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Bolivia

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OVERVIEW

In Bolivia, you can purchase birth control pills without a prescription at pharmacies. While you technically need a prescription to purchase emergency contraceptive pills (morning after pills), this does not seem to be widely enforced and locals report you can buy it without a prescription at pharmacies. There are no travel or residency restrictions attached to HIV status. If you can afford it, the best gynecologists are generally found at private hospitals. There is no PrEP program, but Bolivia does have a nationwide HPV vaccination program. There is a maternity leave policy but not paternity leave policy. Abortion is only permitted under very specific circumstances.

Contraception (Birth Control)[edit]

General Note: There are many types of contraceptives, also known as "birth control," including IUDs, oral contraceptives, patches, shots, and condoms, etc. If you would like to view a full list, click here.

Laws & Social Stigmas[edit]

In Bolivia, oral contraceptives (birth control pills) are available without a prescription at pharmacies.[1] [2] It is estimated that about 62% of Bolivian women (who are married or in unions between the ages of 15 and 49) use some form of contraception and that 40% use a modern contraceptive method. Furthermore, it's estimated that 18% have unmet family planning needs. The most popular methods of contraception are the rhythm method (17.1%), injectables (13.6%), IUDs (10.1%), female sterilization (7.8%) and male condom (4.8%). Other methods include the pill and withdrawal, but they were used by only 4% of women on average.[3]

What to Get & Where to Get It[edit]

  • You can purchase birth control pills ("píldoras anticonceptivas") in Bolivia without a prescription at pharmacies, clinics, or social marketing programs. There are at least 12 birth control pill brands that you can find in Bolivia including Diane-35, Microgynon, Microgynon-30, Minigynon, Nordette, Norvetal, Yasmin and Yaz. For birth control pill information from Marie Stopes Bolivia, click here.
  • You can find male ("condón masculino") and female condoms ("condón femenino") in Bolivia. Click [1] here for information on male condoms (in Spanish) and click here for information on female condoms (in Spanish) from Marie Stopes Bolivia.
  • If you want an IUD ("El DIU"), you can get it at Marie Stopes. They have both the hormonal IUD or the copper IUD.
  • If you want the contraceptive implant ("implante anticonceptivo"), you can get the FEMPLANT at Marie Stopes. At CIES, they can also provide implants (price was 200Bs. in June 2015).
  • If you want a contraceptive shot/injectable ("anticonceptivo inyectable"), you can find Cyclofem, Cyclofemina, Depo-Provera and Mesiyna in Bolivia. You can get monthly or quarterly injectables at Marie Stopes.

Costs[edit]

Emergency Contraception (Morning After Pill)[edit]

Important Notes: Emergency contraception may prevent pregnancy for three days (72 hours) and sometimes five days (120 hours) after unprotected sex. Take EC as soon as possible after unprotected sex. If you don't have access to dedicated EC, oral contraceptives can be used as replacement EC, but remember the following: 1) Only some contraceptives work as EC 2) Different contraceptives require different dosages and time schedules to work as EC 3) You must only use the first 21 pills in 28-day packs and 4) They may be less effective than dedicated EC. For general information on emergency contraceptives, click here and here.

Laws & Social Stigmas[edit]

In Bolivia, emergency contraception (the morning after pill) is technically only available by prescription. However, locals report that emergency contraception, along with many other medications, are still sold by pharmacists over-the-counter. If you want to purchase EC, there are no age restrictions. According to Bolivian law, health care providers and pharmacists can refuse to sell EC to you for moral or religious reasons. However, if one health care provider does not sell you EC, you should not give up; there are other providers that will sell it to you without issue. Note that there are many dedicated EC brands available in Bolivia, indicating that you indeed can find EC.

Important Note: In Bolivia, many pharmacies are not open 24 hours or on Sundays. Fortunately, you can find a "farmacia de turno," which translates to on-shift pharmacy. This is a pharmacy that, by law, is taking a required shift to be open on Sundays, so that the residents of a given city can still access pharmacies. So, this means that you can indeed find open pharmacies on Sundays -- you'll just need to know which one is currently open, and it may be a bit of a journey to get there. The newspapers list which pharmacies are "de turno" for each Sunday, including their address and phone number.

