BIRTH CONTROL IN THE PHILIPPINES: CONTRACEPTIVES, CATHOLICS, REPRODUCTIVE HEALTH LAW

BIRTH CONTROL IN THE PHILIPPINES

from UNFPA Philippines

In the Philippines, access to birth control has largely been limited to those who could afford to pay for it. A “reproductive health bill” passed in 2012 has sought to change that by promoting public education about contraceptives and providing government subsidies to make them widely available. The Catholic Church and groups that share the church’s view on contraception stalled the legislation for 14 years. [Source: Kenneth R. Weiss, Los Angeles Times, July 22, 2012; Tom Hundley, Washington Post, June 17, 2013 /^]

According to a 2008 government survey, 39 percent of married Filipino women of childbearing age said they wanted to avoid or delay pregnancy but were not using modern contraceptives. The most frequently cited reason was fear of side effects. Other reasons included opposition from husbands, cost, and lack of access. The survey also found that about half of all pregnancies in the country were unintended. Athough roughly 82 percent of the population of the Philippines identifies as Catholic, opinion polls have consistently showed that slightly more than 70 percent support the reproductive health law. Surveys in the early 2010s indicated that 54 percent of pregnancies each year were unintended or unwanted. Most of these pregnancies occurred among poor women who had limited or no access to modern contraceptives. /^\

In the early 2000s, the only contraceptive method officially accepted by the Catholic Church was Natural Family Planning, particularly the rhythm or cervical mucus method. This approach had a relatively low effectiveness rate due to menstrual irregularities, limited understanding of reproductive physiology among less-educated women, and cultural reluctance to monitor cervical mucus. Before the government launched formal family planning programs in the late 1960s, middle-class couples had already accessed contraceptive information through private doctors, pharmacists, pamphlets, and magazines. [Source: Jose Florante J. Leyson, M.D., Encyclopedia of Sexuality 2001 ~]

By the early 2000s, contraceptives such as pills, condoms, diaphragms, IUDs, and spermicides were widely available in major cities and could be purchased in pharmacies without prescriptions. Women who could afford private care were able to obtain medical assistance for IUD insertions or diaphragm fittings. However, access remained limited in remote rural areas, where birthrates and infant mortality rates stayed higher than in urban centers. The government attempted to integrate family planning into maternal and child health services, while organizations such as Catholic Relief Services helped care for abandoned children and promoted contraceptive education in urban slums.

Contraceptives in the Philippines

clinic in the Philippines that offers family planning services University of Philippines Dilman

Contraceptive prevalence rate: 40 to 42 percent (2022), slightly more than the past. Although about 55–58 percent of women in the Philippines use some form of contraception—including traditional methods— but around 41 percent of married women still do not use any contraceptive method. Oral contraceptive pills are the most widely used method at around 13 percent, followed by injectables at roughly 3 percent. Female sterilization accounts for about 20 percent of contraceptive use, while male sterilization remains rare at less than 1 percent. Approximately 17 percent of women rely on traditional approaches such as withdrawal rather than modern contraceptives. An estimated 16.6 percent of women have an unmet need for family planning, meaning they wish to delay or avoid pregnancy but are not using modern contraception. [Source: Family Planning 2030 ^]

Despite contraceptive use remaining lower than in some ASEAN neighbors—such as Thailand, where usage is about 78 percent—the Philippines has experienced a decline in its birth rate. The total fertility rate has fallen below 2.0, reflecting shifting family values and reproductive preferences. Access to contraception is supported by the government through PhilHealth, which covers long-acting reversible contraceptives (LARCs) and permanent methods. However, many women continue to rely on short-acting methods like pills, which are often purchased out of pocket. ^

In a 2001 Time magazine sex survey 68 percent of males and 32 percent of females said they used a condom and 40 percent of males and 53 percent of females said they had never used a contraceptive. At that time even though the Philippines had one of the highest population growth rates in Southeast Asia the use of artificial contraception was the lowest in region. The use of condoms has been a sensitive issue. In many cases the people who would benefit the most from birth control are the ones least likely to use it. One mother of nine who lives in a slum in Manila told the International Herald Tribune, Children “eat more as they age. Even with my new job...we barely have enough money. I am scared to use contraceptives and do not know what to do if I get pregnant again.”

