Birth control in Lebanon reaches exorbitant heights

Since February, Lebanon has faced severe medication shortages due to the ongoing economic collapse. While the recent lifting of subsidies on medication means more drugs are becoming available again, what used to be an affordable purchase, costing no more than a cup of coffee, now costs most of the minimum wage for basic, yet essential medication.

Birth control is among the products now unsubsidised by the government, leaving some women weighing up the risks of possibility getting pregnant by not purchasing contraceptives, with being able to afford food or bills.

"When they lifted the subsidies and raised the prices recently you can find contraceptives again but what is available is now 10 times the price of what it was before"

The devaluation of the Lebanese Lira against the dollar has pushed the populace to a breaking point, with over 75 percent of Lebanese people now under the poverty line.

Many skilled professionals are now making the equivalent of $100 a month and struggling with basic food items or utilities like the generator subscriptions proving almost all of Lebanon’s power today.

Despite birth control disappearing completely from the market for a long period this year, taboo topics like contraception and reproductive health are often under-reported in Lebanon, with some women unwilling to seek advice to find alternatives.

“We were giving prescriptions to patients but when they got to the pharmacies they could find nothing,” Dr Zaki Sleiman, a gynaecologist at Rizk Hospital, told The New Arab.  “A new contraceptive pill we had never heard of called Diva was the only thing available on the market, so everyone began taking this.

“When they lifted the subsidies and raised the prices recently you can find contraceptives again but what is available is now 10 times the price of what it was before,” he added. “Everything is now priced on the dollar, so what used to cost $10 or LBP 15,000, now costs LBP 200,000. Condoms are now the most expensive form of contraception, the price is extremely high.”

Sleiman has noticed many of his patients switching to an Inter-Uterine Device (IUD), which works out cheaper over a longer period of time, than using contraceptive pills or condoms. The onetime purchase can provide conception for five years or more.

There are two types – the copper IUD or the hormonal IUD – which costs about $100-$200 dollars including the procedure, or $300-$400 respectively, depending on the clinic.

“If you calculate, a $100 is LBP 2 million right now, which will only get you two years worth of contraceptive pills, instead of five years with the IUD,” Sleiman said. “Obviously this is only good for people who want a long-term contraceptive plan, but for a newly married couple who don’t want kids for just six months, I would not recommend it.

“Pregnant women are also facing a lot of issues. They go to buy the multivitamins that used to cost LBP 30,000 two or three months ago, and now costs LPB 300,000-400,000, so people are still getting used to the prices.”

"Women are scared to get pregnant these days. I’m hearing from the women coming to the clinic that they don’t want to have children at all or any more children as they can barely afford to provide for the ones they have already"

While Sleiman’s Beirut-based clientele at his private clinic can justify the expense, women in poorer areas like the Bekaa or refugee camps are unable to pay such prices.   

NGOs are providing increasing amounts of aid as Lebanon’s accumulating crises deepen and spread to more sectors, with new shortages and price hikes occurring on a regular basis. Family planning and reproductive health NGO Salama is one such organisation.

Endorsed by the United Nations Fund for Population Activities [UNFPA], Salama is one of 150 organisations across 170 countries in the programme.

Their three main pillars are the advocacy of sexual and reproductive health rights, spreading awareness on sexual health for both men and women – including comprehensive education for young people – and providing services for all members of the community, including all nationalities like Syrian and Palestinian. 

Their two clinics in Karak, Zahle, and in Beit Chama, Baalbek offer access to a gynaecologist, STI testing and treatments, contraceptives, ultrasound check-ups, paediatricians and general practitioners for a minimal fee.

"They can’t afford to feed the babies, find formula milk or buy nappies, which are now incredibly expensive"

“We’re buying all the medication and contraceptives ourselves and offer them for free at our clinics,” Salama executive director Lina Sabra said. “We’ve always offered this but now in the last year or so what we’ve seen is more Lebanese people coming to the clinics and needing help from NGOs, especially because health insurance no longer covers anything due to the devaluation of the lira.

“More and more women have felt the need to use our services since the crisis began. For example, we offer the IUD for LBP 15,000, whereas it’s a $100 at a private doctor,” she added. “An appointment with a gynaecologist costs a minimum of LBP 200,000, before even getting to the extra cost of medication, or any tests or ultrasound scans needed. Then there may need to be follow-up appointments. At our clinics, an appointment, with scans and an IUD or contraceptive plan will never cost more than about LBP 30,000.” 

Before the crisis, they used to service about 1,500 beneficiaries a year. That number has now risen to about 4,000 beneficiaries as people previously well-off find themselves in poverty.

Salama has had to start new programmes to tackle issues like women being unable to afford sanitary products for their periods or mothers being unable to afford formula milk for babies.

“They can’t afford to feed the babies, find formula milk or buy nappies, which are now incredibly expensive,” Sabra said. “Even the Syrian refugee populations, [which normally have high birth rates], have started taking contraceptives to avoid having children.

 “Women are scared to get pregnant these days. I’m hearing from the women coming to the clinic that they don’t want to have children at all or any more children as they can barely afford to provide for the ones they have already,” she added. “They say, ‘Why would we want to bring a child into the world now, with the situation we are facing?’"

Maghie Ghali is a British-Lebanese journalist based in Beirut. She worked for The Daily Star Lebanon and writes as a freelancer for a number of publications, including The National, Al Arabiya English, Al Jazeera and Middle East Eye, on arts and culture/design, environment and humanitarian topics.

Follow her on Twitter: @mghali6