What to Get & Where to Get It[edit]

  • You can purchase dedicated emergency contraception in Bolivia at public sector clinics, private clinics and pharmacies. For anti-progestin brands, you can find UPRIS (take 1 pill within 120 hours after unprotected sex). For progestin only brands, you can find Glanique 1, Impreviat and Postinor 1 (take 1 pill within 120 hours after unprotected sex). Other progestin only brands you can find are Glanique, Imediat N, Pilem, Postinor-2, Pregnon and Tace (take 2 pills within 120 hours after unprotected sex).[4]
  • You can have an IUD inserted to prevent pregnancy. Please refer to the "Contraception" section for details.
  • If you can't access dedicated emergency contraception, you can use regular oral contraceptives (birth control pills) as emergency contraception. For combined pills (progestin-estrogen), you'll need to remember that, in 28-day packs, only the first 21 pills can be used. You can take Microgynon CD (take 4 pills within 120 hours after unprotected sex and take 4 more pills 12 hours later). You can take Microgynon, Microgynon-30, Minigynon, Nordette or Norvetal (for all of these brands, take 4 pills within 120 hours after unprotected sex and take 4 more pills 12 hours later).[5]

Costs[edit]

LNG Products: $8.00 (55.50 Bolivianos), as of June 2014. UPA Products: $15.00 (102 Bolivianos), as of June 2014.

Sexually Transmitted Infections (STIs/STDs)[edit]

Important Notes - Learn about PEP and PrEP: If you think that you've been recently exposed to HIV (i.e. within 72 hours), seek out PEP (Post-Exposure Prophylaxis). It's a month-long treatment to prevent HIV infection after exposure, and it may be available in your city. Take PEP as soon as possible. For more information, click here. If you are at risk of HIV exposure, seek out PrEP (Pre-Exposure Prophylaxis). It's a daily oral pill that can prevent HIV infection before exposure. To learn more about PrEP, click here.

Laws & Social Stigmas[edit]

To say STD in Spanish, say "enfermedades de transmisión sexual."

There are no travel restrictions tied to HIV status. This means that you can enter the country without a medical certificate. You can also import antiretroviral drugs.[6] However, if you want to apply for residency in Bolivia, you will probably be asked to take an HIV test as part of your application process. This has been confirmed the case as late as July 2017. If you have a positive test result, we don't know if this will disqualify you.

In Bolivia, it is estimated that 0.3% of the population is HIV positive, according to data from 2015.[7] You can read an account of some of the challenges of living with HIV in Bolivia here.

Regarding HPV, according to the HPV Information Centre, "Current estimates indicate that every year 2029 women are diagnosed with cervical cancer and 845 die from the disease. Cervical cancer ranks as the 1st most frequent cancer among women in Bolivia and the 1st most frequent cancer among women between 15 and 44 years of age. Data is not yet available on the HPV burden in the general population of Bolivia. However, in South America, the region Bolivia belongs to, about 12.1% of women in the general population are estimated to harbour cervical HPV-16/18 infection at a given time, and 62.7% of invasive cervical cancers are attributed to HPVs 16 or 18."[8]

Testing Facilities[edit]

  • Clinica Del Sur: They have staff who speak Spanish, English, Dutch and Portuguese. They have a laboratory. Emergencies: 2784001- 2784002. Patient: 2784750 - 2784755. lnternational: (591-2) 278400. Fax: (591-2) - 2,784,753.
  • Clinica Pro Salud: Has a laboratory and should be able to give tests.

