SShortly before a courier arrived, Anna*, a frightened pregnant young woman from the Philippines, had received instructions on Facebook from the vendor on what to do when she received her packet of medicine containing cytotec, cortal and tablets to prevent bleeding.
She should fast for the day. She shouldn’t eat rice but just snack on crackers and drink cola. Anna paid 1,000 pesos (£15) up front, with a second 1,000 pesos due if the abortion was successful.
Anna feared being 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 was asked to leave her parents’ house. Her parents were convicted of drug offenses and have been in prison since she was 10.
“She didn’t want to be told she was stupid,” Carla said. “She said she was scared [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 recognized that the law may authorize 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 the risk.
An estimated 1.1 million abortions each year in the country, according to a 2020 University of the Philippines study, which predicted an increase as health services were disrupted during the Covid pandemic. And the number has kept growing, says Jihan Jacob, senior legal adviser for Asia at the Center for Reproductive Rights. “Like any other country that has restrictive laws, it doesn’t prevent abortions, it just makes them unsafe,” she says.
Women, especially those in urban areas, have increasingly sought treatment online – a trend that Covid has accelerated. “You can’t get 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. This usually goes to online platforms and forums, or even online shopping platforms,” says Jacob.
It was 2 a.m., hours after Anna took the pills, when Carla knocked on her Aunt Rose’s bedroom door for help. Anna was feverish and anxious. She had wrapped herself in a quilt but couldn’t help shivering. His forehead was hot. They tried to calm her down, but she made no sense.
“She asked Aunt Rose: why do you all look purple in my eyes? Carla remembers. “She thought she was cold, but in fact she was sweating.”
They spent the next four hours traveling by tricycle and then by car from hospital to hospital in Cavite and then north to Manila. They have been repeatedly turned away; one facility said the relevant ward only accepted Covid patients, another required a large deposit before treatment.
A hospital employee suggested that Anna needed psychiatric care. “I kept telling him to be calm, that help would come soon,” Rose said.
The next afternoon, a doctor at a hospital who eventually accepted Anna explained that she was in critical condition, suffering from complications from an abortion.
At the hospital, Anna received a message from the Facebook seller, who owed a second payment – the remaining 50% – and wanted an update. “Anna got angry. She said do I have to pay you? I’m also 50/50 here in the hospital,” Carla recalled. The seller blocked it.
She spent a month and 15 days in the hospital. There, she told her relatives that she did not want treatment and that she would rather die. Her aunt, struggling to raise funds to cover hospital bills, walked to visit her as she could not afford public transport.
Anna stabilized and continued dialysis for months at home, she stopped treatment prematurely. She gradually fell ill over the next seven months. She tried to resume treatment but her family could not afford the costs, her aunt said. She died in July 2021.
His 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 for illegal dismissals. The latest estimate, from 2008, suggested that up to 1,000 women died each year from complications related to unsafe abortions. It is feared that this number has risen to more than 2,000 – six women a day – due to the growing number of abortions and ongoing restrictions preventing access to safe services.
“It’s still preventable deaths and unnecessary suffering for women,” says Jacob.
Activists suspect online sales of abortion pills have skyrocketed during the pandemic. On the forums, women share advice and reviews, trying to direct others to reliable suppliers. Sellers post their phone numbers, along with promises that they are legit and fast, 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 are unbearably painful.
Some women turn to traditional healers in their communities, who offer vigorous massage to induce abortion. It’s a painful and dangerous procedure, says Dr. Junice Melgar, co-founder of the Likhaan Center for Women’s Health: “It doesn’t just happen once – you have to do it multiple times until you bleed. “.
Patients are left black and blue with bruises. Others buy medicinal plants. Outside the stalls of Manila’s Quiapo Church, bottles are labeled Pampa Regla (to induce menstruation) alongside tables filled with rosaries and religious icons – a sign of how abortion remains an open secret in the Catholic country.
Abortion drugs are more potent and safer, Melgar says. “When you speak with an obstetrician or a gynecologist, [they say] that in fact, with the introduction of the medicated pills, they noticed fewer septic abortions,” she says.
But there’s no way to know what’s in pills bought online, let alone recourse when things go wrong. There has always been virtually no accountability for those who provide unsafe or unnecessary treatment, as fear of prosecution and stigma deters women from reporting to authorities or confiding in loved ones.
In the past, some vendors in the community may have helped treat women if they got sick, says Likhaan researcher April*, a friend of Anna’s family. Now, when something goes wrong, no one knows what the women took or who sold it.
Some say attitudes are changing in the Philippines. While older generations remain conservative in their views, younger ones want change, says Graciella Moises, a 20-year-old women’s rights advocate.
Parents are mostly strongly opposed to abortion. They would only help because of the perceived shame attached to children born out of wedlock or because of abuse, Moises says. “Abortion, from their point of view, is a cure for a scandal. But young people are increasingly aware that abortion is a form of health care”.
The Philippines’ new president, Ferdinand Marcos, has backed abortion in cases of incest and rape, describing it as “a woman’s decision, because it’s her body.” Supporters treat the comments with caution. They are well aware of the opposition that any legal change would face from the Catholic Church.
Jacob also worries about the ramifications now that the United States Supreme Court has overturned Roe v Wade, undoing decades of access to safe abortions for millions of women across America. “If it happens in the United States, and [anti-choice activists] see that it is possible – that you could overturn established law – it might just embolden them and encourage them to do the same in other countries.
Meanwhile, the loss of women like Anna devastates families across the country. Carla says she was a fun, strong-minded young woman who dreamed of being a lawyer, driven by her parents’ experience with the criminal justice system.
His mother was able to attend his funeral via video link from prison. Her father was not allowed to say goodbye to his daughter.
*Names have been changed to protect identities
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