Before we moved to the Philippines, I filled a prescription for a year’s supply of birth control pills and antidepressants at my local pharmacy in New York. My insurance only covered one month of each prescription at a time, so I had to pay for the remaining 11 months out of pocket. I was taking generic versions so it cost much less than their brand name counterparts, but it was still a lot considering I paid $10/month for antidepressants and birth control pills were free under my insurance.
I recently had to fly to Manila (the country capital) to get my prescriptions refilled because they aren’t available locally. I ended up seeing 3 doctors within the same hospital in one day, and my experience was very different than what it would have been in the US. I went to one of the largest hospitals in Manila and although doctors do take some appointments, for the most part they have walk-in, first come first served hours. The ob-gyn I was seeing for instance had walk-in hours from 1pm-5pm, Monday-Saturday. I was the first one to arrive, so I was seen right away after filling out some paperwork.
When I entered the doctor’s office, I noticed that there were hundreds of religious figurines displayed on bookcases as well as religious posters on the walls. I’m not a religious person but the Philippines is a largely Catholic country, and I wondered if the doctor’s religious beliefs would affect my treatment in any way. He looked like he was around my age – late 30’s. I shared my medical history, got an annual exam, told him I was done having kids, and asked for prescription refills. He told me that he would not prescribe hormonal birth control for anyone over the age of 35 (I’m 38) and suggested I either get a non-hormonal IUD or my husband get a vasectomy. His reasoning was that there is an increased risk for deep vein thrombosis (blood clots) on birth control as you get older and antidepressants can interfere with their efficacy. He told me his wife, who shared a practice with him, would have the same opinion, but said I could seek a second opinion. I was pretty shocked thinking this would be a pretty straightforward appointment. He then referred me to a psychiatrist in the same hospital to get a refill on my antidepressants. I was in and out of there in about 20 minutes and paid $50 for the office visit and my lab tests.
My ob in New York deemed birth control pills + antidepressants at the age of 37 safe for me, and I already knew that blood clots were only a risk with birth control pills if you smoke (I don’t) since doctors always asked me that at appointments. Birth control pills also helped control my moods and greatly reduced the side effects of my period, which were more reasons I wanted to be on them. As I waited for the psychiatrist’s office hours to start, I googled taking birth control pills over the age of 35, and everything I read said that it was fine. My family also does not have a history of cardiovascular disease or blood clots, which highly increase in risk for smokers. I had taken birth control pills safely for years and was not ready to get an IUD, and immediately decided to seek a second opinion. Luckily it was easy to see another ob that same day because everyone had walk-in hours.
The psychiatrist squeezed me in since I arrived before his scheduled appointments that afternoon. I shared my health history, showed him my American prescription for Lexapro, and told him that I’d been on it for the past 3 years. We talked for about 15 minutes and due to the remote nature of where I lived, I asked for a one year prescription, which he gave me. The session cost $50.
Now it was time to find another ob for a second opinion. Each office was labeled with the doctor’s name, their speciality and whether or not they currently had walk-in hours. I popped into 3 different offices before I found someone who was available; the first two doctors were at lunch. I was seen right away by a female ob in her 50’s, and I explained what the first ob had told me about taking birth control pills over the age of 35. She disagreed with his opinion, and after taking a brief medical history she gave me a prescription for a year’s worth of birth control pills. Her office visit fee was $14.
I went to the hospital’s pharmacy to have my year’s worth of birth control pills and antidepressants filled. The cost was comparable to what I paid out of pocket in the US. My entire visit to the hospital lasted 2 hours from start to finish.
My next stop was the Mac store to get our laptops fixed, so I had a lot of time to wait and think about my experience with healthcare in another country. These were some of my thoughts:
– I really liked not having to make an appointment, especially because I never had to wait more than a couple minutes, and I could see multiple doctors in one day. I’m used to waiting weeks for an appointment with my doctors in the US, but they are all private practice doctors. Seeing doctors in a hospital setting where everyone had offices was so convenient and efficient.
– Healthcare costs a lot less in the Philippines than it does in the US. Office visits, tests, etc. are very affordable without any insurance. Prescription medicines cost about the same though because many of the drugs come from America and Europe.
– I am lucky enough to have the means and knowledge to access birth control, but so many other women around the world don’t have that luxury. I wish it were a basic human right and I wish it were a whole lot easier to access.
What does accessing birth control look like in your part of the world?