Bulgaria

OVERVIEW

In Bulgaria, you will find a range of health care options. Condoms are readily available at supermarkets, pharmacies, petrol stations, and various stores, and they are the most commonly used form of contraception. While you technically need a prescription for birth control pills, this is not strictly enforced at all pharmacies. If you are a foreigner, or if you already have a box of pills that you can show the pharmacist, you can typically obtain birth control pills without a prescription. Other forms of contraception, such as IUDs, are also available in Bulgaria, but there are extremely low usage rates for some other forms of contraception, such as contraceptive implants and contraceptive injectables. Regarding emergency contraceptive pills (morning after pills), they are available over-the-counter at pharmacies, even if they may be technically available by prescription only.

Regarding STIS, you can receive an HIV test and other STI tests at a variety of places in Bulgaria, such as VCT (i.e. voluntary counseling and treatment) centers, mobile testing facilities, health education centers, public clinics and hospitals, and private clinics and hospitals. It is possible to get free HIV tests in Bulgaria, though you will generally need to pay for your test if you go to a private hospital or clinic. While HIV infection rates in Bulgaria are generally rather low, the rate of HIV knowledge among young also happens to be low and certainly not everyone who is infected knows their status. Furthermore, Pre-Exposure Prophylaxis (PrEP) does not appear to be generally available yet in Bulgaria, and Post-Exposure Prophylaxis (PEP) is only available in some cases.

You can find pads, pantyliners, tampons, and menstrual cups sold in pharmacies in Bulgaria. However, it should be noted that menstrual cups are a specialty product, and they will not appear in all pharmacies. You can refer to the "Menstruation" section for a list of some pharmacies that do carry cups.

Regarding pregnancy, Bulgaria has a relatively low maternal mortality rate and offers a generous maternity leave plan for women. Finally, abortion is legally available upon request during the first twelve weeks of gestation.

Contraception (Birth Control)

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

In Bulgaria, you can purchase condoms without a prescription at markets, pharmacies, kiosks, and online vendors. You technically need a prescription to obtain birth control pills and most forms of contraception. However, according to online sources, some pharmacies sell birth control pills over-the-counter, particularly if you have a box (including an empty box) of the birth control pill brand that you use on hand. According to one pharmacist in Sofia (November 2018): "If a woman asks for some of these pills, she needs to show a prescription, but if she comes from another country, or if she forgot the prescription and brings the package of the pills she's taking, I am sure the pharmacist will give her the pills."

Generally speaking, condoms are the most commonly used form of contraception, and women tend to have smaller families with 1.46 children born per woman (CIA World Factbook, 2017). It was estimated in 2015 that 67% of Bulgarian women (who were married/in unions and of reproductive age) used any form of contraception, including traditional methods, which was slightly lower than the Eastern European average (about 69% of women). Furthermore, about 13.5% of women had unmet family planning needs, which was slightly higher than the Eastern European average (about 10%). The most common forms of contraception was male condoms, which were used by 26.5% of women. Many women chose to use withdrawal, also known as the "pull-out method," as their main form of contraception (about 18% of women). This was followed by IUDs (about 11% of women) and birth control pills (about 7% of women). There were rather low rates of usage for all other forms of contraception, including female sterilization (2.5% of women), the rhythm method (about 1% of women), male sterilization (less than 1% of women), and female barrier methods (less than 1% of women). There were practically no women who were found to be using contraceptive injectables (0.0% of women) and contraceptive implants (0.0% of women).

