abortion essay philippines

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• v.32; 2023 Mar

The spectre of unsafe abortions in the Philippines

Juan raphael m. perez.

a College of Medicine, University of the Philippines, 1000 Manila, Philippines

Gianica Reena S. Monteagudo

b Department of Family and Community Medicine, Philippine General Hospital, 1000 Manila, Philippines

Pia Juneea C. Nebrada

Ma veronica pia n. arevalo, edelina p. de la paz, frances dominique v. ho, clara rita a. padilla.

c EnGendeRights, Inc., 1105 Quezon City, Philippines

On 24 June 2022, the U.S. Supreme Court overturned Roe v. Wade, the landmark 1973 ruling that protected the constitutional right to abortion, threatening the physical and mental health of millions of pregnant people in the U.S. However, this crisis has long been the reality for pregnant people in the Philippines, a lower-middle income country in Southeast Asia where abortion remains restricted with no explicit exception for high-risk pregnancies, fetal impairment, rape, and incest. 1 Nonetheless, 1.1 million induced abortions occur in the country annually, a number that was estimated to increase by 14.6% in 2020. 2 1000 Filipino women die each year from post-abortion complications. 3

Unsafe abortion contributes significantly to preventable maternal mortality in the country yet remains the sole option for many young, low-income, and rural women, 1 , 3 as 75% of Filipino women seeking abortions are financially unable to raise another child. Disturbingly, over 10% of women are victims of sexual violence. 3 Unsafe abortive methods include unsupervised catheter insertion, abdominal manipulation or massage, and self-induction with unapproved herbs. 3 , 4 Misoprostol, an internationally accepted abortifacient, also remains illegal and inaccessible due to restrictions on abortion. These frequently result in mortality from hemorrhage, sepsis, genital trauma, and bowel necrosis, with many survivors suffering long-term complications (e.g., poor wound healing, infertility, and incontinence). 5

Though the provision of humane post-abortion care is constitutional, Filipino women face both societal stigma and maltreatment from healthcare providers, the latter ranging from verbal abuse and religious sanctimony to outright refusal of care. 4 With over 80% of the Filipino population identifying as Roman Catholic, 6 strong religiosity may be a contributor to societal stigma. This, compounded by fear of legal prosecution, may lead women to delay seeking post-abortion care. Filipino healthcare providers themselves risk criminal prosecution, license revocation, and ostracisation from peers for participating in abortion-related activities. 7

Legal barriers further thwart safe post-abortion care. A 2016 Department of Health Administrative Order (DOH AO), drafted in consultation with reproductive health advocates, provided protections on confidentiality and redress mechanisms for abortion patients. 8 However, a 2018 DOH AO, developed without consulting health advocates, removed these guidelines explicitly maintaining patient privacy. 8

Women who continue with unintended pregnancies are exposed, willingly or unwillingly, to the effects of pregnancy itself, which range from normal physiologic (e.g., increased workload to the heart, hypercoagulable state of the blood) to life-threatening (e.g., preeclampsia, venous thromboembolism). 9 Quality prenatal care manages these risks, but remains out of reach for low-income Filipino women, especially those dwelling in geographically isolated and disadvantaged areas (GIDAs), due to high out-of-pocket costs and concentrated healthcare resources in urban centers. 10

Religious, political, and socioeconomic forces influence the Filipino woman's reproductive freedoms beyond abortion. Unintended pregnancy remains a public health challenge in the Philippines because of limited access to contraception and sexual and reproductive health (SRH) services. Over half of all pregnancies are unintended and over half of these unintended pregnancies end in abortion. 11 Seventeen percent of Filipino women have an unmet need for family planning, an estimate projected to rise by 67% in 2020, due to community quarantine-related service disruptions. 2 Such unmet needs may be partly due to the deep-seated political and cultural power of the Philippine Catholic Church, ineffective widescale implementation of sexuality and contraception education, high rates of gender-based violence, stalled implementation of the Reproductive Health (RH) Law, and the delayed registration of contraceptives due to a former restraining order issued by the national Supreme Court. 1 , 3 , 4 The RH Law, passed in 2012, promises to provide modern contraceptive services, counseling, and sex education, especially for rural and poor Filipinos. 3

We advocate for the decriminalisation of abortion and ensuring access to safe abortion, which begins with halting the prosecution of patients and abortion care providers. Training obstetric and primary care providers for safe abortion care is also critical to expand access, especially in GIDAs. In the meantime, to reduce maternal morbidity and mortality from unsafe abortions, policies addressing post-abortion care should prioritise the expansion of existing treatment options by nurses and midwives according to WHO standards and should be made in consultation with SRH advocates. Legislation should be crafted to protect the privacy of women seeking these services.

The country must address the determinants underlying unintended pregnancies through efforts to promote SRH literacy and universal access to modern contraception, while effectively addressing gender-based violence. Finally, to improve outcomes for people with unintended pregnancies, it is imperative to reduce out-of-pocket costs of prenatal care and mobilise prenatal care providers towards and within resource-limited areas. Ultimately, it is time for the Philippines to rethink its long-standing cultural condemnation of induced abortion and consider how safe abortion access can not only save lives but also defend women's health, security, and dignity.

Contributors

Conceptualisation, resources, writing (original draft), writing (review & editing) - JRMP, GRSM, PJCN, MVPNA, EPDP, FDVH, CRAP.

Declaration of interests

We declare no competing interests.

Acknowledgements

Funding: This study received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Advocating for women’s reproductive rights and decriminalizing the abortion law in the Philippines

Yash Arya | 13 May 2021

Angela was just 14 the first time she got pregnant. It was her first sexual experience. She says “I wanted to cry; I was pushing him away. But he said he would take responsibility and that he loved me,” her boyfriend’s parents told her contraception had bad side effects and it damaged the uterus, “So I got scared … That’s why I kept getting pregnant.” The first time she got pregnant, she miscarried at seven months. By the time she was 16, she had given birth to another baby. Just a few weeks after the birth, she was pregnant again. Now living with her boyfriend, in a ramshackle hut surrounded by mud, Angela the young mother of four often struggles to scrounge together enough food to feed her family. “Sometimes I cry because my children are suffering as sometimes they have nothing to eat.” But she believes having access to contraception and sex education could have changed the course of her life. (original article published in Aljazeera by Mary Ann Jolley dated 24 Jan 2018 )

Adolescent mothers, who should have been the relics of the past when early childbearing was the norm, are still prevalent in the modern scenario both in developed and developing nations. However, while teen pregnancy rates in most countries are declining, the numbers are rising in the Philippines. The United Nations Population Fund (UNFPA) in 2020 reportedly stated that the “Philippines has one of the highest teenage pregnancy rates among the ASEAN member-states.” It documented that “more than 500 Filipino adolescent girls are getting pregnant and giving birth every day,” or above 182,500 births annually . According to the Commission on Population and Development (POPCOM), a Philippine government agency, the number of pregnant children below 15 in the archipelago has doubled in the past 10 years.

