Bangladesh

INTRODUCTION

Au Bangladesh, on peut se procurer la contraception sans ordonnance. Vous pouvez obtenir la contraception d'urgence (pilule du lendemain) sans ordonnance en pharmacie. Concernant les IST, vous pourrez être testée dans la majorité des établissements de santé, et il existe des organisations et groupes de soutien pour les personnes touchées par l'hépatite et le VIH. Il existe de grands hôpitaux privés, associés à des groupes hospitaliers, qui sont réputés offrir parmi les meilleurs soins à Dacca, mais il vous coûteront plus cher. Vous trouverez plus d'informations les concernant dans la rubrique "Examens gynécologiques" ci-dessous. Concernant les menstruations, vous pourrez trouver des serviettes hygiéniques, des protège-slips et des tampons, mais nous ne savons pas si des coupes menstruelles sont en vente dans le pays. L'avortement est généralement interdit sauf si la vie de la femme est en danger. Cependant, le Bangladesh autorise la régulation menstruelle (aspiration) si la femme arrête d'avoir ses règles.

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

Au Bangladesh, les femmes peuvent se procurer des contraceptifs hormonaux sans prescription. En 2015, on estimait que 64,2% de femmes bangladaises utilisaient une forme de contraception et que 56,7% utilisaient des méthodes modernes de contraception. Il était également estimé que 27,1% des femmes avaient des besoins en planification familiale qui n'étaient pas satisfaisants. Les méthodes les plus courantes de contraception sont la pilule contraceptive (32,5%) et les injections (14,1%). Les autres méthodes incluent la méthode Ogino (calcul des cycles) (5,2%), les préservatifs masculins (4%), et la stérilisation féminine (3,8%).

Le Bangladesh est un pays majoritairement musulman (92% de la population). En général, les prêtres musulmans n'ont pas fait reculer les droits à la contraception, ce qui permit de très grands progrès dans les dix dernières années. Le pays commença à expérimenter la livraison gratuite de contraceptifs au porte à porte dans les années 1970. Les études ont montré que, lorsque l'on proposait aux femmes une livraison à domicile par du personnel de santé, il était beaucoup plus probable qu'elles utilisent une contraception à l'avenir. Grâce au succès de cette expérience, le Bangladesh commença à proposer la même chose dans tout le pays dans les années 1980. Depuis lors, le taux moyen de natalité du pays est passé de 6 naissances à environ 2,2 naissances par femme. Comme rapporté par l'Institut Guttmacher concernant les femmes au Bangladesh, "Les raisons principales que les utilisatrices de pilules contraceptives donnèrent pour avoir choisi cette méthode étaient que c'était simple à utiliser, qu'une travailleuse de terrain leur livrait directement chez elles et qu'elles avaient des inquiétudes quant aux effets secondaires des autres méthodes de contraception (cité par 35-41%)."

Que prendre et où le trouver

• Pour une liste complète des options de contraception disponibles au Bangladesh, cliquez ici.
• Vous pouvez acheter des pilules contraceptives dans les pharmacies à Dacca, sans ordonnance. Il existe plus de 10 marques de pilules contraceptives dans le pays, parmi lesquelles Combination 3, Marvelon, Microgynon, Minicon, Minulet, Nordette, Nordette 28, Norquest, Ovacon, Ovastate et Sukhi. La majorité de ces marques viennent d'entreprises européennes et américaines.
• Vous pouvez acheter des préservatifs et pilules contraceptives en ligne grâce à l'entreprise bangladaise Goponjinish. Parmi les marques vendues, on y trouve Ovacon Gold 22 comprimés (65 Tk), Mypill 21 comprimés (99 Tk), Novelon 21 comprimés (400 Tk), Femipil faiblement dosée (25 Tk), Marvelon 21 comprimés (105 Tk), etc. Vous y trouverez aussi des marques de préservatifs comme Durex, Moods et Manforce. Adresse: goponjinish, Bloc - A, Lalmatia, Dacca. Email: support@goponjinish.com. Numéro de téléphone pour les femmes: 01730 332504. Numéro de téléphone pour les hommes: 01730 332502.
• Si vous souhaitez un implant contraceptif, vous pourrez trouver Norplant au Bangladesh.
• Si vous souhaitez un contraceptif injectable, vous pourrez trouver Depo-Provera SAS 150mg/ml, Megestron et Noristerat.

