Colombia/en

Resumen

Como capital de Colombia, encontrará muchos recursos de atención médica en Bogotá. Sin embargo, debe conocer la complejidad de la salud reproductiva y sexual en el país. Por un lado, Colombia es una nación principalmente católica, y muchos colombianos le dan gran importancia a la Iglesia Católica. Como resultado, algunos personal médico pueden tener puntos de vista sociales tradicionales, que puede afectar la forma en que interactúan con los pacientes. Además, la sociedad colombiana es tradicionalmente patriarcal, y algunas mujeres pueden tener dificultades en lograr plena autonomía e independencia, aunque esto varía con cada individuo, familia y comunidad.

Por otro lado, Colombia ha visto una expansión grande de sus servicios de planificación familiar en las últimas décadas, particularmente la de la Asociación Pro-bienestar de la Familia Colombiana (Profamilia), afiliado de la Federación Internacional de Planificación de la Familia, que tiene sesenta seis clínicas y unidades móviles de salud, y casi las tres cuartas partes de la capacidad de planificación familiar del país. Como resultado, la tasa de fertilidad ha disminuido de 6 niños por mujer en los 1960s a un nivel justo por encima del reemplazo (unos 2 niños por mujer) a partir de 2017. Esto se debe a la alfabetización, los servicios de planificación familiar y la urbanización en el país. Mientras tanto, la homosexualidad, el matrimonio homosexual y el cambio de género son todos legales en Colombia.

En general, los anticonceptivos, como las píldoras anticonceptivas y los condones, son legales y son ampliamente disponibles. La anticoncepción de emergencia también es legal y una prescripción técnicamente puede ser necesaria, pero parece fácil obtener independientemente si la mujer no tiene la prescripción. Sin embargo, algunos menores de edad pueden tener dificultades en obtener píldoras anticonceptivas de emergencia, especialmente si se ven como menores de edad. Si es un adolescente, legalmente puede comprar anticonceptivos de emergencia, pero es posible que deba contactar varios farmacéuticos antes de encontrar uno que le conceda acceso a anticoncepción de emergencia. Con respecto a las ITS (infecciones de transmisión sexual), no existen restricciones de viaje o residencia relacionadas con el estado del VIH en Colombia. Además, hay muchos lugares donde uno se puede hacer pruebas de ITS, incluyendo clínicas móviles, en toda Colombia, aunque las tasas de pruebas de ITS siguen siendo generalmente bajas en el país.

De acuerdo con la ley colombiana, las mujeres tienen derecho a 14 semanas de licencia de maternidad. Desde 2006, el aborto ha sido legal para ciertos casos en Colombia, pero aún no está disponible si se solicita. Actualmente solo está disponible según tres criterios. Tenga en cuenta que todavía hay muchos casos de abortos inseguros e ilegales en Colombia, por lo que es importante investigar con anticipación a los proveedores y los procedimientos previstos.

Anticoncepción (Control de la natalidad)

Leyes y estigmas sociales

En Colombia, los anticonceptivos orales (píldoras anticonceptivas) y los condones son legales y son ampliamente disponibles. Se pueden comprar en farmacias y no se requiere receta. Sin embargo, para otros métodos anticonceptivos, como implantes anticonceptivos, inyectables o DIU, necesitará visitar a un médico o un profesional de farmacia capacitado.

Generalmente las mujeres colombianas usan anticonceptivos a una tasa ligeramente más alta que el promedio de América del Sur. En 2015, se encontró que alrededor del 78% de las mujeres colombianas (que tenían entre 15 y 49 años y estaban casada/en unión) usaban algún tipo de método anticonceptivo, incluyendo los métodos tradicionales, que era un poco más alto que el promedio sudamericano para ese año (alrededor del 75% de las mujeres). Además, alrededor del 8% de las mujeres tenían necesidades de planificación familiar insatisfechas, que era inferior al promedio de ese año en América del Sur (alrededor del 10%). Las formas más comunes de anticoncepción fueron la esterilización femenina (alrededor del 34% de las mujeres). A esto le siguieron los anticonceptivos inyectables (9%), las píldoras anticonceptivas (8%), los DIU (7%) y los condones masculinos (7%). Hubo tasas de uso bastante bajas para los implantes anticonceptivos (3%) y la esterilización masculina (3%). Los métodos tradicionales, como el método de extracción / extracción (4%) y el método del ritmo (3%) tampoco eran muy comunes. Prácticamente no hubo usuarios de métodos de barrera vaginal (menos del 1%).