What to Get & Where to Get It

• In Bulgaria, you can easily purchase condoms without a prescription at supermarkets, pharmacies, petrol stations, and various stores. They are generally easy to find and you shouldn't encounter significant stigma if you buy them. You'll be able to find international brands, such as Durex, and Bulgarian brands, which tend to be cheaper. For Bulgarian women, condoms are the most common form of contraception.
• You can find birth control pills at pharmacies. From a legal perspective, a prescription may be required to purchase birth control pills, but some pharmacies may sell pills over-the-counter, according to multiple online sources, especially if you are foreigner or have a box of the pills you commonly use. Some of the brands that you can expect to see are Jasmin (Bayer), Logest (Bayer), Lindinette 30 (Gedeon Richter), Miligest (Gedeon Richter), Belara (Gedeon Richter), and Jazz (Bayer), among other brands.
• You can find intra-uterine devices (IUDs) in Bulgaria. For example, at Acibadem CityClinic - Tokuda Hospital, you can obtain an IUD insertion for 70 BGN, as of November 2018, after you have a consultation. However, you should note that, at Acibadem and some other clinics, you actually buy the IUD at the pharmacy and then they handle the insertion procedure. To learn more about the insertion procedures, brands available, or prices, you should contact a local gynecologist or clinic.
• Generally speaking, contraceptive implants and contraceptive shots/injectables appear to be very rare in Bulgaria, as of November 2018. While most clinics and hospitals will probably not provide such services, some of them may. You should directly contact your health care provider to inquire.
• Pharmacies in Bulgaria sell contraceptive creams and vaginal tablets, but they are rarely used, according to a pharmacist that we spoke to.

Costs

• Here are the quoted prices for condoms from one Sofia pharmacy (November 2018): Durex - 3 pieces around 2 EUR, Bulgarian brands - 10 cents a piece.
• Here are the quoted prices for birth control pills from one Sofia pharmacy (November 2018): Jasmin (Bayer) - around 7 EUR, Logest (Bayer) - around 5 EUR, Lindinette 30 (Gedeon Richter) - around 3-4 EUR, Miligest (Gedeon Richter) - 6 EUR, Belara (Gedeon Richter) - 11 EUR, Jazz (Bayer) - 11 EUR
• Here is the quoted price for IUD insertion (not for the device -- just insertion) at one clinic (as of November 2018): 70 BGN

Emergency Contraception (Morning After Pill)

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

In Bulgaria, emergency contraceptive pills (morning after pills) are generally available over-the-counter at pharmacies, though a pharmacist may first ask for a prescription. Furthermore, for some ECP brands, you can directly view and obtain the pills at pharmacies (i.e. they can be found on pharmacy shelves) without requesting the pills from pharmacists. According to one pharmacist in Sofia (November 2018): Emergency contraceptive pills are sold to "...anyone who really needs it. I mean, we are obliged to ask for a prescription, but if the person forgot it, or simply explains that she really needs it, we make exceptions."

There may be restrictions related to age at some pharmacies, but this does not seem to be the case at all pharmacies. According to the European Consortium for Emergency Contraception, people under 16 years old in Bulgaria can purchase UPA morning after pill brands (such as ellaOne) without a prescription. However, minors (under 16 years old) may need a prescription to purchase LNG morning after pills (such as Postinor-Duo or Escapelle) from pharmacies.

What to Get & Where to Get It

• You can get the emergency contraceptive pill (morning after pill) at pharmacies in Bulgaria. You may be initially asked for a prescription, but you can usually purchase the pills over-the-counter if you do not have one. Some of the brands you can expect to see are Escapelle and ellaOne.
• You may be able to purchase emergency contraceptive pills online from Bulgarian pharmacies. For example, you can buy ellaOne from this online pharmacy, as of November 2018. However, prices will probably be much higher than if you walked into a pharmacy and purchased the medication yourself.

Costs

• According to one pharmacy in Sofia, they sell Escapelle for 15 EUR and ellaOne for 18 EUR (prices from November 2018).