In the 2000s, there appeared to be widespread public support in the Philippines for modern contraceptives. Public opinion surveys consistently found that about 90 percent of respondents supported government funding for contraceptives for people who could not afford them. Government surveys also showed that poor families experienced significantly more unintended pregnancies than wealthier families and had greater difficulty accessing affordable contraceptive supplies. [Source: Blaine Harden, Washington Post. April 21, 2008 =]

History of Birth Control in the Philippine

lecture on birth control in the Philippines, from University of Philippines Dilman

Traditionally agrarian families in the Philippines wanted lots of children in order to provide “cheap” labor, with boys being preferred Despite the deep-rooted influence of Catholicism in favor of large families and its ban on all artificial contraception, family planning has become increasingly popular since World War II. Most of the larger families reside in rural villages and to a lesser extent urbam barrios, especially among poor families. [Source: Jose Florante J. Leyson, M.D., Encyclopedia of Sexuality 2001 ~]

Popcom was the government agency with primary responsibility for controlling population growth. In 1985 Popcom set a target for reducing the growth rate to 1 percent by 2000. To reach that goal in the 1990s, Popcom recommended that families have a maximum of two children, that they space the birth of children at three-year intervals, and that women delay marriage to age twenty-three and men to age twenty-five. [Source: Library of Congress *]

During the Marcos regime (1965-86), there was a rather uneasy accommodation between the Catholic hierarchy and the government population control program. Bishops served on Popcom, and the rhythm method was included by clinics as a birth-control method about which they could give information. A few Catholic priests, notably Frank Lynch, even called for energetic support of population limitation. The fall of Marcos coincided with a general rise of skepticism about the relation between population growth and economic development. It became common to state that exploitation, rather than population pressure, was the cause of poverty. The bishops withdrew from the Popcom board, opposed an effort to reduce the number of children counted as dependents for tax purposes, secured the removal of the population-planning clause from the draft of the Constitution, and attempted to end government population programs. Attacks on the government population program were defeated, and efforts to popularize family planning, along with the provision of contraceptive materials, continued. In the early 1990s, however, the program generally lacked the firm government support needed to make it effective. *

Studies in the late 1990s showed rising social challenges linked to reproductive health. The Philippines had nearly 1.5 million street youth, and about 74 percent of unintended pregnancies occurred among women aged 15 to 24. Roughly 18 percent of Filipino youth engaged in premarital sex. In response, the Family Planning International Assistance office in Bangkok and the Reach Out Reproductive Health Foundation launched the Barkadahan project in 1999 to reduce sexually transmitted diseases and unintended pregnancies among street youth through sexuality education, HIV and STD treatment, and expanded access to family planning services.

Catholic Church in the Philippines and Birth Control

The Catholic church in the view of many is the biggest obstacle to reducing population growth. Contraceptive use is banned by the Catholic Church and promulgated by Catholic clergy at all levels. Following Vatican guidelines, Philippine bishops oppose any "artificial" measures to prevent pregnancy, sanctioning only natural means such as periodic abstention from sex. One priest told the International Herald Tribune that when poor mothers, burdened by large families come to him, he tells them, “Adopt the self control method and look to the life of Christ for inspiration.” In addition to its objections on theological grounds, the church contends that easy access to contraceptives would only lead to promiscuity among the young.

