"The best prevention is a strong, efficient, and comprehensive family planning program."
"The best prevention is a strong, efficient, and comprehensive family planning program."
Years ago, a former staff of my organization called our office, desperate for help. It turned out that not long after resigning, she moved in with her boyfriend and got pregnant. When the guy found out, he packed up and left just like that.
The girl (she was barely 18 then) went home to her mother where she could prepare for childbirth. Unfortunately, she had a miscarriage and because they were poor, was rushed to the nearest public hospital where she was treated very inhumanely. She called my office when she has been at the hospital for hours begging to be treated. The fetus was already exposed between her legs. Yet, a nurse asked her if she was really pregnant. Next, she was accused of having an abortion which she did not.
I had a colleague rush to her and if necessary, transfer her to another hospital for proper medical attention. This happened and the doctor in the next hospital said that had we delayed bringing her in, she could have died. She had no money, the public hospital was full, and because she was young, she was accused of having an abortion. However, these do not justify how the first hospital dealt with the poor girl.
I will never forget this horror story as an advocate for sexual and reproductive health and rights (SRHR). SRHR pertains to many issues including divorce, family planning, teenage pregnancy, LGBTQI++ rights, and abortion. The biggest elephant in the room is abortion.
Abortion has always been totally prohibited in the Philippines. Besides religious dogma, the Philippine Constitution is mainly used by anti-abortion groups to block any attempt to legalize or decriminalize it even in select circumstances. Moreover, the 90-year-old Philippine Revised Penal Code specifically Articles 256 to 259, heavily penalizes abortion.
The Philippines is a predominantly Catholic and the church is the most vocal and influential opposition to SRHR. Due to religion, many Filipinos regard abortion as akin to murder and thus, culturally, it is heavily stigmatized.
It is so stigmatized that even objectively discussing about it is taboo. I remember how in 2014, anti-SRHR groups petitioned a Pasay Court to issue a Temporary Restraining Order and stop the then ongoing Asia-Pacific Conference on Reproductive and Sexual Health and Rights on the basis that the event allegedly encouraged abortion. The Court ruled that there was no actual abortion done in the conference and that talking about abortion was not illegal.
Many times, people are “silenced” to discuss a very real problem lest be accused of being an abortionist. Non-judgmental and non-moralizing discourse on abortion is quite rare. During the 16 years of advocacy for the passage of the then RH bill into law, anti-RH groups led by the Catholic hierarchy relentlessly equated the bill with abortion and anti-abortion rhetoric dominated the public debate.
But stigmatizing abortion discussions does not make the problem go away. Despite the illegality and the strong stigma, hundreds of thousands of abortions happen in the Philippines annually. The most reliable estimates come from The Guttmacher Institute’s ‘Unintended Pregnancy and Unsafe Abortion in the Philippines’ published in July 2013 using the national abortion rate in the year 2000 as basis and took into consideration population growth said:
Abortion is widespread. An estimated 610,000 abortions happened in 2012.
Those who undergo abortions are typically Catholic, married, have an average of three children, and have at least high school education.
Most common reason for having an abortion is economic, that is, the inability to afford to raise another child. Other reasons are: They already had enough children, and the pregnancy came too soon after the last.
Nearly all abortions are clandestine and risky. Providers have varying training and skills. Some moneyed women are able to obtain medically recommended procedures. Most, however, resort to untrained providers who use dangerous methods that put women at serious risk. Poor women are more significantly likely to use riskier methods than non-poor women and, therefore, experience severe complications much more.
About 1,000 Filipino women die each year from abortion complications. In 2012, about 100,000 women were hospitalized for such.
Logically, because the estimates were for 2012, the numbers of abortion incidence, hospitalization, complications, and deaths must be significantly higher now with population growth, and unintended pregnancy rates that remain high. While the RH law is there, data from the 2017 National Demographic and Health Survey show that the implementation of family planning program did not significantly improve.
Abortion is also a class issue because it disproportionately affects poor, underprivileged, and women who are in geographically isolated or hard to reach areas. While there is no exemption in the ban, not even to save the woman’s life, there are talks about medical doctors who perform therapeutic abortions to save women’s health or life. This is not cheap and only rich women are able to afford such. The Guttmacher piece also noted that more poor women undergo riskier abortions from untrained and unskilled “service providers.” Obviously, this is due to financial constraints.
A Rappler article entitled “Secret service: Underground doctors induce safe abortions” discussed the existence of an underground network of medical doctors who provide abortion services. The network is very difficult to find according to it. The costs involved are prohibitive. For instance, termination of a first trimester pregnancy costs between P3,000 and P12,000 depending on the medicines used. Surgical packages for this type of pregnancy range from P10,000 to P20,000. For second trimester, the surgical packages range from P15,000 to P25,000 while for third trimester, one has to pay between P20,000 to P25,000 or higher if there are complications.
These are only for the procedure itself and exclude supplies and some medicines. The doctors do the procedure in motels and hotels. Thus, more costs are incurred. Add- on services can be had like bedside doctor assistance, nurse service, and additional post-abortion uterine irrigation for additional fees. No poor woman can afford these. Thus, like many other issues, unsafe abortion disproportionately affects poor women.
While abortion is a hard topic to tackle, it is a problem that people need to understand, and the government, to address. There is a need to objectively discuss the problem so it is demystified and the stigma is lessened. Thus, women and girls would not suffer like my former staff did.
The best prevention is a strong, efficient, and comprehensive family planning program. The root cause of abortion is unplanned or unwanted pregnancy. Remove this and the number of abortions will drastically go down. While we talk about abortion, government must fully implementation the RH law.
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