Category: reproductive health

RH hurrahs! and a boo

the first HURRAH! is for dr. sylvia claudio, director of the u.p. center for women’s studies, who spoke up in congress at the 2nd deliberation of the house committee of population and family relations on the critical question of when life begins, and fearlessly unequivocally contradicted the notion that life begins at fertilization.

I have a prepared statement today but let me respond to the questions posed to the medical doctors by Representatives Biazon and (Anthony) Golez on the issue of when life begins.

I note that the Chair called upon me because Rep. Biazon also asked who does not believe life begins at fertilization. I do not, for two reasons. The first reason is that as an agnostic I do not subscribe to the beliefs of the Catholic Church. In this regard I would like to remind everyone that the Constitutional provision on religious freedom protects not just the right to belief but also the right to non-belief. …

The second reason I do not believe that life begins at fertilization has to do with my expertise as a medical doctor. . . . I would like to note that “conception” is not a medical term. The terms fertilization and implantation are medical terms and we can describe and explain these processes to lay people. Any scientific discussion requires the precise use of terms. The Philippine Obstetrics and Gynecological Society is correct when it states that the mainstream medical and scientific community agrees that pregnancy begins at implantation.

the second HURRAH! is for dr. marita v.t. reyes, chair of the women’s health care foundation, who recently gave a talk on “Biomedical Ethics and RH” in a u.p. forum. reyes points out that only upon implantation does the woman’s urine test positive for the hormone that signals a pregnancy.

Conception is usually equated with fertilization described as the union of sperm and egg. Clinically, however,conception is synonymous with pregnancy and is established by a pregnancy test based on the presence of the human chorionic gonadotrophin in the blood and the urine. This hormone is secreted by the chorionic villi after implantation of the embryo.

… Implantation is completed 14 days (2 weeks) after fertilization. Studies have shown that 45-70 percent of fertilized ova do not successfully implant. It is after implantation that individuation may be said to occur since twinning and fusion no longer take place. Some books refer to the fertilized ovum prior to implantation as a ‘pre-embryo.’ After implantation, it is referred to as ‘an embryo.’ Sometimes, debates are unresolved because of differences in terminologies! It is at implantation that the hormone, human chorionic gonadotrophin mentioned earlier, is secreted and is used as an indicator of pregnancy.

so there.   as far as these lady scientists are concerned, human life begins with implantation, which doesn’t happen until more than a week after fertilization, if at all there is an egg that is fertilized after unprotected (uncontracepted?) sex.   so what’s the harm of emergency contraception, or the morning-after pill, when one is not pregnant and just wants to make sure one does not get pregnant?

of course the anti-RH folks will insist that life begins with fertilization and any intervention in the reproductive process is morally wrong.   i say again, it’s for the woman to decide who to believe and what to do with her own body.

of course it would help if mainstream media would level-up the information-gathering, yes?   and lead discussions that would help women understand that they have options, and that would make the golezes and sottos in congress see that millions of impoverished men and women who may want to practice contraception (instead of having to resort to abortion) just can’t afford to buy condoms and pills when they can barely feed their families three meals a day.

this brings me to the BIG BOO! which goes to anc‘s the brew that guested paranaque representative roilo golez the other thursday but instead of truly grilling him on his anti-RH stance, the brewhas just let him go on and on — high population is good, contraceptives are already available, maternal deaths should be blamed on lack of doctors and midwives, at kung ano-ano pang kamachohan.   they should have posted a disclaimer: the opinions expressed herein are not those of the brewhas, or the network’s, unless of course anti-RH din pala sila.

sure they tried, pitifully unsuccessfully, to bring the talk to the level of the impoverished family, but golez was just too “good” — poor din daw siya noon but his parents had the right values, sent him to school, blah blah blah.   hay naku.   so the brewhas changed the subject na lang:  how daw kaya to produce more pacquiaos.

like i posted in facebook, the girls didn’t help the RH cause any.   they should stick to trivial issues for which knee-jerk reactions are good enough if they can’t be bothered to do their homework.   if they had bothered to check out golez’s website they could have at least maybe prepared an intelligent counter-attack.   or maybe not?

in last thursday’s episode the brewhas reacted to criticisms lightly, patawa effect — kesyo they didn’t wanna “mess with golez”…  he will “stoop to nothing”…   kesyo  it wasn’t supposed to be a debate, nothing wrong with letting the “charming” golez have his say…  maiba naman from “shrewish zealots” with “magical reasoning”…   ganoon?   ewww

so what do we make of one brewha’s  rant vs. tibaks and the suc budget protests.   i guess matapang lang sila vs. the left at pag di nila kaharap?   ‘yan ba ang girl power, anc style?   BOO!

