Murder In Utero

Even as abortion remains a crime in this country and the debate over its morality and propriety rages, an undetermined number of unborn children are slaughtered each year. Must the medical community do something about it?

By Lucio Victor Jr.

Annette rushed to the emergency room of the government hospital, blood gushing from her vagina and soaking her designer jeans. A flight attendant in her late 20s, Annette knew the implications of another pregnancy. It meant desk job for months and going on leave when she gives birth. And she is not sure whether she can take off for her next assignment or be confined to the desk-an option she wouldn't want to consider.

    Already a mother of two, Annette had a friend who suggested a solution to her predicament-obtaining the prostaglandin misoprostol, inserting two tablets in her vagina and ingesting two more. After a few hours, she felt moderate to strong uterine contractions and the next day, she started to bleed. It was spotting at first. Soon, a deluge of blood and chunks of meaty material came gushing out.

    At the obstetrics and gynecology section, Annette met two other women who, like her, were waiting for their turn to be interviewed by an intern.

    One was a 16-year-old impregnated by her boyfriend who has since left her. For one week, the teenage mother-to-be ingested herbal abortifacients obtained from a neighbor who peddled them in Quiapo. When this did not work, the same neighbor sold them six white tablets of misoprostol. After two days of uterine contractions, a fetus was expelled in the bathroom and flushed down the drain. But their problems were far from over. Retained placental tissue still had to be removed and this caused the girl so much bleeding and pain.

    The other woman, like Annette, already had two kids. But since she and her husband cannot afford to raise any more children, they decided painfully to let the unborn child go. In search of an abortionist, they found their way to Quiapo where an elderly vendor sold them four tablets of misoprostol, guaranteeing quick expulsion of the fetus. What she did not tell the couple was the blood and gore involved and what other complications could possibly arise from the act.

Weak Evidence

    For centuries, abortion has been practiced in many parts of the world. From obscure African tribes to inner city ghettoes, abortion has been a social issue despicable to many. Only a few nations approve of abortion, and many of these countries do so conditionally-for reasons medical other than plain choice. For the vast majority, abortion remains outlawed.

    As in the Philippines, where abortion is illegal and protection for the unborn is enshrined in the Constitution. Article II, Section 12 of the 1987 Constitution reads: The State recognizes the sanctity of family life and shall protect and strengthen the family as a basic autonomous social institution. It shall equally protect the life of the mother and the life of the unborn from conception.

    Presidential Decree 79, which encourages population control through effective family planning, prohibits abortion and does not consider it a mode of family planning.

    According to Dr. Teresita Sanchez, consultant in obstetrics and gynecology at the Makati Medical Center, Philippine laws define abortion as the "willful killing of the fetus in the uterus or the violent expulsion of the fetus from the maternal womb, which results in the death of the fetus." She notes that the legal definition is different from the medical definition, which says abortion is the expulsion of a fetus before 20 weeks of gestation. Medical parlance also draws a line between abortion induced by chemical or mechanical agent and one that is spontaneous.

    Dr. Sanchez explains that medically, induced and spontaneous abortion will present somewhat similarly in the sense that there will be a history of vaginal bleeding and at times passage of meaty material or the fetus itself. Histopathologic study of the curettings and tissues obtained from the uterus of women who had abortion is similar whether induced or spontaneous. She cites only two ways induced abortion can be confirmed. First, when the patient herself admits or a family member or friend informs the attending physician. Second, when there is physical evidence such as any retained instrument used in the process of inducing the abortion and vaginal and cervical lacerations suffered as a result.

    However, if the patient only used drugs, the evidence is weak-unless the abortifacients were recovered from her uterus, vagina, or rectum. It is wrong to assume that all abortions are induced, as spontaneous abortions may also occur especially in cases where the pregnancy is complicated by a medical condition like anti-phospholipid antibody syndrome (APAS), gestational diabetes mellitus (GDM), thyrotoxicosis in pregnancy, or a chromosomal aberration. In many cases, a history of abortion is the only way to know whether a woman has any of these medical conditions.