Cardinal Jaime Sin (1928-2005) in 1988

In 2005, Catholic bishops in the southern Philippines announced that they would deny Communion to government health workers who distributed birth control devices. Over the past two weeks, the Catholic Bishops’ Conference of the Philippines has declined to comment on its family planning policies. The church leadership made its last major statement on birth control last fall. Archbishop Paciano Aniceto, chairman of a bishops’ commission on family life, said, “Chemical agents and mechanical gadgets that make up the cluttered display of contraceptive methods have caused serious damage in family relationships, disrupting the unity and openness that build family life. The effects of the contraceptive culture include extramarital relationships, adolescent pregnancies, and even the hideous, murderous act of abortion.” [Source: Blaine Harden, Washington Post. April 21, 2008]

The Philippines influential Cardinal Jaime Sin was staunch opponent of the Philippines family planning program. He called women "heroes" for providing for their families and accused the U.S. government of "implementing programs' that are actually Satan's" by pushing birth control in Third World countries, a view shared by a Filipino senator who said the U.S. government forged a coalition "bigger than the one assembled for Desert Storm" to promote abortion and "spearhead...global decadence, destruction and death."

In 1994, he appeared with former Philippines president Corazon Aquino, who also strongly opposed contraceptive use, at a protest at the U.N. population conference in Cairo, where the two Filipinos criticized birth control as "intrinsically evil" and burned a replica of the conference's draft program of action. One of Cardinal Sin’s chief critics, Health secretary Juan Flavier, once answered back to accusations by Sin that he promoted abortion with the quip, "It's a sin to tell a lie."

Cardinal Sin, who was one of the last of 15 children, liked to joke that had his parents practiced birth control he never would have been born. On one occasion, the cardinal told a news conference that birth control pills cause premature aging. "I know of...a 26-year-old who looks 60 because she takes pills. So if you want to keep your clear complexion, do not take contraceptives." An editorial in a Manila newspaper responded to this remark by saying, "as the cardinal says, pop babies, not pills, if you want to keep the bridely glow on your cheeks.

Catholic Church Stance on Birth Control Contrast with What Filipino Women Want

Many Catholic women use contraceptives despite the opposition of the church, one woman in a Manila slum told the International Herald Tribune, “Cardinal Sin does not know how difficult it is to use the calendar method when your husband comes home drunk. He also doesn’t know what its like to bring up seven children.”

Kenneth R. Weiss wrote in the Los Angeles Times: “The church's stance puts it at odds with many of its followers in the Philippines. Eight out of 10 Filipinos are Catholic. Even for weekday Mass, popular churches draw huge crowds that tie up Manila traffic. Polls show, however, that 70 percent of the population supports the reproductive health bill, which also calls for sex education in schools. Birth control is a source of political dispute in many societies, including the United States. In the Philippines, however, the battle has been particularly acrimonious because of the church's wide reach and influence. [Source: Kenneth R. Weiss, Los Angeles Times, July 22, 2012]

“A few years ago, one of Yolanda Naz’s neighbors asked her to join a lawsuit by women's rights groups seeking to overturn Manila's ban on contraceptives at public clinics. She became a plaintiff, along with 19 other poor residents of the capital. These women and a few of their husbands are asking the court to grant them access to birth control pills, condoms and IUDs, a rare challenge to church authority. The case has been thrown out twice, once by the Philippine Supreme Court because it lacked a signature from one of the 20 plaintiffs. It was refiled in a lower court, where it has been essentially frozen for three years. |::|

“Naz said she'll always be a Catholic. That doesn't mean she agrees with the priests on everything. "When I go to Mass, I hear the priest give sermons saying that pills are bad," Naz said. "But whenever I hear that, I just say to myself that for me, it's not evil, it's not bad or it's not sinful. "What is more sinful is to have more children than I can afford to feed." |::|

Politics and Opposition to Birth Control in the Philippines

Philippine politicians can be just as stubborn in their objections to birth control. Several Philippine governors have halted the distribution of contraceptives through official channels. After stopping the distribution of contraceptives at public clinics days after taking office, Jose Atienza, mayor of Manila said, “I would be a completely irresponsible leader if I permitted the moral collapse that comes with freely distributed artificial contraception. Our large population may keep us poor twice as long, but we will develop with decency and our cherished values intact.”

