Wednesday, April 22, 2009

Philippines: The risks and the misery of illegal abortions

Some 90,000 women in the Philippines were hospitalised for post-abortion care in 2008. Abortion remains llegal in this predominately Catholic nation of more than 95 million inhabitants

When Jocelyn Cruz, 36, fell pregnant with her seventh child she decided the family could not afford another baby and tried to induce an abortion by jumping up and down.

“When nothing happened, I started banging my stomach against the window. It was painful,” she recalled. Finally, Jocelyn lost her baby. The family lives on US$4 a day, earned by her husband.

According to a 2008 study (made public last week) by the Guttmacher Institute, a non-profit organisation which carries out research on reproductive health, there are an estimated 560,000 cases of induced abortions per year, resulting in some 90,000 women being hospitalised for post-abortion care; and about 1,000 deaths a year in the island nation.

The Guttmacher Institute, which worked on the study with the University of the Philippines Population Institute, said about half of the 3.4 million pregnancies in 2008 were unintended.

The Department of Health (DOH) reports that, on average, Filipino women have one child more than they want.

Abortion in the Philippines is an illegal and punishable act, with no exceptions even on the grounds of endangering a woman’s life, rape, or foetal impairment. The minimum prison term for an abortion is six months, and the maximum six years.

Only traditional contraception methods (with high failure rates) are advocated in this conservative Catholic country. Modern contraceptives are often unavailable and unaffordable.


Outside the Minor Basilica of the Black Nazarene, a church in the district of Quiapo, Manila, street vendors sell homemade herbal concoctions to induce menstruation.

Others go to a local 'hilot' or masseuse, a woman with no formal medical training, who uses intense massage on the abdominal area to induce abortion.

Inday Poso (not her real name), 53, barely finished elementary school. She used to assist a mid-wife in childbirth deliveries and claims this is how she got her training to become a 'hilot'.

Inday prescribes Cytotec, a drug used for the treatment and prevention of gastric ulcers. Relatively inexpensive, but available only on the black market, Cytotec softens the cervix and induces labour.

“They drink one tablet and I insert two more in the vagina,” she said.

Well aware of the risks, Inday said: “I tell them they need to have money for hospitalisation. I also make it clear that I’m not going to be responsible for anything that happens in the event of complications.”


Celia Marquez, 40, went to a `hilot’ to have her sixth pregnancy terminated. She bled internally for days and became very weak. When she was brought to hospital, doctors openly showed their disdain, calling her “Ms. Abortionist” instead of her real name.

Junice Melgar, executive director of Likhaan, a women’s NGO that provides healthcare services and family planning counselling, said maltreatment of women seeking post-abortion care is common in government hospitals.

“We’ve had cases where women were purposely made to wait while profusely bleeding. Others are treated without anaesthesia, or not cleaned as part of post-operation care. Verbal abuse is also common. Some doctors think that this will teach these women a lesson.”

Covering up

To avoid police intervention, health staff sometimes deliberately misclassify post-abortion cases as either medical or surgical, making post-abortion data difficult to find in health facilities.

In extreme cases, women are refused treatment by health staff who fear being implicated.

Under the Revised Penal Code of 1930, a woman who undergoes abortion, and anyone assisting her, faces imprisonment. A higher prison term will be imposed on the woman if the abortion is done to conceal her “dishonour”.

Health professionals who provide abortion services or dispense abortive drugs risk having their license suspended or revoked.

This law has not been changed since pre-colonial times and is a direct translation of the Spanish Penal Code of 1870. Belgium, France, and Italy - also predominantly Catholic - permit abortion upon a woman’s request. Spain permits abortion on grounds of rape and foetal impairment.

Development goal at risk

National health surveys conducted by the DOH in 2006 indicate that the maternal mortality ratio (MMR) was 162 deaths per 100,000 live births.

An estimated 12 percent of maternal deaths are due to unsafe abortions, according to the DOH surveys.

Experts predict that the Philippines will not meet its Millennium Development Goal (MDG) to reduce the country’s MMR to 55 per 100,000 live births by 2015.

The MMR is listed as the MDG least likely to be achieved by 2015, according to the UN Children’s Fund (UNICEF).

Elizabeth Caluag, a DOH officer in the Women’s Health Division, said the department was doubling its efforts to lower the MMR.

“The DOH is determined to meet its commitment to reduce maternal deaths, whatever their cause by 2015. We have developed a comprehensive health care policy to provide services for a seamless continuum of care,” she said.

These services, says Caluag include increased access to contraception methods and proper post-abortion care.

Disclaimer:This material comes to you via IRIN, the humanitarian news and analysis service of the UN Office for the Coordination of Humanitarian Affairs. The opinions expressed do not necessarily reflect those of the United Nations or its Member States.
Photo: Copyright IRIN
Published by Mike Hitchen, Mike Hitchen Consulting
Putting principles before profits