En Colombia, las píldoras anticonceptivas y los DIU fueron la opción anticonceptiva más popular para las mujeres en los años sesenta y setenta. Sin embargo, desde ese tiempo, la esterilización femenina se ha convertido en el método anticonceptivo más común. Algunas mujeres han citado el hecho de que prefieren un método anticonceptivo permanente, en lugar de preocuparse por mantener un régimen de medicamentos, como una razón para buscar la esterilización. Es especialmente común que las mujeres mayores busquen la esterilización cuando sienten que no quieren tener más hijos. . En particular, Profamilia, la principal organización de planificación familiar en Colombia, ha proporcionado servicios de esterilización femenina a muchas mujeres . . Sin embargo, también existe la preocupación de que las personas con discapacidad en Colombia hayan sido sometidas a esterilización forzada.

En 2010, el Congreso de Colombia aprobó una ley que garantiza el libre acceso a los anticonceptivos para todos los ciudadanos, incluidos procedimientos como la vasectomía y la esterilización. Cuando la ley pasó por primera vez, las primeras comunidades en recibir atención fueron las más necesitadas.

En 2016, Colombia se convirtió en el país con la segunda tasa más alta de virus Zika. Esto ha llevado al gobierno colombiano y al Papa a promover el uso del condón para el pueblo colombiano.

Aquí hay un hilo (de 2011) sobre la actitud del público hacia el control de la natalidad en Colombia.

Qué conseguir y dónde conseguirlo

• If you want condoms ("condon" in Spanish), you can find them in pharmacies, drug stores, and sometimes in bathrooms at clubs and bars.
• If you want birth control pills ("píldoras anticonceptivas” in Spanish), you can find over 20 brands of combined and progestagen-only pills in Colombian pharmacies, including Belara, Cerazette, Cilest, Diane, Marvelon, Neogynon, Noral, Nordiol, Microfemin, Microfemin CD, Microgynon, Microgynon 28 and Nordette, etc.
• If you want contraceptive injectables ("anticonceptivo inyectable" in Spanish), there are many options, including Cyclofem, Cyclofemina, Dahlia, Depo-Provera, Mesigyna, Norigynon, Progestin 100 and Progestin Depot. You can get the injections at pharmacies or clinics in Colombia.
• If you want a contraceptive implant ("implante anticonceptivo" in Spanish), you can find Jadelle in Colombia. You should contact a local clinic or health care professional to obtain the implant.
• If you want an IUD ("DIU” in Spanish), you can find Mirena in Colombia. You should contact a local clinic or health care professional to obtain the IUD.

Farmacias recomendadas

Estas son algunas de las farmacias principales a considerar, todas las cuales ofrecen un servicio de medicamentos a domicilio:

• Acuña: es una cadena de farmacias con entrega a domicilio. Tel: (1) 4882888
• Cafam: Tel: (1) 3077011
• Colsubsidio: Tel: (1) 7450999
• Farmacity: Tel: (1) 6214524
• Farmasanitas: abierto las 24 horas. Otra cadena grande de farmacias colombianas con entrega a domicilio. Tel: (1) 4865000
• Farmatodo: abierto las 24 horas. Entrega a domicilio. Esta es una farmacia de cadena de tiendas (muy conocida). Tel: (1) 7469000
• La rebaja: Tel: 018000 939900
• Locatel: Tel: (1) 4192525
• Droguerias Olimpica: Otra cadena grande colombiana con entrega a domicilio. Tel: (1) 6064000
• Superpharma: Gran droguería que ofrece entrega a domicilio. Tel: (1) 4111010

Costos

• El control de la natalidad debería costar entre 18,000-20,000 COP, a partir de 2016.
• En 2011, Microgynon (anticonceptivo) 21 pastillas se pudieron encontrar por 8.374 COP, el control anticonceptivo inyectable costó alrededor de 14.000 COP, la inserción del DIU puede aproximadamente equivaler entre $$23 USD y la eliminación fue de aproximadamente $ 17 USD.

