Brazil to Subsidize the Pill

Interesting news from Brazil:

(SAO PAULO) — President Luiz Inacio Lula da Silva announced a new program Monday to sharply decrease unwanted pregnancies in Latin America's largest nation by subsidizing birth control pills.

Less than a month after Pope Benedict XVI criticized government-backed birth control measures during a visit to Brazil, Silva said the plan will give poor Brazilians "the same right that the wealthy have to plan the number of children they want."

Brazil already hands out free condoms and birth control pills at government-run pharmacies across Latin America's largest nation.

But many poor people in the nation of 190 million don't go to those pharmacies, so the government decided to offer the pills at significantly reduced prices at 3,500 private drug stores, said Health Minister Jose Gomes Temporao.

The number of drug stores offering the subsidized pills should rise to 10,000 by the end of this year, Temporao said. When the 100 million real (US$51 million) program is fully under way, the government will be handing out 50 million packages of birth control pills each year.

Each government-subsidized package — with enough pills to last a month — will cost 0.40 Brazilian reals (US$0.20). They now retail for 5 reals (US$2.56) to 50 reals (US$25.60).

Read the whole thing.

Free Emergency Contraception in Chile

A follow-up to my post on the avilability of the emergency contraception pill in Latin America. From Chile:

SANTIAGO, Chile - The government on Tuesday said it will resume its program to provide free "morning-after" contraceptives to girls as young as 14, but will also offer them advice by specialists.

The program started in September last year, but it was halted earlier this month when the Constitutional Court ruled it had been improperly implemented by administrative decree rather than by a presidential decree or legislation.

The government said it would correct the legal problem.

President Michelle Bachelet on Monday signed a new decree, which should be cleared by the General Comptroller's Office this week, allowing resumption of the program, according to Health Minister Soledad Barria.

She said that the government introduced a change in the program by appointing physicians and psychologists to offer free advice to girls requesting the pill.

...

The program triggered heated debate in a country considered politically liberal but socially conservative. Chile prohibits abortion in all cases and divorce was only legalized here in 2004.

Some conservative mayors have refused to let their city health services distribute the pills.

One of them, Pablo Zalaquet of La Florida near Santiago, called Bachelet's decree "a black day for our country, a slap to the institution of family."

The morning-after pill contains a high dose of the most common ingredient in regular birth-control pills. When taken within 72 hours of unprotected sex, the two-pill series can lower the risk of pregnancy by up to 89 percent. Officials say it will not work on a woman who is already pregnant.

Before the program was implemented, the pill was available only to women who had been raped. The pill was legalized here in 2002 after a Supreme Court battle.

Bachelet has said her program is necessary because the price — $22 per two-pill package — is beyond the reach of poorer women.

Of course, just because in this one instance a government has decided to make emergency contraception available for free in no way means it's ever a good thing for your private medical decisions to be at the mercy of presidential decrees. Politicians, even well intentioned ones, have no business substituting their judgement for yours in medical matters. [Note to the Chilean government: just because a patient requests the emergency contraception pill doesn't mean she needs a psych consult.]

And then there are politicians like Mayor Pablo Zalaquet. Do you really want the mayor of your town deciding what meds, if any, you may be permitted to access?

Religion Shouldn't Interfere In the Passage of Laws

So says Argentinian opposition lawmaker Alicia Tate. And a good thing, too, when you have Argentine Catholic bishops arguing that the emergency contraception pill (ECP) is an assault on human life. On the other hand, illegal abortions that kill about 1,300 women a year in Argentina and are the leading cause of maternal deaths are a veritable blessing.

One very hard to ignore fact from this very interesting article on ECP availability in Latin America [other than Reuters' continued use of the incorrect "morning-after pill" term] is that, like Europe, most of Latin America is years ahead of the U.S.:

- In Buenos Aires, public hospitals offer the emergency contraception for free, no questions asked. Argentine lawmakers are pushing to extend this service nationwide.

- The Mexican government has mandated the pill be distributed at public hospitals, while in Peru it is offered for free. Municipal health services in Brazil dispense the morning-after pill nationwide, although clinics can opt not to do so.

- Chile's first female president, Michelle Bachelet, raised hackles last year when her government required the pill be made available at no charge to girls as young as 14.

Medical Abortion, Misoprostol, and Latin American Pharmacies

Well, isn't this a grand combination: Abortifacient provision is common at pharmacies [in Latin America] but knowledge about medications is low among pharmacy staff.

A number of studies have documented that women seek and that pharmacy staff distribute drugs intended to induce abortion at pharmacies in Latin America. Abortion is legally restricted in almost all of Latin America. Nonetheless, the region has one of the highest abortion rates in the world. In the 1990s, reports that women were using the prostaglandin analog misoprostol to self-induce abortion in Brazil emerged. Interviews with Brazilian women revealed that they tended to use misoprostol because of its lower price as compared with other medical alternatives, its immediate availability, the fact that the process seems more like a natural miscarriage and its apparent safety. In Brazil, prior to the drug's removal from the market, pharmacies were the main source of misoprostol.

Some evidence suggest that the availability and use of medical methods to terminate a pregnancy may contribute to declining complication rates from clandestine procedures, yet little is known about the role of pharmacist provision of medical abortifacients. We performed this study to learn more about pharmacists' knowledge and provision of medical abortifacients, particularly misoprostol, in a large Latin American city. Although the legislation of the country where the study was performed requires a prescription to purchase misoprostol, in practice, this law is not enforced and misoprostol is commonly sold without a prescription in pharmacies. Moreover, misoprostol is not approved for use as an abortifacient and legal abortions are very rare in the study country. We elected not to identify the study location because of the sensitive nature of the topic.

...

Similar to a study on pharmacies in Mexico City in 1993, our study found that the most frequently recommended abortifacients were hormonal injectables in both the survey (67%) and the mystery client encounters (71%). Although there is no scientific evidence to support their efficacy, it is widely believed both by pharmacy staff and the general population in Latin America that hormonal injectables are effective abortifacients. In our study, the second most common abortifacient was misoprostol: 33% of pharmacy staff mentioned it in the survey and 39% recommended it in the mystery client encounters. However, knowledge about adequate dosage, route of administration, side effects, complications and effectiveness was poor. In fact, no information was offered (even when requested) on any of these topics in at least half of the mystery client encounters in which misoprostol was recommended. Few pharmacy staff had received formal training regarding misoprostol use; most had consulted a drug reference guide or learned about the medication from colleagues, which could explain why so little information was known about dosage, side effects and complications.

Read the whole thing.