Laos

OVERVIEW

In the past few decades, Laos has undergone rapid development. While many of the country's health care resources remain limited, they are in a state of transition. You will find that certain birth control methods, such as pills or condoms, are easily purchased over-the-counter. Some more advanced methods, such as IUDs, may be obtained in certain hospitals or clinics. However, other methods, such as patches, implants or injectables, may be technically available but difficult to find. You can purchase emergency contraception (the morning after pill) without a prescription at pharmacies, yet public knowledge of ECPs is not very high overall. You can receive HIV testing at various clinics in larger cities, like Vientiane. While HIV rates in Laos currently remain low, as of 2017, they are increasing at a rapid rate, and one should always practice safe sex anywhere, including in Laos. There is also an HPV vaccination program in place. Regarding menstruation, you can find pads and tampons in city markets. However, it may be very difficult to find menstrual cups, so they should be ordered online or purchased outside of Laos. Finally, the current state of abortion policy (as of June 2017) is in a state of transition in Laos and rather complex. To understand both the practice and policy around abortion in Laos, please refer to the "Abortion" section below.

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 Laos, you can purchase oral contraceptives (birth control pills) over-the-counter. No prescription is required. According to 2015 report, it was found that 53.6% of Laotian women (who are married/in unions and of reproductive age) use any form of contraception. The most common methods were birth control pills (23.2%), injectables (14.9%), female sterilization (5%) and the rhythm method (4.8%). There were very low rates of usage of IUDs (1.8%), condoms (1.25) and implants (0.1%).

Historically, Laos has experienced periods of both rejecting and embracing family planning. In 1969, the International Planned Parenthood Foundation teamed up with the United States Agency for International Development to develop family planning programs. It was under these efforts that the child‐care and maternity wing of Mohosot Hospital, based in Vientiane, was developed. The hospital performed some vasectomies and tubal litigation procedures.

However, in 1976, the Laotian government officially banned birth control. There may have been a few reasons for this ban. First, after the decades long Laotian Civil War (1953-1975), the government wanted to build up its population with a new generation of Laotians. Furthermore, the family planning policies of the past were associated with American involvement in Laos, which the government wished to distance itself from. During this period, birth control pills disappeared from the shelves and any remaining supplies were treating as contraband.

By the late 1980s, birth control was accessible again, and since the 1990s, the Ministry of Health has advocated for birth control and family planning. The Ministry has typically advised women to space out births every two to three years. Since 2012, the the rate of married women using contraception has increased by 0.9% per annum. In 2017, Laos held its first First National Conference on Family Planning, organized by the Ministry of Health and United Nations Population Fund (UNFPA).

Yet these changes have primarily affected the lives of Laotian urban women, who have adopted family planning methods in larger numbers. For rural women, however, contraceptive use remained low into the 1990s, and in areas that were far from provincial capitals or the Thai border, contraceptive usage was "virtually nonexistent," according to one source. As women in rural areas come from a wide range of tribal and ethnic backgrounds, and they speak many different languages, it has been crucial that the women receive locally-tailored resources. Most recently, the Laotian government has begun to make inroads in rural communities due to the work of Community-based distribution (CBD) workers, who are educating their local communities and distributing free contraceptives. The CBD workers have received training from the Laotian government and UNFPA. One of the main issues is that the majority of the CBD workers are male (not female). To read more about CBD workers in Laos, click here.

Today, over half of Laotian women use some form of birth control. Some unmarried women report feeling shamed by judgmental health care providers, yet others report that they can easily purchase contraceptives at their local pharmacy.

