4. Ezquerro Cordón V. Influence of age on infertility. Rev NPunto. 2019;2(14):4-18. https://www.npunto.es/revista/14/influencia-de-la-edad-en-la-fertilidad
5. Social Studies Office of Funcas. Focus on Spanish Society. https://www.funcas.es/wp-content/uploads/2023/05/Focus-may-2-2023.pdf/, 2023.
6. Coronel Rodríguez C, Chávez Barco AM, González Soria MD, Guisado Rasco MC. Madres solteras por elección. Una realidad creciente y no reciente. Aten Primaria. 2017;49(8):502-503.
7. Álvarez-Bernardo G, Roma-Avilés N. Comunitaria, Revista internacional de Trabajo Social y Ciencias Sociales. 2015;10:83-96.
8. United Nations General Assembly. Universal Declaration of Human Rights. https://www.un.org/en/about-us/universal-declaration-of-human-rights/, 1948.
9. Pinto M. International covenant on economic, social and cultural rights. United Nations Audiovisual Library of International Law. 2022;11(01).
10. United Nations General Assembly. International Covenant on Civil and Political Rights. https://www.ohchr.org/sites/default/files/ccpr-es.pdf/, 1966.
11. World Health Organization. 25 Questions & Answers on Health & Human Rights. Health & Human Rights Publication Series. 2002;1.
12. World Health Organization. Human Rights, Health, and Poverty Reduction Strategies. https://apps.who.int/iris/handle/10665/43909/, 2008.
13. Government of Spain. Law 14/2006, of May 26, on Assisted Reproduction Techniques. https://www.institutobernabeu.com/en/spanish-law-on-assisted-reproduction/
14. Government of Spain. Royal Decree 412/1996, of March 1, establishing mandatory study protocols for donors and recipients related to the practice of assisted reproduction techniques. https://www.boe.es/eli/es/rd/1996/03/01/412/con 1996.
15. Government of Spain. Royal Decree 9/2014, of July 4, establishing quality and safety standards for the donation, procurement, evaluation, processing, preservation, storage, and distribution of human cells and tissues. https://www.global-regulation.com/translation/spain/1452440/royal-decree-law-9-2014%252c-of-4-july%252c-establishing-standards-of-quality-and-safety-for-the-donation%252c-obtaining%252c-evaluating%252c-processing%252c-pres.html/, 2014 (accessed 5 July 2014).
16. Council of Europe. Convention for the Protection of Human Rights and Dignity of the Human Being with regard to the Application of Biology and Medicine: Convention on Human Rights and Biomedicine. https://www.coe.int/en/web/human-rights-and-biomedicine/oviedo-convention/, 1997.
17. UNESCO. Universal Declaration on Bioethics and Human Rights. https://unesdoc.unesco.org/ark:/48223/pf0000142825/, 2005.
18. Posner SF, Johnson K, Parker C, Atrash H, Biermann J. The national summit on preconception care: A summary of concepts and recommendations. Matern Child Health J. 2006;10(5): S197-205.
19. Soriano-Ortega KP, Carballo-Mondragón E, Roque-Sánchez AM, Durán-Monterrosas L, Kably-Ambe A. Perception of fertility in women of reproductive age according to their age. Ginecol Obstet Mex. 2017;85(6):364-373.
20. Boivin J, Sandhu A, Brian K, Harrison C. Fertility-related knowledge and perceptions of fertility education among adolescents and emerging adults: a qualitative study. Hum Fertil (Camb). 2019;22(4):291-299.
21. Paricio del Castillo R. Perinatal Mental Health and Assisted Reproduction with Egg Donation: An analysis of the current situation in Spain. Rev Iberoam Fertil Reprod Hum. 2022;39(3).
22. Aviles Alepuz B, Ramón Fernández F. Egg donation in assisted reproduction: risks and responsibilities. IUS ET SCIENTIA. 2020;5(2):11-54.
23. Fernández R. Number of women freezing their eggs to delay motherhood triples. RTVE. In press.
24. Enguer Gonsálbez P, Ramón Fernández F. Bioethical and legal dilemmas of assisted reproduction in today's society in Spain. Rev Lat Bioet. 2018;18(1):104-135.
25. Ruiz I, Ortiz AM, Corral MG. Guardianship withdrawn from woman in Burgos who had twins at 64 due to "risk". El Mundo. 2017 Apr 7. https://www.elmundo.es/sociedad/2017/04/07/58e7b596e2704e4c438b4639.html
26. World Health Organization. Transforming health systems: gender and rights in reproductive health. Training manual for health administrators and program managers. https://www.who.int/publications/i/item/WHO-RHR-01.29/, 2001.