The Philippines is currently one of Asia’s fastest-growing economies and health is a basic human right guaranteed by the Philippine Constitution of 1987. The Philippines spends more than 4.40% of its GDP in healthcare infrastructure which is more than many of the developing economies in Asia like India, Indonesia, Malaysia, Qatar, etc. and also provides for universal health care (UHC) system known as Phil Health which covers the entire population. Yet, despite advances in reproductive health law, many Filipino women experience unintended pregnancies,because abortion is highly stigmatized in the country, many who seeks an abortion, undergo unsafe procedures.

Now you may wonder, why is it so? Why are there so many adolescent mothers here? And the answer is, the Philippines laws allow adults to legally engage in sexual intercourse with children as young as 12. Although girls can legally have sex from the age of 12, they need their parents’ permission to get contraception or an HIV test if they are under 18. The country has one of the world’s lowest ages of consent in the world and health workers say this leads to many girls having unprotected sex, which leaves them vulnerable to pregnancy. However, in a recent development,  the congress of the Philippines now looks set to approve a bill to raise the age of sexual consent from age 12 to 16.

Another question that might follow is when the country itself legalizes it, who are we to pour in our suggestions and challenge the laws. The answer is simple, but before that, I would like you to revisit the data mentioned above and understand it in two aspects. Firstly concerning the future of young girls, due to early pregnancy young girls fail to finish basic education, lack adequate skills for remunerative work, and are economically vulnerable, thus perpetuating inter-generational poverty. Moreover, adolescent pregnancies also negatively affect the economy billions forfeited revenues due to “lost opportunities and forgone savings” consequent to early childbearing as most adolescent mothers remain unemployed and unproductive. As a result, the country fails to reap the benefits of a demographic dividend from the potential of a huge young population.

Secondly, the consequences on the health of young mothers are further aggravated in the absence of safe/legal laws on abortion. According to WHO (World Health Organisation), early pregnancy among adolescents results in major health consequences for young mothers and their babies. Pregnancy and childbirth complications are the leading causes of death among adolescent girls globally with teenage pregnancies leading to some 3.9 million  unsafe abortions  among girls aged between 15 to 19 years old per year, contributing to maternal mortality, morbidity, and lasting health problems. For the Philippines, the Statistics are hard to come by, but according to a 2013 report by the Guttmacher Institute, a US-based sexual and reproductive rights organization, 610,000 women in the Philippines had abortions in 2012, nearly all of them in secret and without the benefit of doctors or nurses, and about 1,000 women die each year from abortion complications.

Many groups in the Philippines, which support laws against abortion and its criminalization cite religious reasons for stating that the Philippines is a predominantly catholic country and it goes against their religious notions. However it is to be noted here that many other predominantly Catholic countries for example Belgium, France, and Italy allow abortion upon a woman’s request, Poland allows abortion to protect a woman’s life and physical health, and in cases of rape, incest, and fetal impairment, Hungary allows abortion up to 12 weeks of gestation, even Spain have liberal abortion laws and allows abortion up to 14 weeks of the pregnancy and thereafter on specific grounds. That is why various women’s rights activists and organizations in the Philippines have advocated for repealing or revising the 1930 Revised Penal Code abortion law (Art. 25618 -259 of the Revised Penal Code) as a restrictive, colonial, and antiquated law that continues to perpetuate discrimination against women.

This brings us to the abortion laws of the Philippines which are among the strictest in the world.  Abortion is illegal under all circumstances. There are also no explicit exceptions to allow abortion in cases of rape, incest, or fetal impairment. The Penal Code considers abortion to be a criminal offense punishable by up to six years in prison for doctors and midwives who perform abortions and by 2‒6 years in prison for women who undergo the procedure, regardless of the reason. A separate set of laws under the Midwifery Act, Medical Act, and Pharmaceutical Act permit the revocation or suspension of the licenses of any practitioner who performs abortions or provides abortifacients. Although therapeutic abortion is recognized as allowed in the Philippines, the problem is lack of information and the pervasive judgment imposed on women who induce abortion, hence, decriminalizing abortion is an important step towards eliminating discrimination against women and ensuring women’s access to reproductive health services, as abortion is highly stigmatized.

Further, the process of obtaining an abortion in the Philippines is often not straightforward and may involve many methods and attempts, with serious health consequences. Dangerous methods involving the insertion of a catheter or other object into the uterus, which often causes infection and perforations, heavy abdominal pressure or “massage” to expel a fetus, by a traditional practitioner and even trying to self-induce abortions by taking misoprostol (a type of drug) are often resorted too. Thus with abortion decriminalized, women can easily access facilities for safe abortion and post-abortion care will not be impeded. This will in turn not only help to prevent maternal deaths and disability from unsafe abortion complications, But also uphold women’s reproductive rights that state, women has the right to bodily autonomy, her basic right to life, heath, and privacy and should not be forced to carry on a pregnancy. These rights have also been enshrined in the Human Rights Charter, CEDAW, International declarations like the Maputo Protocol in Africa, and at times by the Supreme Court of the Philippines itself.

The traditional belief that women should accept “all the children God gives,” the recent glorification of the fetus as having more value than the woman it is dependent on, and male-dominated culture are all used extremely effectively to justify criminal restrictions. Nevertheless, the need for abortion is one of the defining experiences of having a uterus. Thus to fully explore the potential of law and promote women’s health, the policymakers should undertake even more concrete steps to decriminalize not only the law on abortion by allowing for need-based abortions but also work towards removing the stigma associated with it. This upcoming legislation is indeed a welcoming step but the road ahead is long and tumultuous to secure women’s reproductive rights. Adequate access to contraceptives, better sex- education, and awareness about women’s reproductive rights are to be ensured meanwhile till the legislation sees the light of day.

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Why decriminalizing abortion is not possible in the Philippines

Before the last national elections, as I was going through the platforms of senatorial and congressional candidates, I noticed that some of them said they will work for the “decriminalization of abortion.”

With the June 24, 2022 landmark decision of the United States Supreme Court on the case of Dobbs v. Jackson, which ruled that there is no such thing as a “constitutional right to abortion,” those intended moves on the part of these now elected lawmakers would seem to be passé. Now, the trend in the United States is to protect the life of the unborn by enacting state laws that will prohibit abortion.