Anticoncepción de emergencia (píldora del día después)

Leyes y estigmas sociales

Puede acceder a la anticoncepción de emergencia (la píldora del día después) en Colombia sin receta. Aunque técnicamente se necesita una receta para obtener AE, parece que la mayoría de los farmacéuticos venden AE sin receta médica. Desde un punto de vista legal, no hay restricciones de edad para comprar AE. Sin embargo, muchos farmacéuticos colombianos aparentemente no venden AE a adolescentes debido a objeciones personales o morales. Si es un adolescente y necesita comprar AE, se recomienda que busque varias farmacias o que una mujer mayor compre AE para usted.

Según algunas fuentes, los farmacéuticos colombianos a menudo no quieren vender anticonceptivos de emergencia a menores de edad, a pesar de que no existen leyes que los prohíban. Por esta razón, si usted es menor de edad y está buscando píldoras anticonceptivas de emergencia, probablemente tendrá que visitar muchas farmacias antes de encontrar a alguien que esté dispuesto a venderle las PAE.

In 2005, studies found that about 41% of Colombian women had knowledge of emergency contraception, and about 3% had ever used emergency contraceptives. However, as this data is rather old, we can assume that more women may have knowledge of or may have used ECPs today.

What to Get & Where to Get It

• In Colombia, locals report that you can purchase emergency contraceptive pills (the morning after pill) without a prescription at pharmacies (though minors may have some difficulty purchasing ECPs). For progestin-only EC, you'll find Escinor 1.5, NorLevo 1.5mg, PostDay 1 or Postinor 1 (for these brands, take 1 pill within 120 hours after unprotected sex). You can also find Emergyn, PostDay, Postinor-2, Pregnon or Tace (for these brands, take 2 pills within 120 hours after unprotected sex).
• If you can't access dedicated emergency contraception, you can use regular birth control pills as replacement EC. For progestin-only pills, you can take Microlut (take 50 pills within 120 hours after unprotected sex). You can also take progestin-estrogen combined pills but remember that, in 28-day packs, only the first 21 pills can be used. You can take Neogynon, Noral, Nordiol (take 2 pills within 120 hours after unprotected sex and take 2 more pills 12 hours later). You can also take Microfemin, Microfemin CD, Microgynon, Microgynon 28 or Nordette (for these take 4 pills within 120 hours after unprotected sex and take 4 more pills 12 hours later). You can also take Microgynon Suave (take 5 pills within 120 hours after unprotected sex and take 5 more pills 12 hours later).

Costs

• In 2018, emergency contraceptive pills are about 16,000 - 20,000 COP.

Sexually Transmitted Infections (STIs/STDs)

Laws & Social Stigmas

There are no residency and travel restrictions related to HIV in Colombia. This means that, if you're a foreigner and you are planning to visit Colombia, you will not be asked for medical certificates or proof of your HIV status upon entering the country. According to HIVTravel: "The Colombian Embassy in Brazil informs us that the Colombian authorities have never requested HIV-specific information from people entering the country. Proof of Yellow Fever vaccination is required from people who have visited endemic areas. The Embassy refers to the Public Health General Director in Bogotá."

Generally speaking, Colombia has a low rate of HIV infection. It is estimated that 150,000 adults (ages 15-49) , or about 0.5% of the population, are living with HIV, as of 2017. However, HIV does particularly impact certain groups and communities, such as sex workers (1.2% infection rate), men who have sex with men (17% infection rate), injection drug users (2.8% infection rate), prisoners (1.4% infection rate), and transgender people (21.4% infection rate). For people who do live with HIV, there are social issues related to stigma and shame that they may deal with. According to a 2015 survey, only about 37% of Colombian said that they would buy fresh vegetables from a vendor if they knew that person had HIV, and only about 30% of young people (ages 15 to 24) had sufficient knowledge of HIV prevention.

