I - PANIMULA

Surgical versus medical methods for second-trimester induced abortion by: Cheng L. More than one third of the approximately 205 million pregnancies that occur each year worldwide are unintended and about 20% of them end in induced abortion (2). A vast majority (90%) of these abortions take place during the first trimester of pregnancy. Over the past 30 years, there have been continuing efforts to improve abortion technology in terms of effectiveness, safety (lower complication risk), technical ease of performance and acceptability. The optimal method for second-trimester abortion continues to be debated (4). It is important to determine which is the best method because abortions performed in the second trimester account for a disproportionate amount of abortion-related morbidity and mortality (3). The overall risk of death is 10 times higher with D&E abortion than with first trimester suction curettage (5), and the risk of mortality increases progressively with advancing gestational age (6). Any attempt to reduce mortality and morbidity from this procedure can bring significant benefits to the quality of life for the women undergoing this procedure. Ayon kay Cheng L.(2008), sa mahigit 205 milyong nabubuntis sa buong mundo may mga isat tatlong kalahati ang nahahantong sa aborsyon.May dalawampung porsyento ang sapilitang nagpapalaglag at may siyamnapung porsyento naman ng aborsyon ang nangyayari sa unang trimester ng panganganak, sa kabuuan ang aborsyon ay may malaking kumplikasyon para sa mga kababaihan. Sa paglipas ng tatlong taon ay may malaking pag-aaral sa teknolohiya tungkol sa mga kaligtasan ng kababaihan.Sa ngayon ay may pagdedebate pa tungkol sa mga paraan sa paggawa ng aborsyon para sa ikalawang trimester. Importanteng malaman ang mga nakakabuti sa kababaihan dahil sa ang aborsyon ay isa sa mga dahilan ng paglaki ng bahagdan ng namamatay.magiging kapakipakinabang ito para sa mga kababaihan na maaaring papasailalim sa proseso ng aborsyon Medical methods for first trimester abortion By: Grossman David It is estimated that in 2000 27 million legal and 19 million illegal abortions were performed worldwide(5). Up to 95% of illegal abortions (unsafe abortions) were performed in developing countries and 99% of deaths from these abortions also occurred in those countries (5). Access to safe abortion is limited in many developing countries because of legal restrictions, administrative barriers to

access legal abortion services, financial barriers and lack of adequately trained providers (6, 7. 8), Wherever abortion is legally allowed for at least one indication and misoprostol and mifepristone are available, it should be possible to provide services offering first trimester medical abortion. Both methotrexate and misoprostol are more widely available and less costly than mifepristone, and in settings where the latter is not accessible, they represent safe, effective and acceptable alternatives. While one study found that misoprostol alone was associated with an increased risk of failure compared with mifepristone plus misoprostol (RR 2.86, 95%CI 1.077.61), (15), it should be noted that misoprostol alone was 88% effective and was not associated with more side-effects or complications. Prior to initiating medical abortion services, providers will require training in assessment of gestational age, use of the medications, assessment of completion of abortion, and management of complications. However, these educational barriers should be minimal. In facilities that do not currently offer aspiration abortion, there may be cultural barriers to offering abortion services of any kind, and these will need to be addressed in a comprehensive manner. Ayon kay Grossman David(2005),tinatayang sa taong 2000, may dalawamput pitong milyong legal at labing siyam na milyong ilegal ng aborsyon ang nagaganap sa buong mundo.Maraming bansa ang hindi nagiging legal ang aborsyon dahil sa pinansyal at ang komplikadong proseso nito.Ang ilegal na aborsyon ay hindi ligtas para sa mga kababaihan dahil na rin sa komplikasyon. Ang aborsyon bilang legal ay kailangang may mga serbisyo sa medical para sa unang trimester katulad ng mifepristone at misoprostol. Ang mifepristone ay epektibo at ito ay walang komplikasyon kaya naman ito ay mas mainam kung ikukumpara sa misoprostol, ngunit ito ay may mas mura kung kayat ito ang mas ginagamit ng karamihan. Mahalaga ang pag-aaral sa edad ng embrayo para sa paggamit at ang maaaring komplikasyon nito.Kailangan ring magkaroon ng kumprehensibong paraan kung may pagtutol man sa usaping pagpapalaglag. Reasons Why Women Have Induced Abortions: Evidence from 27 Countries By:Akinrinola Bankole In addition, not all women who decide to seek an abortion will succeed in obtaining one. They may face personal and social barriers such as their husband's objections or community values that oppose abortion. In countries where safe abortion services are scarce, only affluent women who can afford the fees of a private doctor will obtain an abortion, along with poorer women who are so determined they are willing to risk their health and life in seeking out unsafe clandestine services.

