The World Health Organization with UNDP, UNFPA &
World Bank Special Programme of Research & Development (HRP)
EXPERT OPINION on
ABORTIVE SUBSTANCES & DEVICES
In the Philippines
*Excerpts from the Expert Opinion Report
Medical methods of abortion use pharmacological drugs to terminate pregnancy, including mifepristone, a synthetic steroid compound, and misoprostol, a prostaglandin. Surgical methods of abortion use transcervical procedures for terminating pregnancy, including vacuum aspiration (with electric or manual vacuum source), dilatation and curettage, and dilatation and evacuation (WHO 2003). Many other drugs and devices, if used inappropriately, can cause harm to a fetus and/or cause an unsafe abortion. Contraceptives are not abortifacients.
Combined Hormonal Methods Although it is known that there are changes in the endometrium during combined oral contraceptive (COC) use, no evidence to date has supported the hypothesis that these changes lead to disruption of implantation. Given the high efficacy of COCs in preventing ovulation, it is very unlikely that “interference with implantation” is a “primary mechanism” of contraceptive action.
It is universally recognized that contraception is the most effective intervention to prevent unintended pregnancy, abortion, child and maternal mortality and morbidity. For example, in 2000, 90% of global abortion-related and 20% of obstetric-related mortality and morbidity could have been averted by use of effective contraception by women wishing to postpone or limit childbearing. A total of 150,000 maternal deaths (representing 32% of all such deaths) and about one million of the 11 million deaths of children under age five could be avoided by effective use of contraception (Cleland et al. 2006).
The evidence indicates that when restrictions on access to contraception are enforced and other pronatalist policies are put in place, unsafe abortion-related maternal morbidity and deaths increase (WHO 2004a).
The global mandate for sexual and reproductive health derives from international consensus agreements such as the Programme of Action of the International Conference on Population and Development (ICPD, 1994) and the Platform for Action of the Fourth World Conference on Women (Beijing 1995). Both consensus documents were signed by the Government of the Philippines. The most recent mandate is given by World Health Assembly Resolution 57.12 which was adopted by WHO Member States, including the Government of the Philippines, in May 2004. This Resolution endorses the strategy entitled, Reproductive health: a strategy to accelerate progress towards the attainment of international development goals and targets