One major concern for health care officials is the low HIV testing rate. The majority of Colombians never receive HIV tests, and only 20% of at-risk Colombians ever get tested. There are many factors that contribute to the low test rate, particularly because HIV tests are expensive, ranging from the equivalent of $20 to $40 USD, which is simply unaffordable to many Colombians. Furthermore, HIV may be perceived as not a real threat or real issue to Colombians, especially if they're in relationships. Doctors also typically do not offer an HIV test to their patients, especially if they're not seen as part of a traditionally high-risk group. These factors worry some officials, who think that the HIV infection rate may grow under these circumstances. There are also new groups of people who are becoming more commonly infected, such as housewives, who have contracted HIV from husbands who had unprotected sex outside of their marriage. Health care experts hope that women, along with all Colombians, can be tested more often.

What to Get & Where to Get It

In Spanish, this is how you say STDs: "Enfermedades de transmisión sexual."

Testing Facilities

• Profamilia: This is basically the Planned Parenthood-like organization of Colombia. Provides STI tests and other sexual/reproductive health services. Has 66 facilities, including mobile clinics, throughout Colombia. Calle 34 #14-52, Bogotá, D.C. Colombia, P: (57-1) 339-0900. Bogota Helpline: 489-1664. Rest of the country helpline (toll free): 01-8000-110-900.

Support

• Corporación de Lucha Contra el SIDA (CLS): This nonprofit, multi-partner organization provides comprehensive care to people living with HIV/AIDS, promotes HIV education and research, and helps support testing at local clinics.
• Fundación Santa Fé de Bogotà: Calle 119 (#) 9-33
• SIDA - Fundación Apoyemonos: CRA. 15 (#) 59 - 57 Ap. 503
• Revista Indectable: An online magazine for people living with HIV. Has a special section for women.
• Fundación Apoyarte: Address: Carrera 15 N°124-29 Of 416 – Edificio las Arcadas, Bogotá - Colombia, Telephone: +57 1 320 4919605, Email: comunicaciones@fundapoyarte.org
• Instituto Nacional de Salud: Vigilancia y Análisis del Riesgo en Salud Pública, Address: Avenida calle 26 No. 51-60, Zona 6 CAN Bogotá, Telephone: +57 1 2207700, Fax: +57 1 2200901, Email: contactenos@ins.gov.co
• Liga Colombiana de Lucha Contra el SIDA: Address: Cl 32 carrera 15, Bogotá, Telephone: +57 1 2454757, Fax: +57 1 2454757, Email: jpacheco@ligasida.org.co
• Red Colombiana de PVVS - RECOLVIH: Address: Calle 9 # 2 - 73, Barrio La Candelaria, Bogotá, Telephone: +57 314 3399985, Email: recolvihbogota@gmail.com
• Red Latinoamericana de Personas con VIH/SIDA - REDLA+: Secretario Regional, Address: Calidonia, Peru Avenue and 35 East Street, Masnou Building, 2-D, Panamá, Telephone: +507 396 5161, Fax: +507 396 5160, Email: repo_pa@yahoo.com
• UNAIDS Latin America: Contact - César Antonio Núñez, Director, Regional Support Team for Latin America and the Caribbean. Phone: +5073014600. Email: nunezc@unaids.org

Costs

• HIV tests can be the equivalent of $20 to $40 USD, which is unaffordable for many Colombians.

Medication & Vaccines

What to Get & Where to Get It

• 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 currently no known formal distributor or trial for Pre-Exposure Prophylaxis (PrEP) in Colombia, as of July 2018.
• Post-Exposure Prophylaxis (PEP) is available in Colombia, though we don't know how common or available it is.