Even though the planning status of a pregnancy does not tell us the full reason why women choose abortion, understanding the prevalence of unplanned pregnancy and its proximate causenonuse of contraceptives or contraceptive failureis essential for understanding the context within which women seek abortion. Evidence abounds that a high proportion of women become pregnant unintentionally, in both developed and developing countries. In the United States and in some Eastern European countries for which data are available, about onehalf to three-fifths of all pregnancies are unintended, and a large proportion of these are resolved through abortion. This level of unintended pregnancy for developing countries would be even higher if more accurate abortion information were available, since most abortions represent, by definition, unintended pregnancies. The limited available data show that high proportions of unintended pregnancies are resolved by abortion in Tanzania (61%) and in six Latin American countries (ranging from 43% in Mexico to 63% in Chile). Ayon kay Akinrinola Bankole (1998), hindi lahat ng mga nagpapalaglag ay nagtatagumpay, maaari pa silang humarap sa pagtutol ng kanilang asawa o ng komunidad. Sa mga bansang may ligtas na paraan sa aborsyon, kaunti lamang ang may kakayahang bayaran ang mahal na pag-aaborsyo at ang karamihan ay napipilitan na lamang isakrepisyo ang kanilang buhay sa hindi ligtas na aborsyon dahil sa kawalan ng pera. Mapag-aalaman na natin ang dahilan kung bakit pinipili ng mga kababaihan ang pag-aaborsyo kahit na hindi naman ito inilalahad ng pagpaplano sa pagbubuntis at ang epekto nito.Sa United States at sa ibang Eastern European na bansa naman, kumakalahati an gang bilang ng mga buntis at madami rito ang napunta sa aborsyon. Hindi malayong lumaki ang bilang ng mga nabubuntis sa umuunlad na bansa kung may tamang impormasyon tungkol sa aborsyon.Malaki ang bilang ng mga babaing aksidenteng nabubuntis at nagpapalaglag dahil sa ito na lamang ang naisip nilang paraan.

Philippines abortion crisis

By Carlos H. Conde

Precisely because of the enormous power of Roman Catholicism - more than 80 percent of Filipinos are Catholics - the government does not have a clear policy on abortion. Filipino politicians never mention it in their public pronouncements except to condemn it. Meanwhile, reports of women dying or hospitalized because of induced abortion, or of fetuses found in garbage dumps, are becoming more common.

Some hospitals refuse to treat women for abortion-related illnesses like profuse bleeding because, as one health official put it, "they look at these women as sinners." In a few instances, according to women's groups, doctors have performed postabortion dilation and curettage without anesthesia as a punishment for these women. Official estimates put annual abortions at 400,000 to 500,000, and rising. The World Health Organization estimate puts the figure at nearly 800,000, one of the highest rates of unsafe abortions in Asia.Seventy percent of unwanted pregnancies in the Philippines end in abortion said Jean-Marc Oliv, the country representative of the World Health Organization. One of four pregnancies in the Philippines end in abortion, according to Pro-Life Philippines, an anti-abortion group.