What to Get & Where to Get It

• In Vientiane, you can find condoms in many stores and minimarts. You can also buy condoms online from local sellers, like Yes Condom Vientiane, which sells 3-piece packs of Durex condoms for 10,000 kip, 6-piece packs of SixSex condoms for 35,000 kip and 24-piece packs of SixSex condoms for 100,000 kip (as of June 2017). If you send them a message on Facebook, they'll give you more details. Note that online sellers of condoms tend to be more expensive than physical stores.
• You can purchase oral contraceptives (birth control pills) at pharmacies. No prescription is required. Some of the brands you can expect to see are Anna and Preme, which are both produced by Thai Nakorn Patana (a Thai pharmaceutical company). Some locals have warned against purchasing medications from China or Vietnam, since they may be lower-quality or unreliable.
  • One local health care professional says (June 2017): "OC pills are widely available in most pharmacies and from public and private hospitals, even in rural areas. The brands will vary and providers may not stock consistent problems [sic: brands]. This can be an issue because it means that women may not always be able to find the brand that they are used to, especially in areas where the outlet may be bringing the drugs in from Thailand, Vietnam, China, etc. A lot of providers just drive over the border to buy their stocks."
  • Important Note: There is a problem with fake, expired or ineffective pills being sold in Laos. Buy medications from reputed pharmacies, look for recognized brands and make sure that the labeling and packing looks correct.
• If you want an IUD, you'll be able to find copper-T IUDs in Laos. You can get them at public hospitals in Vientiane, such as Ban Home Health Center, Chanthabouly District hospital, etc. You can also get an IUD at private hospitals/clinics, such as Alliance, LaoViet and the French Clinic. For a full list of hospitals, visit the "Gynecological Exams" section.
• According to locals, you should be able to find contraceptive implants in Laos, but we need more details.
• According to locals, you should be able to find contraceptive injectables in Laos, but we need more details.
• According to locals, you may be able to find the contraceptive patch in Laos. However, while locals report hearing that it's available, there's no confirmation if anyone can directly report seeing the patch available themselves. We'll need more information.
• The contraceptive ring (such as Nuvaring) is currently not available in Laos, as of June 2017.

IMPORTANT NOTES from Vientiane Health Care Professional (June 2017):

• "The only products registered for use in Laos and widely available are copper-T IUDs, Implants, COC and progestin only pills, Injections, EC pills and condoms. If a provider has anything else, they most likely brought it in illegally from a neighboring country."
• "All contraceptive commodities should be free at public facilities, but they will charge a small fee for the use of consumables (like cotton, betadyne, etc.). This is usually less then 50,00 kip ($6), but it varies by province. Private sector fees will depend on the provider, usually less than $10 I would say."

Costs

• Birth control pills should cost around 5000-10000 kip per month (as of June 2017).
• Contraceptive injections will range from free to 5000 kip every 3 months (as of June 2017).
• Contraceptive implants will cost around 25,000-5000 kip (as of June 2017).
• IUDs will cost around 25,000-5000 kip (as of June 2017).

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 Laos, you can purchase emergency contraception (the morning after pill) without a prescription at pharmacies. While there are no emergency contraception pills (ECPs) that are officially registered in Laos, pills are imported from other countries and sold on pharmacy shelves. This seems to be tacitly approved by the government. The Ministry of Health has approved of pharmacies providing emergency contraception, even if no products are officially registered.

Overall, public understanding of ECPs remains low. According to a 2013 study of 500 young adults in Vientiane City, only 22.4% of respondents had heard of ECPs and only 17.9% knew the proper timeframe for effective usage. Despite these low numbers, the respondents did express generally favorable views of ECPs. In fact, 85% believed that ECPs should be available in Laos and 66.8% said that they would use ECPs, if they ever needed them. Regarding the respondents who said they would not use ECPs, their major concerns were around perceived negative health effects.

According to a health care professional in Laos, there is some stigma around purchasing ECPs: "EC pills are actually pretty widely available from pharmacies and providers. There is not a lot of additional stigma then with the use of regular contraceptives. Generally, stigmas are against unmarried people accessing contraceptives, but this is changing fast in Laos. In some ways, I think providers can have less stigma around EC pills for young people because they are more understanding of an emergency situation (as opposed to a young, unmarried woman having regular sex). This is just my opinion though." (June 2017)

What to Get & Where to Get It

• In Laos, you can purchase the emergency contraception (the morning after pill) without a prescription. You may find the Madonna ECP, which is produced by Biolab Co., ltd., a Thai pharmaceutical company. The pill is typically found in Thailand, Laos and Sri Lanka.
• If you can't access dedicated emergency contraception, you can use regular birth control pill as replacement ECP. In Laos, you can do this with at least two brands of pills. If you have FMP, take 2 pills within 120 hours after unprotected sex and take 2 more pills 12 hours later (to prevent unwanted pregnancy). If you have Anna, take 4 pills within 120 hours after unprotected sex and take 4 more pills 12 hours later (to prevent unwanted pregnancy).

Costs

Emergency contraception pills (ECPs) should cost no more than 30,000 kip (June 2017).

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 Laos, there are no travel or residency restrictions related to HIV status. This means that, if you're a foreigner entering Laos, you will not be asked for a medical certificate certifying your HIV status. Furthermore, if you test positive for HIV in Laos, you shouldn't be deported from the country.