Menstruation

What to Get & Where to Get It

• You can find pads/pantyliners in many stores. One of the most common brands is "Nosotras," which are maxipads that vary in absorbency.
• For tampons, you can expect to find tampons without applicators, particularly OB. Check out the OB Colombia website for details.
• For menstrual cups, you can find a variety of brands. You can find DivaCup sold at Proveestetica (Contact: María Sanchez, E-mail: s.maryh24@hotmail.com; andresfgalvis@hotmail.com, Tel. 1-3037451, Cel. 3122547900). For Ladycup, check out Ladycup Colombia. There are also some online communities that focus on menstrual cups, and which often sell menstrual cups as well, such as Copa Menstrual Colombia, Copa Menstrual LadyCup Colombia, Eva Copa Menstrual, etc.

Gynecological Exams

What to Get & Where to Get It

• Clinica de la Mujer: This clinic, established in 1991, has been recommended by multiple locals. Address: Cra 19C No. 91-17, Bogota Colombia. Phone: Call +57 1 6161799. Email: anarino@clinicadelamujer.com.co
  • Recommended ob/gyn: Ricardo Martin in Clinica Santa Fe and Clinica de la Mujer: A local says: "He is amazing." Phone: 215-2300.

Pregnancy

Laws & Social Stigmas

In Colombia, women are entitled to 14 weeks of maternity leave. They can leave up to 2 weeks before their expected date of delivery. By one week before expected delivery, it is mandatory that the woman takes maternity leave. As detailed in AngloInfo: "After the 37th week of pregnancy, the mother should ask her doctor to prepare a Licencia de maternidad pre parto, entitling her to maternity leave one or two weeks prior to the birth of the baby. In the event of a premature birth the mother should contact the health service provider to follow the procedure with the employer."

Abortion

Laws & Social Stigmas

In Colombia, abortion is legal under three circumstances: to save the life of the woman, risk of fatal fetal malformations and cases of rape, incest or non-consensual insemination. For cases dealing with maternal health, this decision was left to medical authorities (there is no official court finding on what is included). For fetal malformations, there are no specific provisions for what qualifies at the court level, so this is left to medical opinion. For cases of rape, incest or non-consensual insemination, a report must be made to authorities. In all other cases, such as to preserve physical health, to preserve mental health, economic or social reasons, or available on request, are not legal reasons, according to the 2006 Colombian Constitutional Court ruling.

During the 2006 court rulings, the court also considered conscientious objectors. It was decided that health care centers (e.g. clinics, hospitals, etc) cannot refuse to perform an abortion. However, individual doctors can refuse to perform abortions on religious grounds. If this is the case, they must refer women to providers who can perform abortions.

In 2008, it was estimated that 400,400 abortions were performed in Colombia, and only 322 of the abortions were legal. Yet it should be noted that, for decades, the abortion rate in Colombia has remained pretty consistent. For example, the rate was 36 abortions per 1000 women (of reproductive age) in 1989, and it was 39 women out of 1000 women in 2008. Some of the highest rates of abortion are in Bogota. As reported by the Center for Reproductive Rights: "While the government continues to demonstrate its commitment to the promotion and protection of reproductive rights, women in Colombia still face barriers to accessing safe abortion services, such as onerous medical requirements to prove they qualify for a legal abortion, as well as refusals to provide safe abortion services by doctors, medical institutions —and even judges—based on their personal or moral objections."

What to Get & Where to Get It

Medical Abortion - You can access Misoprostol (the abortion pill) in Colombia. It's estimated that half of all abortions are performed this way. Warning - Go to a clinic/doctor that knows what they're doing because "... despite the drug´s safety and efficacy when used correctly, inadequate knowledge of its use among women and providers results in a high rate of complications (32%), primarily heavy bleeding and incomplete abortion."

Surgical Abortion - If you're interested in surgical abortions, you should know that 8 out of 10 facilities use the dilation and curettage (D&C) method. This is considered invasive and expensive. It's recommended to find a facility that performs surgical abortions with the manual vacuum aspiration (MVA), which is also recommended by WHO for first trimester abortions.