Ayon kay Carlos H. Conde (2005),nang dahil sa kapangyarihan ng Katolisismo Romano,mahigit sa walumpung porsyento ang bilang ng mga katolikong Pilipino.Ukol dito,ang gobyerno ay hindi makagalaw sa pagtataguyod ng mga patakaran para sa aborsyon.Kinalaunan, nagiging normal na ang pagkakamatay ng mga sanggol o babae at pagpapadala nito sa doctor ng dahil lamang sa aborsyon. May ibang mga ospital ang naniniwala na makasalanan ang mga kababaihang nagpapalaglag kaya`t hindi nila ito tinatratong mabuti. Ang bilang naman ng aborsyon ay umabot sa apat na daang libo hanggang limang daang libo. Sabi pa ng World Health Organization,umabot hanggang walong daang libo ang bilang ng mga hindi ligtas sa aborsyon .Pitumpung porsyento naman ang mga na buntis na napunta lang sa aborsyon. The Incidence of Induced Abortion in the Philippines: Current Level and Recent Trends By Fatima Juarez, In countries like the Philippines, where induced abortion is against the law,3* many women nevertheless seek an abortion despite conditions that may put their health at riskrather than give birth to children they cannot care for or do not want. A study using an indirect methodology estimated that in 1994, there were 400,000 induced abortions in the country and 80,000 women hospitalized for complications of induced abortion.4 The Department of Health of the Philippines reported that 12% of all maternal deaths in 1994 were the result of illegal abortion.5 Studies from the 1970s onward have shown that despite the law's severity, abortion appears to be widely practiced.6 Evidence from the mid-1990s indicates that Filipino women of all social classes and backgrounds are having induced abortions.7 They do so under varying circumstances, ranging from safe medical procedures performed for better-off women by trained personnel to procedures in

extremely unsafe conditions for poor women who cannot afford to pay for a surgical abortion The evidence of a survey of health professionals in the mid-1990s suggests that about one-third of women seeking an abortion obtain it from a doctor or nurse, but a high proportion of women consult traditional practitioners or attempt to induce the abortion themselves.8 Ayon kay Fatima Jaurrez (2005), sa mga bansang tulad ng Pilipinas na kung saan ay ipinagbabawal ang aborsyon, marami sa mga kababaihan ang hindi nagpapaaborsyon at isinisilang na lamang ang sanggol na hindi naman nila ginusto. Noong 1994, ay umabot sa apat na daang libo ang nagpalaglag at walumpung libo naman ang bilang ng mga kababaihang naipadala sa ospital, ang Department of Health of the Philippines naman ay inilahad na labindalawang porsyento ang patay nang dahil lang sa aborsyon. Ang pag-aaral noong 1970 ay nagsasabing ang pagpapalaglag ay unti-unting lumalawak at ang dokumento noong 1990 ay nagsasaad na ang mga kababaihang Pilipino ay nagpapaaborsyo na rin.Ngunit ang mga kababaihang walang kakayahang magbayad ay nahuhulog na lamang sa hindi ligtas na paraan ng aborsyon. Sa loob ng pagsasaliksik ay may dokumentong nagsasabing umabot ng isangkatlo ang bilang ng mga kababaihang dumaan sa ligtas na proseso ng aborsyon ngunit mas mataas talaga ang bilang ng mga kababaihang dumaan sa mga hindi ligtas na paraan na pag-aaborsyon. Abortion in the Philippines By:Hanna H. Hindstorm The Committee on the Elimination of Discrimination against Women has called on several countries, including the Philippines and Ireland, to liberalize their abortion laws. The UN Committee against Torture described the blanket ban on abortion, reinstated in Nicaragua in 2006, as tantamount to cruel, inhumane and degrading treatment. Amnesty International described it as "a disgrace". All the major UN development agencies, including UN Women and the World Health Organization (WHO), have refused to condemn restrictive laws, despite implicitly recognizing their harmful impacts on women. WHO has published vast guidance on safe abortion practices and added misoprostol to its essential medicines list in 2005. The mainstream focus remains on pregnancy prevention. There is often a correlation between abortion restrictions and low contraceptive use. In the Philippines, the Catholic Church is currently challenging a proposed bill to expand the availability of birth control.

Ayon kay Hanna Hindstorm (2011),isa sa anim na mga babaeng sumailalim sa illegal na paraan ay maghihirap sa sariling kalusugan, at marami na rin ditto ang

namatay.samantalang kahit sa legal na pamamaraan, hindi parin maitatanggi na may negatibong epekto parin ito. Ang Committee on the Elimination of Discrimination against Women ay tinawagan ang maraming bansa . Kasali na rito ang Pilipinas upang ilahad ang kanilang mga batas laban sa aborsyon. Sa pamahalaan pinagtutuunan ng pansin ang pagpigil ng pagbubuntis ng mga kababaihan.Ang pagbabawal ng aborsyon sa Pilipinas ay may kaugnayan sa mababang bilang ng mga gumagamit ng mga contraceptives.Sa kasalukuyan ang katolikong simbahan ay may malaking pagtutol sa aborsyon kaya naman pinapalaki nila ang usaping ito.