Forsaken Lives: Learn More
Criminal bans on abortion are harmful not only to women but also undermine entire health systems. The report, Forsaken Lives: The Harmful Impact of the Philippine Criminal Abortion Ban, documents the experiences of women in the Philippines and sheds light on the role of health service providers who are sometimes guilty of perpetrating abuse as a result of abortion stigma created by the criminal ban and conflicting personal values.
Read the first-hand stories of women affected by the ban, the challenges faced by providers, and recommendations to governing bodies on how to end this avoidable human rights crisis.
Executive Summary &, Key Findings >, A Preventable Crisis of Pregnancy-Related Mortality and Human Rights Abuses Resulting from the Philippines’ Restrictive Abortion Law Methodology >,
Maricel’s Story >, Maricel was 18 years old and already had a child when she died of a severe infection after self-inducing an abortion using three different methods. Post-Abortion Care Complications, Abuse, and Discrimination >, Mylene’s Story >, Mylene, a 26 year old doctor, became pregnant after being raped by the politician who sponsored her medical school scholarship. She died as a result of a severe infection after attempting to self-induce an abortion.
World Health Organization Standards for Post-Abortion Care >,
What Does Safe Abortion Look Like? >,
The Dilemmas and Challenges Faced by Healthcare Providers >,
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Methodology
This study was undertaken by the Center for Reproductive Rights with the cooperation and support of women’s health activists, local healthcare professionals and legal experts who have been involved in efforts to address the crisis of unsafe abortion in the Philippines for many years. It is based primarily on 53 interviews with survivors of unsafe abortion, acquaintances of women who have died from unsafe abortion, and a broad range of key actors and stakeholders including doctors in major government hospitals, lawyers, ethicists, reproductive health activists, psycho-social counselors, academics, political leaders, and law enforcement agents.
Many of the interviews were conducted by Center staff during five visits to the Philippines between February 2008 and May 2010 and involved individual and group interviews in Tagalog and English. Some of the testimonies were gathered and translated into English by local partners. The investigation included numerous visits by Center staff to four major hospitals based in Metro Manila including Dr. Jose Fabella Memorial Hospital (Fabella Hospital), Philippine General Hospital (PGH), Tondo General Hospital (Tondo General), and Ospital ng Maynila (OnM), as well as to Bulacan Provincial Hospital located in Bulacan. This report is also informed by the views shared by health care providers who participated in two trainings conducted by the Center on human rights and ethical standards as they relate to post-abortion care in 2008 and 2009.
This report relies on secondary sources containing public health data relating to unsafe abortion, which is very limited as a result of the criminal ban. Due to the criminal status of abortion, every effort has been made to protect the identities of the interviewees and sources of information. In order to capture a range of experiences, we have included stories of women that date back several years.
In forcing women to resort to potentially fatal abortion methods and leading to serious abuse in the provision of post-abortion care, the criminal abortion ban denies women their basic dignity. This report documents the ways the government has forsaken the lives of Filipino women, including by criminalizing and stigmatizing essential reproductive health services.
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Post-abortion care complications, abuse, and discrimination
“They said you could be put behind bars because it is similar to the taking of life.” – Lisa
Two in every three Filipino women who terminate a pregnancy experience some sort of complication, including severe pain, infection, or even death. It is estimated that 90,000 women seek treatment for post-abortion complications each year.
Treatment for abortion-related complications is one of the top 10 most common reasons for hospitalization at many hospitals in the Philippines. A chief resident at a hospital in Manila City revealed that her department sees four to five cases of abortion-induced and spontaneous-a day. She noted that many of the women who come in for treatment are either quite young or much older and have at least five children.
The criminal ban has put women in a tragic situation where they must risk dangerous procedures before being given life-saving treatment to undo the harm caused by the dangerous procedure. As noted by one medical practitioner:
Women don’t know where to go and end up going to back street providers [where they are given] herbal medicine, abdominal uterine massage, [and are] inserted with catheters for 24 to 48 hours. If during the process, the product of conception is expelled completely, then that is good, but if not they go for D&,C. This is the only time they are provided with services by the medical system.
