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Rio de Janeiro: Difference between revisions
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{{setLocation | {{setLocation | ||
|Country=Brazil | |Country=Brazil | ||
|City=Rio de Janeiro | |City=Rio de Janeiro | ||
}} | }} | ||
[[File:Rio-de-janeiro-809756 960 720.jpg|400px | thumb|right|alt=Image provided by Creative Commons.|]] | |||
'''OVERVIEW''' | '''OVERVIEW''' | ||
==Contraception== | Rio de Janeiro is a massive city, offering many health care options. Condoms and oral contraceptives (birth control pills) are legal and no prescription is required. Other contraceptive options are available at pharmacies or clinics. 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 Rio de Janeiro, and Brazil has 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 Americas, such as Uruguay, Mexico, the USA, the or Cuba, if at all possible, 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). | |||
==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 [https://www.plannedparenthood.org/learn/birth-control here]. | '''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 [https://www.plannedparenthood.org/learn/birth-control here]. | ||
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===Laws & Social Stigmas=== | ===Laws & Social Stigmas=== | ||
Contraceptives are legal 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<ref>[http://www.infoplease.com/ipa/A0193123.html Prevalence of Contraceptive Use in Selected Countries]</ref> In 2001, it was estimated that 1 in 2 Brazilian women have been sterilized, according to a government survey.<ref>[http://www.washingtonpost.com/wp-dyn/articles/A32622-2004Jun10.html Infertile Ground Is Sown in Brazil ]</ref> | 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<ref>[http://www.infoplease.com/ipa/A0193123.html Prevalence of Contraceptive Use in Selected Countries]</ref> In 2001, it was estimated that 1 in 2 Brazilian women have been sterilized, according to a government survey.<ref>[http://www.washingtonpost.com/wp-dyn/articles/A32622-2004Jun10.html Infertile Ground Is Sown in Brazil ]</ref> | ||
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%).<ref>[http://www.un.org/en/development/desa/population/publications/pdf/family/trendsContraceptiveUse2015 Report.pdf Trends in Contraceptive Use Worldwide 2015]</ref> | |||
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. <ref>[http://motherboard.vice.com/read/the-pill-in-brazil z | 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. <ref>[http://motherboard.vice.com/read/the-pill-in-brazil z | ||
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===What to Get & Where to Get It=== | ===What to Get & Where to Get It=== | ||
[[File:Yasmin brazil.jpg|300px | thumb|left|frame|'''Yasmin purchased in Brazil for 70 BRL''']] | |||
If you are interested in female sterilization/tubal litigation, it is called "laqueadura tubária" in Portuguese. | If you are interested in female sterilization/tubal litigation, it is called "laqueadura tubária" in Portuguese. | ||
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===Costs=== | ===Costs=== | ||
==Emergency Contraception== | ==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 [https://www.plannedparenthood.org/learn/morning-after-pill-emergency-contraception here] and [http://ec.princeton.edu/info/ecp.html here]. | '''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 [https://www.plannedparenthood.org/learn/morning-after-pill-emergency-contraception here] and [http://ec.princeton.edu/info/ecp.html here]. | ||
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===Laws & Social Stigmas=== | ===Laws & Social Stigmas=== | ||
In Brazil, you need a prescription to | 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,<ref>[http://www.cecinfo.org/country-by-country-information/status-availability-database/countries/brazil/ EC Status and Availability: Brazil]</ref> 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.<ref>[http://www.cecinfo.org/country-by-country-information/status-availability-database/countries/brazil/ Brazil: EC Status & Availability]</ref> 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.<ref>[http://www.csmonitor.com/2007/1120/p07s02-woam.html Christian Science Monitor: Brazil doles out 'morning after' pills]</ref> | ||
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."<ref>[Emergency Contraception: Knowledge, Attitudes and Practices Among Brazilian Obstetrician-Gynecologists]</ref> | 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."<ref>[Emergency Contraception: Knowledge, Attitudes and Practices Among Brazilian Obstetrician-Gynecologists]</ref> | ||
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===What to Get & Where to Get It=== | ===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).<ref>[http://ec.princeton.edu/worldwide/ Emergency Contraception Website]</ref> | |||
* 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).<ref>[http://ec.princeton.edu/worldwide/ Emergency Contraception Website]</ref> | |||
In Brazil, if you would like to buy dedicated, progestin-only EC, you can find Postinor Uno and Pozato Uni (take 1 pill within 120 hours after unprotected sex). Furthermore, there is also | |||
===Costs=== | ===Costs=== | ||
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==Medications & Vaccines== | ==Medications & Vaccines== | ||
[[File:Pharmacy londrina brazil.jpg|400px | thumb|right|'''Pharmacy in Londrina, Brazil''']] | |||
===Laws & Social Stigmas=== | ===Laws & Social Stigmas=== | ||
===What to Get & Where to Get It=== | ===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 [http://www.aids.gov.br/pt-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."<ref>[http://www.prepwatch.org/brazil/ PrEPWatch: Brazil]</ref> | 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."<ref>[http://www.prepwatch.org/brazil/ PrEPWatch: Brazil]</ref> | ||