The majority opinion of the US Supreme Court was written by Justice Samuel Alito. It is a masterpiece of philosophical and legal reasoning, and research on the history of the criminal nature of abortion in English and American jurisprudence. We can say that it is common sense which tells us that abortion is the killing of an innocent person who does not even have the capacity to defend himself. In our own language, we call a pregnant woman “nagdadalang-tao” (someone who is carrying within herself another human being). We naturally think she has inside her another person.

Decriminalizing abortion means removing the status of abortion as a crime. Laws have a role to play in the moral education of a society. When the laws remove the criminal status of a crime like abortion, it is teaching society that you may commit abortion and the state will not punish you. Go ahead. You can do it. The act is not banned.

In the context of the Philippines, the decriminalization of abortion is not possible because of our basic law, the Constitution . In Article II Section 12 it says, “[The state] shall equally protect the life of the mother and the life of the unborn from conception.” How else can the state protect the life of the unborn except by banning abortion and imposing penalties on those who take away the life of the unborn? In the same way that Justice Alito repeated several times in his piece that there is no such thing as a right to abortion, it might be worth repeating that it is not possible to decriminalize abortion in the Philippines given our Constitution and given our culture and traditions.

Because abortion is prohibited in the Philippines, it is very difficult to get accurate data on the number of abortions performed in the country. There are only estimates that range from 600,000 to even over a million for the last year. This is not a small number to say the least. This is a real problem for our society. But decriminalizing abortion is not the solution. As the experience of the US shows, decriminalizing it made the problem worse.

Like poverty, abortion is a complex problem that will require a complex and manifold solution. It is above all a moral problem. The Catholic Church has always advocated the moral education of people so that their mores might conform to right reasoning about their sexuality and morality. At the root of the problem about unwanted pregnancies and abortions is difficulty about virtues related to human sexuality. Chastity is the virtue that is at stake here. It is grossly misunderstood and misinterpreted as meaning “don’t do this or that” or “being a killjoy.” Understood well, it means love, affirmation, and happiness in life.

The Church has also fought for the defense of the dignity of each human person. In the case of abortion, she has fought for respecting the dignity of both the mother and the unborn child. What happens in an abortion is that both the mother and the baby are reduced to and manipulated as commodities. Their personhoods are destroyed and eliminated. The existence of the post abortion stress syndrome attests to the destruction of the person of the women who committed abortion. They find it very difficult to live with the thought, “I killed my own baby!”

It might be better for our lawmakers to think about how to help those mothers who are contemplating having an abortion solve their problems and difficulties. They need counseling, financial help, moral support, livelihood, education. They don’t need the decriminalization of abortion.

FR. CECILIO L. MAGSINO [email protected]

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Abortion in Philippines

The Philippines abortion law is among the strictest in the world. Abortion is illegal under all circumstances and there are no explicit exceptions. Nonetheless, because of high levels of unintended pregnancy, abortion is common in the country.[1]

Is Abortion Legal in the Philippines?

Abortion is illegal in the Philippines, under the Revised Penal Code of 1930.

What Types of Abortion are Available in the Philippines?

MVA, D&C is available only as post-abortion care.

What is the abortion rate in the Philippines? How Many Women Have Abortions?

Projections that were based on the national abortion rate in 2000 (the most recent available) and that took into account population increase estimated that 560,000 abortions occurred in 2008 and 610,000 abortions took place in 2012.

Abortion with Pills (Medical Abortion) in the Philippines

Are the abortion pills (mifepristone and misoprostol) available in the philippines.

Abortion pills are not sold legally in the Philippines. Misoprostol is registered in the Philippines for the treatment of a range of medical conditions. [2]

How Late Into a Pregnancy Can the Abortion Pills Be Used?

You may be able to get a medication abortion up to 13 weeks after the first day of your last period. If it has been 78 days or more since the first day of your last period, you can have an in-clinic abortion to end your pregnancy.

Do I Need a Prescription for Mifepristone? Misoprostol?

A prescription is needed for Misoprostol.

What Brands of Abortion Pill Are Popular in the Philippines?

Popular abortion pills brands in the Philippines are Cytotec and Mifepristone.

How Much Do the Abortion Pills Cost in the Philippines?

Cytotec 0 weeks – 2 months: Php 3400 3 months and above – Price varies on how many months

Mifepristone 0 weeks – 2 months: Php 5200 3 months and above – Price varies on how many months [4]

Who Can I Contact for More Information on Abortion in the Philippines?

For more information about post-abortion care, please contact https://likhaan.org/

In-Clinic Abortion in the Philippines

What are the different types of in-clinic abortion procedures available in the philippines.

Through the Department of Health Administrative Order No 2016 – 0041, the following are the available post-abortion care services available: Dilation & Curettage, Manual Vacuum Aspiration, Uterotonics.

Where Can I get a Manual Vacum Aspiration (MVA) Abortion in the Philippines?

Manual Vacuum Aspiration can be provided as post-abortion care by any nurse, midwife, obstetrician-gynaecologist and general practitioners.

How Much Does Manual Vacuum Aspiration (MVA) Cost in the Philippines?

Manual Vacuum Aspiration costs Php 11, 000.00[3]

How to get further information?

For additional information and support, you can get in touch with our trained multilingual female counselors

LEARN ABOUT YOUR COUNTRY

by the safe2choose team and supporting experts at carafem , based on the 2019 recommendations by Ipas , and the 2012 recommendations by the WHO .

[1] https://attorney.org.ph/legal-news/35-the-criminal-law-on-abortion

[2] https://www.howtouseabortionpill.org/abortion-laws-by-country/philippines/

[3] https://www.philhealth.gov.ph/circulars/2013/annexes/circ35_2013/Annex2_ListOfProcedureCaseRates.pdf

[4] https://abortionpillsph.blog/

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Abortion in the Philippines: A Matter of Choice or Life

Abortion should equally protect the life of the mother and the life of the unborn from conception.

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[OPINION] It’s time for the Philippines to decriminalize abortion

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This is AI generated summarization, which may have errors. For context, always refer to the full article.

Finally, the overwhelming vote of 66.4% to repeal the 8 th amendment is in line with women’s right to health. It clearly manifests respect for women’s right to decide and a significant step to save women’s lives and freedom from disability that result from denial of access to safe and legal abortion. 

Currently, abortion is only allowed in Ireland to save the woman’s life. This restriction led to the death in 2012 of a woman who miscarried and was denied her request to complete abortion. She was told that there was no risk to her life, eventually leading to her death due to sepsis.  

Irish legislators are immediately proposing to allow abortion for 12 weeks of gestation and thereafter on various grounds.  

