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El Salvador

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OVERVIEW

Generally speaking, El Salvador is a conservative country when it comes to sexual and reproductive health care. Technically speaking, you can purchase birth control without a prescription and many forms of contraception are available. However, in reality, birth control pills are expensive and inaccessible for some people, and they are used by a very small percentage of Salvadoran women. The most common forms of contraception are female sterilization and injectables. Regarding emergency contraception (the morning after pill), you may technically need a prescription, but this doesn't seem to be widely enforced as locals report buying it over-the-counter in San Salvador. Regarding STIs, there are no travel or residency restrictions, and you can get tested at many clinics. There is no PrEP program or nationwide HPV vaccination program. You can find pads very easily and tampons are sold in select locations, which we list in the "Menstruation" section. We know of at least one seller of menstrual cups in El Salvador. There is maternity leave for 12 weeks, but we don't know how often women actually find coverage in less official or regulated jobs. Finally, El Salvador has one of the strictest abortion laws in the world, prohibiting abortion in all cases. For more details, visit the "Abortion" section. As there are many unsafe clandestine abortions that are performed in El Salvador each year, it's strongly recommended that someone exercises extreme caution if they are considering going down this route.

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 El Salvador, you can purchase contraception (birth control) without a prescription.[1] [2] According to a 2015 report, 70.7% of Salvadoran women (who are married or in unions) use any form of contraception, including traditional methods. The most common forms of contraception are female sterilization (34.4%), injectables (19.5%), pills (4.8%) and male condoms (4.2%).[3]

El Salvador has one of the highest rates of female sterilization in Latin America and the Caribbean. The rise in female sterilization began in the late 1970s, when many women began obtaining tubal ligation. Between 1975 and 1985, the number of women (of childbearing age) who had been sterilized rose from 10% to 31%. Many of the women who have received sterilization are quite young (in 2004, almost 25% of women under 30 had been sterilized), and young women often regret getting the procedure done so early in their lives. It is common for young women to try to reverse the surgery. Typically, women are offered the option of sterilization when they're obtaining prenatal or post-natal care (as a way to prevent future births), and they say that they often choose to have the surgery because they're concerned about the reliability or side effects of contraceptives.[4]

Since the 1960s, family planning services have been available through the Ministry of Health and the Social Security Institute of El Salvador (ISSS) and the Asociación Demográfica Salvadoreña (ADS), a private affiliate of the International Planned Parenthood Federation.[5]

What to Get & Where to Get It[edit]

  • For a comprehensive list of available contraceptives in El Salvador, click here.
  • In El Salvador, you can purchase birth control pills ("píldoras anticonceptivas” in Spanish) at pharmacies without a prescription. Some pharmacies may refuse to sell you contraception due to their religious or personal beliefs, but you'll find many other pharmacies that do sell contraception There are over 20 birth control pill brands registered in El Salvador, including combined and phasic pills. Some of the brands you can expect to see are Cilest, Diane-35, Femiane, Gynovin, Lo-Femenal, Miranova, Microgynon, Nordette, Yasmin, Yaz and more other brands. For a full list, click here.
  • In Spanish, the word for "condom" is "condón."
  • If you want contraceptive injections ("anticonceptivo inyectable” in Spanish), there are over 20 injectable brands available in El Salvador, including Depo-Provera, Norigynon Noristerat and other brands. In many Latin American countries, you can get the injection directly at the pharmacy, but we're not sure if this is possible in El Salvador. For a full list of injectables available, click here.
  • If you want contraceptive implants ("implante anticonceptivo” in Spanish), you should be able to find Norplant and Jadelle in El Salvador.[6]
  • If you want an IUD ("DIU” in Spanish) or IUS, you should be able to get copper or hormonal IUDs in El Salvador. From Aleida Parducci @ the Gineceo, you can get Mirena (hormonal) IUS for $300 or the IUD Copper 380 for $75. For the copper IUD, you can get it from Dra alicia corleto carpio for (we think) $40.

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]

From a legal standpoint, it appears that you need a prescription to obtain emergency contraception (the morning after pill) in El Salvador.[7] However, this law may not be enforced, so we'll need to confirm this (does anyone know?).