Atienza told the Los Angeles Times he sees economic potential in a growing population."Our people are so talented and so skilled and brilliant and bright," he said, citing Manila's entrepreneurial street vendors and the 10 million Filipinos working overseas who boost the economy by sending money home. "When you have more people, you have a bigger labor force. You have a bigger social security base. You have more productivity. You have more consumption. More production. The whole cycle of the economy moves faster." Atienza said he also opposes birth control because he believes it "weakens the family" and is in conflict with the Filipino Constitution's protection of the unborn. [Source: Kenneth R. Weiss, Los Angeles Times, July 22, 2012]

Even politician who privately support family planning are afraid to oppose it. One governor told the International Herald Tribune, “I could not possible say in public that the same bishops, priest and nuns who helped me win three elections were wrong. But when I visited poor families, I often whispered that they should be using contraceptives.”

A devout Catholic, Cory Aquino, the President of the Philippines from 1986 to 1992, followed the church by discouraging birth control and dismantling her country's family planning program. Fidel Ramos, the President of the Philippines from 1992 to 1998, told the Los Angeles Times: "We have a population policy that is based on, first, family planning. We respect the family as the basic social unit. That's a part in our constitution. But we do not force anything on anyone. We do it by persuasion. In this way, we're able to maintain our good relations with the church...We are seeing, by voluntary decisions by married couple, smaller and smaller families.” Joseph Estrada, the President of the Philippines from 1998 to 2001, initially said he opposed birth control, partly on the basis that he was the eighth out of ten children. But as president he softened his position and said something had to be done to slow population growth.

Philippine Government, NGOs and Birth Control

Up until the 2010s, the Philippines government had never paid for artificial contraceptives. All the condoms, birth control pills and injectable contraeptibes distribed through official channels have been done so with financing from foreign countries, principally the United States and NGOs. Former Spice Girl Geri Halliwell traveled to the Philippines to promote contraceptive use. Commenting on the move one cleric compared it to "sending Salman Rushdie as an ambassador of goodwill to a Muslim country."

Between 1968 and 1970, the United Nations, working through the World Health Organization and Planned Parenthood, initiated a large-scale population control campaign in the Philippines. Contraceptive pills were distributed free to married women, and health personnel received training to support the effort. Although the program initially faced little opposition from the Church, it failed to significantly reduce pregnancy rates after two years because of government mismanagement in funding and distribution.

In the 2000s, the Philippine government, in line with the teachings of the Catholic Church, supported only “natural” family planning methods. National funds could not be used to purchase contraceptives for the poor, although those who could afford them were free to buy them privately. Local governments were permitted to distribute contraceptives, but many lacked sufficient resources. At the same time, donated contraceptives distributed through the public health system were phased out, including a long-running commodities program funded by the United States Agency for International Development, which for decades had supplied most of the condoms, pills, and intrauterine devices used by low-income Filipinos. [Source: Kenneth R. Weiss, Los Angeles Times, July 22, 2012] Blaine Harden, Washington Post. April 21, 2008]

President Gloria Macapagal Arroyo stated in 2003 that family planning could help reduce poverty, but she maintained that the government would back only methods acceptable to the Catholic hierarchy. She advised women to rely on fertility awareness techniques, such as tracking body temperature and abstaining during fertile periods. Although she acknowledged having used birth control pills as a young mother, she said she later sought forgiveness from a priest. When the administration of George W. Bush phased out USAID’s contraceptive program in 2008, saying the Philippines should assume responsibility, Arroyo declined to expand national funding, reportedly deferring to supportive bishops.

After U.S. funding ended, affordable contraceptives became increasingly scarce, particularly in Manila. Limited access for the poor was maintained through a patchwork of programs financed mainly by foreign donors and nongovernmental organizations, some of which operated discreetly out of concern about opposition or retaliation. As a result, many low-income women struggled to obtain reliable birth control, even as unintended pregnancies remained widespread.

