Medellín

Colombia / Medellín

OVERVIEW

As a major city in Colombia, you will find many health care resources in Medellín. However, you should be aware of the complex picture regarding reproductive and sexual health care in the country. On the one hand, Colombia is a primarily Catholic nation, and many Colombians attach great importance to the Catholic Church. As a result, certain health care personnel may hold traditional social views, which may impact how they interact with patients. Furthermore, Colombian society is traditionally patriarchal, and some women may struggle to realize full autonomy and independence, though this certainly varies by each individual, family, and community.

On the other hand, Colombia has seen a massive expansion of its family planning services in the past few decades, particularly that of Asociación Pro-bienestar de la Familia Colombiana (Profamilia), an affiiliate of the International Planned Parenthood Federation, which has sixty-six clinics and mobile health units, and accounts for nearly three-quarters of the country’s family planning capacity. As a result, fertility rate has fallen from 6 children per woman in the 1960s to just above replacement level (i.e. about 2 children per woman), as of 2017. This is largely due to increased literacy, family planning services, and urbanization in the country. Meanwhile, homosexuality, gay marriage, and gender change are all legal in Colombia.

Generally speaking, contraceptives, such as birth control pills and condoms, are legal and widely available. Emergency contraception is also legal and, while a prescription may be technically required, it seems easily obtainable regardless of prescription status for women. However, some minors may experience difficulty obtaining emergency contraceptive pills, particularly if they look underaged. If you are a teenager, you are legally allowed to purchase emergency contraception, but you may need to contact a few pharmacists before finding one who grants you access to emergency contraception. Regarding STIs, there are no travel or residency restrictions related to HIV status in Colombia. Furthermore, Profamilia is a great resource, and there are numerous locations, including mobile clinics, throughout Colombia.

According to Colombian law, women are entitled to 14 weeks of maternity leave. Since 2006, abortion has been legal for certain cases in Colombia, but it is not yet available upon request. It is currently only available based on three criteria. Note that there are still many cases of unsafe and illegal in Colombia, so it's important to research providers and the intended procedures in advance.

Contraception (Birth Control)

Laws & Social Stigmas

In Colombia, oral contraceptives (birth control pills) and condoms are legal and widely available. They can be purchased over-the-counter at pharmacies. No prescription is required. However, for other contraceptive methods, such as contraceptive implants, injectables or IUDs, you will need to visit a physician.

Generally speaking, Colombian women use contraceptives at a slightly higher rate than the South American average. In 2015, it was found that about 78% of Colombian women (who were between 15-49 years old and married/in unions) used some form of contraception, including traditional methods, which was a bit higher than the South American average for that year (about 75% of women). Furthermore, about 8% of women had unmet family planning needs, which was lower than the South American average of that year (about 10%). The most common forms of contraception was female sterilization (about 34% of women). This was followed by contraceptive injectables (9%), birth control pills (8%), IUDs (7%), and male condoms (7%). There were rather low rates of usage for contraceptive implants (3%) and male sterilization (3%). Traditional methods, such as withdrawal/pull out method (4%) and the rhythm method (3%) were also not very common. There were practically no users of vaginal barrier methods (less than 1%).

In Colombia, birth control pills and IUDs were the most popular contraceptive option for women in the 1960s and 1970s. However, since that time, female sterilization has become the most common contraceptive method. Some women have cited the fact that they prefer a permanent contraceptive method, rather than worrying about maintaining a medication regimen, as a reason for seeking out sterilization. It is especially common for older women to seek out sterilization when they feel that they want no more children. In particular, Profamilia, the main family planning organization in Colombia, has provided female sterilization services to many women. However, there are also some concerns that people with disabilities in Colombia have undergone forced sterilization.

In 2010, the Colombian Congress passed a law that guaranteed free access to contraceptives for all citizens, including procedures like vasectomies and sterilization. When the law first passed, the first communities to receive attention were those most in need.

In 2016, Colombia has became the country with the second highest rate of Zika viruses. This has lead the Colombian government and the Pope to promote condom usage for the Colombian people.

Here's is a thread (from back in 2011) about public attitude toward birth control in Colombia.

What to Get & Where to Get It

• 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.

Recommended Pharmacies

• For an extensive list of pharmacies in Medellín, check out the links here and here.

Costs

• Birth control should cost between 18,000-20,000 COP, as of 2016.
• In 2011, Microgynon (birth control) 21 tablets could be found for 8,374 COP, injectable birth control cost about 14,000 COP, IUD insertion was about $23 and removal was about $17.

Emergency Contraception (Morning After Pill)

Laws & Social Stigmas

You can access emergency contraception (the morning after pill) in Colombia over-the-counter. While you may technically need a prescription to obtain EC, it appears that most pharmacists sell EC without a prescription. From a legal standpoint, there are no age restrictions for purchasing EC. However, many Colombian pharmacists reportedly do not sell EC to teens due to personal or moral objections. If you are a teen and you need to buy EC, it's recommended that you seek out a few pharmacies or have an older female purchase EC for you.

According to some sources, Colombian pharmacists often do not want to sell emergency contraception to minors, even though there are no laws that prohibit them from doing so. For this reason, if you're a minor who is seeking out emergency contraceptive pills, you may need to visit many pharmacies before you find someone who is willing to see ECPs to you.

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. Country-wide helpline (toll free): 01-8000-110-900. Address : Cl. 54 ## 43-47, Medellín, Antioquia, Colombia. Phone : +57 4 2836688.

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

• Dr. Mauricio Arango Gonzalez: Address: Salud Sura, Carrera 43A #1-50 , Torre 3, Room 1004, San Fernando Plaza. Tel: 604-1361
• Clínica Medellín: This clinic provides services to foreigners and international patients. "The Clinic Medellin has two locations strategically located in the south and west of the city, where we provide our users with complete facilities, equipped with the best technology and a high quality medical and assistance group." Western Address: Carrera 65 B No. 30 - 95; Switch: (574) 444 61 52. El Poblado Address: Calle 7 No. 39 - 290; Switch: (574) 311 28 00; Fax: (574) 312 49 30
• Clínica Rosario: This is supposed to be a small yet high-quality that provides services to foreigners and locals. They have eight gynecologists on staff, as of December 2018. Contact Details - Address : Cra. 20 # 2 Sur 185, Medellín, Antioquia, Colombia. Hours: Open 24 hours; Single service line: 4441555 Appointment; request: EPS - 3269200; Prepaid Medicine - 3269299; Private Patient - 3269179; Email: clinicaelrosario@clinicaelrosario.com

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."

What to Get & Where to Get It

• Asociación Pro-bienestar de la Familia Colombiana (Profamilia): They have many locations across the country, and they offer fertility services. To learn more about their fertility services, click here.

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.

• Asociación Pro-bienestar de la Familia Colombiana (Profamilia): They have many locations across the country, and they offer abortion services. You can schedule a consultation for an abortion on their website by clicking here. To learn more about abortion from their website, click here. "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

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

• Asociación Pro-bienestar de la Familia Colombiana (Profamilia): They have many locations across the country, and they offer resources/support for victims of gender-based or domestic violence. To learn more, click here.
• The Restorative Shelters: "The Restorative Shelters in Medellín, Antioquia provide refuge and comprehensive support for women and their children below the age of 14 years whose lives and physical integrity are threatened by domestic violence."

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

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."
• Red Feminista Antimilitarista: Address: Cl. 61 #50a49, Medellín, Antioquia, Colombia
• 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