Furthermore, as revealed by women’s testimonies, while post-abortion care itself is legal, the criminal ban on abortion has had a deeply chilling effect on post-abortion care. Instead of receiving dignified, humane care, women are routinely made to suffer compromised quality of care and are subjected to physical and mental abuse. Criminal sanctions have created an environment of judgment and stigma, prompting the abuse of women in healthcare settings and legitimizing such abuse. That women who have had illegal abortions are often harassed and abused by service providers is well known and has deterred women from seeking timely care. For some, the harassment is enough to deter them from seeking care altogether or to cause them to leave
Download the report to read more >,
* All citations are available in the full version of the report
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The Dilemmas and Challenges Faced by Healthcare Providers
The criminal ban on abortion has made the procedure almost completely unavailable in the Philippines, except in clandestine clinics or in very narrow cases where the act is not perceived as abortion, such as ectopic pregnancy. Most abortions are performed by unskilled providers, commonly referred to as “doctoras,” in settings that are not medically appropriate, or by traditional midwives, or hilots. Many women induce abortions themselves with no counseling or assistance. Although some legal experts opine that both the Constitution and the Penal Code may potentially be interpreted to allow abortions to save the life of the pregnant woman, criminal sanctions prescribed by the Penal Code have deterred physicians from openly providing abortions. Aside from denying women access to safe abortion services, the prohibition has undermined the quality of post-abortion care by portraying women who have abortions as criminals. As a result, they are often considered unworthy of the level of care normally accorded patients seeking help for other medical problems and are subjected to discrimination and abuse.
Abortion stigma within the healthcare system is a leading cause of negative attitudes toward women who undergo abortion and who subsequently seek post-abortion care. The report discusses issues including the dilemmas and challenges that healthcare providers face as a consequence of the criminal ban on abortion and which specifically relate to abortion itself and the provision of post-abortion care.
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Conclusions
There Is an Urgent Need for Legal and Policy Reform and Accountability Measures to Address Unsafe Abortion and Related Abuses of Women’s Human Rights in the Philippines
The wide array of evidence presented in this report amply demonstrates the human rights abuses brought on by the sweeping criminal ban on abortion in the Philippines. The testimonies document and contextualize the experiences of women in the Philippines, establishing that the criminal ban violates a range of women’s human rights and signifies the failure of the Philippine government to comply with its obligations under international law. The report also sheds light on the dilemmas and challenges many healthcare providers face as they are caught between the criminal ban which prescribes penalties for providers of abortion and their professional obligation to treat their patients with compassion and respect.
In failing to address the suffering and abuse experienced by women as a direct consequence of the criminal ban on abortion, the government has forsaken the lives of women who are represented through the testimonies in this report. Society’s lack of outcry has legitimized the government’s inaction and led to complicity in these grave and systemic violations of women’s rights. The government has a binding legal obligation to recognize, protect and promote the rights of women that are being violated by the criminal ban on abortion and it is up to key stakeholders to take the initiative to make the government accountable for doing the same. Government actors and key stakeholders have an obligation to break the silence around the issue of unsafe abortion and enable the voices of women to become a basis for change.
We hope that this report brings national and international attention to the high cost in women’s lives and suffering as a result of the criminal ban on abortion, as well as the many challenges it creates for healthcare providers in their role of securing the health and dignity of women.
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Recommendations
The Philippine Congress should:
- Assume the secular responsibility of protecting women’s rights and ensure compliance with human rights obligations by amending the Revised Penal Code to lift criminal sanctions on abortion at a minimum in the following circumstances: when the life and health (physical and mental) of the woman are in jeopardy, when the pregnancy is a result of rape or incest, and in cases of fetal impairment.
- Demonstrate a stronger commitment to women’s reproductive health and rights by making it a national priority and support the formulation and adoption of laws that permit abortion in certain circumstances. Such laws should be drafted in accordance with the government’s international human rights obligations and the fundamental rights of women guaranteed by the Philippine Constitution.
- Ensure that abortion-related laws adopted by Congress, the Senate, and local governing bodies comply with international human rights standards on reproductive rights and relevant ethical norms of practice and are grounded in public health data.
- Authorize increased funding for women’s reproductive health programs, especially post-abortion care and contraceptive access.
