Thaïlande

INTRODUCTION

La Thaïlande est renommée pour ses hôpitaux internationaux, sa vie nocturne et sa communauté LGBT prospère. Mais cela ne veut pas dire que tout est accessible ou progressiste dans le pays. Concernant les médicaments et les bilans de santé, le pays semble relativement bien avancé. Vous n'avez pas besoin d'ordonnance pour une contraception, même la contraception d'urgence, et vous pouvez vous la procurer en pharmacie à bas prix. Il existe une vive conscience des MST, vous trouverez donc un grand nombre de centres de dépistage, et la Thaïlande est le seul pays de l'Asie du Sud-Est à effectuer des tests et études sur la PreP, en 2016. Quant aux ressources LGBT, Silom est considéré comme le quartier gay principal de Bangkok, surtout Soi 2 et Soi 4.

Mais la loi sur l'avortement est très contraignante. Selon la loi thaïlandaise, les femmes ne peuvent avoir accès à un avortement que sous certaines conditions, comme le danger pour la vie de la mère ou le viol. Les raisons sociales ou économiques ou le libre choix ne sont pas acceptées. Cependant, la loi n'est pas complètement imposée, et on estime qu'il existe 15 cliniques d'avortement dans le pays. Il n'existe qu'un seul hôpital à Bangkok qui pratique des avortement sûrs avec peu de restrictions (voir la section "Avortement" pour plus de détails).

Contraception

Note : il existe de nombreux moyens de contraception, comme les DIU (dispositifs intra-utérins ou stérilets), les contraceptions orales, les patchs, les injections, les préservatifs, etc. Pour une liste complète, cliquez ici.

Lois et stigmatisation sociale

En Thaïlande, vous pouvez vous procurer une contraception sans ordonnance. On estime qu'entre 72 et 78% des femmes en âge de procréer utilisent une forme de contraception moderne. Selon une étude, 23% étaient sous pilule, 17% utilisaient des implants ou des injections contraceptifs, et 22% étaient stérilisées. Ces 25 dernières années, le gouvernement a mené de nombreuses campagnes pour que les travailleuses et travailleurs du sexe utilisent des préservatifs avec le Programme 100% Préservatif. Mais il s'est moins concentré sur le reste de la population. Cela a impliqué que de nombreuses personnes hors de la communauté des travailleurs du sexe n'utilisent pas de préservatifs, mais optent plutôt pour la contraception d'urgence ou la contraception habituelle.

Que prendre et où le trouver

Marvelon, une marque de contraceptif courant en Thaïlande

Pilule contraceptive Cerazette achetée en Thaïlande

• Vous pouvez acheter lapilule contraceptive dans pratiquement toutes les pharmacies (sauf herboristeries) à Bangkok. Les pharmacies réputées sont Boots, Watsons, P&F, Fascino, Siam Pharmacies et la Pharmacie de l'Université de Chulalongkorn. Faire des achats dans des pharmacies ayant la climatisation est recommandé, car les médicamenets sont mieux conservés dans un environnement frais. Pour des recommandations ciblées sur les hôpitaux /cliniques où vous pouvez consulter, aller sur les pages des villes Bangkok/fr et Chiang Mai/fr.
• Certaines marques de pilule contraceptive que vous pourrez trouver en Thaïlande sont AnNa, Anteovin, Cerazette, Diane-35, Eugynon, Exluton, Gynera, Jeny-FMP, Lo-Femenal, Logynon, Lyndiol 50, Marvelon 21, Marvelon 28, Meliane, Mercilon 21, Microgest ED, Microgynon, Minulet, Miranova, Nordette-28, Nordette-21, Yasmin and Yaz.
• L'anneau vaginal (Nuvaring) n'est pas disponible en Thaïlande en 2017. Cependant, il a déjà été importé et le sera peut-être encore.
• Les préservatifs sont faciles à trouver dans la majorité des pharmacies. Il existe même un restaurant à Bangkok, Condoms & Cabbages, qui distribue des préservatifs gratuits (Sukhumvit 12 Alley, Khlong Toei, Bangkok 10110, Thaïlande). Notez que les préservatifs thaïlandais sont de petite taille.
• Les marques de contraceptifs injectables disponibles en Thaïlande sont Contracep, Depo-Gestin ANB, Depo-Progesno, Depo-Progesta, Depo-Provera, Depo-Medeton, et Noristerat.
• Les implants contraceptifs sont disponibles, avec les marques Implanon, Jadelle, et Norplant.
• Les DIU hormonaux (comme Mirena) et en cuivre sont disponibles en Thaïlande. L'hôpital King Chulalongkorn Memorial Hospital (1873, Rama 4 Road, Pathumwan, Bangkok, 10330, +6622564000) est recommandé car c'est un endroit relativement bon marché pour acheter des DIU et de le faire poser.