Support[edit]

Costs[edit]

Medications & Vaccines[edit]

Laws & Social Stigmas[edit]

What to Get & Where to Get It[edit]

  • If you have a yeast infection ("infección por levaduras" in Spanish), you can ask the pharmacist for Fluconazole, which is antifungal medication. They'll be able to give you Fluconazole or something similar.
  • If you have a urinary tract infection ("Infecciones de las vías urinarias" in Spanish), you can contact a doctor/pharmacist to find out next steps.
  • You can find the HPV vaccine in Bolivia. There is also a nationwide HPV vaccination pilot program in place.[9]
  • There is currently no PrEP program in place in Bolivia, as of January 2017.[10]

Costs[edit]

Menstruation[edit]

Note: In addition to pads and tampons, you can also use menstrual cups and menstrual underwear for your period. To learn more about menstrual cups, click here. To learn more about menstrual underwear, click here.

Laws & Social Stigmas[edit]

What to Get & Where to Get It[edit]

In Bolivia, you can easily find pads. You'll find some tampons in certain supermarkets (especially in more urban areas, like La Paz), but they will typically be non-applicator tampons (like OB) and you won't find much variety. As for menstrual cups, you can buy Mia Luna Menstrual Cups for 220 Bolivianos from Warmi Yasi, which is a Bolivian company that sells alternative and eco-conscious menstrual products. They can be reached through their Facebook page, phone (Call +591 72558332) or email (warmiyasi@gmail.com). There appears to be no official there appears to be no official sellers of major brands, like DivaCup, LadyCup or Lunette, so you should try to buy them online or find a small-scale boutique seller.

Costs[edit]

Gynecological Exams[edit]

Laws & Social Stigmas[edit]

What to Get & Where to Get It[edit]

Public & Low-Cost Options[edit]

While public hospitals are generally less efficient and less well-equipped, they are the only option available to many Bolivians. They can also receive free health care at these facilities under Caja Nacional de Salud (National Health Fund). If you cannot afford a private hospital and you're a Bolivian national, we recommend that you contact [www.mariestopes.org.bo/ Marie Stopes - Bolivia] to learn about their gynecological exam options.

Private Hospitals[edit]

  • Alemena Clinic (German Hospital): This is potentially the best hospital in La Paz, and it's recommended by many locals. It's a private international hospital, so it will be more expensive. They have a general gynecology department, which includes: Management of endometriosis, uterine fibroids, ovarian cysts, metrorrhagia, endocrine disorders of women, pathology of the cervix, and breasts. Address: Av.6 de Agosto 2821, La Paz, Bolivia. Phone: +591 2 2432155.
  • Clinica Del Sur: This is one of the best clinics in Bolivia. Since it's a private hospital, it will be more expensive.
  • Clinica Cemes: This is considered one of the best clinics in Bolivia, and many of its ob/gyns are on the list of recommended physicians from the US Embassy in La Paz. Some of the recommended practitioners include:
    • Dr. Ovidio Suárez: This is an ob/gyn who is recommended by the US Embassy. Address: Edificio Illimani, Piso 1, Of. B, Avenida Arce esquina Campos, Phones: 243-1501/243-1578, Mornings: Clínica Cemes, Phones: 243-0360/50.
    • Dr. Marcelo Koziner Udler (Post Advisor): This ob/gyn is on the list of doctors from US Embassy, which is usually a good sign. Address: Edificio Altamira Piso 1, #102, Ave. Arce. Phone: 243-3724, Calle 21 #8514, Edif. Basaure #1D, Calacoto. Phones: 279-5668/279-8243. Also early in the morning: CEMES CLINIC. Phone: 243-0360 .
  • Clinica Unifranz: This clinic is connected to Unifranz University and it's considered a good clinic. Address: Landaeta Nro. 1855 esq. Héroes del Acre, Frente Instituto Americano - La Paz, LA PAZ. Email: info@clinicaunifranz.org
  • Dr. Jaime Terán: This is a US-trained ob/gyn who is recommended by the US Embassy. Address: Edificio Rhesus, Calle G #1367, Calles Rene Moreno y Claudio Aliaga, Phone: 279-6589

Costs[edit]

Pregnancy[edit]

Laws & Social Stigmas[edit]

In Bolivia, mothers get 13 weeks of maternity leave with 95% of their wages covered. There is no paternity leave policy.[11]

What to Get & Where to Get It[edit]

Costs[edit]

Abortion[edit]

Important Note: There are two main types of abortions: medical (also known as the "abortion pill") and surgical (also known as "in-clinic"). For medical abortions, you take a pill to induce abortion. For surgical abortions, a procedure is performed to induce abortion. For general information about medical and surgical abortions, click here.