The Department of Health (DOH) should:
- Issue regulations clarifying the existing legal and medical grounds on which abortion may be permitted. These should include, at a minimum, internationally recognized ethical grounds for abortion: when the life and health of the woman are in jeopardy, when the pregnancy is a result of rape or incest, and in cases of fetal impairment.
- Create a system to gather data on the number of deaths caused by unsafe abortion and its causes with the objective of developing appropriate policies and programs to reduce unsafe abortion mortality and morbidity and to improve the quality of post abortion-care. Abortion-related deaths should be included in maternal death reviews.
- Take immediate action to improve women’s access to timely, humane, and quality post-abortion care by prohibiting and penalizing abusive practices against women who seek post-abortion care. Increase awareness of their right to humane post-abortion care through information campaigns and establish patient feedback mechanisms that allow women to file complaints against abuses. These measures should be supported by increased funding for post-abortion care programs, including for medical supplies, equipment, and appropriate training for staff.
- Implement strategies aimed at reducing unplanned and unwanted pregnancy by ensuring universal access to contraceptive supplies and information. Secure adequate funding for a full range of contraception methods and take steps to lift bans on modern contraceptives such as the Manila City EO. The Food and Drug Administration (FDA) must make the emergency contraceptive Postinor available.
- Address training gaps around abortion and post-abortion care.
The Department of Justice (DOJ) should:
- Issue regulations clarifying the existing legal grounds on which abortion may be permitted. These should include, at a minimum, internationally recognized ethical grounds for abortion: when the life and health of the woman are in jeopardy, when the pregnancy is a result of rape or incest, and in cases of fetal impairment.
- Officially clarify the situations in which the criminal defense of necessity or the legal ground of a justifying circumstance contained in the Revised Penal Code may be invoked in cases of abortion.
National courts should:
- Ensure that women’s rights are upheld and protected in the judicial decision-making process in accordance with international human rights norms and obligations of the state as established under international law.
- Enforce the constitutional guarantees of separation between church and state, the fundamental right to freedom of religion, and the right to found a family in accordance with one’s conscience in a manner that prevents the promotion of a particular religious ideology through official laws and policies and protects and promotes women’s dignity and human rights.
The Commission on Human Rights of the Philippines should:
- Investigate the occurrence of abuses arising from the criminal ban and make appropriate recommendations to the government for abortion law reform and prevention of abuses in the context of post-abortion care. Ensure compliance with key observations and recommendations of UN TMBs
The Philippine Commission on Women (PCW) should:
- Investigate the occurrence of abuses arising from the criminal ban on abortion and in the context of post-abortion care based on the rights guaranteed in the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW).
- Take steps to protect women’s health and human rights by promoting abortion law reform, taking into account the concluding observations of CEDAW Committee and the Beijing Platform for Action’s discouragement of a punitive approach to abortion.
Health professional groups and education and training institutions should:
- Adopt codes of conduct and strategies for members of professional associations such as Philippines
- Medical Association (PMA), Philippine Obstetrical and Gynecological Society (POGS), the Philippines Nurses Association, and associations of midwives to ensure that medical professionals and health workers who provide post-abortion care do not harass, intimidate, or abuse women and that healthcare providers who advocate for safe abortion or better post-abortion care are not harassed or stigmatized.
- In hospitals providing post-abortion care, establish a complaint mechanism to provide women with an official channel for reporting maltreatment and abuse. Establish official rules for confidential and unbiased investigations of violations of patients’ rights and disciplinary action against providers who commit such abuse.
- Educators handling the training and education of students in medical, nursing, and midwifery schools should include in their respective curricula information about the medical, public health and human rights aspects of abortion. Training in clinical skills necessary to provide quality post-abortion care should be provided. All students must be informed about their ethical obligations to provide humane, compassionate, and nonjudgmental care to women with post-abortion complications.
- To ensure sustained access to quality post-abortion care, medical schools and teaching hospitals must increase training to doctors, nurses, and midwives individually and as a team, with emphasis on client-centered counseling, use of the manual vacuum aspiration (MVA) method, and post-abortion family planning.
Legal experts and academic institutions should:
- Promote a dialogue about the harmful impact of the current punitive approach to abortion. Experts should develop legal strategies to address the violations of women’s fundamental rights guaranteed by the constitution and internationally protected human rights that result from the criminal ban.