27. United Nations. Programme of Action of the International Conference on Population and Development, Cairo. United Nations: 1994.
28. Assembly UG. Convention on the elimination of all forms of discrimination against women. Retrieved April. 1979;20:2006.
29. De Marinis MG, Piredda M, Petitti T. Governance of Prevention in Spain. Biomed. Prev. 2018;3:226-9.
30. Reproducción Asistida ORG. Analysis of assisted reproduction clinics in Spain. https://www.reproduccionasistida.org/clinicas/espana/, 2006.
31. Martínez AL, Bote M. Reconcile or burst: socioeconomic and demographic determinants of the use of assisted human reproduction techniques from a territorial perspective. Polit Soc. 2019;56(3):583-601.
32. Zegers-Hochschild F. Some ethical reflections on the use of modern reproductive technology for the treatment of infertility. Rev Med Clin Condes. 2010;21(3):469-478.
33. Cárdenas-Castro M, Salinero-Rates S. The continuum of violence against women: Gynecological violence within the Medical Model in Chile. Sex Reprod Healthc. 2023;37:100891.
34. Bellón Sánchez S. Obstetric violence from the contributions of feminist critique and biopolitics. Dilemata. 2015;18:93-111.
35. World Health Organization. The prevention and elimination of disrespect and abuse during childbirth in health facilities. https://www.who.int/publications/i/item/WHO-RHR-14.23
36. Bohren, M. A., Mehrtash, H., Fawole, B., Maung Maung, T., Balde, M. D., Maya, E., & et al. (2019). How women are treated during facility-based childbirth in four countries: A cross-sectional study with labour observations and community-based surveys. Lancet, 394(10210), 1750–1763. https://doi.org/10.1016/S0140-6736(19)31992-0
37. United Nations. Human rights-based approach to mistreatment and violence against women in reproductive health services, with special emphasis on childbirth and obstetric violence (A/74/137). 2019 Jul 11.
38. Assembly P. Obstetrical and gynaecological violence. European Council. 2019.
39. World Health Organization. World Mental Health Report: Transforming Mental Health for all. https://www.who.int/publications/i/item/9789240049338
40. Pozza A, Dèttore D, Coccia ME. Depression and Anxiety in Pathways of Medically Assisted Reproduction: The Role of Infertility Stress Dimensions. Clin Pract Epidemiol Ment Health. 2019;15:101-109.
41. Cui W. Mother or nothing: the agony of infertility. Bull World Health Organ. 2010;88(12):881-2.
42. Gameiro S, van den Belt-Dusebout AW, Smeenk JM, Braat DD, van Leeuwen FE, Verhaak CM. Women's adjustment trajectories during IVF and impact on mental health 11–17 years later. Hum Reprod. 2016;31(8):1788-1798.
43. El País. Spain, the European egg barn. El País. 2019 Jul 20.https://elpais.com/sociedad/2019/07/19/actualidad/1563531405_529791.html
44. Piersanti V, Consalvo F, Signore F, Del Rio A, Zaami S. Surrogacy and "Procreative Tourism": What Does the Future Hold from the Ethical and Legal Perspectives? Medicina (Kaunas). 2021;57(1):47.
45. Department of Statistics of the Ministry of Health. Statistical Report on Assisted Reproduction Techniques, 2019. Ministry of Health; 2021. https://cnrha.sanidad.gob.es/registros/actividades.htm
46. European Parliament. European Parliament resolution of 17 December 2015 on the Annual Report on Human Rights and Democracy in the World 2014 and the European Union’s policy on the matter. https://www.europarl.europa.eu/doceo/document/TA-8-2015-0470_EN.html/, 2017.
47. United Nations. Sale and sexual exploitation of children, including child prostitution, child pornography and other child sexual abuse material. https://digitallibrary.un.org/record/1638578?v=pdf, 2018.
48. United Nations. Convention on the Rights of the Child. https://www.un.org/es/events/childrenday/pdf/derechos.pdf/, 1989.
49. United Nations. Optional Protocol to the Convention on the Rights of the Child on the involvement of children in armed conflict. https://www.ohchr.org/en/instruments-mechanisms/instruments/optional-protocol-convention-rights-child-involvement-children/, 2000 (accessed 25 May 2000).
