By ELENA MASILUNGAN. Originally published on Newsbreak.
Newsbreak’s Maggie de Pano Fellow
Poor pregnant women are faced with very few choices
MANILA, Philippines – Many mothers go through abortion for economic reasons.
According to a 2006 study made by the Guttmacher Institute, the average Filipino woman wants 2.5 children, a goal that can be achieved if she uses effective family planning methods. But to almost half of the female population, this need remains unmet.
The study also notes that nearly half of the 1.43 million pregnancies each year in the country were unintended and six out of 10 Filipino women had experienced an unintended pregnancy.
When she asked about free condoms and contraceptive pills, the midwife informed her that they were not giving them out anymore ever since the city mayor issued an order allowing only natural family methods for residents.
By coincidence, a nongovernment organization visited the community to research on the reproductive health practices of the women living there. It also held training on family planning and maternal and child health for the mothers.
“I attended the training. They also gave free condoms to us. One day, they came with doctors who did tubal ligation to mothers who wanted to have them. At another time, the doctors did vasectomy,” she said.
Amelia availed of the free condoms and gave them to her husband. “At first, he did not want to use it. He said there was no need for us yet to plan our family because we had just two children at that time. But I was stubborn. I told him that ‘no condom, no loving-loving.’ Eventually, he gave in,” Amelia said, laughing.
The NGO stayed in the community for a little over a year. When it left, Amelia’s supply of free condoms went with it.
“When the NGO left, we bought our own condoms but only if we had extra money. Later on, what extra money we had we spent on food and other expenses for the children. We used ‘withdrawal’ but it is not as effective as the condom. So I started getting pregnant again,” she said.
When Amelia learned that she was pregnant with her ninth child, she became desperate.
“I thought at once of abortion.” Many of her neighbors who had unwanted pregnancy had been through it already anyway. A hilot living in their neighborhood helped perform the abortion. Amelia told her husband what she wanted to do. “He agreed because he knew that with the kind of life that we have right now, there is no way that we can afford another child.”
Posters around the Fabella Memorial Hospital speak about saving mothers’ lives. The Philippines has one of the highest maternal mortality rates in southeast Asia
The decision almost cost Amelia her life. (See first part: Dying in silence, how abortion kills)
Gambling with life
“Once a woman has decided to have an abortion because of an unwanted pregnancy, there is nothing much that anybody can do to change her mind. Not even a doctor’s cautionary advice will do,” noted Dr. Alejandro San Pedro, an OB-Gyne.
As chair of the Department of Obstetrics and Gynecology of the Bulacan Provincial Hospital, San Pedro has counseled a number of women who have dealt with unwanted pregnancy and has experienced treating patients with post-abortion complications as a result of unsafe abortion.
A woman with an unwanted pregnancy is ready to risk all to end it, doctors say. Many go to the extent of having an unsafe abortion where the possibility of suffering from further disabilities, and even dying, is a real gamble.
While Filipinos generally believe that pregnancy is a blessing from the heavens, not all pregnant women feel the same way.
This is true among many poor mothers particularly when the prospect of having one more child could spell economic doom for the family. This is also true for those who want to protect their health from medical complications arising from pregnancy.
There are also women who opt to have unsafe abortion rather than give birth to a child who was the result of rape or incest. Or those who do not want to get pregnant but are unable to control their fertility because of lack of access to information and affordable contraceptive methods.
Therapeutic abortion
Most doctors interviewed for this story think that abortion is justified in certain cases, particularly if based on ethical grounds.
One is when the pregnancy is the result of rape or incest. The other is when it threatens the health, or even the life, of the mother, such as when she has eclampsia, malignant hypertension, or a heart condition.
They would also consider therapeutic abortion in cases of ectopic pregnancy or fetus malformation or deformity such as anencephaly, a condition present at birth where the brain of the baby does not develop fully and for which there is no treatment.
But doctors in the country are in a legal bind even on this matter. (See: what the law says about abortion)
“In other countries, doctors will end the pregnancy as soon as they detect anencephaly,” said an OB-Gyne doctor, who prefers to remain anonymous.
In the Philippines, doctors are compelled to let the pregnancy continue and wait for the baby to die, which may take a few hours, days, or weeks after delivery, she added. “In some ways, it would be kinder to just end the pregnancy rather than have the mother carry it to term when there is no chance at all that her baby will live longer.”
Cost of contraceptives
Depending on size and texture, condoms cost anywhere from P31 to P38.25 A mat of 28 contraceptive pills cost anywhere from P33.50 to P1,028.50
While it appears more humane and compassionate, especially for the mother, to terminate an anencephalic pregnancy, doctors do not do this in deference to the guidelines of the Philippine Obstetrics and Gynecological Society that regard the fetus “as a patient from the time of conception.” This blanket ban further fuels the demand for underground and unsafe abortion services in the country.
Dangerous procedures
The common ways of unsafe abortion include painful massages by hilots, taking abortion-inducing drugs such as misoprostol, inserting catheters or other pointed objects into the uteri, undergoing dilation and curettage (raspa), drinking herbal concoctions that induce muscle contractions in the uterus, and even doing heavy physical labor and jumping from great heights.
Many women combine two or three of these methods together when trying to get rid of unwanted pregnancies.
But these methods of getting rid of a fetus could be dangerous. A whole range of medical complications can develop from unsafe abortion, including hemorrhage, sepsis, perforation of the uterus, damage to other internal organs, and toxic reactions to the chemicals or the drugs taken to induce abortion.
Patients may also have to undergo hysterectomy and be unable to bear children anymore in the future. Worse, complications from unsafe abortion can be fatal and can result in the patients’ death.
These risks, however, are not enough to deter women from having an abortion.
Pregnant women wait to consult a doctor at the Fabella Memorial Hospital
A 2008 Guttmacher Institute study bears this out: out of 560,000 women who had induced abortions, 90,000 of them were treated for complications, and 1,000 of them died because of these post-abortion complications.
Choices
“If I have other choices, I would not have an abortion,” Amelia said. “I wanted to try and use contraceptives but I don’t have any money to buy them. I tried withdrawal, even abstinence, but they didn’t work.”
After her abortion, while recovering in the hospital for complications she sustained after the procedure, Amelia asked the doctor to do a tubal ligation on her. “I should have done it years ago when doctors brought by the NGO offered to do it for us for free. But I did not know any better then.”
Having an abortion is one experience that she said she does not want to ever live through again. “I do not want to experience that terrible pain again. I do not want to experience being scolded and shamed by people who do not know me. I do not want to experience the panic and fear of being arrested or losing my life,” she said.
The way things are, Amelia said, she will never live down the guilt. “The guilt because I killed my own child never leaves me. They said I will never be forgiven by God for this one sin.”
The only remedy to salve a guilty conscience is to pray. “I keep praying to Him everyday. I believe that He understands my reason for doing what I did. If He cannot forgive me, I pray that He can at least have mercy on me,” she sighed. – Newsbreak
The series was produced under the Maggie de Pano Fund for Investigative Reporting on Health. The Fund, which is managed by Newsbreak, is made possible through a grant from Macare Medicals, Inc.
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