Secret service: Underground doctors induce safe abortions

AT A GLANCE

Conclusion


MANILA, Philippines – Amanda had gotten pregnant twice.

The first time she got pregnant, her then-boyfriend left her after finding out she was expecting.

“I decided to keep the child and now have a very close relationship with my son,” she wrote in an online forum for Filipina women.

“But one never knows the future and I fell again for another single successful man. We had a year of a good relationship and I got pregnant 5 months ago,” she said. “When he got to know I was pregnant this man bolted faster than the speed of light.”

Amanda said she wanted to have another child to give her son a sibling, but as a single mother, she knew that what she was earning was only enough for her and her son to have a decent life.

“I decided to abort and did my share of crying when deciding on this,” she wrote. “Once I made my decision, I had to find a reliable abortionist.”

Amanda asked various doctors to help her, but each one refused – abortion being strictly illegal in the Philippines. She finally got a break when a friend referred her to a doctor who she said could help.

“I visited this doctor in her clinic for a prenatal consultation and gently put the question to her but was surprised when she too refused,” she wrote. “I told her that my friend recommended you but she said maybe that was someone else. My heart sank and I was about to cry sorely when she wrote something on a piece of paper.”

The doctor handed Amanda her prescription, along with a separate note.

Scribbled on the piece of paper was one sentence, and a cellphone number: “CALL ME AFTER 4PM AT THIS NUMBER, MY SECRETARY IS LISTENING NOW."

Amanda, who was 5 months pregnant at the time, felt a surge of hope and relief. She phoned the doctor that afternoon.

“I called her and introduced myself and she said she does not do abortions anymore because she was almost caught with a well-planned entrapment operation," Amanda wrote.

"But the best she can do now to help me is to give me a referral to a group of doctors she knows does abortions underground in the Philippines with a well protected system."

“She told me that even to give a referral for an abortion is punishable by our laws so to keep confidential everything," she said.

"That's how I got the number of the secretary of the group of abortion doctors in the Philippines.”

Tedious and thorough

The most-read topic in the online forum, where Filipinas flock to desperately seek abortions, is about a group of medical doctors who offer safe abortion options. As of this writing, it has 180,661 views, 4,060 replies, and is 407 pages long.

The thread is from 2014, but the group of doctors was founded 6 years prior, in 2008, precisely to help women in the Philippines. They are a network of doctors all across the country, in urban and rural areas, from Luzon to Visayas to Mindanao.

The group works in a systematic, professional way, aided by its own dedicated secretary. They operate under intense secrecy, and are hard to find, only traceable through referrals of doctors or former patients, or by looking deep into the internet. But finding them is only half the battle.

To undergo an abortion with them, the process is detailed and tedious – a stark contrast to backstreet abortionists who, after a few text messages, will immediately agree to a procedure.  (READ: The reality of abortions in the Philippines)

Rappler reached out to the secretary to request for an interview. While the secretary refused, she referred Rappler to an introduction document that is given to potential patients.

“We are very sorry but almost every month we get requests like this. To keep our group and the service underground with the utmost of confidentiality we do not entertain interviews on the service, its extent, its network of medical professionals, and its operation,” the secretary wrote in her reply to Rappler. “But you are welcome to go through what we give to new inquirers as an introduction.”

The document, an introduction letter, has two versions: one in English and another in Filipino. It’s a thorough, 5-page long introduction, which summarizes 10 steps to follow for women who wish to engage in their services:

Step 1: The patient is asked to read an article sent by the secretary via email, which details the process and answers frequently asked questions (FAQs).

Step 2: The patient is made to answer a questionnaire on her pregnancy, health history, and lifestyle to help the doctors decide on the appropriate procedure. The introduction document notes that, “no two cases are the same,” hence abortion procedures differ per person, depending on each patient’s status.

Step 3: The patient is given 3 articles on the medicines, cost of the different packages with these medicines, and the surgery packages if a medical abortion is no longer an option.

Step 4: Patients are offered an anonymous online consultation with one of the doctors on duty. This is especially useful for those who listed health problems in the questionnaire, and for doctors to determine any health risks.

Step 5: The patient is asked to take an Obstetrical Ultrasound through any clinic and hospital, and to send the results to the doctor for evaluation and assessment of possible complications.

