Brazil

OVERVIEW

In Brazil, contraceptives are legal and no prescription is required. You can buy emergency contraceptives at pharmacies and there are no age restrictions. Menstrual pads and tampons (mostly without applicators) can be found, and select local businesses carry menstrual cups. Nearly all major hospitals and clinics offer STD/STI test -- and, if you are a legal citizen or resident, you can get these tests done free of charge. You can access most medication in Brazil, and there have been some trials for PrEP. However, it is not clear if PrEP or PEP are universally available.

Regarding gynecologists, there are some well-renowned, international hospitals as well as cheaper, though more inefficient, public ones. Keep in mind that abortion is not legal in Brazil except for some extremely specific cases. So, it is advised to seek out abortions in other countries in the Americas, such as Mexico, the United States or Cuba, if at all possible. If this is not an option, you may be able to access the abortion pill in Brazil (see "Abortion" section for details). Check out the Rio de Janeiro page for details on local city resources.

Contraception (Birth Control)

General Note: There are many types of contraceptives, including IUDs, oral contraceptives, patches, shots, and condoms, etc. If you would like to view a full list, click here.

Laws & Social Stigmas

Yasmin purchased in Brazil for 70 BRL

Contraceptives are legal and available in Brazil. You can purchase condoms or birth control pills in pharmacies without a prescription. Other contraceptives, like shots or patches, may be found at local hospitals. Generally speaking, most Brazilians do not wear condoms and, in the 1990s, the most commonly practiced form of contraceptive was found to be female sterilization ("laqueadura tubária" in Portuguese), which remains very popular today In 2001, it was estimated that 1 in 2 Brazilian women have been sterilized, according to a government survey.

In 2015, it was found that 79% of Brazilian women (who were married/in unions and between ages 15-49) used any form of contraception, including traditional methods, and about 8% of Brazilian women had unmet family planning needs. The most common forms of contraception were female sterilization (about 29% of women), birth control pills (about 24% of women), and male condoms (about 12% of women)). The less commonly used methods were male sterilization (used in relationships by about 5% of women), contraceptive injectables (about 4% of women), and IUDs (about 2% of women). Traditional methods, such as withdrawal (about 3% of women) and the rhythm method (about 1% of women) were not very common. There were especially low usage levels of contraceptive implant (less than 1%).

The first birth control pill introduced to Brazil, ENOVID, came in 1962. Many of these early pills had very high hormonal dosages, leading to health issues, though the pills today are generally healthier and lower-dosage. In 1996, Brazil passed a law ("Lei Nº 9.263, De 12 De Janeiro De 1996") that legalized female sterilization This law requires spousal consent prior to sterilization. In addition, it applies to any "man or woman with full citizen’s rights and older than 25 years of age, or who has at least two living children, such that s/he observe at minimum a 60-day period between the request and surgery, in which the person must have access to fertility regulation services, including counseling by a multidisciplinary team, in order to discourage premature sterilization."

In 2007, President Luiz Inácio Lula da Silva announced a plan to provide cheap birth control ($2.40 for a one year supply) to over 10,000 Brazilian pharmacies. While birth control was already available for free at government-run pharmacies, many of the country's poor did not visit the public pharmacies. For this reason, the plan aimed to reach private pharmacies, thereby allowing the poor to have "the same right that the wealthy have to plan the number of children they want."

What to Get & Where to Get It

• If you are interested in female sterilization/tubal litigation, it is called "laqueadura tubária" in Portuguese.
• If you would like to get an IUD, check out the Rio de Janeiro page for some resources.
• Check out our local city pages for recommended pharmacies.

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 Brazil, you can buy emergency contraception (the morning after pill, or "pilula do dia seguinte" in Portuguese) without a prescription. Technically-speaking, it appears that you do need a prescription, according to Brazilian law, but this doesn't seem to be enforced. Many pharmacists sell EC pills over-the-counter. There are no age restrictions. In most of the country, EC is fully legal but, in the municipality of Margina (Parana), EC is provided only in cases of rape. In 2007, in an effort to reduce unwanted pregnancies and abortions, Sao Paolo began offering emergency contraception in metro stations. These efforts inflamed social conservatives and religious groups, and one city council unsuccessfully tried to ban the morning after pill.

In the late 1990s, many Brazilian pharmacists remained unaware of EC specifics. According to a study, "Nearly all respondents (98%) had heard of emergency contraception, but many lacked specific knowledge about the method. Some 30% incorrectly believed that emergency contraception acts as an abortifacient, and 14% erroneously believed that it was illegal. However, 49% of physicians who thought that the method induces abortion (which is largely illegal in Brazil) and 46% of those who thought that emergency contraception was itself illegal have provided it to clients. Most surprisingly, while 61% of respondents report having provided emergency contraception, only 15% of these physicians could correctly list the brand name of a pill they prescribed, the dosage and regimen, and the timing of the first dose."