Predominantly Catholic countries have liberalized their laws on abortion. In Spain in 2010, Prime Minister Zapatero was at the helm of legalizing abortion on request during the first 14 weeks of the pregnancy and thereafter on specific grounds. Countries such as Belgium, France, and Italy allow abortion upon a woman’s request. Poland allows abortion to protect a woman’s life and physical health and in cases of rape, incest, and fetal impairment. Hungary allows abortion up to 12 weeks of gestation. Portugal allows abortion up to 10 weeks of gestation. Brazil allows it on certain grounds.   

Almost all former Spanish colonies, mostly with predominant Catholic populations, have liberalized their laws on abortion, allowing abortion on certain grounds: Argentina, Bahamas, Bolivia, Chile, Colombia, Costa Rica, Cuba, Ecuador, Guatemala, Jamaica, Mexico, Panama, Paraguay, Peru, Puerto Rico, Trinidad and Tobago, Uruguay, and Venezuela. That leaves the Philippines to contend with its antiquated colonial Spanish law.

Mexico City, a predominantly Catholic city, even provides safe and legal abortion for free. In 2017, then former head of state of Chile, Michelle Bachelet, strongly campaigned to relax their abortion law. Only 6 countries – particularly, Honduras, El Salvador, Nicaragua, Malta and Dominican Republic – are left with a total ban on abortion.

Other countries with constitutional protection of the life of the unborn from conception allow abortion under certain exceptions: Hungary (up to 12 weeks of gestation); Costa Rica, South Africa, Slovak Republic, Poland (risk to woman’s life and health, rape, fetal impairment); and Kenya.

I hope the Philippines will follow this global liberalization on abortion and soon decriminalize abortion since presently abortion is only recognized in our country to save the woman’s life and for medical necessity based on a 1961 supreme Court decision.  

In August 2016, a 21-year old Filipino woman who became pregnant as a result of the rape died a day after her risky childbirth due to complications resulting from her dwarfism condition. Her mother lamented that her daughter might still be alive had her daughter been able to access safe and legal abortion.

While therapeutic abortion is allowed in the Philippines to save the life of a woman or to prevent disability, there various other reasons why Filipino women undergo abortion – why they induce abortion: 

• Inability to afford the cost of raising a child or an additional child  – 75% of the women
• Having enough children or their pregnancy came too soon after their last birth – more than half of the women
• Too young – 46% were women younger than 25
• Health risks – nearly one-third of the women
• Rape – 13% of the women
• Pregnancy not supported by partner or family – one-third of the women  

There is a very high incidence of rape in the Philippines. A Filipino woman or girl is raped every 58 minutes, and about one in every 9 Filipino women who induce abortion are rape survivors. Some women and girl-children who became pregnant resulting from rape were forced to resort to clandestine and unsafe abortions to end their unwanted pregnancies while others have tried to commit suicide. 

Without access to safe and legal abortion, they end up part of the statistics of women who die from unsafe abortion complications. These cases fall under the ambit of therapeutic abortions to save the life and health of the woman.

Most of the women who are hospitalized and die from complications from unsafe abortion are poor, Roman Catholics, married, with at least 3 children, and have at least a high school education. Poor women comprise two-thirds of those who induce abortion, using riskier abortion methods, thus disproportionately experiencing severe complications. This clearly shows that lack of access to safe abortion is a social justice issue. 

The archaic Spanish colonial law on abortion in our 1930 Revised Penal Code has not decreased the number of women who induce abortion. Rather, it has made it dangerous for women who resort to clandestine and unsafe abortion.  

It is urgent to increase access to safe and legal abortion. The problem, in the past years and until now, is that certain medical health care providers deny life-saving post-abortion care to women and threaten them with criminal prosecution whether the women had induced or spontaneous abortion.  Women who suffer complications from induced and spontaneous abortion are often denied treatment or experience delay and harsh treatment by health professionals, leading to high maternal mortality and morbidity. There have also been documented cases where medical health care providers deny life-saving procedures even in cases of intrauterine fetal death where therapeutic abortion is needed to save the life of the woman.

Abortion is common in the Philippines with about 70 women inducing abortion every hour and about 11 women hospitalized every hour from unsafe abortion complications in 2012. The number of women who have induced abortion in 2018 would be significantly higher since the number of women inducing abortion increases proportionally with the growing Philippine population. About 1,000 women died from unsafe abortion complications in 2012, translating to about 3 women dying every day.  

Unsafe abortion is the 3rd leading cause of maternal death and is a leading cause of hospitalizations. The Philippines needs to step up its efforts to increase access to safe and legal abortion to meet its Sustainable Development Goals commitment to decrease maternal mortality ratio to two-thirds of 2010 levels.  

It is time to make abortion safe and legal in the Philippines.

In August 2006, the Committee on the Elimination of Discrimination Against Women (CEDAW Committee), the United Nations body tasked to monitor Philippine compliance with the CEDAW Convention, recommended for the Philippines to “consider reviewing the laws relating to abortion with a view to removing punitive provisions imposed on women who undergo abortion and provide them with access to quality services for the management of complications arising from unsafe abortions.”  

In May 2015, the CEDAW Committee released its report on its inquiry on reproductive rights and recommended to the Philippine government that articles 256 to 259 of the Revised Penal Code be amended to “legalize abortion in cases of rape, incest, threats to the life and/or health of the mother, or serious malformation of the foetus and decriminalize all other cases where women undergo abortion, as well as adopt necessary procedural rules to guarantee effective access to legal abortion.” 

In the 2016 CEDAW Committee Concluding Observations, the committee recommended for the Philippines to “fully implement, without delay, all the recommendations issued by the Committee in 2015 in the report on its inquiry, including on access to modern contraceptives and legalization of abortion under certain circumstances.”

We must all work to eliminate abortion stigma and religious and personal prejudices against abortion, as abortion is a reality for Filipino women. Health care providers must set in place institutional safeguards and protocols to ensure patient confidentiality, privacy, and protection of women’s human rights. Women who suffer complications from unsafe abortion must be treated humanely and with compassion and should not be threatened with prosecution. Together, let us save women’s lives and prevent disability resulting from denial of access to safe and legal abortion. – Rappler.com 

Lawyer Clara Rita Padilla is the founder and executive director of EnGendeRights. She has worked in the Philippines and in New York, and has been practicing law for over 24 years, working in the fields of gender and has won several Supreme Court en banc cases. She successfully proposed language in various laws, including the Anti-Sexual Harassment Act, Reproductive Health Law, Expanded Anti-Trafficking Law, Quezon City Protection Center for Victims of Gender-based Violence ordinance, and QC Gender-Fair City ordinance. She spearheaded the submission of the request for inquiry to the CEDAW Committee in collaboration with the Philippine Task Force CEDAW Inquiry, Center for Reproductive Rights, and IWRAW-Asia Pacific.