Step 6: The patient is finally able to have a face-to-face consultation in a clinic or hospital with one of the group’s nearest willing doctors.

Step 7: Payment options are provided. Accounts in 5 different banks are given to the patient to choose from.

Step 8: The patient can schedule her procedure and can decide on additional options like having a nurse.

Step 9: The patient provides updates post-procedure and receives post-procedure advice as needed, from her assigned doctor or any of the online doctors on duty.

Step 10: The patient is required to update her doctor when she gets her first menstruation post-abortion, which marks the end of the process and a successful abortion. Only then does the process officially end.

The introduction letter also encourages prospective patients to read the online reviews of other women about their services – both negative and positive.

It then ends with an honest reminder, distinctly different from the “painless procedures” promised by backstreet abortionists.

“There has never been a perfect procedure even with doctors. There are always problems from failure, to critical complications, to avoidable delays of doctors and nurses to unavoidable delays due to anatomical and physiological aberrations,” the letter said.

“So do not expect our service to go perfectly as impressed and always plan for the worst. Our doctors can only guarantee that they will do their best to keep you safe primarily and have success secondarily.”

Abortion procedures

Aside from the exhaustive process the group requires before the abortion, the group is evidently professional – advertised services are aligned with those recommended by the World Health Organization (WHO).

The group recommends medical abortions for the first trimester and various surgeries, depending on how far along the pregnancy is: vacuum aspiration, dilation and evacuation, and dilation and extraction.

For the third trimester, the method used is induced premature live birth – although many doctors from the group don't accept third trimester abortions.

Understanding the need for emotional, physical and mental support, the group also highly encourages bringing a companion or two to the procedure – unlike backstreet abortionists who strictly ban any sort of companions to be present.

The services are also priced significantly higher than those charged by backstreet abortionists.

Prices for a medical abortion in the first trimester vary from P3,000 ($56) to P12,000 ($225), depending on whether the medicine is branded or generic and what the doctor recommends, and P10,000 ($188) to P20,000 ($375) for surgical packages.

For the second trimester, a surgical abortion costs between P15,000 ($280) to P25,000 ($470), while for the last trimester, it ranges between P20,000 ($375) to P25,000 ($470).

The fees go up further in the event of complications.

THOROUGH. Some sample questions on the long questionnaire required from patients. Photo obtained by Rappler

THOROUGH. Some sample questions on the long questionnaire required from patients.

Photo obtained by Rappler

There are also options for bedside doctor assistance (P3,000 or $56), nurses (P500-P2,000 or $9-$37, depending on whether they are in rural or urban areas), home service (P3,000-P5,000 or $56-$94), and an additional uterine irrigation post-abortion (P5,000 or $94).

Despite the prices however, it is clear the doctors are not doing it for the money.

A separate document given to patients explains that the surgical costs are high because major surgeries are sometimes done in hospitals where the doctors work, and due to costs of sterilization of instruments, the medicines, and the doctor’s professional fee. 

The group does offer discounts of up to 75% for poor patients, but require the submission of paperwork that proves financial need. For those needing to cut costs, some doctors agree to not doing it in a hospital room and instead doing it at home or in hotels, as long as it is safe for the patient. 

The group also offers a free procedure if the woman’s body does not respond to a medical abortion. Sometimes, doctors even waive their professional fees to help the women.

Risks are also too high for the doctors just to do it for money: doctors can lose their medical licenses and go to jail if caught by authorities performing abortions. (READ: A hard look at abortion in the PH)

Security mechanisms

Based on the hundreds of reviews Rappler dissected, the group of doctors – which has been doing underground abortions for 10 years – put in place tried-and-tested methods to ensure the security and protection of themselves and their patients.

Medicine is mailed to patients via courier, or can be picked up in courier locations.

The secretary of the group will never pick up phone calls and insist only on SMS, chat messaging, or emails for communication. In their FAQ sheet, the group explains, “Nobody wants to have their voices recorded as an abortionist, especially the secretary.”

The abortions are also often done during off hours – very late in the evening or in the wee hours of the morning – between 11 pm and 5 am, particularly for medical abortions, or minor surgeries, which are done in motels or hotels near the doctor’s hospitals.

These hotels and motels are listed and pre-selected by the group to ensure security, and are near hospitals so the doctor can check on the women easily and in case an emergency requires the women to be rushed to the emergency room.