There are an estimated 11,000 people with HIV living in Laos. While this number is lower than neighboring countries, such as Thailand or Cambodia, HIV rates are on the rise with about 1000 new cases being reported each year, leading to the claim that there's currently a "Lao epidemic." The highest risk groups tend to be sex workers, transgender people, injection drug users, and MSM (men who have sex with men). As the Laotian borders have opened up in the recent years, the country is seeing higher rates of transmission among foreigners, migrant workers and injection-drug users along the borders as well. These groups have been difficult to reach because they have been historically disenfranchised from mainstream Laotian society, and many feel intimidated by or wary of medical services. However, it should be noted that heterosexual intercourse has also been recorded as a primary form of transmission.

When some people test positive for HIV, they may not seek out medical services, which puts future sexual partners (or people with whom they have intimate contact) at risk. This can be partially attributed to lack of education surrounding HIV and STIs as well. According to a 2013 UN report, only 23% of women and 30% of men had a comprehensive understanding of HIV.

In response to rising HIV rates, the Laotian government has taken some important steps. From 2006-13, the number of ARV treatment centers rose from merely two to eight centers, and five support offices were created. However, the Laotian government most likely needs to more heavily invest in HIV/AIDS treatment and prevention. Currently, the country is heavily reliant on foreign aid and humanitarian agencies, such as the Global Fund. This is concerning to many people in Laos, since this does not create a sustainable long-term model.

Testing Facilities

For local testing facilities, please visit the city pages, such as the Vientiane page.

Support

• World Health Organization Representative Office Lao People's Democratic Republic: 125 Saphanthong Road, Unit 5 Ban Saphangthongtai, Sisattanak District Vientiane Capital, Lao People's Democratic Republic. Telephone: (856) 21 353-902 / 3 / 4 . Facsimile: (856) 21 353-905. E-mail: who.lao@wpro.who.int
• The Global Fund: This organization provides a lot of the funding for HIV/AIDS work in Laos.

Medications & Vaccines

What to Get & Where to Get It

• If you have a yeast infection, you can try to ask for Canesten or Fluconazole, and the pharmacist may be able to determine what you need based on those requests. Canesten is a common yeast infection medication found in Southeast Asian countries, such as Vietnam. Meanwhile, Fluconazole is an active ingredient/foundational base of many yeast infection medications around the world.
• "If a woman had a UTI, she might visit a public or private provider, or she may go directly to the pharmacist. Many pharmacists are public providers who have a pharmacy practice on the side; they are often a first stop for people who are sick (especially in rural areas where they may be much closer than a health facility)." - Local Health Care Professional
• There is an HPV vaccination program (Gardasil) in Laos, launched in 2013 and lead by the Global Alliance for Vaccines and Immunization.
• There is no evidence of Pre-exposure prophylaxis (PrEP) in Laos, but it can be found in Thailand.
• We're not sure if Post-exposure prophylaxis (PEP) is available in Laos. If you have information on this topic, please add to this section.

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

• By far, the most menstrual popular option for Laotian women are pads/pantyliners (especially in urban areas) and cloth menstrual products (especially among rural or village women). In cities, they can certainly be found in many markets.
• You can find tampons in certain markets in larger cities, such as Vientiane and Luang Prabang. Some markets that may carry tampons are M-Point marts, Home Ideal, Simeuang Market (opposite the wat) and Pimphone market. According to a health care professional, based in Laos, "Tampons are sold in most modern grocery stores in the city. Most Lao women do prefer pads or cloth."
• Regarding reusable menstrual products, organic menstrual products or menstrual cups, there seems to be very little available resources, other than traditional cloth methods used by village women. There are no known sellers of major menstrual cup brands (such as DivaCup, MoonCup, RubyCup, Lunette, etc) in Laos. However, menstrual cups can be purchased online and sent to Laos, or they can be purchased in other countries in the regions, such as Thailand, Vietnam or Singapore, and brought back to Laos. According to one health care professional, based in Laos, "There are a few projects for reusable menstrual pads and hygiene. I’ve never seen the cup for sale myself, and most of my colleagues in the city don’t know about this."

