Friday, August 27, 2010

“No se necesita receta, or, Prescription unnecessary”

 Eugenia de Altura is a female graduate student conducting research on issues of women and gender in the cities of La Paz and El Alto, Bolivia. Bolivia is the poorest country in Latin America with the exception of Haiti, and over 60% of the country’s population is of indigenous descent. Eugenia’s postings explore women’s rights, sexuality, and reproductive health in Bolivia and in Latin America as a whole.
On a recent visit to a U.S. drugstore, I was amazed and delighted to find that customers can now find a few different types of vibrating sex toys next to the personal lubricants and condoms.  Without going through what some might describe as the embarrassment of speaking to a pharmacist or visiting a sex-toy shop, or the risk of ordering an item online and having your brother or kid open your mail, you can now buy sex toys off the shelf.  Of course, there is not a huge variety of toys to choose from at your local Rite Aid or Walgreens, but in a relatively small city, I was amazed to make this discovery.
In much of Latin America, over-the-counter access to drugs and other items functions in a very different way than it does in the U.S. or in other parts of the developed world.  In Bolivia, pharmacies are white, brightly lit stores with counters lining every wall.  Apart from cheap items like chapstick and gum, all other merchandise is kept behind the counters, and customers must speak with a pharmacist—within earshot of anyone else standing in the store—to get what they want.  (There are no requirements that those waiting in line stand a meter or two back from the counter when another customer is being served.)

To add to the anxiety of the experience, pharmacists dress in white lab coats and hats, making them even less approachable.  Fortunately for me, many of them are women, so at least I can avoid the awkwardness of requesting condoms or a pregnancy test from a guy.  In other words, although many items are available without a prescription, they are very literally “over the counter”—you can’t simply pluck them off the shelf.

Mustering up the courage to approach a pharmacist and make a sex-related purchase like lube may be possible for me—an older, sex-positive, educated woman—but it proves more difficult for Bolivian youth.  One twenty-year-old woman told me she waited weeks to confirm her unwanted pregnancy, since she was horrified at the prospect of buying a test.  In a country where sex education in schools is almost nil and parents’ discussion of sex is limited to barking, “don't get pregnant,” approaching a stranger in a lab coat in public to ask for condoms or a pregnancy test seems an insurmountable task.  Despite the fact that many young people know that condoms exist, few are brave enough to acquire them.

At the other end of the spectrum, many drugs are available (albeit clandestinely) over the counter in Latin America that are highly regulated in the U.S. and elsewhere.  Several Bolivian doctors have complained to me of unscrupulous pharmacists who sell misoprostol tablets—a medication that can be used to induce miscarriage—at several times its actual value to desperate women willing to pay.  In the U.S., misoprostol is approved by the Food and Drug Administration (FDA) in combination with another medication to induce abortion under about 9 weeks in pregnancy, under strict supervision by a doctor.  In Bolivia, women procure misoprostol often without any advice about how to use it, and are terrified when intense bleeding and cramping begin.  One woman told me that, even though she bought misoprostol from a doctor at a clinic, she had no idea how much bleeding she would experience—or, how to know if the abortion was complete. 

Considering the poor state of the current U.S. health insurance system, I would not be surprised if there is a black market for misoprostol in that country, too, although at least there its use is legal.  In Latin America, the over-the-counter concept seems to be a double-edged sword—on the one hand, it discourages people from exploring their sexuality safely, while on the other, it makes unsafe abortion both necessary (since the procedure is illegal) and possible.