abortion

it’s something women don’t really talk about, even among themselves, but if one needs that kind of help, it’s not hard to find out where to go, depending on one’s paying capacity.   there are crude back-alley operations (catheter style, the unsafest unkindest scariest), there are clandestine clinics (d & c, pain pain pain), there are even small hospitals (suction, painless, relatively).    also there are meds, pharmaceuticals, banned here of course but widely known about even in the provinces and can be had under the counter, or in quiapo, requiring little medical supervision.   but elizabeth angsioco is right, it is never an easy decision, rather always an agonizing one, and always out of desperation.   poor women.

The ‘A’ word
Elizabeth Angsioco

A stands for abortion.

Five hundred seventy thousand Filipino women underwent induced abortions in 2008. Around 90,000 of them were hospitalized, and 1,000 died from complications. Surely, these abortion figures (Guttmacher Institute) should be more than enough to shock people. But will these make us closely look at the problem? More importantly, will these data jolt the government into action? Or will we be like the moralists whose knee-jerk reactions are to condemn women and brush these numbers aside as untrue?

Abortion is illegal in the Philippines. The Constitution criminalizes it. Because it is also culturally taboo, abortion is rarely discussed and done mostly within the context of religion or morality – that abortion is a mortal sin. Opportunities to objectively, honestly and intelligently dialogue on abortion is severely lacking. There is virtually no venue for women to freely discuss abortion without the moral prescriptions and judgment from others. Because it is illegal and stigmatized, abortion remains hidden; the data are hard to come by.

Admittedly, the above-mentioned numbers are estimates. These are, however, intelligent estimates, and the result of a rigorous process of research and data extrapolation based on factors used in comparative estimations in other countries. Thus, these figures cannot and should not be disregarded as untrue.

These numbers show how critical and widespread the problem is. Despite its being illegal, more than half a million women undergo abortion a year. This is more than the entire population of Makati City in 2007. The number of women who are hospitalized as a result of the abortion is a few thousands more than Isabela City’s population. The number of women who died is comparable to the population of an entire small barangay. Such is the magnitude of the problem.

Abortions are performed clandestinely. In many cases, unsafe manners are used by those who perform them. They endanger women’s lives. There were cases of women who used barbecue sticks and clothes hangers to induce abortion. Highly dangerous ways such as these are more common for poor women. Their rich ‘sisters’ can pay for needed services, sometimes even getting the procedure (and vacation) in another country.

Profiling women having induced abortions will reveal that 68 percent are poor, 91 percent are married/in union, 57 percent have more than three children and 87 percent are Catholics.

When asked why they resorted to abortion, 72 percent cited poverty, 54 percent said they already had enough children, and 57 percent indicated that the pregnancy occurred too soon after the last one.

Therefore, contrary to popular notion that those who have abortions are young women who sleep around, the reality is that it is the poor, Catholic married women with several children who are forced into this situation. Moreover, it is clear from the women’s reasons that their pregnancies were unplanned or unwanted. Fifty-four percent of those who had abortion were not using any contraceptive when they got pregnant. Of those who were doing family planning, 75 percent were using a traditional method.

In my decades of working with community women, I have yet to meet one who is pro-abortion but have encountered many who said they had to resort to it out of desperation. Deciding to have an abortion is never easy. Women agonize over this and in most cases, make the decision not for themselves but for their families, especially the several children they already have.

Take D, for example. Now 48 years old and an ambulant vendor, she gave birth to her first child at 17 and was pregnant each year for the next five years. Thus, at the age of 22, she already had six children. A devout Catholic, D. had three abortions after her sixth child because her husband would not hear of pills when they could hardly provide food for their children. She said that the abortions saved her six living children. After, she decided to take the pill and only told her husband five years later. She now says that without the abortions and pills, she could have given birth to at least six more children, something that they definitely could not afford.

T also had an abortion. She and her husband used to work in the same factory but her man was retrenched and became seriously ill. T became the sole breadwinner and then she got pregnant. With four children, high medical costs for the husband, no savings and only her meager earnings to tide the family over, the couple knew that it was the worst time to have another child. They decided that an abortion was the only solution.

