Friday, March 7, 2014

To Secretary Ona of DOH: Are miscarriages abortions?

Dangerous Pregnancies: Mothers, Disabilities, and Abortion in Modern America
Dangerous Pregnancies: Mothers, Disabilities, and Abortion in Modern America
A. DOH Releases Abortion Statistics

DOH published another set of statistics regarding abortion in the country:
DOH data showed that based on OB-GYNE admissions of abortion cases in 2013, Vicente Sotto Memorial Medical Center ranked number one with 1,915 abortion cases, up from 1,552 cases in 2012; followed by East Avenue Medical Center, 1,819 cases (1,511 in 2012); Quirino Memorial Medical Center, 1,272 (1,247); Jose Fabella Memorial Hospital, 1,240 (1,274 in 2012); Paulino J. Garcia Memorial Medical Center, 869 (891 in 2012); Baguio General Hospital and Medical Center, 635 (825); Jose Reyes Memorial Medical Center, 624 (761 in 2012); Tondo Medical Center, 508 (586 in 2012); Cagayan Valley Medical Center, 438 (383 in 2012). (Manila Times)
But the DOH interpreted this statistics as showing the need for contraceptives for family planning:
“Let’s stop abortion. Pregnancy can be a welcome phase for any woman and her partner, if it comes as planned and without any complications".... Ona underscored that women and their partners should have the knowledge of sex education along various strategies such as abstinence and use of contraceptives such as condom to avoid unplanned pregnancies.
In advertising, this technique is called reframing: to put a set of facts under a different perspective in order to push one's agenda.  For this case, the agenda of DOH is to compel the Supreme Court to vote in favor of the RH Law--not because of its constitutionality, but because the law would help prevent unwanted pregnancies.  So if there are no pregnancies there is nothing to abort, and the abortion rate goes down.  Or so it seemed.

Miscarriage, Medicine & Miracles: Everything You Need to Know about Miscarriage
Miscarriage, Medicine & Miracles: Everything You Need to Know about Miscarriage
B. Redefining Abortion and Miscarriage

DOH appears to be redefining the term abortion here in the same way as the RH Law redefined the phrase reproductive health to include more than reproduction:
(p) Reproductive Health (RH) refers to the state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and processes. This implies that people are able to have a responsible, safe, consensual and satisfying sex life, that they have the capability to reproduce and the freedom to decide if, when, and how often to do so. This further implies that women and men attain equal relationships in matters related to sexual relations and reproduction. (RH Law, Section 4, Definition of Terms)
How did DOH try to redefine abortion? DOH tried to redefine abortion by lumping miscarriages as abortions in the same way as Guttmacher Institute classified miscarriages as "spontaneous abortions":
Ona, however, clarified that the data contain both induced and spontaneous abortions or miscarriages.
“These are only gross figures but for me it also gives you a picture of the high number of abortions in the country, whether induced or spontaneous. We can assume from these numbers that there are very high number of unplanned pregnancies that end up with induced abortion and this is what we want to avoid,” he said. Induced abortions are done using instruments or by drinking medicine. Ona said about 12 to 15 percent “or maybe a little bit higher” pregnancies end in miscarriage. (Philippine Star)
This is a sleight of hand for the unwary.

Miscarriages have the original connotation of unintentional, while abortion have the connotation of intentional.  These are two different words: intention separates them.  One doesn't need to define a new phrase "spontaneous abortion" when there is a handy and shorter word for it: miscarriage.  And one does not need to define induced abortion, because abortion already assumes the word "induced".  Well, this may just be a matter of philosophy, but words define a worldview, and if we are not careful with our words, we shall order our actions and that of the whole society based on the worldview defined by the words we choose.  As Laozi said:
Watch your thoughts; they become words. Watch your words; they become actions. Watch your actions; they become habit. Watch your habits; they become character. Watch your character; it becomes your destiny.
Misoprostol in Midtrimester Termination of Pregnancy: Oral and Vaginal Misoprostol in Midtrimester Termination of Pregnancy
Misoprostol in Midtrimester Termination of Pregnancy: Oral and Vaginal Misoprostol in Midtrimester Termination of Pregnancy
C. Critique of DOH's Statistical Analysis

Let us look at the 12 to 15 percent of pregnancies ending up as miscarriages.  These are spontaneous abortions according to DOH terminology. But DOH provided no statistic about induced abortions.  So if we make our distinction between miscarriage and abortion, then DOH showed only statistics on miscarriages and zero on abortion.  So what DOH further said has no statistical basis, unless you agree to classify miscarriages as abortion:
The data shows us that abortion is happening in our midst more likely because there are women who lack the proper information on how to deal with high-risk or complicated pregnancies.
Here are several questions that may serve as guide for DOH in designing a methodology in order to interpret the abortion statistics more precisely.  These questions should be answered by each patient together with the attending physician:
  1.  Did the woman take medicines that are abortifacients?  
  2. Did the woman perform certain actions that cause the fetus to be expelled prematurely?  
  3. Did the woman plan to have her baby or not?
  4. Was the woman and her partner using contraceptives like pills and condoms? 
  5. How frequently were these used?
  6. Was the woman's pregnancy a high risk or complicated?
  7. Did the woman know that her pregnancy is high-risk or complicated?
There is already a wealth of information that can be obtained from the statistical analysis of the replies to these seven questions. The first two questions would determine whether the fetal death was due to miscarriage or abortion.  The third question would determine whether the child was unwanted or not.  The fourth and fifth questions would determine the contraceptive used and their usage frequency; the study would then be able to determine precisely the contraceptive failure rate.  The sixth question would determine the chance of survival of the fetus.  And the seventh question would determine the knowledge of the women that regarding their pregnancy complications.  The answers to these questions would determine whether Sec. Ona's conclusion is valid or not.

Emergency Contraception: The Story of a Global Reproductive Health Technology
Emergency Contraception: The Story of a Global Reproductive Health Technology
D. If DOH is really against abortion

It should be the DOH's job to determine precisely the causes of fetal deaths and propose ways to eliminate these deaths one by one by addressing each of the possible causes.  If Mifepristone and Cynotec are recommended by Women on Waves and World Health Organization for the first trimestral abortion, then it is the duty of DOH to ban these abortifacients in pharmaceuticals.  In turn, it is the doctor's duty to admonish his patients that use these abortifacients in the hope that they can complete their abortion in the doctor's clinic.  Actually this is one possible mechanism for making abortion available to the Philippines through the RH Law, despite abortion's unconstitutionality:
(j) While this Act recognizes that abortion is illegal and punishable by law, the government shall ensure that all women needing care for post-abortive complications and all other complications arising from pregnancy, labor and delivery and related issues shall be treated and counseled in a humane, nonjudgmental and compassionate manner in accordance with law and medical ethics; (RH Law, Section 3)
Thus, if DOH is really against abortion, then DOH must ban abortifacients (deceptively labeled as emergency contraception), prevent Women on Waves from entering the Philippine waters, admonish World Health Organization for recommending abortion as a treatment of pregnancy which is never a disease, and fight against the implementation of the RH Law.