• Fundación Oriéntame: One of the two main nonprofit clinics in Bogotá that provide legal abortion services. You can read an account by someone who worked at Fundacion Orientame.

Costs

For surgical abortion, you can expect to pay between $45 (at lower-end facilities) to $200 (at higher end facilities).

Advocacy & Counseling

What to Get & Where to Get It

• Casa de la Mujer, Apartado 36151, Bogota, Colombia. Tel. 248 2469.
• FANA: "Located in Suba, the 11th locality of the Capital District of the Colombian capital city, Bogotá, FANA (the Spanish acronym for the Foundation for the Assistance of Abandoned Children) is a modern facility with up-to-date medical care, staff and equipment capable of caring for 150 children. FANA is also able to offer prenatal and delivery services to any birth mother in need. Any child who is placed for adoption is cared for in a new born intensive care facility under the supervision of full-time physicians and medical personnel."

List of Additional Resources

LGBTQ Resources

• Click here to learn about LGBTQ rights and laws in Colombia. As of 2018, homosexuality is legal, homosexual marriage is recognized, and it is legal to change gender.
• Colombia Diversa: "Founded in 2004, Colombia Diversa is the leading organization for the defense of human rights of LGBT people in Colombia. [The organization's] work focuses on three main areas: 1. Promote and defend the human and legal rights of LGBT people in Colombia. 2. Work to positively transform perceptions about LGBT people in Colombia. 3. The promotion of the organization and the political impact of the LGBT community in Colombia." Website in Spanish and English.
• Colombia Diversa - Trans Rights & Cases: To learn more about transgender-related rights and cases in Colombia, this webpage is a useful resource, which can be found on the Colombia Diversa website.
• Caribe Afirmativo: "Our purpose is to influence the construction and positioning of sexual and gender diversity agendas in the Caribbean, which allow the recognition of rights and access to justice for LGBTI people in a post-conflict scenario." Address: Cra 53 No. 75-87, office 4, Barranquilla, Colombia. Phone: (5) 3116810. Email: info@caribeafirmativo.lgbt
• Centros Comunitarios LGBT de Bogota: This webpage provides a community space/portal for the LGBTQ community in Colombia. They have information on groups, events, etc.
• LGBT Bogota Facebook Page: This is an active Facebook page for the LGBTQ community in Bogota. They tend to focus on news and world events related to the community.

General Women's Resources

• Asociación Pro-bienestar de la Familia Colombiana (Profamilia): "Profamilia operates sixty-six clinics and mobile health units in Colombia, accounting for nearly three-quarters of the country’s family planning capacity. It works to ensure poor people living in urban and rural communities are able to receive high-quality sexual and reproductive health services, including contraception, gynecological exams, pregnancy and STI testing, abortion, and cervical and breast cancer screenings. In 2015, Profamila provided more than three million services." Address: Asociación Pro-bienestar de la Familia Colombiana, Calle 34 #14-52, Bogotá, D.C. Colombia. P: (57-1) 339-0900
• Casa de la Mujer: "We are a feminist organization, legally constituted as a non-profit entity. We were born in 1982, in a country at war and in the midst of critical cases of violence against women that were not registered by official sources or recognized as a violation of their rights. After 35 years, we are assuming one of the most important challenges for the country: the construction of peace with social justice and with the active and equal participation of women. " Address: Corporación Casa de la Mujer, Carrera 35 # 53a - 86, Bogotá - Colombia. Telephones: (57 1) 221 8785 Fax (57 1) 222 9170. Email: coordinacion@casmujer.com.
• Corporación Sisma Mujer: Colombian feminist organization focused on women's citizenship and human rights
• Sisma Mujer: "We are a Colombian feminist organization that since 1998 has contributed to the consolidation of the women's movement, has worked with women victims of violence and discrimination because of being women, in private, public and armed conflict, for the expansion of their citizenship, the full validity of their human rights and the promotion of their role as transforming actors of their reality." Address: Carrera 13 No. 33 - 74, office 304. Email: infosisma@www.sismamujer.org. Phone: (+571) 285 93 19