Coûts

Une réserve d'un mois de pilule contraceptive coûte en général entre 60 et 300 baht, ce qui équivaut à environ 1,50€ - 8€ (en 2016).

Contraception d'urgence (pilule du lendemain)

Notes importantes: La contraception d'urgence peut prévenir une grossesse jusqu'à 3 jours (72h) et parfois 5 jours (120h) après un rapport non protégé. Prenez le contraceptif d'urgence le plus tôt possible après le rapport non protégé. Si vous n'avez pas accès à la contraception d'urgence, les contraceptifs oraux peuvent être utilisés en remplacement, mais souvenez-vous de ce qui suit: 1- Seulement quelques contraceptifs peuvent être utilisés comme contraceptifs d'urgence, 2- Des contraceptifs différents nécessitent des dosages et des horaires différents pour pouvoir fonctionner en tant que contraceptifs d'urgence, 3- Vous devez uniquement utiliser les 21 premières pilules dans les packs de 28 pilules, 4- Ces contraceptifs seront probablement moins efficaces qu'une véritable contraception d'urgence. Pour des informations générales sur la contraception d'urgence, cliquez ici et ici. Les stérilets en cuivre peuvent aussi prévenir une grossesse jusqu'à 5 jours après un rapport non protégé.

Lois et stigmatisation sociale

Vous devriez pouvoir vous procurer une contraception d'urgence sans trop de stigmatisation à Bangkok. Elle est bon marché et très utilisée par des thaïlandaises de tous les âges, y compris des adolescentes, vivant à Bangkok, et il n'existe aucune restriction quant à son utilisation.

What to Get & Where to Get It

In Thai, emergency contraception is ยากันท้อง or "Ya kun tong." You can get emergency contraception without a prescription at pharmacies. For dedicated EC pills (progestin only), there is Madonna and Postinor. For both brands, you take 2 pills within 120 hours after unprotected sex. For progestin-estrogen combined (birth control pills), you can take 2 pills within 120 hours after unprotected sex and take 2 more pills 12 hours later with the following brands: FMP, Jeny FMP, Nordiol, Ovidon and Ovral. You can also take 4 pills within 120 hours after unprotected sex and take 4 more pills 12 hours later with the following brands: Anna, Lo-Femenal, Microgest, Microgest ED, Microgynon 30 ED, Microgynon-30, Nordette, Nordette 28, Nordette-21, R-den, Riget, Rigevidon and Rigevidon 21 + 7.

Costs

Emergency contraception was reported as 50 baht in 2009.

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

Like all countries, there are stigmas attached to STDs in Thailand. But the country has also made solid progress in HIV prevention and education. According to AVERT, "In 2013, Thailand was one of only two countries in Asia and the Pacific, (along with Cambodia) that had more than 50% of people living with HIV on antiretroviral treatment. In Thailand, 56% of adults who are eligible for treatment are receiving it, alongside 62% of children."

What to Get & Where to Get It

• Thai Red Cross - This tends to be the #1 place that many people go. You can get an anonymous STD test at Thai Red Cross (04 Ratchadamri Road, Pathumwan, Bangkok), where they typically focus on HIV, hepatitis and syphilis. If you want to get tested for gonorrhea and chlamydia, you may need to say that you display some symptoms because they have reportedly not wanted to test asymptomatic patients in the past.
• For local recommendations of testing facilities, visit city pages like the Bangkok and Chiang Mai pages.

Costs

Here are the costs at MedConsult Bangkok: Syphilis test the VDRL 200 THB, HIV test 350 THB, Urethral swab 400 THB, Rapid chlamydia test 400 THB, HSV (Herpes) 750 THB, Pap Smear 1350 THB, HPV Vaccine 2500 THB, 3 dose package over 15 years 7000B, 2 dose package under 15 years 4700 B, PCR2 (NATO) (Gonorrhea and Chlamydia) 2800THB.