Laws & Social Stigmas[edit]

In Bolivia, abortion is only permitted under certain circumstances, which are: if the pregnancy threatens the life/health of the women, or if the pregnancy is the result of rape or incest. If the woman is seeking an abortion on the grounds of rape, she must file a police report. Fortunately, since 2014, women no longer need permission from doctors to receive the procedure, which was a huge issue in the past and lead women (who were legally entitled to receive abortions) to seek out clandestine ones instead (due to lack of doctor's approval).[12]

Technically, Bolivian law punishes people who consent to or perform abortions, but it's not clear if this is often enforced. According to the laws, if a person illegally performs an abortion with the pregnant woman's consent, of if the pregnant woman as under sixteen years of age, that person can receive one to three years in prison. If the woman did not consent to the abortion, that person can get to two to six years in prison. Furthermore, if a woman consents to an abortion, she may receive one to three years in prison. If the abortion was approved by the pregnant woman but it was supposedly done to "save her honor," the woman may receive a lighter sentence.[13]

Despite these strict laws, clandestine abortions are performed every day in Bolivia. Many women seek out abortions for reasons that are not covered under Bolivian law, so they must seek out underground providers. There are also many women who are technically covered under Bolivian law, yet they still experience bureaucracy, social stigmas or lack of resources, leading them to seek out clandestine abortion providers. While figures vary, it is estimated that about 60% of all pregnancies in Bolivia are unintended[14] and, in 2015, it was estimated that 185 illegal abortions happen in Bolivia every day.[15] Many of these clandestine providers are not medically trained or do not have the proper equipment, so please exercise extreme caution if you seek them out.

As of January 2017, Bolivian courts have rejected challenges to existing abortion laws, despite reproductive rights groups calling for a more open abortion policy.[16] The organizations that are probably the most prominent in the fight for reproductive rights in Bolivia are IPAS, an international NGO and the Movement for Socialism, a a Bolivian left-wing political movement. The strongest opponents are the Catholic Church and conservative Catholic groups.

What to Get & Where to Get It[edit]

  • You can potentially get the "abortion pill" by mail. Check out this link for details
  • If you are looking to obtain an abortion, there is a probably an underground network of pro-choice doctors and feminists who may help you. Ask around.
  • If you are considering leaving the country to obtain a legal abortion, you can legal abortions on request in Uruguay, Guyana, French Guiana, Mexico City and the United States. You can get abortions when the woman's life endangered or to preserve the woman's physical/mental health in Argentina and Peru.

Costs[edit]

There are probably underground abortion providers for "rich people" that are known to be trustworthy yet expensive. We don't know the costs.

If you are pregnant and considering getting an abortion outside Bolivia, you will need to consider the following costs: transportation to the country where you will be obtaining an abortion, hotel or accommodation costs in that country, cost of the abortion in the country and the total amount of days you may need to be in the country both before and after the abortion.

Advocacy & Counseling[edit]

Laws & Social Stigmas[edit]

What to Get & Where to Get It[edit]