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Home Essay Samples Social Issues Pro Choice (Abortion)

A Pro-Choice Approach on Abortion in the Philippines

• The whole population should rightly be informed and educated regarding the procedures, benefits (if it includes any), and any potential risk,
• All grounds must be legal; standards must be set between legal and illegal forms and methods of abortion,
• There must be uniform procedures throughout the country,
• The women has the right to choose what happens in her own body, meaning that nothing is forced against her will, let anyone who forces a woman to have an abortion be charged and punished by the state,
• Educate the population about contraceptives or birth control methods; let it be known the significance of family unit as building blocks of the society,
• Laws that will protect women regarding the right to terminate pregnancies must be promulgated,
• Any medical specialist must be registered and must have a license in order to perform such procedure.

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Anna bought abortion pills via social media. Now, like thousands of other Filipinas, she is dead

The case of one 20-year-old from Manila reveals the dangerous role of online sellers of illicit methods in a country where terminations are outlawed

S hortly before a courier arrived, Anna*, a scared, pregnant young woman from the Philippines , had received instructions on Facebook from the seller about how to proceed when she received her packet of medication containing cytotec, cortal and tablets to prevent bleeding.

She should fast for the day. She must not eat rice but just snack on crackers and drink cola. Anna paid 1,000 pesos (£15) upfront, with a second 1,000 peso due if the abortion was successful.

Anna feared she would be judged for becoming pregnant, says her younger sister Carla*. There were few people the 20-year old could turn to. Her relationship with her partner, the father of her first child, had broken down, and she had been asked to leave his parents’ home. Her parents were convicted of drug offences and have been in prison since she was 10.

“She didn’t want people to tell her she is dumb,” says Carla. “She said she was afraid [to have an abortion], but she really wanted to do it.”

The Philippines has one of the strictest anti-abortion laws in the world; while the government has acknowledged that the law may allow abortion to protect the life and health of pregnant women, in practice such exceptions are not made. Women have little choice but to resort to whatever underground treatment they can access and afford, regardless of risk.

An estimated 1.1 million abortions occur every year in the country, according to a University of the Philippines study in 2020, which predicted a rise as heath services were disrupted during the Covid pandemic. And the number has been growing, says Jihan Jacob, senior legal adviser for Asia at the Center for Reproductive Rights. “Like in any other country which has restrictive laws, it does not prevent abortion, it just makes them unsafe,” she says.

Women, especially those in urban areas, have increasingly sought treatment online – a trend that Covid accelerated. “You cannot travel to Quiapo [a market known for selling herbal treatments] with a pandemic and with all the lockdowns and restrictions, so everyone has to resort to finding other ways. That’s usually going to online platforms and forums, or even online shopping platforms,” says Jacob.

It was 2am, a few hours after Anna took the pills, when Carla knocked on her Aunt Rose’s bedroom door for help. Anna was feverish and distressed. She had wrapped herself in a comforter but couldn’t stop shivering. Her forehead was hot. They tried to calm her, but she wasn’t making sense.

“She asked Aunty Rose: why do you all look violet in my eyes?” remembers Carla. “She thought she was chilling, but actually she was sweating.”

They spent the next four hours travelling by tricycle and then by car from hospital to hospital in Cavite and then, northwards, in Manila. They were repeatedly turned away; one facility said the relevant ward was only accepting Covid patients, another demanded a large deposit before treatment.

One hospital worker suggested Anna needed psychiatric care. “I kept telling her to be calm, that help would come soon,” says Rose.

The next afternoon, a doctor at a hospital that finally accepted Anna explained she was in a critical condition, experiencing complications from an abortion.

In the hospital, Anna received a message from the Facebook seller, who was due a second payment – the other 50% – and wanted an update. “Anna became angry. She said: should I pay you? I’m also 50:50 here in the hospital,” Carla recalls. The seller blocked her.

She spent one month and 15 days in hospital. While there, she told relatives she didn’t want treatment and would rather die. Her aunt, struggling to raise funds to cover hospital bills, walked to visit her because she could not afford public transport.

Anna stabilised and continued dialysis for months at home, she stopped treatment prematurely. She became progressively ill over the next seven months. She tried to restart treatment but her family could not afford the fees, her aunt said. She died in July 2021.

Her aunt still faces 600,000 pesos (£9,000) in medical bills.

Across the Philippines, many women face the same decisions as Anna, feeling they have no choice but to risk their lives seeking illegal terminations. The latest estimate, from 2008 , suggested that as many as 1,000 women died each year from complications related to unsafe abortions. It is feared that this has increased to more than 2,000 – six women a day – due to the rising number of abortions, and ongoing restrictions that prevent access to safe services.

“These are still preventable deaths and unnecessary suffering among women,” says Jacob.

Activists suspect that online sales in abortion pills have soared during the pandemic. On forums, women share advice and reviews, trying to point others towards reliable providers. Sellers post their phone numbers, alongside promises that they are legitimate and speedy, or send private messages to new group members.

There are harrowing stories of what can go wrong. Women describe medications that simply didn’t work or unbearably painful.

Some women approach traditional healers in their communities, who offer vigorous massages to induce an abortion. It’s a painful and dangerous procedure, says Dr Junice Melgar, co-founder of the Likhaan Centre for Women’s Health: “It happens not just once – you have to do it several times until you bleed.”

Patients are left black and blue with bruises. Others buy herbal medicine. Outside Manila’s Quiapo churchstalls offer bottles labelled Pampa Regla (to induce menstruation) alongside tables packed with rosaries and religious icons – a sign of how abortion remains an open secret in the Catholic country.

Abortion medication is more potent and safe, says Melgar. “When you talk with an obstetrician or gynaecologist, [they say] that actually with the introduction of medication pills that they have noticed less septic abortions,’ she says.

But there is no way to know what is in pills bought online, and even less recourse when things go wrong. There has always been virtually no accountability for those providing dangerous or useless treatments, as the fear of prosecution and stigma deters women from reporting to authorities or confiding in relatives.

In the past some sellers in the community might have helped look after women if they became ill, says April*, a researcher at Likhaan, a friend of Anna’s family. Now, when something goes wrong, nobody knows what women have taken or who sold it.

Some argue that attitudes are changing in the Philippines. While older generations remain conservative in their views, younger people want change, says Graciella Moises, a 20-year-old women’s rights advocate.

Parents are mostly strongly opposed to abortion. They would only help due to the perceived shame attached to children being born outside of marriage, or due to assault, says Moises. “Abortion, from their standpoint, is a remedy to a scandal. But young people are increasingly aware that abortion is a form of healthcare”.

The incoming president of the Philippines, Ferdinand Marcos has backed abortion in cases of incest and rape, describingit as “a woman’s decision, because it is her body.” Advocates treat the comments with caution. They are well aware of the opposition any legal change would face from the Catholic church.