Philippines' Reproductive Health Law

In December 2012, the Philippines enacted a landmark measure expanding reproductive health services: the Responsible Parenthood and Reproductive Health Act (Reproductive Health Law). The law mandates universal access to free modern contraceptives, fertility control, and age-appropriate sexuality education, with a focus on maternal health and poverty reduction. Government health centers were required to distribute free condoms and birth control pills, public health workers were to receive family planning training, and post-abortion medical care was legalized, although abortion itself remained illegal. [Sources: Kenneth R. Weiss, Los Angeles Times, July 22, 2012; Tom Hundley, Washington Post, June 17, 2013; Mark McDonald, New York Times, December 18, 2012]

The bill’s passage followed a bitter 14-year struggle between women’s rights advocates and Catholic bishops. When the measure came to a vote, bishops and nuns filled the galleries of Congress, but lawmakers approved it by 13 to 8 in the Senate and 133 to 79 in the House. A week later, President Benigno Aquino III signed it into law despite Church pressure, though the Supreme Court soon suspended implementation after constitutional challenges. “This is the first time we quote-unquote ‘lost’ on this issue,” said the Rev. Francis Lucas of the bishops’ conference. “We may have lost a battle, but we haven’t lost the war.”

Support for the law came from a broad coalition of women’s groups, medical professionals, academics, business leaders, celebrities, and some progressive Catholic organizations. Aquino campaigned actively for its passage despite threats of excommunication. Advocates argued that improving poor families’ access to contraception would lower birthrates and reduce abortions. Amnesty International welcomed the law’s passage but called it “imperfect,” noting that minors still needed written parental consent for contraceptives. “The Philippines still have a long way to fully respect, protect and fulfill women’s right to reproductive health,” said Polly Truscott, the group’s deputy Asia-Pacific director.

Opposition remained fierce. The Pro-Life Philippines Foundation denounced the bill as “ungodly” and published a list of absent lawmakers it labeled “Judases,” asking, “Where were the other congressmen in time of such a crucial vote like the RH bill?” Catholic bishops vowed to campaign against supporters in future elections. Senator Vicente Sotto III, known as Tito, argued that allowing teenagers access to contraception would promote premarital sex. Church leaders also warned of spiritual consequences; Bishop Nereo Odchimar suggested Aquino could face excommunication, while retired Archbishop Oscar V. Cruz claimed contraceptive pills “do not only prevent conception, they even destroy conception once it is already there. That is abortion.”

The debate also featured high-profile figures. Congressman Manny Pacquiao, absent from the final vote after being knocked out in a Las Vegas fight against Juan Manuel Márquez, declared on the House floor, “Manny Pacquiao is pro-life. Manny Pacquiao votes ‘no’ to House Bill No. 4244.” He linked his defeat to his belief in “the sanctity of life.” In contrast, Representative Romero Quimbo left the hospital while suffering from dengue fever to cast his vote in favor, later tweeting a photo of himself in an ambulance returning for treatment—an image that symbolized the intensity and drama surrounding the law’s passage.

In April 2014, the Philippines Supreme Court (SC) of the Philippines unanimously declared the Reproductive Health (RH) law (Republic Act 10354) constitutional but voted to strike down 8 provisions partially or in full. SC spokesman Theodore Te said: "The RH law is not unconstitutional." An SC insider told Rappler the "core provisions were upheld...except those provisions they declared unconstitutional." The eight provisions struck down related to things like the terms in which abortions were to be carried and services offered by health care facilities run by religious organizations. The SC also limited to scope of the RH law somewhat. A survey in March 2014, by the respected Social Weather Stations polling group said 72 percent of respondents were in favor of the law. [Source: Buena Bernal, Rappler, April 8, 2014]

Catholic Church Fights Against the Philippines' Reproductive Health Law

The Catholic Church was bitterly opposed to the Philippines' Reproductive Health Law. Catholic bishops in the Philippines argued that any form of contraception other than Vatican-approved natural methods or abstinence was equivalent to abortion. They warned that the reproductive health (RH) law represented the first step down a “slippery slope” that would eventually lead to the legalization of divorce, abortion, euthanasia, and same-sex marriage. Archbishop Ramon Arguelles, a vice chairman of the Catholic Bishops’ Conference of the Philippines, described President Benigno Aquino III’s support for the measure as a declaration of “open war” against the Church. [Sources: Kenneth R. Weiss, Los Angeles Times, July 22, 2012; Tom Hundley, Washington Post, June 17, 2013]

Church leaders, long accustomed to significant political influence, feared that their moral authority was weakening amid rapid economic growth and persistent poverty. Activist Sylvia Estrada-Claudio of the University of the Philippines said the battle over reproductive health was crucial for both the Philippine Church and the Vatican, calling the country “the last bastion of Catholicism in the Old World colonies.” The hierarchy saw the fight as essential to maintaining its influence in a changing society.