Sexually Transmitted Infections (STIs/STDs)

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

In Bulgaria, there are an estimated 2800 adults living with HIV, which accounts for less than 0.1% of the population, as of 2017. Furthermore, the infection rate has decreased by 14% since 2000. It is estimated that about 87% of people living with HIV in Bulgaria know their status, and 43% of adults and children who have HIV are receiving ART. However, there are higher HIV infection rates in certain communities, such as men who have sex with men (3.9%), prisoners (1.7%), and injection drug users (1.7%). It is estimated that around 0.3% of sex workers are living with HIV. One factor to consider is that HIV knowledge in Bulgaria tends to be low, with a little under 19% of young people (ages 15-24) holding knowledge of HIV prevention.

Testing Facilities

• Tip: You can receive an HIV test and other STI tests at a variety of places in Bulgaria, such as VCT (i.e. voluntary counseling and treatment) centers, mobile testing facilities, health education centers, public clinics and hospitals, and private clinics and hospitals. For a list of testing facilities in Bulgaria, you can visit this informational page, created by Deystvie.
• CheckPoint Sofia: Free and anonymous testing for HIV, hepatitis B and C, syphilis. Hours: Monday – Friday: 12:00 – 20:00, Saturday: 12:00 – 18:00, Break: 16:00 – 16:30. Address: ul. Tsar Samuil 111, Sofia. Phone: +359 2 952 33 99. Email: info@checkpointsofia.info
• Dr. Greenberg Diagnostic & Consultative Center: HIV blood test costs 25 euros, syphilis RPR - 18 Euros, gonorrhea genetic test - 38 euros, chlamydia trachomatis serum test - 37 Euros, as of November 2018. Address: 23-A, Kopenhagen st, Druzhba-2, 1582-Sofia, Bulgaria - Mladost-3, Dr. At. Moskov st, Block 325. 02/4170519, 0898776812, 02/9744933. e-mail: dccgreenberg@gmail.com, dccgreenberg@intech.bg
• Acibadem CityClinic - Tokuda Hospital: This international hospital group offers high-quality care. Here are their quoted prices for STI tests, as of November 2018: estimated prices are as it follows (after the consultation the specialist will refer to the best option, because there are some package prices that include different tests) - HIV 1/2 blood test is 13 bgn, cervical test for gonorrhea is 28 bgn and chlamydia test is 49 bgn. Location: 51B "Nikola I. Vaptsarov" blvd. (if you drive, the entrance is from "At. Dukov" str.), "Hladilnika" distr., 1407 "Lozenets." Call center:02/ 403 4000. Emergency: 02/ 403 4112.

Support

• Note on HIV treatment: You can receive ART for HIV treatment at five hospitals that receive funding from the Ministry of Health, though costs can be high. For a list of HIV wards in Bulgaria, you can visit the linked informational page, created by Deystvie.
• In Sofia, here's the contact information for the main HIV ward: medical institution: SBALIPB - “Prof. Ivan Kirov” - Address: Sofia 1606, Acad. Ivan Geshov “17; Tel: (02) 9023 732; (02) 9023 733; Dr. Nina Yancheva, MD, Head of OPIN (Immune Deficiency Division)
• Ministry of Health - Expert Council on HIV/AIDS: Address: Ministry of Health, 26, Yanko Sakazov blvd., 1504 Sofia. Telephone: +359 2 9301 152. Fax: +359 2 981 57 25. Email: press@mh.government.bg
• ANTI-AIDS Coalition: Address: Akad. Ivan Evstatiev Geshov Blvd 15, 1431 Sofia. Telephone: +359 2 954 96 72. Email: anina@ncphp.government.bg
• National Centre for Addictions: Address: 117, Pirotska str, 1303 Sofia. Telephone: +359 2 831 90 15. Email: ncn@ncn-bg.org

Costs

• HIV tests can be free or you can pay money, depending on various factors. Generally, if you go to the Regional Health Inspectorates, which can be found in district cities, or to mobile testing sites, which are often set up by NGOs, you can get a free HIV test (but you may need to be a Bulgarian citizen or legal resident to receive free services). However, if you go to a private clinic or hospital, you will need to pay for the test and laboratory results.
• Regarding treatment costs for hepatitis and other STIs: Health insurance in Bulgaria is supposed to cover the treatment, but this may not always be the case. For this reason, it appears that some people purchase antibiotics to treat STIs over-the-counter at pharmacies in Bulgaria.