What to Get & Where to Get It[edit]

  • In El Salvador, you can find dedicated emergency contraception. For anti-progestin EC, you should take 1 pill within 120 hours after unprotected sex. Here are the brands you may find: Duprisal 30[8]
  • For progestin only EC, you should take 1 pill within 120 hours after unprotected sex. Here are the brands you may find: Postinor [9]
  • If you cannot access dedicated emergency contraception, you can use some oral contraceptives (regular birth control pills) as replacement EC. To do this, you should remember that, in 28-day packs, only the first 21 pills can be used. Here is what you can use:
    • Take 2 pills within 120 hours after unprotected sex and take 2 more pills 12 hours later: Denoval, Eugynon, Neogynon, Nordiol, Ovral[10]
    • Take 4 pills within 120 hours after unprotected sex and take 4 more pills 12 hours later: Lo-Femenal, Microgynon, Nordette[11]
  • Remember that IUDs can also prevent pregnancy for up to 5 days after unprotected sex. Check out the "Contraception (Birth Control)" section for details.

Costs[edit]

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]

There are currently no travel or residency restrictions related to HIV status, according to HIVTravel. In the past, there were a restrictions, but this was repealed.[12] It is estimated that 20,000 people are living with HIV in El Salvador, accounting for 0.5% of the adult population (ages 15-49).[13]

Regarding HPV, according to the HPV Information Centre, "Cervical cancer ranks as the 1st most frequent cancer among women in El Salvador 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 El Salvador. However, in Central America, the region El Salvador belongs to, about 4.7% of women in the general population are estimated to harbour cervical HPV- 16/18 infection at a given time, and 63.1% of invasive cervical cancers are attributed to HPVs 16 or 18."[14]

Testing Facilities[edit]

Check out the city pages, like the San Salvador page, for local recommendations.

Support[edit]

  • UNAIDS El Salvador
  • Asociacian Atlacatl Vivo Positivo (Atlacatl): 81 Avenida Norte y 13 Calle Poniente N. 749, Colonia Escalón, San Salvador. Tel +503 2298-3950, +503 2298-5801, +503 2298-4697.
  • Comisión Nacional Contra el SIDA, CONASIDA: Address: Ministerio de Salud, Calle Arce No.827, San Salvador, Telephone: +503 800 7012
  • Fundación Contrasida: Address: Colonia Médica, 23 Avenida Norte, # 1326, San Salvador, Telephone: +503 2235 2795, Email: coordinacion.general@fundacioncontrasida.org
  • Fundasida El Salvador - Fundación Nacional Para la Prevención, Educación y Acompañamiento de la Persona con VIH: Address: 13 Avenida Norte # 244 entre 1a y 3a Calle Poniente, Centro Historico, San Salvador, Telephone: +503 2221 0029, Email: ort.fran@gmail.com.
  • Ministerio de Salud - Programa de ITS/VIH SIDA: Address: Ministerio de Salud, Calle Arce Número 827, San Salvador, Telephone: +503 22057302, Fax: +503 2221 0790. Email: anieto@salud.gob.sv.
  • Red Centroamericana de Personas con VIH-Sida (REDCA+) - Secretaría Regional: Address: 85 Av. Norte y 13 calle Poniente No. 749 Col. Escalón, San Salvador, Telephone: +503 2298 5801, Email: otoramirez@gmail.com

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.
  • There is no nationwide HPV vaccination program in El Salvador. However, you may be able to get the HPV vaccine at a hospital or clinic.[15]
  • There is no PrEp program in El Salvador.

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]

While you can easily find pads, tampons tend to be more difficult to find. You can try to look for them in larger and international chain stores, especially in larger cities like San Salvador. As for menstrual cups, you can find the iCare Copa Menstrual, which is only sold in El Salvador and Guatemala. In El Salvador, you can find it sold at Bichos (Centro Comercial Galerías, 3er nivel Kiosco, San Salvador, Teléfono: +503 6422 3151) or at Closicloset (Calle La Mascota Edificio 316 local 1, San Salvador, Teléfono: +503 6422 3151). You can also buy the FemmeCycle menstrual cup from Traetelo, a Salvador online retailer, though the total price with shipping is very expensive - link here.

Costs[edit]

Gynecological Exams[edit]

Laws & Social Stigmas[edit]

What to Get & Where to Get It[edit]

Check out the city pages, like the San Salvador page, for local recommendations.