50. Government of Spain. Penal Code. Off State Gaz. 1995. https://www.boe.es/eli/es/lo/1995/11/23/10/con/,1995.
51. Government of Spain. Law 54/2007, of December 28, on international adoption. https://www.mjusticia.gob.es/es/AreaTematica/DocumentacionPublicaciones/Documents/Act%2054-2007%2C%20of%20December%2028th%2C%20on%20Intercountry%20Adoption-Ley%2054-2007.pdf/, 2007.
52. Pardo-Miranda M. Illegal adoption and surrogacy as purposes of the crime of human trafficking. Anales Derecho. 2023;40. https://digitum.um.es/digitum/handle/10201/128487?mode=full
53. Irwin, R. (2024). Politics, law and a lack of sperm: single women and fertility treatment in the Swedish health system. Anthropology & Medicine, 31(1–2), 89–103. https://doi.org/10.1080/13648470.2023.2274684.
54. Boladeras M. Anonymity in gamete donation: Does the current situation need improvement? Musas. 2023;8(1):05-20. https://doi.org/10.1344/musas2023.vol8.num1.1
55. Government of France. Law n° 2021-1017 of August 2, 2021, on bioethics. Off J Fr Rep. 2021.
56. Council of Europe, Parliamentary Assembly. Anonymous donation of sperm and oocytes: balancing the rights of parents, donors and children (Recommendation 2156). 2019.
57. Spanish Bioethics Committee. Report of the Spanish Bioethics Committee on the right of children born through assisted reproductive techniques to know their biological origins. 2020.
58. Muñoz M, Abellán-García F, Cuevas I, de la Fuente A, Iborra D, Mataró D, et al. Document on the position of the Spanish Society of Fertility regarding the anonymity rule in gamete donations. Fase 20 Ediciones: 2019.
59. Hammond K. The role of normative ideologies of motherhood in intended mothers' experiences of egg donation in Canada. Anthropol Med. 2018;25(3):265-279.
2. Ortiz Movilla R, Acevedo Martín B. Assisted reproduction and child health. Pediatr Aten Primaria. 2010;12(48):651-671.
3. World Health Organization. Infertility. https://www.who.int/news-room/fact-sheets/detail/infertility/, 2020.
4. Ezquerro Cordón V. Influence of age on infertility. Rev NPunto. 2019;2(14):4-18. https://www.npunto.es/revista/14/influencia-de-la-edad-en-la-fertilidad
5. Social Studies Office of Funcas. Focus on Spanish Society. https://www.funcas.es/wp-content/uploads/2023/05/Focus-may-2-2023.pdf/, 2023.
6. Coronel Rodríguez C, Chávez Barco AM, González Soria MD, Guisado Rasco MC. Madres solteras por elección. Una realidad creciente y no reciente. Aten Primaria. 2017;49(8):502-503.
7. Álvarez-Bernardo G, Roma-Avilés N. Comunitaria, Revista internacional de Trabajo Social y Ciencias Sociales. 2015;10:83-96.
8. United Nations General Assembly. Universal Declaration of Human Rights. https://www.un.org/en/about-us/universal-declaration-of-human-rights/, 1948.
9. Pinto M. International covenant on economic, social and cultural rights. United Nations Audiovisual Library of International Law. 2022;11(01).
10. United Nations General Assembly. International Covenant on Civil and Political Rights. https://www.ohchr.org/sites/default/files/ccpr-es.pdf/, 1966.
11. World Health Organization. 25 Questions & Answers on Health & Human Rights. Health & Human Rights Publication Series. 2002;1.
12. World Health Organization. Human Rights, Health, and Poverty Reduction Strategies. https://apps.who.int/iris/handle/10665/43909/, 2008.
13. Government of Spain. Law 14/2006, of May 26, on Assisted Reproduction Techniques. https://www.institutobernabeu.com/en/spanish-law-on-assisted-reproduction/
14. Government of Spain. Royal Decree 412/1996, of March 1, establishing mandatory study protocols for donors and recipients related to the practice of assisted reproduction techniques. https://www.boe.es/eli/es/rd/1996/03/01/412/con 1996.
15. Government of Spain. Royal Decree 9/2014, of July 4, establishing quality and safety standards for the donation, procurement, evaluation, processing, preservation, storage, and distribution of human cells and tissues. https://www.global-regulation.com/translation/spain/1452440/royal-decree-law-9-2014%252c-of-4-july%252c-establishing-standards-of-quality-and-safety-for-the-donation%252c-obtaining%252c-evaluating%252c-processing%252c-pres.html/, 2014 (accessed 5 July 2014).