Medications & Vaccines

Old pharmacy in Plovdiv, Bulgaria

Laws & Social Stigmas

There are many pharmacies in Bulgaria, though most of them are not open 24 hours. In fact, in April 2018, it was reported that there were only 30 "non-stop" (i.e. 24 hour) pharmacies in Bulgaria. You can find a range of medications available over-the-counter at pharmacies. There are some medications that may technically be available by prescription only, but these laws may not be followed by all pharmacists. It should also be noted that some pharmacies may run out of certain product. This is partially due to a practice known as "parallel trade," where middle-men buy large quantities of medications in Bulgaria and sell the medications in other European countries (thereby depleting the stock of such products in Bulgaria).

What to Get & Where to Get It

• You can find medications to treat yeast infections in Bulgaria. They should be available over-the-counter at pharmacies.
• You can find medications to treat urinary tract infections (UTIs) in Bulgaria. They may be available over-the-counter at pharmacies, but we're still gathering more information on this topic.
• You can find the HPV vaccine in Bulgaria, and the country has had a nationwide HPV immunization program since 2012. According to one clinic: "The HPV vaccine is usually being provided to children up to 18 y.o., but you can discuss its possibility individually during the consultation with one of our specialists."
• There appears to be no official vendors or distributors of Pre-Exposure Prophylaxis (PrEP) in Bulgaria, as of October 2018.
• Regarding Post-Exposure Prophylaxis (PEP), it was previously reported that PEP was only available for occupational exposure (i.e. not for sexual exposure) in Bulgaria, but we don't know if this is still the case.

Menstruation

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.

What to Get & Where to Get It

• You can find pads/pantyliners sold at a variety of stores in Bulgaria, from small stores to larger supermarket chains, such as Lilly’s and DM. There is also a local menstrual product company, called Palomita, which produces pads and pantyliners.
• You can find tampons sold at a variety of stores in Bulgaria, from small stores to larger supermarket chains, such as Lilly’s and DM. There is also a local menstrual product company, called Palomita, which produces tampons.
• You can find menstrual cups sold in a variety of stores in Sofia and other Bulgarian cities. For example, in Sofia, you may be able to find menstrual cups sold at Аптека Ремедиум (ul. "Ivan Denkoglu" 34), Аптека Ремедиум (ul. "Graf Ignatiev" 40), Аптека Ремедиум (ul. "Boris Hristov" 2), and Аптека Ремедиум (ul. "Geo Milev" 34). For a list of some other stores that may carry menstrual cups, you can check out the MeLuna listing page for Bulgarian sellers.

Gynecological Exams

Hospital in Sofia, Bulgaria

What to Get & Where to Get It

• Tip: To find a doctor in Bulgaria, you can visit DocTiming, which lets you browse for different doctors and book an appointment online. The website is in Bulgarian and English.

Public Hospitals & Clinics

• Lozenetz Hospital: This is a government hospital. Address: гр. София 1407, кв. Лозенец, ул. „Козяк“ № 1. Phone: 02 / 96 07 607