Medications & Vaccines

What to Get & Where to Get It

For many STD medications in Thailand, you may be tested in advance or show a prescription before receiving treatment (since they are antibiotics). But they should be generally available.For Trichomoniasis, Metronidazole should be available. For gonorrhea, the treatment is a bit more tricky, since gonorrhea in Asia (and specifically in Thailand) is resistant to many antibiotics. so you should go to the hospital to see how they can treat you. While treatment may vary, you may get Azithromycin or a a shot of a Cephalosporin. HPV vaccines, like Gardasil, are reportedly available in Thailand. PreP is available in Thailand, but is mostly used in trials with men who have sex with men (MSM), transgender (TG) women, women and people who inject drugs. Truvada is registered for treatment but not prevention. People with HIV/AIDS can bring their medications into Thailand, and there are no travel restrictions. Protease inhibitors only exist as original formula.

Some recommended pharmacies:

• Boots: An international pharmacy chain
• Watsons: An international pharmacy chain

Menstruation

What to Get & Where to Get It

Pads and tampons without applicators (OB) are widely available. You may be able to find tampons with applicators in Boots or other large pharmacies/drug stores. There are no known sellers for DivaCup or MoonCup in Thailand so you'll need to buy them online.

Gynecological Exams

What to Get & Where to Get It

From Pink Pangea: "Dr. Witima Sangtawan is a good gynecologist and she speaks good English. Her staff, however, speaks little to no English. She is located at BangPo hospital in BangSue, which is a bit off the beaten path. The hospital has very little English signage as well." Source: http://www.pinkpangea.com/tips-women-travelers-in-thailand/

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 Thailand, abortion law is ambiguous. On the one hand, it is only legal under certain conditions, which are: to save the life of the woman, to preserve physical health, to preserve mental health, or when the pregnancy is due to a criminal offense (i.e. rape or incest). It is not legal for economic/social reasons or available upon request. Under the Thai Penal Code of November 13 1956, abortions are generally prohibited, and they are only allowed in certain instances. If women cause their own abortion or allow anyone else to do so (when they are not allowed to get an abortion), they face up to 3 years imprisonment and a fine of maximum 6000 baht. A person who procures an abortion with a pregnant woman's consent may receive up to 5 years imprisonment and a maximum fine of 10,000 baht.

On the other hand, according to a UN report, "In practice, the law is not rigorously enforced. The prevalence of illegal abortion has been widely documented, particularly in the rural areas of the country." There are supposed to be around 15 clinics that provide abortion care somewhat openly in Thailand, most notably Klongton Medical Center (โรงพยาบาลคลองตัน) in Bangkok.

What to Get & Where to Get It

Women receive illegal abortions or grey-area legal abortions in Thailand every year. In Bangkok, Klongton Medical Center (โรงพยาบาลคลองตัน) is the only known hospital to provide safe abortions to women (between 12-24 weeks of pregnancy) with little questions or restrictions. This hospital is expensive. For cheaper options, there are some less well-known or underground abortion clinics in Bangkok. But they may not be very safe, and they are not recommended. It is estimated that there are 400,000 illegal abortions in Thailand every year. For more information, check out this blog entry about getting an abortion at Klongton Medical Center (โรงพยาบาลคลองตัน) in 2011) and this Rewire article about abortions in Thailand.

PERSONAL TESTIMONIALS:

Testimonial 1: Getting an Abortion in Bangkok (testimonial from a foreigner in Thailand, 2017)

After searching the web for days and finding very little information on abortions here in Thailand, I’ve decided to write up about my experience so more people know what to do and what to expect.

As someone who had been living in Chiang Mai for over 10 months at the time, making what would be minimum wage in most Western countries, I wasn’t able to get myself to Bangkok as early as I would have liked. I had to save up a bit of money after paying rent and making sure I had enough to endure not only the procedure, which I had read could be anywhere from 2,000-5,000 baht, but also just the generally more expensive capital city.

Using online calculators and common sense, I figure I was about 8-9 weeks along. Too far along for what is called a “medical abortion,” which is taking a pill that basically forces an abortion (not sure if that’s even offered at this clinic, as I didn’t have any experience with it). I had to have a suction abortion, where, to my disadvantage, they usually do not dilate the cervix prior to the operation. A suction abortion is exactly what it sounds like and take about 3 minutes or so.

On the day of the procedure, I took a taxi to Cabbages and Condoms, the place I had read most about when I was doing research. When you walk into the parking lot of the restaurant you will see a big green sign with an arrow pointing left that says: “Clinic.” I followed that sign towards a set of stairs that I felt was a little bit in the open for what it was, right next to the entrance of the restaurant.