What to Get & Where to Get It

• In Brazil, if you would like to buy dedicated, progestin-only EC, you can find Postinor Uno and Pozato Uni (for all of these, take 1 pill within 120 hours after unprotected sex). Furthermore, there is also Diad, Minipil 2, Nogravide, Pilem, Poslov, Postinor-2, Pozato, PPMS, Previdez 2 and Prevyol (for all of these, take 2 pills within 120 hours after unprotected sex).
• If you cannot access dedicated EC, you can use some regular oral contraceptives as EC instead. For progestin-only pills, you can use Microval or Nortrel (take 50 pills within 120 hours after unprotected sex). For progestin-estrogen combined pills, you can take Anfertil, Evanor, Neovlar, Nordiol, Normamor, Ovral or Primovlar (for all of these, take 2 pills within 120 hours after unprotected sex and take 2 more pills 12 hours late). There is also Ciclo 21, Ciclon, Gestrelan, Microvlar, Nociclin or Nordette (for all of these, take 4 pills within 120 hours after unprotected sex and take 4 more pills 12 hours later).

Costs

The price of EC ranges from R$ 20 = R$ 35 ($8.50 - $14.88), as of 2013.

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

The word for STDs in Portuguese is "Doenças Sexualmente Transmissíveis."

Regarding HIV/AIDS, Brazil has the highest infection rate in Latin America, accounting for 43% of infections. In 2015, it was estimated that 830,000 people in Brazil were living with HIV, which covered 0.6% of the adult population. According to AIDS.gov, "Currently there are still more cases of the disease among men than among women, although this difference has been decreasing over the years. The proportional increase in the number of female AIDS cases can be seen in the sex ratio (number of male cases divided by the number of female cases). In 1989 the sex ratio was around 6 male AIDS cases to 1 female case. By 2010 the ratio had reached 1.7 male cases to 1 female case."

If you have HIV/AIDS, there are no travel restrictions in Brazil. Furthermore, if you have a residence permit, and if you have HIV/AIDS, your residence permit cannot be cancelled exclusively due to HIV or AIDS. If you are a Brazilian national or have a Brazilian residence permit, you are eligible for treatment in the country's 300+ medical facilities specializing in HIV/AIDS. There are PrEP trials going on in Brazil. Check out the "Medications" section for details.

Regarding hepatitis ("hepatite" in Portuguese), many Brazilians are completely unaware of Hepatitis C. According to a recent global survey, Brazilians were the least aware of Hepatitis C of all participating countries, with only 13% being aware.

What to Get & Where to Get It

Testing Facilities

Check out our local pages for recommended testing facilities.

Support

• Coordenação Nacional de Doenças Sexualmente Transmissiveis e AIDS: This site has a list of all Brazilian HIV treatment centers
• GAPA
• Grupo Pela Vidda/Rio de Janeiro: a non-governmental, not-for-profit, community-based organization, formed by people living with HIV/AIDS.
• Grupo Positivo

Costs

Brazil has a free universal health care system for Brazilian citizens and residents under the public health system (known as "Sistema Único de Saude – SUS"). If you're a Brazilian citizen/expat, you are thus entitled to free STD/STI tests. If you're not a citizen/expat, or if don't want to use the public health care system, you can opt for private clinics, which will be more expensive but offer better facilities and higher efficiency overall.

Medications & Vaccines

Pharmacy in Londrina, Brazil

What to Get & Where to Get It

If you have a yeast infection, ask for "Fluconazole" at the pharmacy. They will give you a local version of the general medication.

If you have a urinary tract infection, you may want to tell the pharmacist that you have "infecção do trato urinário."

Regarding HPV, Brazil has had a national vaccination program in place since 2014, which targets 9 year olds for immunization. If you would like to receive the HPV vaccine and you do not fall under the Brazilian national program, contact your local hospital for more info.

For HIV treatment, there is a network of over 300 treatment centers in Brazil. Check out this [www.aids.gov.br list].

Regarding PrEP: "Brazil hosted three sites in the phase III iPrEx trial, and the open label extension of iPrEx. Brazil has an ongoing PrEP demonstration project in MSM and transgender women, PrEPBrasil. A second demonstration project is scheduled to start by mid-2015 and will enroll MSM, commercial sex workers and drug users. Gilead submitted an application for Truvada as PrEP to Brazil’s regulatory authority in 2014. There is no national PrEP policy or guidance at present. However, the ongoing demonstration project may be used to inform such policy."

Menstruation

Note: Aside from pads and tampons, you can use menstrual cups or menstrual underwear for your period. To learn more about menstrual cups, click here. To learn more about menstrual underwear, click here.

Laws & Social Stigmas

While tampons are available in Brazil, less than 25% of Brazilian women use them, and some women have very little to no understanding of how to use them. For these reasons, among others, tampons are not incredibly common.

What to Get & Where to Get It

You can easily find pads in Brazil. You'll be able to find tampons with no applicators (like OB) at supermarkets and pharmacies. But note that tampons are not sold in every store, and they are sometimes out of view, stocked below or behind other items in stores. Check out this blog entry from an American expat about buying tampons in Brazil. Note that, if you want to buy tampons with applicators (like Tampax), they may be very difficult to find.