While invisible, women having abortions are real women with real stories to tell. Unfortunately, society seems uninterested.

In fact, the abortion scare is used by the Catholic hierarchy and its fundamentalist allies against the reproductive health bill. Virtually all anti-RH positions equate the bill with abortion. Particularly, the FP provisions are under attack. Let’s look at what House Bill 96 (Lagman) actually says.

Section 3, i. states that, “While nothing in this Act changes the law against abortion, the government shall ensure that all women needing care for post-abortion complications shall be treated and counselled in a humane, non-judgmental and compassionate manner.” Clearly therefore, the RH bill does not promote abortion’s legalization but takes serious notice of and addresses abusive treatment suffered by poor women in the hands of medical practitioners even when these women are already suffering from complications.

The same section says that government shall promote, without bias, all modern natural and artificial, medically safe, legal, and effective family planning methods. The bill has related provisions that ensure access to family planning of those who need the services the most – those in poverty. Note that the unmet need for family planning of poorest women is 51 percent and; those who are not poor need much less. (National Demographic and Health Survey, 2008).

Addressing abortion necessitates dealing with unplanned, mistimed and unwanted pregnancies. Access to family planning programs is a must. Studies show that correct and regular use of contraceptives can bring down abortion rates by as much as 85 percent (Allan Guttmacher Institute). Therefore, contrary to what anti-RH groups say, the bill’s passage will bring down the number of induced abortions in the country.

Anti-abortion groups should actually support the reproductive health bill.

media, priests & abortion

media is plural for mediocre, rene saguisag says in his manila times column on the same day that mark robert b. baldo in a letter to the inquirer editor decries the failure of media to level-up the public debate on the RH bill.

A cursory look on the articles printed in this broadsheet shows this to be a recurring theme: luminaries using the infidelities of some Catholic priests in Europe to discredit the Church; some citing the political affiliations of some bishops; and others, presenting flawed accounts of Church history. This is a mistake because no longer do we hear mention of arguments by both parties.

… Media inevitably shape the public debate. I am not talking here about whether the bill should be passed or not, or whether the media should frame it in such a way that it would be passed or not. I am simply talking about how to frame the debate in such a way that it would stimulate productive discussion rather than a stirring drama about a declining institution in Philippine society.

indeed, na-sidetrack, nagpa-sidetrack, na lang ang media sa rizal vs. damaso drama ni carlos celdran.   easier naman talaga to go with the flow, kahit paatras, than to move on, against the tide, to the more difficult formidable challenging task of helping along the RH discourse toward a clear resolution.

in Some issues about the RH bills fr. joaquin bernas writes:

When does human life begin? We probably are all agreed that man must not destroy human life. Our Constitution protects life “from conception.” There is some indication in the deliberations of the 1987 Constitution Commission that this means “from fertilization.” But there are contrary views. Who will decide which view is correct?

granted, for the sake of no-argument, that the philippine constitution means “from fertilization” and that congress will so concur, what then?   logically, it should mean the end of all debate because as with the natural family planning method (no sex during ovulation), with artificial contraceptives no fertilization happens, which means no life is destroyed, so condoms, pills, and IUDs should be okay-all-right.

and yet and yet and yet, priests and other rabid pro-lifers continue to insist that birth control pills (that prevent ovulation so no egg is produced for sperm to fertilize) are abortifacients.   nakakaloka.   how canyou even begin an intelligent discussion???   for the longest time i couldn’t figure it out.   why the lying.   why the dishonesty.   why the misinformation.   until suddenly it dawned on me, after reading this, still from fr. bernas:

The determination about the beginning of human life will also be relevant to the debate on abortion. Clearly abortion is prohibited and penalized by law. But when does abortion take place? At what stage of the reproductive process will interruption be considered an offense against life? At fertilization or only after implantation? Are there birth control devices or pills which are abortifacient? If so, in what way? There is debate about the abortifacient effect of some birth control means. Who is to settle this debate—Congress? The Courts? Science? the Church? The ralliers? I understand that the various pharmaceutical and medical literature on this are conflictive.

the questions tell me that fr. bernas knows more than he’s telling, much like a parent who has a hard time talking to a teen child about sex because the openness and the info could be misconstrued as license to have sex.   in this case the information, which is most likely new to many many filipino women, rich and poor, young and old, could be misconstrued as license to interrupt the reproductive process by preventing the implantation of a fertilized egg, which apparently he equates with abortion.   i totally disagree.

just to make sure i have it right, i emailed my balikbayan brother dr. godofredo “butch” stuart, now based in tiaong, quezon, who is my first resource on contraception.   his response:

REPRO 101

Fertilization occurs when sperm-meets-ovum, 200 to 500 million sperms in the ejaculate, discharged into the vaginal vault, embarking on journey up the vagina, up the cervix. Only less than a thousand survive the swim and make it to the fallopian tube, into the “last lap” of their swim. These sperms have fertilizing capabilities that last only for 72 hours, sometimes 96 hours.