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 Bangladesh, you can purchase emergency contraception (the morning after pill) without a prescription. There are no age restrictions. Generally speaking, you can obtain emergency contraception from the following people: field workers, NGO providers, pharmacists, nurses, and physicians. In the public sector, the lowest cadre of health care workers who are permitted to sell or dispense EC are auxiliary nurses. In the private sector, the lowest cadre of workers who are allowed to sell or dispense EC are community health workers.

Historically, the Bangladeshi government introduced emergency contraceptives into the National Family Planning Program in 2001. Between the years of 2003-2004, the government trained 44,774 providers and trainers in the handling of emergency contraception. The government effort was also in collaboration with the Directorate General for Family Planning, the FRONTIERS Program of the Population Council and UNFPA. However, here have still some critical issues to address. In most cases, EC was not found to be available as part of post-rape care in hospitals or police stations. This issue is worsened by the fact that, in most cases, staff in hospitals and police stations report having received little or no training regarding post-rape care and they received no official guidelines. As of 2008, EC was not listed in Bangladesh's Essential Medicines List. In 2012, EC was distributed via 5000-10,000 IPPF outlets in Bangladesh.

You can watch a Bangladeshi commercial for Norix, an EC pill, here.

What to Get & Where to Get It

• In Bangladesh, you can buy emergency contraception (the morning after pill) at pharmacies. There are two dedicated EC (progestin-only) brands that you'll find, which are Emcon 1 and Postinor-2. You should take take 2 pills within 120 hours after unprotected sex. Be sure to take the pills as soon as possible.
• You can also expect to see Norix and Emcon1 at pharmacies. These both contain 1.5 mg levonorgestrel, which belongs to a group of medicines called progestogen.
• You can purchase emergency contraception online in Bangladesh through Goponjinish. They sell brands like Postinor 2 (80 Tk), Norix (55 Tk) and Emcon 1 Emergency (65 Tk). However, you should only purchase EC online for future issues; you shouldn't depend on the delivery service to arrive on time if you need emergency contraception immediately. When you need EC immediately, you should go to the nearest pharmacy.
• If you can't access dedicated emergency contraception, you can take regular birth control pills as replacement EC. You can take Minicon (take 40 pills within 120). For the following medication, which is progestin-estrogen pills, you should only take the first 21 pills in 28-day packs. You can take Ovral (take 2 pills within 120 hours after unprotected sex and take 2 more pills 12 hours later). You can also take Combination 3, Microgynon, Nordette, Nordette 28 and Ovral (take 4 pills within 120 hours after unprotected sex and take 4 more pills 12 hours later).

Costs

For online purchases, EC generally costs between 55-200 Tk, depending on the brand.

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 Bangladesh, there are no legal travel or residency restrictions regarding STI status. However, there have been some potential cases of immigration determination based on HIV status. According to HIVTravel, "The Government of Bangladesh has no written policy regarding the entry of individuals with HIV/AIDS. However, according to anecdotal reports, some HIV/AIDS entry restrictions may exist for visitors to and foreign residents of Bangladesh. The Government of Bangladesh has informed the Embassy that a health officer or immigration officer at the airport who has concerns about an individual's possible HIV/AIDS status will make a case-specific determination regarding that individual's entry."

In 1985, Bangladesh launched an HIV prevention program. This helped the country prepare for its first reported HIV case in 1989. Generally speaking, HIV rates in Bangladesh are very low at less than 0.1% of the general population. For at-risk groups, this number is a bit higher, but still rather low (.7%). Some of the highest rates of HIV infection were found in sex worker populations of the Hili with a 2.7% infection rate.

Regarding HPV: "Data is not yet available on the HPV burden in the general population of Bangladesh. However, in Southern Asia, the region Bangladesh belongs to, about 4.4% of women in the general population are estimated to harbour cervical HPV- 16/18 infection at a given time, and 81.2% of invasive cervical cancers are attributed to HPVs 16 or 18."

What to Get & Where to Get It

Note: There appears to be no PrEP available in Bangladesh.

Testing Facilities

Please visit the city pages, like the Dhaka page, for local recommendations.