If you would like to buy a menstrual cup, you can local stockers of MoonCups, which include the following:

• Mutações: Largo dos Leões, 81, loja C, Humaitá, Rio de Janeiro 22260-210, T: 21 2530 420, skype: mutacoes, contato@lojamutacoes.com.br
• Ana Domitila de Leão Rodrigues Pereira: T: (021) 3486-9536 ou (021)8871-9007, anadomitila@ig.com.br
• Bebel Clark: T: (21) 9408-3027, bebelclark@gmail.com, Twitter: @bebelclark // @sobrepessoas
• Catarina Lozinsky Mariath: T: (21) 9607-8276 e (21) 3598-0007 , catarina_bio12@hotmail.com, Facebook: Catarina Lozinsky Mariath
• Mariana França: T: (21) 93643607 / (21) 22328254, skype: mari.una, mariterrauna@gmail.com

There is a Brazilian LadyCup website. There appear to be no local sellers of DivaCup in Brazil, so it should be purchased online.

As for menstrual underwear, there are no known sellers in Brazil, so they should also be purchased online.

Costs

In 2012, pads were R$2 while tampons were R$9.

Gynecological Exams

Pregnancy

What to Get & Where to Get It

If you are a Brazilian citizen or resident, you ca get free prenatal care through Brazil's public healthcare system (SUS - Sistema Única da Saúde) by going to the neighborhood Health Clinic (UBS Unidade Básica da Saúde), often called "Posto de Saúde."

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

According to the Brazilian Penal Code (1940), abortion is generally illegal. There are only two exceptions: to save the life of a woman, or if the woman was impregnated due to rape or incest. All other reasons for abortion, such as the preservation of the woman's heath (mental or physical), risk of fetal impairment, economic or social reasons, etc., are not recognized. If a woman wants to legally obtain an abortion, she must give consent. If she is considered incompetent, then her legal representative/guardian must give consent.

If an illegal abortion is performed, the physician/practitioner may be punished with 1-4 years in prison. If the woman does not give consent, or if she is under 14 years old, or if she dies during the abortion, the imprisonment may be much longer. If a woman illegally receives an abortion, she may be sentenced to 1-3 years in prison.

Furthermore, Brazil has signed the American Human Rights Convention, also known as the Pact of San José. This pact grants that, "from the moment of conception," human embryos have the right to life. In 2008, the Brazilian Supreme Federal Court ruled that the right to life only applies to intrauterine embryos, thereby excluding frozen embryos. In 2012, the Supreme Court authorized abortion on fetuses with anencephaly.

Since 1975, Brazil has seen strong efforts to try to ease abortion restrictions, which have been unsuccessful. According to a 2007 poll, 65% of Brazilians think that abortion laws "should not be modified." Yet, despite these restrictions, abortion seems to be rather common. In a 2005 survey, it was found that 1/3 Brazilian doctors had performed an abortion, and a 1991 World Bank report estimated the lifetime abortion rate as two abortions per woman. According to a UN Report, "abortions are widely performed. According to most recent estimates, approximately 1 to 4 million women a year obtain abortions in Brazil. The majority of women seeking abortions are married. Prosecution for unlawful abortion is rare. The requirement of legal proof of pregnancy as a precondition for prosecution allows abortion to be performed despite current prohibitions. Moreover, although not authorized to do so by the law, judges in approximately 350 cases in recent years have allowed abortions to be performed in cases of severe foetal defect."

Regarding the abortion pill, the UN Report found the following: "Near the end of 1991, the Government of Brazil took steps to end the use of Cytotec for the performance of illegal abortions. Acting in part in response to a campaign of a number of groups against the drug, the federal Ministry of Health issued an order placing Cytotec in a category of drugs that could be sold only in authorized drugstores; these drugstores were required to retain a copy of the physician’s prescription for official use. State Governments adopted similar measures. In Rio de Janeiro, use of the drug was limited to hospitals; in Ceará, its sale was completely prohibited; and in São Paulo, sales through drugstores were restricted to use for gastrointestinal purposes and drugstores were required to keep detailed records on the patient, prescribing physician and indications for the use of the drug. Use of Cytotec for gynaecological reasons in hospitals in São Paulo required the permission of health officials. Approval of the regulations has dramatically decreased the sale of Cytotec, although its effect on the number of abortions performed in Brazil is unknown at this time. "

What to Get & Where to Get It

In Brazil, Misoprostol (part of the abortion pill) is registered as Cytotec and Prostokos, but it is difficult to get. If you cannot access Misoprostol, you have the following options: 1) Contact Women on Web for an online consultation to access Mifepristone and Misoprostol (the abortion pill) or 2) Travel to another country where you can safely and legally obtain an abortion. You may want to consider getting an abortion in Mexico City, Guyana, Cuba or the United States of America. For more details about a abortions in other countries, visit the Women on Waves Options Page for Brazil.

Advocacy & Counseling

List of Additional Resources

• Rede Feminista de Saúde (Feminist Network for Health, Sexual Rights, and Reproductive Rights): This organization was formed in 1991. Politically organizes around issues related to sexual and reproductive health care and rights.
• Cepia: This women's rights organization was founded in 1990. Phone: +55 21 2558-6115. Email: cepia@cepia.org.br