16. Council of Europe. Convention for the Protection of Human Rights and Dignity of the Human Being with regard to the Application of Biology and Medicine: Convention on Human Rights and Biomedicine. https://www.coe.int/en/web/human-rights-and-biomedicine/oviedo-convention/, 1997.
17. UNESCO. Universal Declaration on Bioethics and Human Rights. https://unesdoc.unesco.org/ark:/48223/pf0000142825/, 2005.
18. Posner SF, Johnson K, Parker C, Atrash H, Biermann J. The national summit on preconception care: A summary of concepts and recommendations. Matern Child Health J. 2006;10(5): S197-205.
19. Soriano-Ortega KP, Carballo-Mondragón E, Roque-Sánchez AM, Durán-Monterrosas L, Kably-Ambe A. Perception of fertility in women of reproductive age according to their age. Ginecol Obstet Mex. 2017;85(6):364-373.
20. Boivin J, Sandhu A, Brian K, Harrison C. Fertility-related knowledge and perceptions of fertility education among adolescents and emerging adults: a qualitative study. Hum Fertil (Camb). 2019;22(4):291-299.
21. Paricio del Castillo R. Perinatal Mental Health and Assisted Reproduction with Egg Donation: An analysis of the current situation in Spain. Rev Iberoam Fertil Reprod Hum. 2022;39(3).
22. Aviles Alepuz B, Ramón Fernández F. Egg donation in assisted reproduction: risks and responsibilities. IUS ET SCIENTIA. 2020;5(2):11-54.
23. Fernández R. Number of women freezing their eggs to delay motherhood triples. RTVE. In press.
24. Enguer Gonsálbez P, Ramón Fernández F. Bioethical and legal dilemmas of assisted reproduction in today's society in Spain. Rev Lat Bioet. 2018;18(1):104-135.
25. Ruiz I, Ortiz AM, Corral MG. Guardianship withdrawn from woman in Burgos who had twins at 64 due to "risk". El Mundo. 2017 Apr 7. https://www.elmundo.es/sociedad/2017/04/07/58e7b596e2704e4c438b4639.html
26. World Health Organization. Transforming health systems: gender and rights in reproductive health. Training manual for health administrators and program managers. https://www.who.int/publications/i/item/WHO-RHR-01.29/, 2001.
27. United Nations. Programme of Action of the International Conference on Population and Development, Cairo. United Nations: 1994.
28. Assembly UG. Convention on the elimination of all forms of discrimination against women. Retrieved April. 1979;20:2006.
29. De Marinis MG, Piredda M, Petitti T. Governance of Prevention in Spain. Biomed. Prev. 2018;3:226-9.
30. Reproducción Asistida ORG. Analysis of assisted reproduction clinics in Spain. https://www.reproduccionasistida.org/clinicas/espana/, 2006.
31. Martínez AL, Bote M. Reconcile or burst: socioeconomic and demographic determinants of the use of assisted human reproduction techniques from a territorial perspective. Polit Soc. 2019;56(3):583-601.
32. Zegers-Hochschild F. Some ethical reflections on the use of modern reproductive technology for the treatment of infertility. Rev Med Clin Condes. 2010;21(3):469-478.
33. Cárdenas-Castro M, Salinero-Rates S. The continuum of violence against women: Gynecological violence within the Medical Model in Chile. Sex Reprod Healthc. 2023;37:100891.
34. Bellón Sánchez S. Obstetric violence from the contributions of feminist critique and biopolitics. Dilemata. 2015;18:93-111.
35. World Health Organization. The prevention and elimination of disrespect and abuse during childbirth in health facilities. https://www.who.int/publications/i/item/WHO-RHR-14.23
36. Bohren, M. A., Mehrtash, H., Fawole, B., Maung Maung, T., Balde, M. D., Maya, E., & et al. (2019). How women are treated during facility-based childbirth in four countries: A cross-sectional study with labour observations and community-based surveys. Lancet, 394(10210), 1750–1763. https://doi.org/10.1016/S0140-6736(19)31992-0
37. United Nations. Human rights-based approach to mistreatment and violence against women in reproductive health services, with special emphasis on childbirth and obstetric violence (A/74/137). 2019 Jul 11.
38. Assembly P. Obstetrical and gynaecological violence. European Council. 2019.
39. World Health Organization. World Mental Health Report: Transforming Mental Health for all. https://www.who.int/publications/i/item/9789240049338
40. Pozza A, Dèttore D, Coccia ME. Depression and Anxiety in Pathways of Medically Assisted Reproduction: The Role of Infertility Stress Dimensions. Clin Pract Epidemiol Ment Health. 2019;15:101-109.