The constitutional challenge centered on whether the RH law violated the 1987 Constitution’s guarantee of protection for “the life of the unborn from conception.” In an effort to sway public opinion, bishops sought to turn the May 2013 midterm elections into a referendum on the law. Branding supporters as “Team Death” and themselves as “Team Life,” clergy urged voters from the pulpit to reject candidates who had backed the bill. The results were mixed, with roughly half of each side’s candidates winning, a result widely viewed as a setback for the bishops.

The Church also openly lobbied members of the Supreme Court, many of whom had been appointed by former President Gloria Macapagal Arroyo, a strong ally of the bishops on contraception. Supporters of the law emphasized that it did not legalize abortion and argued that the Constitution prohibited abortion, not contraception. Meanwhile, priests denounced the measure during Mass, some churches displayed graphic anti-abortion billboards, and lawmakers reported threats of being denied Communion if they voted in favor of the legislation.

Increased Access to Birth Control Reduces the Birth Rate in the Philippine

The Philippines’ annual population growth rate declined in the early and mid 2010s as people in the country began using contraception more. Results of the 2015 census showed that the population grew by 1.72 percent, down from 1.9 percent recorded in 2010, according to the Commission on Population. The trend followed the passage of the Responsible Parenthood and Reproductive Health Act of 2012, Experts said the increased use of modern contraceptives contributed to the slowdown. By 2015, about 45 percent of couples were using modern contraceptive methods, up from 38 percent in a 2013 national survey. He noted that fertility was also declining naturally as more women chose to have fewer children. [Source: Teresa Cerojano, Associated Press, May 25, 2016]

In January 2017, Philippines President Rodrigo Duterte ordered the free distribution of contraceptives to an estimated six million women in the Philippines who lacked access to them. Ignoring expected opposition from the Catholic Church, he said the goal was to reduce unwanted and teenage pregnancies, particularly among poor families. Of the six million women expected to benefit, about two million were identified as poor and were prioritized to receive contraceptives by 2018 under the president’s order. [Source: Claire Toureille, Newsweek, January 12, 2017]

The initiative followed a 2015 decision by the Philippine Supreme Court to impose a temporary ban on contraceptive implants after complaints from anti-abortion groups, a ruling the government appealed. Economic Planning Secretary Ernesto Pernia said the program aimed to achieve “imoto zero unmet need for family planning” as part of a broader strategy to reduce poverty. The administration sought to cut the poverty rate from 21.6 percent in 2015 to around 13 or 14 percent by the end of Duterte’s term in 2022.

Abortion in the Philippines

Abortion in the Philippines is illegal except in rare cases, such as when a pregnancy endangers a woman’s life or involves rape, incest, or severe mental incapacity. Despite the strict law, studies have estimated that hundreds of thousands of abortions occur annually, many involving women facing unwanted pregnancies. The procedure is strongly condemned by the Catholic Church, whose influence reinforces the country’s restrictive policies. [Source: Blaine Harden, Washington Post. April 21, 2008; Jose Florante J. Leyson, M.D., Encyclopedia of Sexuality 2001; Tom Hundley, Washington Post, June 17, 2013; Kenneth R. Weiss, Los Angeles Times, July 22, 2012]

Historically, abortions in the 1930s were often performed in rural areas by untrained practitioners using crude methods, frequently resulting in severe complications or death. After World War II, more procedures were carried out by physicians, but abortion remained illegal under the criminal code, with penalties for both women and providers. Although publicly denounced, enforcement has generally been limited, and prosecutions are rare unless a woman dies from complications.