Support

• Marie Stopes Bangladesh - They have many clinics throughout Bangladesh that can provide STI management. Click here for a list of clinic addresses in Bangladesh. "The majority of our work specifically targets the poor, young people, factory workers, and vulnerable groups including slum dwellers, homeless people, drug users, sex workers, and transgender people." Marie Stopes Head Office House Address: # 6/2, Block - F, Lalmatia Housing Estate, Kazi Nazrul Islam Road, Lalmatia, Dhaka - 1207, Bangladesh. Tel: 880-2-8114392, 880-2-8114394, 880-2-9121208, 880-2-9129022, 880-2-8116117. Fax: 880-2- 8117673. E-mail: mscs@mariestopesbd.org.
• National Liver Foundation Bangladesh: "National Liver Foundation of Bangladesh is a not-for-profit organization established in April, 1999 at Dhaka, Bangladesh. This Organization is the first of its kind in Bangladesh which is dedicated to Prevention, Treatment, Education and Research on liver diseases with special emphasis on viral hepatitis. The foundation is the member of World Hepatitis Alliance since its inception." Contact: Mr. Zunaid Murshed Paiker, Coordinator (Operations & Program), 150,(2nd Floor)Green Road, Panthapath,, Dhaka – 1215, Bangladesh. Call us : +8801755528811, , +88 02 9146537 + 01732999922, Fax: 088-02-9128239, Email: info@liver.org.bd
• Jagrata Juba Shangha (JJS): This is an HIV NGO in Bangladesh, which was recommended by HIVTravel. Address: 96 South Central Road, Khulna-9100, E-mail: jjs@khulnanet.net. Contact person: Kaniz Fatima.
• HIV/AIDS and STD Alliance Bangladesh (HASAB): This mission is to "Contribute in reducing vulnerability and mitigating impact through integrating HIV programme with sexual and reproductive health, TB and other health services that are critical to communities most affected by HIV." Address: House-66, 1st Floor, Apartment- B-1, Road-5, Block-C, Monsurabad Housing, Mohammadpur, Dhaka-1207. Phone: 880-2-9132705. Fax: 880-2-9857485. E-mail: hasab@bdmail.net.
• UNAIDS Bangladesh: "The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections..."

Medications & Vaccines

What to Get & Where to Get It

• There appears to be no PrEP (Pre-exposure prophylaxis) available in Bangladesh.
• Bangladesh has an HPV vaccine pilot program in place (as of 2016).

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

In Bangladesh, pads are available in most cities and towns, but they're rather bulky. Some people find them ineffective. Tampons are very difficult to find. You will need to bring your own toilet paper into most bathrooms. If you're interested in menstrual cups, you may have some difficulty finding them in Bangladesh. There are no known sellers of major menstrual cup brands, such as DivaCup, MoonCup, LadyCup or Lunette, in Bangladesh, so you may want to order one online, if you're interested in buying one.

Gynecological Exams

What to Get & Where to Get It

Check out this list of specialist gynecologists and obstetricians in Dhaka.

• Marie Stopes Bangladesh: Provides gynecological services to the poor, high-risk groups, homeless, transgender people and factory workers. Services include: family planning (cafeteria of choice) including temporary, long acting and permanent methods, ante and post natal care, general health care, RTI/STI management, menstrual regulation, immunization, child Health Care, supportive pathological tests, essential Obstetric Care( delivery) in selected clinics, ultra sonogram services in selected clinics, etc.
• Apollo Hospitals Dhaka: High-quality and more expensive. "Apollo Hospitals Dhaka enjoys the distinction of being the first private sector for-profit corporate hospital in Bangladesh. We started our operations as a tertiary care super specialty hospital on March 30, 2005. Our affiliation with the prestigious quality brand of Apollo Hospitals Enterprises Limited (AHEL) of India, reflects the International Standard for Quality and Patient Safety in providing corporate healthcare and consumer value in our market niche."
• Labaid Specialized Hospital: High-quality and more expensive. "The Department of Obstetrics and Gynaecology at Labaid Specialized Hospital caters to the complete needs of women from adolescence through to menopause and beyond."
• Square Hospital: High-quality and more expensive. "Square Hospitals Limited, a concern of Square Group is a 400-bed tertiary care hospital. The hospital is an affiliate partner of Methodist Healthcare, Memphis, Tennessee, USA, SingHealth, Singapore, Bangkok Hospital Medical Centre, Thailand and Christian Medical College, Vellore, India."