    Dr. Sanchez also points out that, whether abortion is induced or spontaneous, complications like the retention of the dead fetus or placental tissue in the uterus may cause further bleeding and infection. This situation is remedied by completion curettage or the administration of misoprostol to induce more contractions that would hopefully expel the rest of the placental and fetal tissues.

Principal, Accessory, Accomplice

    Under the Revised Penal Code, abortion is a crime because it results in the destruction of life. Article 256 penalizes anyone who uses violence to cause abortion to a woman with reclusion temporal (12 years and one day to 20 years imprisonment). If no violence is involved but the act is without the woman's knowledge or consent, the penalty is prision mayor (six years and one day to 12 years). The penalty becomes prision correccional (six months and one day to six years) if the abortion was done with the woman's consent. In such case, the woman will also be charged.

    Under Article 258 a woman who performs abortion herself or consents to any person to do so shall suffer a penalty of prision correccional in its medium and maximum terms. If mitigated by a desire to conceal dishonor, the penalty is reduced to minimum to medium terms. If committed by either parent with consent of the woman in order to conceal dishonor, the penalty is prision correccional in its medium and maximum terms.

    The penalty is reclusion temporal for any medical practitioner who "takes advantage of their scientific knowledge or skill" to perform or assist in performing an abortion. A pharmacist who dispenses an abortifacient without proper prescription may be imprisoned for one month and one day to six months.

    In case the woman admits to having an induced abortion, Dr. Sanchez says medical practitioners that attended to her are obliged but not forced to report her case to the authorities. She notes that many doctors and hospitals fail to report such cases because "they do not want to get involved." Since the woman's reasons for having an abortion is personal, many people feel that the "privacy" of the issue relieves them of their obligation to report such a "crime" to the authorities. Besides, Dr. Sanchez says that most women do not admit to having an induced abortion and tell the doctor they had a miscarriage. In most cases, the physician is not be able to draw a confession from the patient and, therefore, cannot come up with the most basic evidence that can stand in court. On the other hand, many feel that too much probing may be unfair to a woman who has actually been through a spontaneous abortion. The medical professional doing the questioning may appear to be judgmental and in the process alienate the patient, who may, after all have really gone through spontaneous abortion.

In the US and Elsewhere

    The US Centers for Disease Control and Prevention in 1997 said the abortion rate in the United States dropped to its lowest in 20 years. Abortion declined from 1.3 million cases in 1993 to 1.2 million in 1994, which the CDC attributes to "better and greater use of contraceptives, decreased access to abortion facilities, and changing social attitudes towards abortion."

    Other reasons could be an ageing population yielding more women beyond childbearing age, increasing rates of infertility, and the rising number of medical facilities operated by the Catholic Church that do not operate abortion clinics.

    Still, it is estimated that 43 percent of American women will have at least one abortion in their lifetime.

    Legal abortions in the US heightened in 1970 and reached all-time high in 1984 with 36.4 cases per 100 live births. The rate gradually declined to 33.5 in 1992 and 31.1 in 1995. In the mid-90s there were 20 abortions per 1,000 women aged 15 to 44.

    Nearly half of all US abortions are performed within the first eight weeks age of gestation. About 80 percent of women who undergo abortion are over 18 years old, 78 percent of them unmarried. Abortion rates are highest for women under 15 (77.5 in 1992) and over 40 (47.0 in 1992) and lowest in those 30 to 34 years old (18.3 in 1992).

    California's 39 abortions per 1,000 women ages 15 to 44 is the highest, followed by New York (37), Florida (27), Delaware (26), and Rhode Island (24).

    There are 54 countries where abortion is legal against 97 where it is outlawed (Center for Reproductive Law and Policy, New York). It is estimated that 36 to 53 million abortions are performed each year, making up 20 to 30 percent of all pregnancies. Of these, about 10 to 22 million are done in secrecy.

    England and Wales in 2000 reported 175,000 abortions, 134 of which were done for therapeutic reasons and over 162,000 (92 percent) because of risk of injury to the physical or mental health of the woman.