Jacob worries, too, about ramifications now that the US supreme court has overturned Roe v Wade , rolling back decades of access to safe abortions for millions of women across America. “If this is happening in the US, and [anti-choice activists] see that this is possible – that you could overturn an established right – this could just embolden them and encourage them to also do the same in other countries.”

Meanwhile the loss of women like Anna is devastating families across the country. Carla says she was a fun-loving and strong-minded young woman who dreamed of being a lawyer, motivated by her parents’ experience of the criminal justice system.

Her mother was able to watch her funeral via video link from prison. Her father was not permitted to say goodbye to his daughter.

*Names have been changed to protect identities

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The Supreme Court Got It Wrong: Abortion Is Not Settled Law

By Melissa Murray and Kate Shaw

Ms. Murray is a law professor at New York University. Ms. Shaw is a contributing Opinion writer.

In his majority opinion in the case overturning Roe v. Wade, Justice Samuel Alito insisted that the high court was finally settling the vexed abortion debate by returning the “authority to regulate abortion” to the “people and their elected representatives.”

Despite these assurances, less than two years after Dobbs v. Jackson Women’s Health Organization, abortion is back at the Supreme Court. In the next month, the justices will hear arguments in two high-stakes cases that may shape the future of access to medication abortion and to lifesaving care for pregnancy emergencies. These cases make clear that Dobbs did not settle the question of abortion in America — instead, it generated a new slate of questions. One of those questions involves the interaction of existing legal rules with the concept of fetal personhood — the view, held by many in the anti-abortion movement, that a fetus is a person entitled to the same rights and protections as any other person.

The first case , scheduled for argument on Tuesday, F.D.A. v. Alliance for Hippocratic Medicine, is a challenge to the Food and Drug Administration’s protocols for approving and regulating mifepristone, one of the two drugs used for medication abortions. An anti-abortion physicians’ group argues that the F.D.A. acted unlawfully when it relaxed existing restrictions on the use and distribution of mifepristone in 2016 and 2021. In 2016, the agency implemented changes that allowed the use of mifepristone up to 10 weeks of pregnancy, rather than seven; reduced the number of required in-person visits for dispensing the drug from three to one; and allowed the drug to be prescribed by individuals like nurse practitioners. In 2021, it eliminated the in-person visit requirement, clearing the way for the drug to be dispensed by mail. The physicians’ group has urged the court to throw out those regulations and reinstate the previous, more restrictive regulations surrounding the drug — a ruling that could affect access to the drug in every state, regardless of the state’s abortion politics.

The second case, scheduled for argument on April 24, involves the Emergency Medical Treatment and Labor Act (known by doctors and health policymakers as EMTALA ), which requires federally funded hospitals to provide patients, including pregnant patients, with stabilizing care or transfer to a hospital that can provide such care. At issue is the law’s interaction with state laws that severely restrict abortion, like an Idaho law that bans abortion except in cases of rape or incest and circumstances where abortion is “necessary to prevent the death of the pregnant woman.”

Although the Idaho law limits the provision of abortion care to circumstances where death is imminent, the federal government argues that under EMTALA and basic principles of federal supremacy, pregnant patients experiencing emergencies at federally funded hospitals in Idaho are entitled to abortion care, even if they are not in danger of imminent death.

These cases may be framed in the technical jargon of administrative law and federal pre-emption doctrine, but both cases involve incredibly high-stakes issues for the lives and health of pregnant persons — and offer the court an opportunity to shape the landscape of abortion access in the post-Roe era.

These two cases may also give the court a chance to seed new ground for fetal personhood. Woven throughout both cases are arguments that gesture toward the view that a fetus is a person.

If that is the case, the legal rules that would typically hold sway in these cases might not apply. If these questions must account for the rights and entitlements of the fetus, the entire calculus is upended.

In this new scenario, the issue is not simply whether EMTALA’s protections for pregnant patients pre-empt Idaho’s abortion ban, but rather which set of interests — the patient’s or the fetus’s — should be prioritized in the contest between state and federal law. Likewise, the analysis of F.D.A. regulatory protocols is entirely different if one of the arguments is that the drug to be regulated may be used to end a life.

Neither case presents the justices with a clear opportunity to endorse the notion of fetal personhood — but such claims are lurking beneath the surface. The Idaho abortion ban is called the Defense of Life Act, and in its first bill introduced in 2024, the Idaho Legislature proposed replacing the term “fetus” with “preborn child” in existing Idaho law. In its briefs before the court, Idaho continues to beat the drum of fetal personhood, insisting that EMTALA protects the unborn — rather than pregnant women who need abortions during health emergencies.

According to the state, nothing in EMTALA imposes an obligation to provide stabilizing abortion care for pregnant women. Rather, the law “actually requires stabilizing treatment for the unborn children of pregnant women.” In the mifepristone case, advocates referred to fetuses as “unborn children,” while the district judge in Texas who invalidated F.D.A. approval of the drug described it as one that “starves the unborn human until death.”

Fetal personhood language is in ascent throughout the country. In a recent decision , the Alabama Supreme Court allowed a wrongful-death suit for the destruction of frozen embryos intended for in vitro fertilization, or I.V.F. — embryos that the court characterized as “extrauterine children.”

Less discussed but as worrisome is a recent oral argument at the Florida Supreme Court concerning a proposed ballot initiative intended to enshrine a right to reproductive freedom in the state’s Constitution. In considering the proposed initiative, the chief justice of the state Supreme Court repeatedly peppered Nathan Forrester, the senior deputy solicitor general who was representing the state, with questions about whether the state recognized the fetus as a person under the Florida Constitution. The point was plain: If the fetus was a person, then the proposed ballot initiative, and its protections for reproductive rights, would change the fetus’s rights under the law, raising constitutional questions.

As these cases make clear, the drive toward fetal personhood goes beyond simply recasting abortion as homicide. If the fetus is a person, any act that involves reproduction may implicate fetal rights. Fetal personhood thus has strong potential to raise questions about access to abortion, contraception and various forms of assisted reproductive technology, including I.V.F.

In response to the shifting landscape of reproductive rights, President Biden has pledged to “restore Roe v. Wade as the law of the land.” Roe and its successor, Planned Parenthood v. Casey, were far from perfect; they afforded states significant leeway to impose onerous restrictions on abortion, making meaningful access an empty promise for many women and families of limited means. But the two decisions reflected a constitutional vision that, at least in theory, protected the liberty to make certain intimate choices — including choices surrounding if, when and how to become a parent.

Under the logic of Roe and Casey, the enforceability of EMTALA, the F.D.A.’s power to regulate mifepristone and access to I.V.F. weren’t in question. But in the post-Dobbs landscape, all bets are off. We no longer live in a world in which a shared conception of constitutional liberty makes a ban on I.V.F. or certain forms of contraception beyond the pale.