Many abortions today are clandestine and unsafe. Estimates suggest that between 475,000 and 600,000 women undergo illegal abortions each year, with around 90,000 hospitalized for complications and about 1,000 deaths annually due to botched procedures. Women who experience medical emergencies often seek care at facilities such as Dr. Jose Fabella Memorial Hospital, where treating abortion-related injuries is a common occurrence.

Research indicates that abortion cuts across social classes but may be more frequently reported among middle-class and college-educated women, particularly in urban centers. Poor women often rely on unlicensed providers and deny having abortions to avoid legal trouble. Government surveys have suggested that a significant number of women have had abortions, often linked to economic hardship or coercive relationships.

Health experts argue that the high rate of unsafe abortion reflects inadequate access to sexual education and contraception. Some scholars and medical professionals maintain that expanding family planning services, improving hospital access, and reconsidering restrictive laws could significantly reduce maternal illness and death associated with illegal abortion.

Philippine Massage Abortionist

Many abortions are performed by traditional healers, known as hilots, who often perform an abortion by massaging the partially-formed fetus in a pregnant woman who has taken a powerful herbal mixture called pamparegla, which sells for about one dollar at a curbside stall. One Filipina told a Japanese newspaper that she had two abortion. When she was asked how, she said, “I ran a lot, I took lots and lots of drugs and beat my tummy. I think the second time I had twins. I’ve lost three children.”

Kenneth R. Weiss wrote in the Los Angeles Times: “Erlinda A. Casitas presses her thick thumbs into her thigh to demonstrate how she dislodges a fetus and massages it out of the womb. "I usually feel for the baby, for the swelling, and then I apply pressure gradually downwards," said Casitas, a middle-aged woman with wide-set eyes. "I'm very careful. If I apply too much pressure, the patient will experience shock or the woman will get bruises." [Source: Kenneth R. Weiss, Los Angeles Times, July 22, 2012 |::|]

“Casitas is a hilot, one of the massage abortionists who perform a large share of the estimated 475,000 illegal abortions in the country every year. Before she gives the aggressive massage, Casitas has her clients take three tablets of Cytotec, an ulcer medication sold on the black market and used to bring on uterine contractions. Many women seeking abortions go to the area around Quiapo Church, in old downtown, where street vendors sell crucifixes and statues of the Virgin Mary, alongside bitter herbal brews such as "Pampa Regla" (which means "induce menstruation" in Tagalog) to end pregnancy. Cytotec is on sale, too, but kept out of sight. "Everyone knows about Quiapo," Casitas said. |::|

“Among her clients, she said, are "mothers who have many kids, who can no longer afford to have more children," and mothers with children under a year old who want "birth spacing." Casitas said she doesn't have a fixed fee. She often asks patients for a $20 donation, less if they are very poor. "First what I do is to pray to God and ask for forgiveness," said Casitas, a practicing Catholic who wears a small silver crucifix around her neck. "I'm telling God I'm not charging a big amount…. It's just like helping the patient with her problem." "I think God hears my prayers because so far I haven't had any patient who suffered any hemorrhage and has to be rushed to the hospital." |::|

Casitas said she quizzes clients on why they got pregnant. "I advise the women to use pills, injectables [hormones] or IUDs." She knows many will not follow her advice, or cannot afford to. But she said she has a strict rule: "I only allow myself to help a woman twice. So when she comes to me to abort her first pregnancy, I do it. If she comes back to me a second time, I do it. The third time, I refuse." |::|

Image Sources: Wikimedia Commons

Text Sources: “Encyclopedia of World Cultures Volume 5: East/Southeast Asia:” edited by Paul Hockings, 1993; “Culture Shock!: Philippines” by Alfredo Roces and Grace Roces, Marshall Cavendish International, 2010; National Geographic, Live Science, Philippines Department of Tourism, New York Times, Washington Post, Los Angeles Times, Smithsonian magazine, Encyclopedia.com, Library of Congress, The Conversation, The New Yorker, Time, BBC, CNN, Reuters, Associated Press, AFP, Lonely Planet Guides, Google AI, Wikipedia, The Guardian and various websites, books and other publications.

Last updated March 2026