Private Hospitals and Clinics

• Femina Medical Center: This may be a solid choice for ob/gyn care in Sofia. They specialize in women's health care. However, we need more information on their services and prices. Адрес: 1202 София, България, ул.”Дунав” No 47“. Телефон за контакти: 02 / 983 30 20, 0889 03 05 95. Email адрес: info@mcfemina.com
• Acibadem CityClinic - Tokuda Hospital: This international hospital group offers high-quality care. The price of the standard gynecology exam, as of November 2018, is 75-95 BGN, microbiology is 38 BGN, pap test is 32 BGN. This clinic be a good choice if you're able to afford the services or if you have a very specialized condition."Acibadem City Clinic Tokuda Hospital is the biggest private hospital in Bulgaria. It was officially opened on 28th of November 2006 as part of a Japanese medical corporation, owned by the physician and entrepreneur Dr. Torao Tokuda. " Location: 51B "Nikola I. Vaptsarov" blvd. (if you drive, the entrance is from "At. Dukov" str.), "Hladilnika" distr., 1407 "Lozenets." Call center:02/ 403 4000. Emergency: 02/ 403 4112.
• St. Sofia Medical Center: This modern medical center, opened in 1992, has three specialties: orthopedics and traumatology, obstetrics and gynecology, and internal medicine. Address: 104 Bulgaria Blvd., 1618 Sofia. Phone: + 359 2 8184600. Mobile: +359 2 8184608. Fax: +359 2 8184666
• Dr. Greenberg Diagnostic & Consultative Center: They offer a gynecology exam and pap smear for 60 Euros, as of November 2018. Address: 23-A, Kopenhagen st, Druzhba-2, 1582-Sofia, Bulgaria - Mladost-3, Dr. At. Moskov st, Block 325. 02/4170519, 0898776812, 02/9744933. e-mail: dccgreenberg@gmail.com, dccgreenberg@intech.bg

Costs

• The price for a gynecological exam will vary, depending on if one goes to a private or public clinic. For example, at Acibadem City Clinic is 75-95 BGN and the price of a pap test is 32 BGN, as of November 2018.

Pregnancy

Laws & Social Stigmas

Bulgaria is known to have some of the best maternity leave laws in the world. When a woman has a baby, she is entitled to 410 days of maternity leave, and 45 of those days must be taken before the actual birth. Furthermore, people on maternity leave are entitled to 90% of their pay, once they have covered the risk of the period with a 12-month contributory service. However, paternity leave benefits are much less flexible and comprehensive. Fathers are entitled to 15 days of paternity leave after the birth of the baby. If the mother consents, the father can use any unused maternity leave credit once the child has reached six months old.

Child birth is comparatively safe for women in Bulgaria. There are 11 deaths per 100,000 live births, making Bulgaria has the 146th lowest maternal mortality rate in the world (out of 184 in the CIA World Factbook).

What to Get & Where to Get It

• To find a doctor in Bulgaria, you can visit DocTiming, which lets you browse for different doctors and book an appointment online. The website is in Bulgarian and English.

Abortion

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

In Bulgaria, abortion is fully and legal and available upon request during the first twelve weeks of gestation. During this period, all reasons for abortion are permitted. Between twelve and twenty weeks of gestation, an abortion is permitted for special medical reasons (it is not available upon request), provided that the pregnant person has a documented and proven disease or condition that would endanger her or the life of the child.

In 1956, abortion became available upon request for the first twelve weeks of pregnancy in Bulgaria. However, there have been periods where abortion has been challenged or heavily restricted in the country. In 1968, the government was concerned about the declining birth rate -- and, in response, the government banned abortion services for childless women, except for cases when abortions were medically necessary. The government also discouraged abortions for women who had one or two children, though they typically received abortion services if they persistently requested such services. These restrictions were expanded in 1973, and abortions were banned for women with one child. In 1974, the laws changed again, and abortion was permitted for unmarried women. Yet, it was only in 1990 when abortion was again available upon request for all women, regardless of their marital or parental status, during the first twelve weeks of pregnancy. These laws can be found in Decree No. 2 of 1 February 1990.