Melissa Murray, a law professor at New York University and a host of the Supreme Court podcast “ Strict Scrutiny ,” is a co-author of “ The Trump Indictments : The Historic Charging Documents With Commentary.”

Kate Shaw is a contributing Opinion writer, a professor of law at the University of Pennsylvania Carey Law School and a host of the Supreme Court podcast “Strict Scrutiny.” She served as a law clerk to Justice John Paul Stevens and Judge Richard Posner.

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What Stephen Breyer gets wrong about the Supreme Court’s ‘civility’

The public’s trust in the Supreme Court has plummeted , as the conservative supermajority decisions have already stripped Americans of rights and threaten more of the same. But in a new essay published Wednesday in The New York Times , former Supreme Court Justice Stephen Breyer suggests a more pressing concern for the high court and the country: Are the justices friends?

For all Breyer’s anecdotes, the core of his essay is still emphasizing the humanity of justices who are more than willing to de-emphasize the humanity of others in their decisions.

Breyer suggests that differences of opinion between the justices, “important as they are,” must “remain professional, not personal.” This was the case while he was a justice, he writes, and “this meant that we could listen to one another, which increased the chances of agreement or compromise.” Such congeniality is a template for a divided nation, Breyer argues — without going into detail about the actual disagreements between the left and the right on matters like race, gun safety and voting rights.

The retired justice’s piece is filled with anecdotes about the various justices he served alongside ribbing each other and finding connection despite their policy differences. It would all be charming — if it weren’t for the obscene amounts of power those nine justices wield, no matter how chummily they do it. Instead, the sentiment of Breyer’s writing manages to combine that of a disgruntled retiree’s sepia-tinged remembrances and an overly earnest Facebook post. For all Breyer’s anecdotes, the core of his essay is still emphasizing the humanity of justices who are more than willing to de-emphasize the humanity of others in their decisions.

In a sense, this is nothing new for the former justice. It hearkens back to his former traveling debate with the late Justice Antonin Scalia, a lion of the conservative originalist movement in the courts. It was their way of demonstrating that strenuous debate over the law doesn’t equate to being enemies who use political calculations in their rulings. “Judges make terrible politicians,” Breyer told a Senate hearing back in 2011 alongside Scalia, arguing that there was little room for making political calculations in their rulings. “We have to make decisions based on reason. That’s it.”

It’s a sentiment that was worthy of a side-eye even at the time, and has only gotten less convincing as the court’s composition has shifted away from the center. Placing civility and agreeability over differing views is a hallmark of the centrist line of thought, using the appearance of goodwill to disguise the depth of division between two positions. Politics is the art of being able to determine the law, and the law is the codified result of a society’s politics. That is never more the case than when decisions of vast importance before the Supreme Court are decided based almost entirely on the political considerations of the justices in the majority.

The gulf between Breyer’s hopes and reality was on display in the momentous 2022 decision to overturn Roe v. Wade’s abortion protections.

The gulf between Breyer’s hopes and reality was on display in the momentous 2022 decision to overturn Roe v. Wade’s abortion protections. In a Times article from this past December on the behind-the-scenes maneuvering ahead of that opinion, Breyer is described as someone who “was sometimes dismissed by other liberals as an overly optimistic institutionalist who underestimated the ambitions of the conservative majority.” It emphasized though his “strong ties with justices on the right” that he hoped could be used to find some kind of consensus on the Dobbs case.

He was deeply mistaken. Unlike the Casey decision in 1992 , there was no consensus that could be forged when the end goal — striking down Roe — was predetermined before the court had heard a single word of the oral arguments. It didn’t matter how many hockey games they’d attended together, or rounds of golf had been played among them. The callous disregard from the majority for the people its decisions affect makes it hard for Chief Justice John Roberts’ complaints about criticisms of the court to find much traction. It’s also why the recent joint appearances of Justices Amy Coney Barrett and Sonia Sotomayor to promote civil debate in the face of polarization, which Breyer’s essay praised, are sure to do little to instill greater trust in the court’s decisions.

The most generous explanation is that Breyer’s intended audience isn’t the average reader of The New York Times, but his former colleagues still serving on the bench. Even if that’s the case, I’m skeptical that reminding them of the good times they’ve shared will do much to affect the actual decisions that are made. If those pleasant memories couldn’t sway his conservative colleagues when Breyer was actually voting on opinions, there’s little reason for them to listen to him now.

Hayes Brown is a writer and editor for MSNBC Daily, where he helps frame the news of the day for readers. He was previously at BuzzFeed News and holds a degree in international relations from Michigan State University.

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The Anti-Abortion Endgame That Erin Hawley Admitted to the Supreme Court

Somewhat lost in the debate around abortion pills and oral arguments that took place at the Supreme Court in FDA v. Alliance for Hippocratic Medicine on Tuesday was one deeply uncomfortable truth: The very notion of what it means to practice emergency medicine is in dispute, with anti-abortion doctors insisting upon a right to refuse treatment for any patient who doesn’t meet their test of moral purity. Indeed, the right asserted is that in the absence of certainty about which patients are morally pure, the doctors want to deny medication to all patients, nationwide.

In public, the plaintiffs in this case—a group of doctors and dentists seeking to ban medication abortion—have long claimed they object to ending “unborn life” by finishing an “incomplete or failed” abortion at the hospital. But in court, they went much further. Their lawyer, Erin Hawley, admitted at oral argument that her clients don’t merely oppose terminating a pregnancy—they are pursuing the right to turn away a patient whose pregnancy has already been terminated . Indeed, they appear to want to deny even emergency care to patients whose fetus is no longer “alive,” on the grounds that the patient used an abortion drug earlier in the process. And they aim to deploy this broad fear of “complicity” against the FDA, to demand a nationwide prohibition on the abortion pill to ensure that they need never again see (and be forced to turn away) patients who’ve previously taken it. This is not a theory of being “complicit” in ending life. It is a theory that doctors can pick and choose their patients based on the “moral distress” they might feel in helping them.

It should come as no surprise that the same judge who tried to ban mifepristone in this case, Matthew Kacsmaryk, has also attempted to legalize anti-LGBTQ+ discrimination in health care nationwide. This is the ballgame: weaponize subjective religious beliefs against secular society to degrade the quality of care for everyone. If you can’t persuade Americans to adopt hardcore evangelical views, exploit the legal system to coerce them into it anyway.