I walked up to the 2nd floor where I told the woman behind the desk I wanted an abortion. She took my passport and I sat and waited as she filled out my information. When she was finished, she called me to collect my papers and sent me upstairs to the 3rd floor. On the 3rd floor, I walked to the desk on the far right and handed the woman my papers. She asked me how far along I was and I told her I thought around 8 weeks. After about 2 minutes they called me into the ultrasound room where a woman took a quick picture and sent me on my way (she spoke the least English of everyone I interacted with). She didn’t tell me how far along I was and didn’t show me the screen but some curious part of me tried to peak unsuccessfully. I handed my papers to the lady at the desk again and she told me I had to pay 400 baht for the ultrasound (I’m not sure if any of the Thai women paid this fee).

From there, I handed my papers to the other desk on that floor and sat and waited about 5 minutes. There were maybe 7 other people there and they all looked at me as I was the only foreigner. I felt a little awkward but I believe I would feel just the same if there was also foreigners there.

I was called in to a room where I sat down with a woman who asked me some questions. She asked where I was from, how long I had been there and what my job was. As I’m studying Thai, I told her I did not have a job and was only a student (since the legalities of working online are questionable). She was very sweet and spoke a little bit of Thai to me. To my surprise, she asked what my boyfriend’s name was and what he did for a living and wrote it all on a piece of paper. She was surprised to hear he was Thai and asked me what his salary was. I told her I didn’t know, as this all felt very personal and as the relationship was ending. I didn't want to bring him into it. She took my phone and told me to go to another room where I would pay 3,500 baht. I think that the interviewer assesses your financial position and bases your fee on that. I had read that it could cost between 2,000 and 5,000 baht. Since the clinic helps low-income women as well, I think they do this to make sure everyone is charged reasonably for their income.

I went back to the waiting room for about 2 minutes. Then, me and two other Thai girls (who were probably close to my age, 22) were called in. We walked into a room and put our shoes in plastic bags. We continued on to another room, where we were sat on a couch and each were given a pill and some water and told it was for the pain (though I understood her saying in Thai that there would be no pain). The woman explained the process in Thai and handed me a paper with some very vague instructions in English. She brought us to another room and I was separated from the other girls and brought to a small room with a bed, a sarong and a curtain for a door. They told me to put on the sarong and lie in my bed and wait.

I waited for what felt like hours but was probably closer to 35 minutes. The room was freezing and I tried to use my sarong to cover my toes, which were losing feeling from being so cold. Finally, the woman came in to get me. She helped me fix my sarong and sat me in a group of chairs outside of a closed door. Another girl, different from the two that had come in with me was brought over 5 seconds later and sat across from me looking just as terrified as I’m sure I did. 

The door opened and out came one of the girls I had originally been brought in with. She was hunched over, holding tight to her lower stomach. She was rushed over to the beds where she had been lying prior. They called me in and it all went by so quickly.

I walked in the white medical room and, as they finished wiping the bed/seat, they told me to lie down. The nurse was very kind to me, asking about my Thai language school and all sorts of questions about living in Thailand. As she continued to attempt to comfort me with distracting conversations, the doctor came in and he told me to adjust myself back slightly with my thighs in the stirrups. He lifted my sarong and told me to relax my muscles.

Everything happened so quickly but at the same time felt like lifetimes. I could hear the suctioning of him manually pumping the syringe that was inside of me. At first there was a little pain but eventually it became unbearable. I couldn’t cry and my mouth was open, trying to let out a scream, as the nurse begged me not to and told me it was almost over. I thought she must have not wanted the girl waiting to be even more afraid then she probably already was. There were 2 very strong unbearable parts when the pain peaked, but after about 3 minutes, it was over.

They handed me a large sanitary pad to hold between my legs, under my sarong and just as the girl had before me, I shuffled back to my room with a nurse guiding me as I hunched over. I laid in my bed, curled up in a ball with what felt like the worst period pains I had ever had multiplied by 20. At this point, I was so thankful for the fact my room was freezing because sweat had soaked through my t-shirt and was dripping down my forehead. A nurse came in and told me to drink the tea they had brought me, but I couldn’t bear it and instead opted to lean over the bed with the garbage can next to me, as the pain made me feel like I was going to be sick. After a few minutes of moaning and whimpering the pain slowly faded away. Again, the nurse came in and handed me my tea, insisting I drink and telling me I could leave.

This is when the emotions kicked in and I just wanted to stay in the room and cry thinking about everything that had just happened, but I knew they wanted me to leave. I got dressed and made my way to the interview room. She explained to me again the things I needed to know for aftercare (i.e. take birth control every day for the month, antibiotics until they were complete and Ibuprofen for the pain). I started to cry and she gave me tissues and comforted me, which was really sweet of her. 

