A hard look at abortion in the PH
MANILA, Philippines - At the height of the debates surrounding the Responsible Parenthood and Reproductive Health Law (RH law), many pro-life groups vowed that passing the law could signal the country’s transition to legalized abortion.
The Catholic Bishops’ Conference of the Philippines (CBCP), for instance, warned the public that a “contraceptive mentality” preceded “abortion mentality.”
Statistics on induced abortion in the Philippines, however, paint a different reality.
Although induced or elective abortion has never been legal in the country, thousands of women every year choose to terminate their pregnancy, with most of these procedures being performed unsafely.
Researchers from the Guttmacher Institute and the University of the Philippines Population Institute estimated that over 470,000 induced abortions were performed in the Philippines in 2000.
This translates to almost a third of women aged 15 to 44 choosing to have an abortion after getting pregnant.
This estimate was based mainly on patient records indicating post-abortion care from over 1,000 hospitals nationwide. But because not all women need or successfully obtain treatment after an abortion, hospitalization numbers alone do not capture the magnitude of induced abortions in the country.
In 2010, the number of hospitalizations due to abortion complications was projected at 90,000. This raised the estimated incidence of induced abortions to 560,000 in that year alone.
Who are having abortions?
Although women of all ages and socio-economic backgrounds have induced abortions, more poor women (68%) choose to have this procedure compared to non-poor women (32%). And because safe surgical abortions can cost as much as P15,000, poor women are also more likely to have unsafe abortions compared to their richer counterparts.
Researchers have also shown that 90% of the women who have abortions are Catholic, and that 70% have some high school education.
There are also regional differences in abortion rates. Metro Manila has the highest rate at 52 per 1,000 women. This figure is almost double the national average.
The rest of Luzon has a rate of 27 per 1,000 women, while Mindanao and Visayas have a similar rate of 18 and 17 per 1,000 women respectively.
Based on Guttmacher Institute’s estimates, at any given year, more than 78,000 women seek post-abortion care in a medical facility and 800 to 1,000 Filipino women die of abortion complications.
This high number of abortion-related hospitalizations and deaths is due largely to the unsafe methods that women resort to.
According to the New York-based Center for Reproductive Rights, women employ a variety of methods to induce abortion. Some women resort to plant and herbal concoctions (pamparegla), abdominal massage (hilot), insertion of objects (such as catheters, hangers, and brooms) in the vagina, and ingesting Vino de Quina and other liquors.
Others also try to induce abortions by hitting their bellies, exercising intensively, and jumping from high places. Cytotec, a drug used to prevent stomach ulcers, is also commonly used to induce abortion.
Only a third of Filipino women receive a dilation and evacuation or vacuum aspiration, which are the medically prescribed procedures for terminating a pregnancy. And because abortion is illegal in the Philippines under Section 2 of the Revised Penal Code, clinicians deny and sometimes even scorn those who request for a safe abortion.
Core issue: unintended pregnancy
Experts in the field of reproductive health stress that unintended or unwanted pregnancies lie at the heart of high abortion rates. Women, they argue, are only pushed to induce abortions because they cannot bear the cost of raising a child.
This argument is backed up by research in the Philippines and other countries that show the primary reason for having an abortion is economic (and not the stigma of out-of-wedlock pregnancies, as we are inclined to think).
Women who already have children and wish to limit the size of their family or space their children’s births grapple with this choice more intently.
In the Philippines, it is believed that 22% and 24% of married and single women respectively have an unmet need for contraception. This means that these women do not want to have a child but have no access to modern contraception.
A direct consequence of this is that almost half of pregnancies among Filipino women 15-45 years of age are considered unintended, according to a study. This is equal to 1.3 million unplanned births every year.
Not just an access issue
Though the unmet need for contraception largely contributes to the high abortion rate, experts admit that the issue is not quite simple.
Research from other countries has shown that access to contraceptives alone does not lower high abortion rates. Or at least, not immediately.
A recent paper by the Population Council, for instance, reports that high contraceptive use in Vietnam did not translate directly to lower abortion rates. The researchers explained that many women still refused to use modern methods (non-use) or used contraception improperly (contraceptive failure).
There is also a cultural preference in Vietnam for sons over daughters, which contributed to the high abortion rate.
Thus, along with access to contraception, researchers stress the importance of education about the proper use of pills, IUDs, condoms, and other methods.
This may be equally compelling for the Philippines, where 40% of women report fears or health concerns about contraceptive methods. - Rappler.com
Anton Avanceña currently works for the California Department of Public Health and the Santa Clara County Mental Health Department and volunteers as an HIV test counselor at the UCSF Alliance Health Project. Anton, who studied public health at Santa Clara University, will begin graduate studies in global health at the University of California, San Francisco in September.
The author wishes to thank Rubina Hussain of Guttmacher Institute for explaining the findings of her work for this article.