Bitter roots and reproductive rights: Access to abortion services in Canada and the Philippines
Editorial note: This feature was first published on September 28, 2019, and updated in 2024 with the latest abortion-related numbers.
Around the world, sexual and reproductive health services fall short of women's needs. Women and others, including trans people, face ongoing obstacles when exercising their reproductive rights, particularly when it comes to the right to safe abortion and post-abortion care.
As an SRHR program officer working with women's rights organizations and service providers in the Philippines, I'm often struck by women's challenges in accessing basic services and making safe and free decisions about their bodies. And while many Canadians can exercise sexual and reproductive rights, myself included, I'm also reminded that similar challenges exist here and that equal access is far from guaranteed.
A snapshot of the situation in the Philippines
I walk past colourful cellphone covers, flip-flop kiosks, and aromatic fish stands in a bustling Manila market. Eventually, I approach a few small stalls brimming with roots, herbs and bottles filled with dark liquids. A fellow women's rights advocate has brought me here, and she immediately strikes up a conversation with one of the women selling these herbal concoctions.
As they fan themselves to fight off the midday heat, they hold up various roots and leaves, discussing their respective medicinal properties. Some soothe arthritic pain; others help with eczema. The conversation is hushed as my colleague asks if she sells pampa regla, roughly translating from Tagalog to "to get your period." The vendor subtly points to a bottle of amber liquid.
This liquid herbal concoction has bitter roots, including a thorny tuber called makabuhay. It's used when a woman's period is up to two weeks late. For centuries, Filipinas have been using this as a substance that induces an abortion. It pre-dates the Spanish colonial times when abortion was first banned.
There's not enough scientific evidence to show that these plants and herbs work to cause an abortion or are safe to use to end a pregnancy. Using herbs, plants, or other untested chemicals can put people at significant risk for things like poisoning, an allergic reaction, or an incomplete abortion.
"And when the period is more than two weeks late?" asks my colleague.
In these cases, the vendor suggests Cytotec, a misoprostol brand initially developed to treat ulcers. It's commonly used for medical abortions in restrictive settings. Even though the vendor can arrange for the purchase of Cytotec, the cost of misoprostol is out of reach for most Filipinas — 10 pills are needed and cost 2,500 Filipino pesos or roughly C$65. My colleague suggests another option. Ordering pills online from the Chinese black market. However, those are also expensive and out of reach for most women in the country.
Restrictive settings and unsafe abortions in numbers
Despite these critical obstacles, women in the Philippines want control over their bodies and the power to decide things most of us take for granted in Canada — whether to have children, how many children to have, and when. However, without legal or safe options, many Filipinas resort to folk remedies, expensive black-market pills and unsafe procedures, especially if they're poor or marginalized.
Of the 73 million induced abortions taking place every year worldwide across restrictive and less restrictive settings, 45 per cent are unsafe. Restrictions don't stop people from having abortions. They stop people from accessing safe abortions — and the more prohibitive the laws, the higher the rates of complications and death.
The impact of this is undeniable. Globally, over 13 per cent of all maternal deaths are caused by unsafe abortions.
Challenges to abortion access are all the more pronounced in countries like the Philippines, where abortion is completely criminalized. There are no exceptions allowing abortion, not in cases to protect the life or health of the pregnant person, or in cases of rape or incest, or simply not wanting to be pregnant.
Women, especially if they're from lower-income groups, are pushed to the margins of society where no legal or regulated options exist and often must resort to unsafe means. While those with the financial means can access Cytotec or travel to access safer options elsewhere, most are forced to undergo unsafe procedures that include many risks.
Women can face unsanitary conditions, lack of anesthesia, and absence of post-abortion care. They undergo these problematic experiences to avoid more barbaric methods that many women without access to information about safer medical abortion options are forced to resort to. Some of these include abdominal manipulation or massage, physical self-harm, or the insertion of sharp objects to terminate pregnancies. The consequences of these brutal methods result in death from hemorrhage, sepsis, genital trauma or bowel necrosis. Many survivors suffer long-term complications like infertility and incontinence.
Despite the Philippine's restrictive laws against abortion, more than a million unsafe abortions take place annually, a number that increased by almost 15 per cent in 2020. A thousand women die each year from post-abortion complications.
In 2016, the Philippines' Department of Health issued an order to prevent and manage abortion complications and some post-abortion services are allowed in the country. However, even those few who seek post-abortion care when experiencing complications face human rights violations and inhumane treatment, including denying women anesthesia, in turn deterring others from seeking the urgent medical care they may need.
The situation in Canada
While abortion is decriminalized in Canada, various barriers remain — from financial costs and travel distance to health facilities to varying provincial laws. Each barrier results in making abortion inaccessible to many women.
Ironically, Canada was one of the last industrialized countries to make medical abortion or Mifegymiso, known as the "abortion pill," available. This safe alternative to surgical abortion has been legal in countries like France and China for more than 35 years but was only introduced in Canada in 2017. Since then, it has remained out of reach for many Canadians outside urban centres. And while primary care physicians nationwide can prescribe Mifegymiso, most are reluctant to do so.
And so, despite decriminalization and a wide range of options on paper, in practice, abortion remains out of reach to many Canadians — particularly for those who are low-income, live in rural areas, or are Indigenous.
However, where there are violations or barriers to reproductive rights, there are also champions and advocates fighting for a woman's right to her bodily autonomy and access to safe abortion.
I think of my friends on Prince Edward Island, who fundraised and organized hotels and rides to New Brunswick or Nova Scotia for abortion services because their province didn't have adequate facilities. Or of my neighbours in Ontario becoming abortion doulas to support those facing stigma and bureaucratic obstacles. Or of my northern colleagues raising awareness and providing services for women travelling hundreds of kilometres to access abortion services.
Agency, resilience and reproductive rights
Working in women's health and sexual and reproductive rights has taught me innumerable lessons. Lessons about the mutable but slow-to-change laws and institutions that govern women's bodies, about religious groups that claim a moral authority to make decisions on others' behalf, and about conservative movements that are rolling back hard-earned gains made by reproductive rights advocates.
While we all exercise agency, I'm repeatedly reminded that many are still limited in their self-determination and ability to make decisions freely and safely.
But mostly, I've learned lessons about women's infinite resilience and enduring strength to fight for services and rights, including their right to bodily autonomy. For millennia, women have tracked their periods and ovulation, brewed herbal remedies to induce miscarriages, and shared information with fellow women to access the services they need. Modern medicine now affords us more reliable contraceptive methods and safer abortion options.
However, we're far from having equitable and far-reaching access.
Almost 30 years ago, September 28 was first marked by feminist movements in Latin America to campaign for the decriminalization of abortion, a cause that activists worldwide have since taken on. Today, this fight continues, and advocates continue to step up for women where governments have failed as duty bearers.
In Canada, we must close the gaps in access. Around the world, we must continue to support feminist and women's movements fighting for sexual and reproductive health and rights because having equitable access to safe abortion services is, first and foremost, a human right.
Alex Wilson is a women's rights advocate and the Sexual and Reproductive Health and Rights (SRHR) program manager at Oxfam Canada. When she wrote this piece in 2019, she was an SRHR program officer.
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