Volume 142, Issue 2 p. 255-256
ETHICAL AND LEGAL ISSUES IN REPRODUCTIVE HEALTH
Free Access

The Philippines rolls back advancements in the postabortion care policy

Melissa Upreti

Corresponding Author

Melissa Upreti

Center for Women's Global Leadership, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA

International Reproductive and Sexual Health Law Program, Faculty of Law, University of Toronto, Toronto, ON, USA

Correspondence

Melissa Upreti, Center for Women's Global Leadership, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA.

Email: [email protected]

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Jihan Jacob

Jihan Jacob

Center for Reproductive Rights, New York, NY, USA

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First published: 10 May 2018
Citations: 3

Abstract

In 2018, the Philippines announced a postabortion care policy that rolls back crucial safeguards aimed at protecting women who seek medical treatment for postabortion complications from discrimination and abuse. It replaces another policy that was introduced in 2016, following years of advocacy by national and international advocates who were concerned about the mistreatment of women seeking postabortion care due to discriminatory practices in the health system and abortion stigma. The new policy is narrower in scope than the previous policy and reinforces abortion stigma by emphasizing the legal prohibition on abortion, failing to clarify that women seeking postabortion care need not be reported to the authorities, and not recognizing the availability of complaint mechanisms for women who are mistreated. These and other crucial gaps put the new policy at risk of being in violation of ethical standards of medical care and guarantees of human rights.

On February 18, 2018, a new postabortion care policy was issued by the Department of Health in the Philippines, in the form of Administrative Order 2018-0003.1 This policy rescinds Administrative Order 2016-0041, dated November 25, 2016,2 which was developed by the Technical Working Group established by the Department of Health to implement the Philippines’ landmark reproductive health law passed in 2012,1 (p.7) Unlike the 2016 policy, the 2018 policy was drafted without broadly soliciting the input of reproductive health advocates whose collective efforts had led to the passage of a more ethical and human rights-based postabortion care policy in 2016, as discussed in depth in an article in the May issue of the International Journal of Obstetrics and Gynecology.3

The new policy departs from the 2016 policy in several crucial respects. First and foremost, its premise is narrow and moves away from a holistic and ethical approach to women's reproductive health that is respectful of their human rights to one that focuses mainly on the elimination of what is described as their “preference for illegal and unsafe abortion.”1 (p.1) It purports to do this by singularly focusing on improving family planning services.1 (p.1) What is inherently problematic about the 2018 approach is its failure to recognize that contraceptives, even when widely available and accessible, do not provide absolute protection against unwanted pregnancy.

Second, the new policy refers to the “absolute prohibition on abortion” as it states its commitment to uphold the right to health of every Filipino.1 (p.1) The language in the policy referring to women's “preference for illegal and unsafe abortion” seems to suggest that women choose to engage in criminal behavior. This reiteration is likely to perpetuate existing abortion stigma and reinforce negative attitudes toward women who have abortions who are typically viewed as criminals and, on this basis, frequently denied ethical, non-judgmental, and humane medical care.

Third, unlike the 2016 policy, the new policy is not geared towards addressing the most widely documented challenges faced by women and healthcare providers in the context of postabortion care, which include the lack of privacy and confidentiality of patients, the practice of reporting women who have abortions to the authorities, the invocation of conscience to refuse legally indicated care, and the absence of a redress mechanism for women who are mistreated and abused. In fact, many of the outstanding features of the former policy have been eliminated:
  1. The new policy does not speak of healthcare providers being duty bound to ensure the privacy and confidentiality of their patients or to prioritize the creation of institutional safeguards. It merely speaks of the need for “audio-visual privacy” standards for rooms where consultations will be held, which is limited in scope.1 (p.2)
  2. The new policy limits the range of treatment available for postabortion complications. While the 2016 policy explicitly allowed the use of uterotonics and vacuum aspiration and manual vacuum aspiration, the new policy limits the use to lifesaving drugs such as oxytocin, antibiotics, and anticonvulsants.1 (p.4) Furthermore, while the former policy permitted trained nurses and midwives to perform vacuum aspiration and manual vacuum aspiration under certain conditions, the new policy has narrowed down their role to administrating lifesaving drugs when a doctor is unavailable, referrals, counseling, and home visits for follow-up care.1 (pp.4–5)
  3. The new policy fails to clarify the absence of a reporting requirement for women seeking medical attention for post abortion care, which will perpetuate the misconception that healthcare providers are legally required to report patients to the authorities. The policy's explicit reference to the legal prohibition on abortion is further likely to reinforce this misconception and deter women from seeking legally permissible postabortion care.
  4. Unlike the 2016 policy, the new policy does not prohibit health service providers from denying emergency medical care to women seeking postabortion care based on conscientious objection. Moreover, it does not clarify that third party authorization is not required for treatment of postabortion complications.
  5. The new policy excludes provisions recognizing the availability of complaint mechanisms for abuses in the context of postabortion care and the provision of free legal assistance and protection against retaliatory suits against a complainant.

The new policy excludes key provisions that are necessary to ensure the ethical provision of postabortion care, eliminate stigma against women and service providers, and ensure redress for survivors of discrimination and abuse. With the introduction of the new policy, the postabortion care framework in the Philippines has been stripped of the very components that made it a progressive and exemplary model that embodied ethical standards and human rights. Unlike the 2016 policy, the 2018 policy was adopted quietly and without the participation of a broad range of stakeholders which helps explain its narrow premise, crucial gaps, and lack of grounding in widely recognized ethical standards of medical care.

The 2018 postabortion care policy can be aptly described as a regressive measure that will be harmful to women and make it difficult for health service providers to overcome the challenges they face in providing ethical and medically appropriate postabortion care to their patients in a highly stigmatized and restricted legal environment.

Considering the crucial gaps in the new policy, it will be important for advocates within and outside the medical profession to find ways to work together to fulfill women's right to humane, compassionate, non-judgmental, and ethical postabortion care, as guaranteed under national law and as required by international law and medical ethics.

AUTHOR CONTRIBUTIONS

MU drafted the manuscript with contributions from JJ.

ACKNOWLEDGMENTS

We thank Rebecca Cook and Bernard Dickens for their review of the manuscript and for their time and continued support.

    CONFLICTS OF INTEREST

    MU was a member of the UN Working Group on the issue of discrimination against women in law and in practice, a Special Procedure established by the Human Rights Council, at the time of publication of this article. The views expressed in this article do not officially represent those of the UN Working Group. JJ was a member of the technical working group that drafted the 2016 National Policy on the Prevention and Management of Abortion Complications. MU advised the working group by providing technical support to JJ during the development of the policy, as Regional Director for Asia at the Center for Reproductive Rights, USA.