Management of Abortion in the Philippines
In the Philippines, abortion management primarily focuses on post-abortion care (PAC) due to legal restrictions, with the primary methods being sharp curettage and manual vacuum aspiration (MVA) for first-trimester uterine evacuation. 1
Post-Abortion Care Practices
- Sharp curettage is universally used (100% of providers) for first-trimester post-abortion care in the Philippines, despite not being the safest method available 1
- Manual vacuum aspiration (MVA) is also widely used (84.4% of providers) as an alternative method for uterine evacuation 1
- Despite its unregistered status in the Philippines, misoprostol is prescribed by 55.6% of physicians for first-trimester post-abortion uterine evacuation, though often at lower doses than recommended by evidence-based guidelines 1
- Dosing regimens for misoprostol in the Philippines range from 50 to 200 micrograms as a single dose or repeated every 4-24 hours, which is lower than evidence-based recommendations 1
Medical Complications and Management
- For incomplete or inevitable abortion, oxytocin infusion is indicated as adjunctive therapy, particularly in second-trimester abortion where it can successfully empty the uterus 2
- The standard protocol for oxytocin administration involves adding 10 units to 1,000 mL of physiologic saline solution and infusing at a rate of 20-40 drops/minute 2
- Post-abortion complications requiring hospitalization affect approximately 12% of women who undergo abortion in the Philippines, representing a significant public health concern 3
- Infection and sepsis are serious complications of abortion that require immediate treatment with broad-spectrum antibiotics and uterine evacuation 4
Epidemiology and Public Health Impact
- The estimated abortion rate in the Philippines is 27 per 1,000 women aged 15-44 per year (as of 2000), with approximately 473,400 women having abortions annually 5
- Metropolitan Manila has a significantly higher abortion rate (52 per 1,000 women) compared to the national average 5
- The high rate of abortion complications is attributed to unsafe conditions, as abortion is legally restricted in the Philippines 5
- Despite legal restrictions, about half of Filipino women in rural areas approve of abortion, and 57% incorrectly believe that abortion is legal 3
Ethical and Legal Considerations
- Healthcare providers have an ethical and legal duty to provide immediate post-abortion care regardless of whether the abortion was induced or spontaneous, legal or illegal 6
- Delay in providing care can lead to avoidable disability, loss of childbearing capacity, or death 6
- Rendering post-abortion care is not an abortion procedure nor illegal, and does not justify conscientious objection 6
- Mandatory reporting of patients suspected of criminal abortion violates professional confidentiality 6
Evidence-Based Recommendations for Improvement
- There is a need to disseminate evidence-based information about safe and effective use of MVA and misoprostol for post-abortion care to physicians in the Philippines 1
- Combined medical regimens (such as mifepristone with prostaglandins) are more effective than single agents for medical abortion, though access to these medications is limited in the Philippines 7
- Misoprostol administered vaginally is more effective than when administered orally and should be preferred when available 7
- Policies and programs regarding both post-abortion care and contraceptive services need improvement to address the high rate of unintended pregnancies 5
Practical Considerations
- Post-abortion care should include both medical treatment and psychological support, delivered with compassion and respect for dignity 6
- Healthcare practitioners' refusal or failure to provide available post-abortion care might constitute ethical misconduct and attract legal liability 6
- Harm reduction strategies to reduce effects of unsafe abortion may legitimately inform women of their rights to professional post-abortion care 6
- The Society for Maternal-Fetal Medicine supports access to abortion care as a critical health service and opposes policies that limit its access, though this position faces significant challenges in the Philippine context 8