Pregnancy

Laws & Social Stigmas

In Bangladesh, working mothers in the public sector get 6 months of maternity leave. For working mothers in the private sector, they are guaranteed at least 66 days of maternity leave.

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 Bangladesh, abortions can be legally obtained. While induced abortions isn't generally permitted, according to the Penal Code of 1860, abortion is permitted under two conditions. First, if a woman's life is endangered by the pregnancy, she may obtain an abortion. Second, a woman may seek an abortion under Menstrual Regulation (MR), which has been under Bangladeshi family planning since 1979. MR is a procedure that uses manual vacuum aspiration (MVA) after a missed period. The woman can receive MR in a range of 8-10 weeks after the missed period, with specifications varying based on providers. In 2010, it was estimated that 653,100 MR procedures were performed in health facilities nationwide.

In Bangladesh, it was found that about two-thirds of MR procedures were performed in public health facilities, such as Union Health and Family Welfare Centres, which are the primary providers in rural areas. NGOs provide about one quarter of MR services and private clinics provide about 9%. However, many of the public health providers do not perform the procedure. In 2010, only 57% of the facilities that were expected to provide MR services actually did provide them.

In 2015, the Population Council found that "In spite of wide availability of menstrual regulation services, women often resort to a variety of medicines for inducing abortion. The Bangladeshi Government is now supporting attempts to investigate the introduction of medical menstrual regulation in the public sector." The study found that "Overall 61.4% of women who used medical menstrual regulation found the method satisfactory, and 34.2% were very satisfied. Of the 3.9% of women who were not satisfied, most received services from rural facilities."

What to Get & Where to Get It

• You can try to get an abortion pill online through Women on Web.
• Marie Stopes Bangladesh - They will probably be able to direct you to the best services. Call these numbers for information on their services: 01730450678, 01755578215, 01762686866. Head Office Address: Marie Stopes Bangladesh, House # 6/2, Block – F, Kazi Nazrul Islam Road, Lalmatia Housing Estate, Dhaka – 1207, Banglades, (Behind Mohammadpur Police Station, Thana), Phone: 8116117, 9121208, 9124781, 9129022, 9146478, 58152540, 58152538. Fax: 880-2-8117673. Email: mscs@mariestopesbd.org.
• Asia Safe Abortion Partnership - Bangladesh: Contact them to get information. Bangladesh Nari-Bandoph - Call 880 – 1853892424 (Bangla)
• Naribandhob Hotline: “Naribandhob” hotline 088-01853-892424 will provide information about safe MR in Bangladesh. “Naribandhob” hotline can be reached at 088-01853-892424. The hotline will provide safe and scientific information on how a woman can use the life-saving drug misoprostol for safe MR, post-MR care, and to prevent deadly bleeding after giving birth (PPH – postpartum hemorrhage), the leading causes of maternal death and injury in Bangladesh. These deaths and injuries can be prevented with women are given safe and scientific information and access to essential medications and services. Information is provided free of charge through a regular mobile phone number."

Advocacy & Counseling

What to Get & Where to Get It

• Maya Apa: This is a Bangladeshi app that's totally anonymous. You only need an email address to register. Then, you can ask questions about sexual health and receive responses within 24-48 hours by a team of doctors, lawyers and counselors. The response is in the language that the question is written in.
• Hope for the Destitute Women and Children: "Mission: Improve protection and rehabilitation of sexually abused pregnant girls and their abandoned children." Address: Road: 11, House No: 2, Shekhertek, Dhaka, Bangladesh. Twitter: @bdhdwc. Call +880 2-9126259.

List of Additional Resources

• YouthAID: YouthAID is a network which aims to build social movement to ensure women rights, safe abortion rights and Sexual and Reproductive Rights.
• Bangladesh National Woman Lawyers' Association: Address: Monico Mina Tower, West Agargaon, 48/3 Shahid Shahabuddin Shorok, Dhaka 1207, Bangladesh. Phone: +880 811-2858.