- Engage with international human rights bodies by submitting shadow reports highlighting the Philippine government’s violation of women’s reproductive rights through the implementation of the criminal ban. Rely on concluding observations issued by UN TMBs in national advocacy to seek accountability for the harmful impact of the ban and use the same as a basis for legal reform.
- Promote a fair and informed discussion about the propriety of the criminal ban on abortion and its impact on women’s human rights. Promote greater intellectual freedom around the topic of abortion and encourage legal academics and other members of the legal community to develop an alternative legal regime for abortion, one based on principles of human rights, science, and public health data.
Women’s reproductive health and rights advocates should:
- Work together to break the taboo and stigma on abortion by initiating public discussions about the negative impact of the criminal ban and the harm they cause to women and society across communities.
- Collaborate with healthcare workers to increase their level of compassion toward women who undergo abortion through training and other interactive programs that integrate discussions about ethics and human rights.
- Monitor the government’s compliance with its human rights obligations to ensure access to safe and legal abortion and post-abortion care. Expose its failure to do so by highlighting human rights violations resulting from the criminal ban and reporting the same to national and international human rights bodies and institutions.
The Catholic Bishops’ Conference of the Philippines should:
- Demonstrate respect for the nation’s constitution, which recognizes religious freedom and the right of individuals to establish their family in accordance with their own religious beliefs and conscience, and establishes the principle of separation of church and state.
- Take positive steps to promote women’s survival, health, and economic empowerment by supporting their reproductive health needs and choices.
The Asian Human Rights Commission should:
- Recognize and condemn human rights violations resulting from the criminal ban on abortion in the Philippines and other legal restrictions on women’s access to contraceptives that have put the government of the Philippines in violation of international law.
The Asia and Oceania Federation of Obstetrics and Gynecology (AOFOG) should:
- Take steps to implement the Tokyo Declaration of 2007 on the prevention of unsafe abortion, which calls upon members of the obstetrics and gynecology societies in the region to advocate for laws that establish women’s access to abortion and to ensure that healthcare providers behave ethically and do not impose their personal religious views relating to abortion on patients.
United Nations bodies should:
- UN TMBs should question the government of the Philippines about its failure to implement concluding comments and observations by the CESCR, the CEDAW Committee, and the Committee on the Rights of the Child at the next periodic reporting sessions for these committees.
The international donor community should:
- Demonstrate stronger support for women’s reproductive rights by increasing financial and technical support for women’s reproductive health programs in the Philippines. Actively promote the integration of human rights standards and targets set out in the MDGs into health programs by promoting the incorporation of such standards and goals in national health policies and programs.
- Support local activists and organizations in developing legal strategies to address human rights violations arising from the implementation of the criminal ban. Support the efforts of activists to seek clarity on legal exceptions for abortion in certain circumstances in order to reduce the incidence of unsafe abortion.
- Increase funding for post-abortion care programs, including for training programs. Help the government establish mechanisms for preventing and monitoring abuses in the provision of post-abortion care.
- Promote efforts to reduce the incidence of unsafe abortion by providing contraceptives and other assistance for the establishment of comprehensive family planning programs.
The United States Agency for International Development (USAID) should:
- Renew their commitment to the implementation of the Philippine government’s post-abortion care policy and program by increasing funding and providing technical support to improve the accessibility and quality of care and assist in the prevention and monitoring of abuses against women who seek post-abortion care.
- Support local activists and organizations in developing legal strategies to address human rights violations arising from the implementation of the criminal ban. Support the efforts of activists to seek clarity on legal exceptions for abortion in certain circumstances in order to reduce the incidence of unsafe abortion.
- Restore the provision of contraceptives to the Philippines to help the government immediately address the unmet need for contraception. Contraceptive supplies should be accompanied by technical support for counseling on family planning and other initiatives to deal with misconceptions about family planning methods.
The United States Department of State should:
- Address unsafe abortion mortality as part of the State Department’s commitment to the reduction of maternal mortality worldwide. Include violations arising from the criminal ban on abortion and legal restrictions on contraceptives and important drugs such as misoprostol in the State Department’s annual report on human rights.