And once a month, normally, one mature egg is released from the ovary, fertilizable only for 24 hours. Into the fallopian tube it begins the journey, where it is met by one of the surviving sperma. So fertilization occurs, resulting in a zygote.

The germinal stage (0 to 2 weeks) begins when the zygote journeys down the fallopian tube to the uterus, reaching the uterus in 4 to 5 days, floating freely in the uterine cavity for several more days, finally adhering to the uterine wall about the 8th day after fertilization. By the 12th the egg is firmly implanted. And by the end of the second week the uterine wall has completely surrounded the newly developing organism.

This is the basic arithmetic on sperm and ovum life spans, and how the implantation happens many days later after fertilization. And how morning-after contraception works in the schemata of the germinal stage and implantation.

check out his website stuartxchange.com where he has a page on emergency post-coital contraception.   between fertilization of the egg and its implantation in the uterus, there’s a 7-day window during which contraceptive pills taken in certain doses effectively prevents implantation, which is how the morning-after pill (banned here) works.

the question is, when a woman resorts to emergency contraception, is that abortion?   i don’t think so.   while it is true that a fertilized egg has life, still it’s NOT A VIABLE LIFE, not until implantation.

DOC BUTCH :  Yes, non-viable until implantation.  Alive, yes, as in in-vitro fertilization, alive in the laboratory milieu, but still needing the uterine implantation to enter a sustaining nutritional environment.

which brings me back to fr. bernas’s questions: when does abortion take place?   answer: certainly not when a woman resorts to emergency contraception “the morning after” sex, because a fertilized egg (if at all there is one) is not yet a viable life-form.   and no, BIRTH CONTROL PILLS ARE NOT ABORTIFACIENTS:  once a fertilized egg has implanted onto the uterine wall, no amount of these pills can dislodge or remove it from the uterine wall.   (only real abortifacients can dislodge, abort, a zygote, but that’s for another blog.)

of course pro-lifers would disagree with me till kingdom come.   but try googling it and you will find that there are as many arguments for fertilization, as there are for implantation, as the beginning of human life.   so fr. bernas asks: who is to settle the debate re the alleged “abortifacient effect of some birth control means” — congress? the courts? science? the church? the ralliers?   answer: NONE OF THE ABOVE.   i say THE WOMAN DECIDES, not the priests or the opus deists.

DOC BUTCH : From opposing ends, it will never be answered or agreed upon. Yes, in the end, it should be the woman’s right, sole and inalienable, unburdened by archaic church edicts and impotent male political will. Too, a daunting responsibility for “educators” with the burdensome task of educating the womenfolk. And how to make the information available and comprehensible to the masa, who still resort to coat-hangers, grapevine pharmaceuticals, and dangerous herbal concoctions.

indeed.   widespread underground procedures kill about 1,000 women each year in this predominantly roman catholic country.

An estimated 560,000 women in the Philippines in 2008 sought abortion involving crude and painful methods such as intense abdominal massages by traditional midwives or inserting catheters into the uterus, said a report by the New York-based Center for Reproductive Rights.

which brings me back to the media, which have the power and the means not only to shape the debate but to make available the information and educate the womenfolk, thereby “to change the status quo of high rates of infant mortality, maternal deaths, and abortions. It is a moral imperative that such dehumanizing conditions should not be allowed to continue.”

DOC BUTCH :    Media seems to kowtow to the powers that be.  It seems like institutional fear.  No cojones to challenge the church on such matters.  Or perhaps everyone of note in media went to the same church-sponsored Sex Education 101.  Masyadong malakas ang simbahan.

but is it just fear of excommunication and hellfire,  or is it also a lack of critical thinking,  and not caring enough about the issues that matter?   media is plural for mediocre?   yes, all of the above.

face off

At last!  A president takes on the church, puts nation over religion, reason over dogma.  Noy stands tall.  Finally, Rizal’s battle is joined! Bernardo breaks free! — Satur Sulit