Costs[edit]

Pregnancy[edit]

Laws & Social Stigmas[edit]

What to Get & Where to Get It[edit]

In El Salvador, women are given 12 weeks of maternity leave with 75% of their wages covered.[16]

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 El Salvador, abortion is completely prohibited. No matter the reason, including when pregnancy endangers the life of the woman, when pregnancy endangers the physical or mental health of a woman, when the pregnancy is the result of rape or incest or when there is serious risk of fetal impairment, abortion is not permitted. If a woman is found to have illegally terminated her pregnancy, she can face up to 12 years in prison. Depending on the stage of a pregnancy, prosecutors can charge the women with homicide, which carries a penalty of up to 40 years in prison.[17] Today, in El Salvador, some women sit in prison due to these strict laws. You can read an article about a lawyer who defends some of these women here.

As reported in Foreign Policy, "Doctors, nurses, and pharmacists who offer a defiant reprieve from the law find themselves on the front lines of this underground industry. They risk prison terms to provide clandestine abortions inside public hospitals, private clinics, or outside facilities. Many of them operate independently or in small groups, unaware of the others. If they’re caught, they face six to 12 years in jail.".[18]

Before 1998, El Salvador allowed abortion under limited circumstances. However, following a bill proposed by by the Nationalist Republican Alliance (ARENA) in 1997, a new Penal Code was introduced in 1998. The current laws are strongly supported by the Catholic Church and pro-life lobby. However, there are also vocal opponents, including IPAS, MADRE and Women's Link Worldwide. These groups claim that Salvador abortion laws go against many treaties signed by El Salvador, so they have submitted a report to the United Nations Human Rights Committee.[19]

What to Get & Where to Get It[edit]

  • There is an underground network of abortion providers in El Salvador. Since it's completely illegal, we cannot direct you to any resources. If you want to find a providers, you should carefully consult only people you trust. It appears that many of the providers do have access to "the abortion pill," so you can get a clandestine medical abortion (and you can probably get a surgical one too).
  • You can potentially get the "abortion pill" by mail. Check out this link for details.
  • You can legally obtain an abortion on request in Mexico City or the United States.

Costs[edit]

Depending on the woman's needs, one clandestine abortion provider (who is also a certified doctor ) in El Salvador charges between $0-$1000.[20]

Advocacy & Counseling[edit]

Laws & Social Stigmas[edit]

What to Get & Where to Get It[edit]

Costs[edit]

List of Additional Resources[edit]

  • ORMUSA: "ORMUSA, the Organization of Salvadoran Women for Peace, is dedicated to working for gender equality and economic, social and political women’s empowerment."
  • Melida Anaya Montes Women’s Movement (MAM): "MAM is a feminist organization founded in 1992 that works to promote women’s rights through education and health promotion, programs to combat gender-related violence, citizen engagement and the promotion of labour rights. The organization operates at the national level, working in 11 of the country’s 14 departments."

References[edit]

  1. Global Oral Contraception Availability
  2. [Online conversation with El Salvador local, December 2017]
  3. [http://www.un.org/en/development/desa/population/publications/pdf/family/trendsContraceptiveUse2015Report.pdf Trends in Contraceptive Use Worldwide 2015]
  4. El Salvador Survey Shows Lower Fertility, Increased Contraceptive Use
  5. UN Report: El Salvador - Abortion Policy
  6. IPPF El Salvador
  7. EC Status and Availability: El Salvador
  8. Princeton EC Website
  9. Princeton EC Website
  10. Princeton EC Website
  11. Princeton EC Website
  12. EL SALVADOR - REGULATIONS ON ENTRY, STAY AND RESIDENCE FOR PLHIV
  13. El Salvador HIV and AIDS estimates (2015)
  14. El Salvador Human Papillomavirus and Related Cancers, Fact Sheet 2016
  15. El Salvador Human Papillomavirus and Related Cancers, Fact Sheet 2016
  16. Parental Leave
  17. On the Front Lines of El Salvador’s Underground Abortion Economy
  18. On the Front Lines of El Salvador’s Underground Abortion Economy
  19. Abortion in El Salvador
  20. On the Front Lines of El Salvador’s Underground Abortion Economy