What to Get & Where to Get It

• Bulgarian Family Planning and Sexual Health Association: You can contact this organization to find out where you can receive abortion services in your area. Address: 67 Knyaz Dondukov Boulevard, Sofia 1504. Phone: +359(2) 943 30 52 , +359(2) 943 37 10 . Fax: +359(2) 943 37 10. Email: bfpa@safesex.bg

Advocacy & Counseling

What to Get & Where to Get It

• Emergency: Call 112
• Ambulance: Call 150
• Police: Call 166
• Fire Brigade: Call 160
• Bulgarian National Helpline for Children: Call 116 111
• National Hotline for Victims of Violence - Additional Info: operated by Foundation “Animus Association”: Number: national - 0800 186 76; international - 00359 800 186 76
• Tourism Complaint Line (Sofia): Call 02/ 940 3003
• Nadja Center Foundation: This association helps women and children who have been victims of violence and abuse, including physical, sexual, and psychological abuse. Call +359 2 981 9300. E-mail: office@centrenadja.org

List of Additional Resources

General Women's & Health Organizations

• Ministry of Health: Inquiries 02/981 01 11 Administrative services 02/9301 175 02/9301 176
• Bulgarian Family Planning and Sexual Health Association: "The Bulgarian Family Planning and Sexual Health Association (BFPA) focuses on advocacy, and on information and education activities for the whole community, but with a particular emphasis on young people. The organization runs comprehensive sexual and reproductive health care clinics in Sofia and other cities. The clinics function as training centres for health personnel and social workers. BFPA is working in close partnership with the government on a project designed to extend these facilities to other parts of the country." Call: +359 2 943 3052. Email: bfpa@safesex.bg
• Council of Refugee Women in Bulgaria: "The CRW is a non-profit organization with mission to assist newly recognized refugees in the process of their initial adaptation and integration." Call: +359 87 676 6588. Email: office@crw-bg.org.
• Billits: "Bilitis works as an advocacy organization towards achieving elimination of all forms of discrimination and achieving equality for LGBTI people in Bulgaria."
• Bulgarian Fund for Women: "Bulgarian Fund for Women (BFW) is the only indigenous donor in Bulgaria that raises funds and gives grants to local NGOs working to advance women’s and girls’ rights, eliminate gender stereotypes, gender-based violence and discrimination, achieve gender equality in all spheres of life and make a social change." Address: 37B Parchevich Str., Sofia 1000. Phone: +359 2 986 47 10. Email: office@bgfundforwomen.org
• Bulgarian Gender Research Foundation: "The organization works in the field of gender equality, prevention of domestic violence, reproductive rights and anti-discrimination by providing information, elaboration and production of researches, analyses and draft laws, conducting campaigns and lobbying for legislative changes, provision of training and consultations for professionals and working in wide networks in cooperation with other organizations, public institutions and experts." Address: 33 Vasil Levski Blv. 1142 Sofia, Bulgaria. E-mail: office@bgrf.org. Telephone: 02 963 53 57. Fax: 02 963 53 57. Mobile Phone Number: 0878 567 620
• Center of Women's Studies and Policies: "CWSP continues and enhances the work on women's, gender and equal opportunities issues in Bulgaria and further develops new areas of expertise and activities. It implements its own or joint projects with similar domestic or international organizations." Address: Sofia 1000, 38 Tsar Asen street. Phone: ++359 2 981 04 73. E-mail: cwsp@cwsp.bg.
• Bulgarian Association of Women Entrepreneurs: This organization aims to stimulate women's entrepreneurship in Bulgaria.

LGBTQ Resources and Organizations]

• Equaldex Bulgaria: This website provides information on LGBTQ rights and laws in Bulgaria. 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 Bulgaria.
• GLAS Foundation: "GLAS /Gays and Lesbians Accepted in Society/ is a non-governmental organization which aims to deliver positive change for lesbian, gay, bisexual and transgender people in Bulgaria, ensuring full equality and protection from all forms of discrimination. "
• LGBT Deystvie: "Established in 2010, the youth LGBT “Deystvie” provides support and support to young homosexual, bisexual and transgender people, developing a self-confident LGBT community, and combating homophobia and illiteracy in society." Contact: Sofia, Luben Karavelov str.24 flor 1 apartment 4. Phone: +359-884 851. Email: info@deystvie.org