Alliance for Hippocratic Medicine is at once embarrassingly frivolous and existentially important. Don’t let the jokes about how silly the Comstock Act seems , or how speculative the theory of standing is, get in the way of taking a serious look at the claims on offer. The plaintiffs say they are terrified that one day, a patient may walk into their emergency room suffering complications from a medication abortion prescribed by some other doctor. This patient may need their assistance completing the abortion or simply recovering from the complete abortion, which these plaintiffs deem “complicity” in sin. And they say the solution is either a total, nationwide ban on mifepristone, the first drug in the medication abortion sequence, or a draconian (and medically unnecessary) set of restrictions that would place mifepristone out of reach for many patients. (The U.S. Court of Appeals for the 5 th Circuit ruled to reinstate those restrictions at their behest.)

It is a twisted line of logic, one that should never have reached the Supreme Court in the first place. But it is also a product of the court’s past indulgence of outlandish claims about moral “complicity.” As was made plain in the oral arguments and briefing, activist doctors are no longer satisfied with personal conscience exemptions already granted under state and federal law; they now insist that nobody, anywhere, should have access to the abortion pill, in order to ensure that they themselves won’t have to treat patients who took one. At a minimum, they say, they should be able to radically roll back access to the pill in all 50 states to reduce the odds that one of these handful of objectors might someday encounter a patient who took it. This extremist argument lays bare the transformation of the idea of “complicity” from a shield for religious dissenters to a sword for ideologues desperate to seize control over other people’s lives and bodies.

At oral arguments, several justices pressed Hawley, who argued on behalf of Alliance for Hippocratic Medicine, with an obvious retort: Why can’t her clients simply refuse to treat these hypothetical someday patients on the grounds that they cannot help end the “life” of a fetus or embryo? After all, federal law guarantees doctors the right not to have to provide an abortion if doing so is “contrary to his religious beliefs or moral convictions.” Justices Amy Coney Barrett and Brett Kavanaugh secured assurances from Solicitor General Elizabeth Prelogar, early in the arguments, that under no circumstances could the government force any health care provider to ever participate in an abortion in violation of their conscience. Justice Elena Kagan asked Prelogar: “Suppose somebody has bled significantly, needs a transfusion, or, you know, any of a number of other things that might happen.” Would the plaintiffs object to treating them? Prelogar said the record was unclear.

Hawley, who is married to far-right Republican Sen. Josh Hawley, then approached the lectern and cleared up any confusion: Yes, she insisted, treating a patient who has undergone a medication abortion violates the conscience of the plaintiff physicians even if there is no “live” fetus or embryo to terminate anymore. “Completing an elective abortion means removing an embryo fetus, whether or not they’re alive, as well as placental tissue,” Hawley told Kagan. So the plaintiffs don’t object just to taking a “life.” They also object to the mere act of removing leftover tissue, even from the placenta.

Of course, these doctors must remove “dead” fetal tissue and placentas all the time—from patients who experienced a spontaneous miscarriage. By their own admission, the plaintiffs regularly help women complete miscarriages through surgery or medication. Those women they will gladly treat. Other women, though—the ones who induced their own miscarriage via medication—are too sinful to touch. Before the plaintiffs can administer even lifesaving emergency treatment, they need to know the circumstances of this pregnancy loss: Spontaneous miscarriages are OK; medication abortions are not.

Justice Ketanji Brown Jackson, too, zeroed in on this admission. She told Hawley that she had thought the objection was to “participating in a procedure that is ending the life [of the fetus].” Hawley told her no: Any participation in an abortion, even through the indirect treatment of a patient without a “live” fetus, violated the doctors’ conscience. So, wait. What about “handing them a water bottle?” Jackson asked. Hawley dodged the question, declining to say whether helping a patient hydrate would constitute impermissible complicity in sin.

All this is reminiscent of Little Sisters of the Poor , a case about a Catholic charitable group that was afforded an exemption from the Affordable Care Act’s contraception mandate. The Little Sisters were asked to check a box signaling to the government that they could not comply with the mandate, at which point the government would step in to cover their employees. But the Little Sisters refused, viewing this action—the checking of a box to opt out of coverage—as “complicity” in abortion because it would in turn trigger government payment for contraception (which they viewed as abortifacients). The Supreme Court and the Trump administration ultimately indulged the Little Sisters’ claim .

Here, we have emergency room physicians asserting that they will not participate in lifesaving medical intervention unless they approve of the reason for the pregnancy loss. Presumably, if the pregnant patient is an unwed mother, or a gay or transgender person, the doctor would be similarly complicit in sin and decline service. Seen through this lens, since one can never know which sins one is enabling in the ER, each and every day, a narrow conscience exemption becomes a sweeping guarantee that absolutely nobody in the country can ever have access to basic health care, let alone miscarriage management. (Of course, these plaintiffs might focus only on one set of “sins” they see as relevant.) In a country effectively governed by Kacsmaryk and his plaintiff friends, a gay person suffering a stroke could be turned away from any hospital because of his sexual orientation, all to spare a doctor from a glancing encounter with prior sin. As Tobias Barrington Wolff, a professor of law at the University of Pennsylvania Law School, put it to us in an email, this unbounded view of complicity “is part of enacting the social death of people and practices you abhor, which in turn can contribute to the material death of people and practices you abhor.”

One of the most exhausting lessons of post- Roe America is that being “pro-life” definitively means privileging the life of the presumptively sin-free unborn—or even their “dead” remains—over the life of the sin-racked adults who carry them. This is why women are left to go septic or to hemorrhage in hospital parking lots; it is why C-sections are performed in nonviable pregnancies, at high risk to mothers; it’s why the women who sued in Texas to secure exceptions to that state’s abortion ban are condemned by the state as sinners and whores . And it’s why—in the eyes of the Alliance for Hippocratic Medicine — it is a greater hardship for a physician to “waste precious moments scrubbing in, scrubbing out” of emergency surgery, as Hawley put it, so long as they don’t believe that the emergency warrants their professional services, than it is for a pregnant person, anywhere in the country, including in states that permit abortion, to be forced to give birth.

At oral argument, Hawley explained that her clients have “structured [their] medical practice to bring life into the world. When they are called from their labor and delivery floor down to the operating room to treat a woman suffering from abortion drug harm, that is diametrically opposed to why they entered the medical profession. It comes along with emotional harm.” The emotional harm alleged here is that unless these doctors approve of the specific circumstances of the ER visit, they violate not only their own medical preference but also their religious convictions. But they will never truly know enough about the sins of their patients to be able to shield themselves against being a link in a chain of subjective lifelong sin. And to be a doctor, especially an emergency physician, should be to understand that your patients’ private choices and spiritual life are not really open to your pervasive and vigilant medical veto. This deep-rooted suspicion of patients deemed insufficiently pure for lifesaving treatment didn’t begin with the availability of medication abortion. It will assuredly not end there.