41. Cui W. Mother or nothing: the agony of infertility. Bull World Health Organ. 2010;88(12):881-2.
42. Gameiro S, van den Belt-Dusebout AW, Smeenk JM, Braat DD, van Leeuwen FE, Verhaak CM. Women's adjustment trajectories during IVF and impact on mental health 11–17 years later. Hum Reprod. 2016;31(8):1788-1798.
43. El País. Spain, the European egg barn. El País. 2019 Jul 20.https://elpais.com/sociedad/2019/07/19/actualidad/1563531405_529791.html
44. Piersanti V, Consalvo F, Signore F, Del Rio A, Zaami S. Surrogacy and "Procreative Tourism": What Does the Future Hold from the Ethical and Legal Perspectives? Medicina (Kaunas). 2021;57(1):47.
45. Department of Statistics of the Ministry of Health. Statistical Report on Assisted Reproduction Techniques, 2019. Ministry of Health; 2021. https://cnrha.sanidad.gob.es/registros/actividades.htm
46. European Parliament. European Parliament resolution of 17 December 2015 on the Annual Report on Human Rights and Democracy in the World 2014 and the European Union’s policy on the matter. https://www.europarl.europa.eu/doceo/document/TA-8-2015-0470_EN.html/, 2017.
47. United Nations. Sale and sexual exploitation of children, including child prostitution, child pornography and other child sexual abuse material. https://digitallibrary.un.org/record/1638578?v=pdf, 2018.
48. United Nations. Convention on the Rights of the Child. https://www.un.org/es/events/childrenday/pdf/derechos.pdf/, 1989.
49. United Nations. Optional Protocol to the Convention on the Rights of the Child on the involvement of children in armed conflict. https://www.ohchr.org/en/instruments-mechanisms/instruments/optional-protocol-convention-rights-child-involvement-children/, 2000 (accessed 25 May 2000).
50. Government of Spain. Penal Code. Off State Gaz. 1995. https://www.boe.es/eli/es/lo/1995/11/23/10/con/,1995.
51. Government of Spain. Law 54/2007, of December 28, on international adoption. https://www.mjusticia.gob.es/es/AreaTematica/DocumentacionPublicaciones/Documents/Act%2054-2007%2C%20of%20December%2028th%2C%20on%20Intercountry%20Adoption-Ley%2054-2007.pdf/, 2007.
52. Pardo-Miranda M. Illegal adoption and surrogacy as purposes of the crime of human trafficking. Anales Derecho. 2023;40. https://digitum.um.es/digitum/handle/10201/128487?mode=full
53. Irwin, R. (2024). Politics, law and a lack of sperm: single women and fertility treatment in the Swedish health system. Anthropology & Medicine, 31(1–2), 89–103. https://doi.org/10.1080/13648470.2023.2274684.
54. Boladeras M. Anonymity in gamete donation: Does the current situation need improvement? Musas. 2023;8(1):05-20. https://doi.org/10.1344/musas2023.vol8.num1.1
55. Government of France. Law n° 2021-1017 of August 2, 2021, on bioethics. Off J Fr Rep. 2021.
56. Council of Europe, Parliamentary Assembly. Anonymous donation of sperm and oocytes: balancing the rights of parents, donors and children (Recommendation 2156). 2019.
57. Spanish Bioethics Committee. Report of the Spanish Bioethics Committee on the right of children born through assisted reproductive techniques to know their biological origins. 2020.
58. Muñoz M, Abellán-García F, Cuevas I, de la Fuente A, Iborra D, Mataró D, et al. Document on the position of the Spanish Society of Fertility regarding the anonymity rule in gamete donations. Fase 20 Ediciones: 2019.
59. Hammond K. The role of normative ideologies of motherhood in intended mothers' experiences of egg donation in Canada. Anthropol Med. 2018;25(3):265-279.
| Files | ||
| Issue | Vol 19, No 2 (June 2025) | |
| Section | Review Articles | |
| DOI | https://doi.org/10.18502/jfrh.v19i2.19296 | |
| Keywords | ||
| Women Human Rights Assisted Reproductive Techniques Reproductive Health Right to Identity | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Paricio-del-Castillo R, Cano-Linares M de los Ángeles, Díaz de Neira Hernando M. A Human Rights-Based Approach to Health in Assisted Reproductive Care in Spain. J Family Reprod Health. 2025;19(2):85-96.