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===Laws & Social Stigmas=== | ===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.<ref>[https://www.reddit.com/r/europe/comments/3p7v64/tampon_consumption_around_the_world/?st=iqnp19ec&sh=0dea54f0 Tampon Consumption Around the World]</ref> | |||
===What to Get & Where to Get It=== | ===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 [http://adventuresintheamazonjpr.blogspot.com/2012/04/one-thing-that-bugs-me-about-brazil.html 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 [http://www.ladycupbrasil.com.br/ 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=== | ===Costs=== | ||
In 2012, pads were R$2 while tampons were R$9. | |||
==Gynecological Exams== | ==Gynecological Exams== | ||
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===What to Get & Where to Get It=== | ===What to Get & Where to Get It=== | ||
Check out the 'STD/STI' Testing section for some recommended private hospitals/clinics in Rio. | |||
Also, if you are a foreigner, you may find this [http://www.expat.com/en/business/south-america/brazil/rio-de-janeiro/6_health/gynecologists/ list of recommended ob/gyns in Rio] useful. | |||
* [http://www.albertofreitas.med.br/english Alberto Freitas, MD]: english speaking gynecologist and obstetrician, based in Rio de Janeiro's Botafogo neighborhood. Online booking available via website. | |||
* [http://www.doctorluisa.com.br Doctor Luisa Czeresnia]: She speaks English and has an office in Ipanema in Zona Sul. Website is in English and Portuguese. | |||
===Costs=== | ===Costs=== | ||
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===What to Get & Where to Get It=== | ===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." | |||
===Costs=== | ===Costs=== | ||
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===Laws & Social Stigmas=== | ===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.<ref>[https://www.womenonwaves.org/en/page/4938/brazil--abortion-law Brazil: Abortion Law]</ref> | |||
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.<ref>[https://en.wikipedia.org/wiki/Abortion_in_Brazil Wikipedia: Abortion in Brazil]</ref> | |||
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.<ref>[https://en.wikipedia.org/wiki/Abortion_in_Brazil Wikipedia: Abortion in Brazil]</ref> 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. "<ref>[http://www.un.org/esa/population/publications/abortion/profiles.htm UN Report, Brazil - Abortion Policy[</ref> | |||
===What to Get & Where to Get It=== | ===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. It is also important to exercise extreme caution when trying to access clandestine abortion services, as they may not be safe or you may not be offered by trained professionals. | |||
* If you cannot access Misoprostol, you have the following options: 1) Contact Women on Web for [https://www.womenonweb.org/en/i-need-an-abortion 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]], [[Uruguay]], [[Guyana]], [[Cuba]] or the [[United States of America]]. | |||
* For more details about an abortions in other countries, visit the [https://www.womenonwaves.org/en/page/4939/brazil--options-for-abortion-and-organizations-for-women Women on Waves Options Page for Brazil]. | |||
===Costs=== | ===Costs=== | ||
If you are pregnant and considering getting an abortion outside Brazil, you will need to consider the following costs: transportation to the country where you will be obtaining an abortion, hotel or accommodation costs in that country, cost of the abortion in the country and the total amount of days you may need to be in the country both before and after the abortion. | |||
==Advocacy & Counseling== | ==Advocacy & Counseling== | ||
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===What to Get & Where to Get It=== | ===What to Get & Where to Get It=== | ||
* Human Rights Secretariat: Call 100 | |||
* Brazil Suicide Hotline: Call 212339191 | |||
* Anonymous crime reporting: Call 181 | |||
* Ministry of Health Hotline: Call 136 | |||
* Ambulance: Call 192 | |||
* Firefighters: Call 193 | |||
* Federal Police Department: Call 194 | |||
* Civil Police: Call 197 | |||
===Costs=== | ===Costs=== | ||
==List of Additional Resources== | ==List of Additional Resources== | ||
* [http://portalms.saude.gov.br/ Ministry of Health] | |||
* [https://www.facebook.com/bemfam The Brazilian Society for Family Welfare (BEMFAM)]: Founded in 1965. This nonprofit focuses on sexual and reproductive health care and human rights. Email: info@bemfam.org.br | |||
* [https://www.dktinternational.org/country-programs/brazil/ DKT International - Brazil]: "DKT Brazil, founded in 1991, is the largest social marketing operation in Latin America and is now building on that success in several neighboring countries in South America... DKT’s condom brand Prudence is the best-selling condom in the country... In addition to condoms, DKT Brazil sells IUDs and MVA kits to hospitals, clinics, and healthcare providers. There are five IUD variants, to broaden the access and meet different users’ needs." | |||
* [http://www.equaldex.com/region/brazil Equaldex Brazil]: This website provides information related to LGBTQ rights and laws in Brazil. Note that homosexuality is legal and gay marriage is legal in Brazil. It is also legal to change gender. Gay parents can adopt. There are laws against employment discrimination related to sexual identity or gender identity. | |||
* [http://redesaude.org.br/comunica/ 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. | |||
* [https://cepia.org.br/en/ Cepia]: This women's rights organization was founded in 1990. Phone: +55 21 2558-6115. Email: cepia@cepia.org.br | |||
==References== | ==References== | ||
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