  • Police: Call 110
  • Ambulance: Call165
  • Fire department: Call 119
  • The CUBE Centre: The CUBE Centre focuses on sexual violence prevention and support. They provide legal, psychological and social support to over 1,500 survivors. Address: Mayor Rocha #166 entre Junin y Ayacucho, Cochabama, Bolivia. Telefono: 4537506 y 5527505. Email: cube.ccba@gmail.com. You can also contact them on Facebook. Hours: Monday to Friday - 8:00-12:30 y 14:00- 18:30.
  • A Breeze of Hope (ABH): "Founded in 2004, A Breeze of Hope Foundation exists to provide free legal, social, and psychological services to victims of sexual violence, to eradicate sexual violence through transdisciplinary prevention strategies, and to foster a society that encourages healthy and comprehensive childhood development." Email: parkerpalmer@abreezeofhope.org, brisadeangulo@abreezeofhope.org​​
  • IJM - Bolivia: They work to defend children from sexual violence. They provide the following services: Rescue Victims ("We partner with the Bolivian National Police and Defensoría de la Niñez (Bolivian social services) to rescue children who are at risk of further abuse and bring them into safe places"); Bring Criminals to Justice ("We support the Bolivian National Police to locate and arrest suspects, and partner with government prosecutors to ensure that child rapists and pedophiles are convicted."); and Restore Survivors ("We provide trauma-focused therapy for children who have endured sexual violence, and help survivors who choose to participate in the trial prepare to share the truth in court. We make sure families have the support they need, so children can heal in a stable environment").

Costs[edit]

List of Additional Resources[edit]

  • Equaldex Bolivia: This website provides information on LGBTQ rights and laws in Bolivia. As of 2018, homosexuality is legal in Bulgaria and it is legal to change gender (but a surgery is required to do so). There are laws against employment or housing discrimination based on sexual-orientation or gender. However, gay marriage is not legal in Bolivia.
  • Marie Stopes International - Bolivia: Marie Stopes International Bolivia has 7 fixed centers, 6 community extension units and 6 clinics for adolescents and young people. Address: Calle Guerrileros Lanza No. 1238 (between Guatemala and San Salvador) Miraflores area. Casilla: 619 - La Paz, Bolivia. Telephones: (591-2) 2242476. Email: info@mariestopes.org.bo. WhatsApp Line: 789-98014. Confidential Line: 901-111-901
  • CIES: "We are a private non-profit social development organization that contributes to the exercise of the DSDR to improve the quality of life of Bolivian urban and rural population, with an emphasis on the one that lives in situations of vulnerability. We develop the CIES sexual and reproductive health promotion and assistance model, which has a comprehensive and innovative approach, with a gender, generational and intercultural approach."
  • Centro de Desarrollo Integral de la Mujer Aymara Aymata "Amuyt’a" (CDIMA): "CDIMA is a leading indigenous women’s rights organisation in Bolivia, founded in 1989 to promote Aymara women’s rights, cultural identity and women’s access to social, political and economic rights."
  • Centro de Promocion de Mujer Gregoria Apaza (CPMGA): "CPMGA has established successful leadership and violence prevention courses in Bolivia and runs an influential radio station which broadcasts powerful social messages. The organisation's vision is of a society where women and men can exercise their democratic and human rights without discrimination."
  • Womankind - Bolivia: "Our partners - local or national women’s rights organisations - provide direct support for women and girls, from a safe place to escape violence or information about their rights to leadership training or funding to start their own business. They also work to change laws and policies which discriminate against women and girls, and challenge the damaging attitudes and stereotypes at the root of inequality."

References[edit]

  1. Global Oral Contraception Availability
  2. Free the Pill World Map
  3. Trends in Contraceptive Use Worldwide 2015
  4. Princeton EC Website
  5. Princeton EC Website
  6. BOLIVIA - REGULATIONS ON ENTRY, STAY AND RESIDENCE FOR PLHIV
  7. UNAIDS: Bolivia
  8. Bolivia: Human Papillomavirus and Related Cancers, Fact Sheet 2016
  9. Bolivia: Human Papillomavirus and Related Cancers, Fact Sheet 2016
  10. PrEPWatch: World Map
  11. Parental Leave
  12. Bolivia eases strict abortion law - rights group
  13. UN Report: Abortion in Bolivia
  14. Unmet Need for Contraception in Developing Countries: Examining Women’s Reasons for Not Using a Method
  15. Bolivians Call for Abortion To Be Decriminalized
  16. For Abortion Rights in Bolivia, A Modest Gain