Organizations working on menstrual issues in Laos:

• Laos Teen Girl Project: "The Lao Girls Teen Project was started by the French NGO, Eau Laos Solidarité (ELS). In partnership with the Luang Prabang Library Community Outreach programme, we teach hygiene awareness in schools through fun workshops with trained Laotian hygiene educators."
• Days for Girls - Laos: Learn about when Days for Girls, an organization that focuses on women's hygiene, went to Laos.
• Generation Education Period: "GEP supports women and girls in Laos & Cambodia by providing them with sanitary kits. Many girls & women, who are living in poverty, find life difficult when they have their period. They miss work & school and are often isolated. By providing them with eco friendly, washable GEP Kits, girls can attend school, women can work and they can enjoy their life feeling safe and protected. The kits will last up to 3 years, which will give them more money for education and for their family."
• Period - Lotus Educational Fund Ltd: "With the support of NGO's Green Umbrella, Khmer women are being trained to sew sustainable hygienic sanitary kits to be distributed to women and girls in Cambodia and Laos. This project aims to reduce absenteeism for secondary school girls while providing dignity to the lives of women and girls in socially impoverished villages."
• [lup.lub.lu.se/student-papers/record/4442938/file/4442943.pdf Period of Shame]: This report provides information on the effects of menstrual hygiene management on rural women and girls' quality of life in Savannakhet, Laos.

Gynecological Exams

What to Get & Where to Get It

For local recommendations of hospitals, clinics and ob/gyns, we recommend that you visit our city pages, such as the Vientiane page.

Pregnancy

What to Get & Where to Get It

See gynecological exam section for information on recommended ob/gyns or women's clinics.

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.

What to Get & Where to Get It

The state of abortion law in Laos is in transition. Here's how a health care professional, based in Laos, explains the current situation (as of June 2017): "It is really difficult to figure out what to say in this transition period because what happensin practice is very different than what happens by law:In Laos, abortion is generally available, however, the area around what is legal vs what is available in practice is grey. Safe abortion services are available at provincial and district hospitals, where OBGY providers are generally trained in MVA and Medical Abortion with Misoprostol. Though historically abortion has been illegal or highly restricted except in incidences where a mother's life is in danger or the fetus is impaired, in fairly common practice a woman could also seek abortion services for socioeconomic reasons with a written certificate from their village chief, which confirms that the woman is too poor or has too many children to afford any more children. Misoprostol, a drug that is effective on it's own for abortions, is legally registered and available in Laos under the brand name Ace Miso. Many (but certainly not all) pharmacies routinely stock this drug and some will provide it even without a prescription. Mifepristone, a drug that greatly increases the effectiveness of Misoprostol when taken together, is available through some pharmacies and providers, though it is not yet legally registered or regulated in Laos.

Laotian abortion law is also in a state of transition. In 2016, the government went through a process of liberalizing the guidelines for safe abortion services and these changes will become publicly disseminated later in 2017. The penal code still needs to be revised, as it currently does not comply with these new guidelines."

List of Additional Resources

• Equaldex Profile on Laos - Learn about LGBT rights in Laos
• Gender Development Association: "The Gender and Development Association (GDA) formerly the Gender and Development Group (GDG) and the Women in Development (WID) network, was formed in 1991. A collaboration of the Lao Women’s Union (LWU), UNICEF, with International Non-Governmental Organizations (INGOs), the WID network focused on women and gender development issues in Lao PDR." "GDA wants to contribute to a society where women are empowered and can live in society without violence and discrimination. Therefore, GDA wants to achieve that women can work along with men to reduce poverty and benefit from opportunities for development."
• Lao Women's Union: "The Lao Women’s Union (LWU) was originally established in 1955 to mobilize women for the Lao People’s Revolutionary Party. Over forty years later, it has a membership of some 600,000 women nation-wide. In 1991 the LWU was recognized under the Constitution of the Lao People’s Democratic Republic (Lao PDR) as having responsibility for: responding to women’s development needs; promoting the status and role of women; and promoting unity amongst women of different ethnic groups and social strata throughout the country."
• Lao Disabled Women's Development Center: "The Center is a non-profit organisation, approved by the Lao Ministry of Social Welfare and Labour, which is staffed by disabled women for disabled women. The Centre is located near the Lao-Thai Friendship Bridge and is open 7 days a week." "Our vision is to be a successful organization of people with disabilities in Lao P.D.R. and empower people to engage their abilities by accessing education and employment."
• Population PSI - Laos: "PSI/Laos has been working since 1999 in the Lao People’s Democratic Republic (PDR) to: Reduce the spread of HIV/AIDS, sexually transmitted infections (STIs), and malaria. Find new cases of tuberculosis (TB). Prevent unintended pregnancies. Reduce undernutrition. Improve overall reproductive health and sanitation among Lao people."
• Oxfam International - Laos: "Oxfam's objective is to support the development of Laos as an open and just society, where vulnerable women and men are able to participate in its growth and enjoy their rights to sustainable development."