Perceptions and Practices of Illegal Abortion among Urban Young Adults in the Philippines: A Qualitative Study

Abstract

This study draws on in-depth interviews and focus group discussions with young adults in a metropolitan area of the Philippines to examine perceptions and practices of illegal abortion. Study participants indicated that unintended pregnancies are common and may be resolved through eventual acceptance or through self-induced injury or ingestion of substances to terminate the pregnancy. Despite the illegality of abortion and the restricted status of misoprostol, substantial knowledge and use of the drug exists. Discussions mirrored broader controversies associated with abortion in this setting. Abortion was generally thought to invoke gaba (bad karma), yet some noted its acceptability under certain circumstances. This study elucidates the complexities of pregnancy decisionmaking in this restrictive environment and the need for comprehensive and confidential reproductive health services for Filipino young adults.

The role of men in induced abortion decision making in an urban area of the Philippines

“…Men's perceptions of unintended pregnancy and induced abortions were strongly influenced by concerns that their knowing or unknowing association with an induced abortion would result in judgement from God, from their community, or both. Similarly, in a previous study in the Philippines, many men felt that the “sin” of abortion was something that they would have to endure for their lifetime for having killed an “innocent child.” These religious sentiments mirror public discourse on abortion in the Philippines, a discourse heavily influenced by the Roman Catholic Church and an influence that may likely serve to perpetuate abortion stigma at the community level …”

“…Young women are expected to remain chaste until marriage, whereas young men are afforded more sexual latitude though are expected to be “breadwinners” for the family . Consequently, unintended pregnancies present unique concerns for young women and men as they attempt to navigate social expectations alongside potential stigma arising from a premarital pregnancy …”

“…Whereas numerous studies have examined women's experiences with unintended pregnancy and induced abortion, few studies have focused on men's experiences, despite the fact that men often play a significant role in pregnancy decision‐making . Men's involvement and mobilization of material resources is often a critical determinant of the decision to terminate a pregnancy and the choice of induced abortion method . Consequently, understanding men's role in pregnancy decision‐making is necessary to identify factors that may lead to the use of unsafe abortion in the Philippines…”

Self-management of medical abortion: a qualitative evidence synthesis

“…36,38 Women's perceptions of the acceptability of self-management without in-person contact with health professionals depended on: the standard of care and their prior experiences with medical abortion, local notions of professional medical hierarchy, abortion taboos and stigma, and perceptions around the strength, danger and complexity of the drugs. 20,32,40,41 Providers' perceptions about which healthcare workers should be able to provide medical abortion drugs to women for self-administration varied and depended on: perceptions of the strength of the drugs and hence the expertise in anatomy and physiology needed to explain their full effects; a provider's training in appropriate counselling for abortion; a provider's knowledge of abortionfriendly emergency departments to refer women to in the case of complications; and the client's experience, and therefore trust, of different healthcare workers. 16,33,42 Preparation for self-management In preparing for self-management of medical abortion, women reported anxiety, uncertainty, or ambivalence, sometimes to do with the decision to terminate the pregnancy, but more often in relation to the process and experience of the medical abortion.…”

“…Women expressed a desire to be able to choose the method of abortion that fit their context and circumstances. 20,29,41,42,44 Having the choice to self-administer medication at home (versus having it in clinic), may be an important element of acceptability of medical abortion for women. 4,20,23,25,43 There were some concerns among women and providers, with respect to women's autonomy over their sexual and reproductive health decisionmaking, around the potential unintended consequences of increasing access to medical abortion through self-management and self-administration.…”