I walked out of the clinic, feeling a bit embarrassed as I walked past patients in the waiting room, trying to hold back tears. I went outside and ordered a motorbike taxi (bad idea, a seat in a cab would have been much more comfortable, but I didn’t want to sit in a car where someone would try and make conversation with me). When I got back to my hotel, I was still bleeding, but not as heavy as a period. I gave myself time to cry and be emotional but was so exhausted, both emotionally and physically, so I decided to take a nap. 

The morning sickness, which had prevented me from eating anything more than a smoothie a day for the past 2 weeks, disappeared almost immediately. I still had sore breasts for a couple of days and remained very tired for a couple of weeks. I felt extremely sad and depressed for a month and it’s slowly been getting better. Now, 3 months later, I feel a lot better about my decision than 2 weeks after the procedure, but it’s still the hardest thing I’ve ever done, even knowing it’s what I needed to do.

Overall, my experience at this clinic was a much more professional experience than what I had expected. Everything was sanitary and in order. While not everyone I interacted with was oozing friendliness, they were all very helpful and considerate with what they did. I know that the fact I could speak a little Thai probably contributed to how kind they were to me, so don’t expect too much other than women just doing their jobs. I was fine afterwards, no infections or complications and am so grateful that this facility was available to me in Bangkok.

Location: Next to Cabbages and Condoms restaurant on Sukhumvit 12 Total cost: 3,900 baht
 Total time: 1.5 hours

Advocacy & Counseling

What to Get & Where to Get It

• Global Alliance Against Trafficking Women (GAATW), 191 Sivalai Condominium, Issaraphap Road, Soi 33, Bangkok Yai, 10600 Bangkok, Thailand, Mailing address:, PO Box 1281, Bangkok Post Office,, Bangkok 10500, Thailand, Tel: 662 8641427/28, Fax: 662 864163, E-mail: mailto:gaatw@mozart.inet.co.th, URL: http://www.inet.co.th/org/gaatw
• Foundation for Women (FFW) - Does preventative/awareness work around domestic violence and trafficking of women (http://www.womenthai.org/eng)

List of Additional Resources

• Planned Parenthood Association of Thailand - http://www.ippf.org/about-us/member-associations/thailand
• Global Alliance Against Trafficking Women (GAATW), 191 Sivalai Condominium, Issaraphap Road, Soi 33, Bangkok Yai, 10600 Bangkok, Thailand, Mailing address:, PO Box 1281, Bangkok Post Office,, Bangkok 10500, Thailand, Tel: 662 8641427/28, Fax: 662 864163, E-mail: mailto:gaatw@mozart.inet.co.th, URL: http://www.inet.co.th/org/gaatw
• Tangerine Community Health Center Thailand: Asia's first transgender clinic, located in Bangkok.
• National Council of Women of Thailand - http://www.inet.co.th/org/ncwt
• National Commission on Women's Affairs (Thailand) - http://www.inet.co.th/org/tncwa
• National Council of Women, Clearinghouse and Information Centre - Bangkok 10200
• Thailand Gender Development and Research Institute - 501/1 Mu 3Dechatungka Road, Sikan, Donmuagn, Bangkok 10210, Thailand
• Asian Confederation of Women's Organizations - 127/1 Sukumvit 79, Bangkok 10250, Thailand
• National Council For Women of Thailand, Umbrella Organisation - Manangkasila Mansion, Lanluang Road, Bangkok 10300, Thailand, T: 2 281 0081, F: 2 281 2189
• Foundation For Women - 35/267 Charansanitwongse Road 62, Soi Wat Paorohit, Bangkoknoi, Bangkok 10700., Thailand, Mailing address:
• Foundation of Women -P.O. Box 47 Bangkoknoi, Bangkok 10700, Thailand
• Friends of Women Foundation (Grassroots Women's Network-GROWNET) - 218/16 Soi Pradipat 18, Phayathai, Bangkok 10400, Thailand, Tel: 279-0867, 278-3551
• Women's Information Centre and Foundation - 2/3 Soi Wang Lang, Arunamarin Road, Bangkok 10700, Thailand, Mail address:, P.O. Box 7-47, Bangkok 10700
• EMPOWER Foundation, supports women in the sex industry - 57/60 Tivanond Road, Nontburi 11000, Thailand, Tel: 02-526-8311, 02-968-8021,, 02-968-8022, Fax: 02-526-3294
• Women in Development Consortium (WIDCIT) - Network for women in development, Office of the Rector, Thammasat University, Bangkok, Thailand