The doctors have full-time jobs and shifts, and do the abortion services on the side, on top of their daily medical duties in hospitals and clinics. Often they have several abortion patients lined up in one night, and see women one after the other.

But the risks of the doctors’ underground operations appear worth it when it comes to ensuring the safety of the women.

'Thank you'

User tiarafate8888, who posted on the forum on August 12, 2018, got accidentally pregnant with her boyfriend. Desperate to terminate her then two-month pregnancy, her boyfriend searched online and bought medicines advertised as abortifacients for P2,900. She bled for two weeks straight after taking the pills.

But after the abortion process was supposedly over, her menstrual period never came. Tiarafate8888 found out she was still pregnant months later, when she was almost 5 months along. Frantic, she searched online and stumbled upon the group of doctors.

After undergoing the necessary steps and being approved for an abortion, tiarafate888 and her boyfriend received a list of things to buy from the drug store for the procedure (things like sterile gloves, cotton, alcohol, betadine, adult diaper, etc), a timetable for her fasting and medicine intake, and a list of hotels to choose from where they could check-in for the procedure. They were told the doctor would come at 2 am.

“Someone knocked on our door and we saw through the peephole the nurse with a man who’s wearing a cap, white polo shirt and pants. We opened the door and they asked us if I am (my name)," she wrote.

"They entered and opened his laptop and discussed everything about the risk and the success of the procedure since I earlier had a failed procedure with the fake medicines. He also asked us to ask questions. They cleaned themselves and prepared the procedure."

Tiarafate8888 and her boyfriend stayed in the hotel for a total of 3 days, and was visited by the doctor and a nurse 3 times. Her abortion was successful.

“I would like to thank the Secretary who patiently entertained us. To the nurse who gave her time to comfort me. And especially to the doctor who did the procedure,” she wrote. “For my baby, I am so sorry.”

User Room716 also posted her experience in the forum on June 21, 2018, explaining she and her husband decided on an abortion since they already had 3 children, aged between 7-12 years old.

“I am now focusing on my career and giving them a good life. Which is already hard, as it is very expensive sending 3 kids to school,” she said.

“Luckily I found this group of doctors. They have extensive data requests and had plenty of locations to choose from as to where you can check in. From motels to expensive hotels,” she wrote.

“They were very professional in every way. It’s more expensive than the others. But girls! It is your lives on the line. If you can find a way, please don’t skimp on this service. Abortion is a very risky procedure.”

She said she had a successful medical procedure and a uterine irrigation afterwards, as well as a nurse who guided her throughout the process. “Your fears will go away, she will check your vitals,” she said.

“I posted this to help other women in making this important decision. Don’t be afraid. They are there to help. It’s hard to get a schedule, they have plenty of patients. But they’re the best one. Don’t go for the others,” she wrote.

She encouraged women not to fear submitting their medical histories, their names, and the information asked for, admitting “I was scared too. But they just need these for medical history and health.”

“They are real doctors. I thought it was too good to be true. But they did this to help us fellow Pinays to get better and safe options,” she said.

Aside from some complaints of physical pain during the procedure, and the emotional trauma after the abortion – all of which can't be prevented even by medical doctors – Rappler found no negative reviews about the group of doctors.

Data collected by Rappler from the forum also shows that when safe abortion options are available, women will indeed choose them over riskier options.

As of July 27, 2018, 323 women availed of an abortion with the group of doctors since 2014, compared to backstreet abortionists like Miss Julie, who did 138 procedures, and Miss Shine who did 98. (Miss Julie only had recorded abortions from 2016 onwards).

The real numbers are of course greater – since these numbers count only those who left comments on the forum – but the data paints a picture of what women seek and ultimately choose.

Watch the video of this young woman who had two abortions, and who spoke to Rappler about how different her experience was when she got an unsafe abortion versus having a safe medical abortion:

'God is an abortionist'

Yet while there is demand for safe abortion options in the Philippines, it is unlikely that an abortion bill will be passed anytime soon.

The Catholic Church continues to wield strong influence on policies and Filipinos, and in 2017, Philippine President Rodrigo Duterte said he supports family planning but “hates” abortion. Many, if not majority, of Filipinos themselves are anti-abortion as well.

This, despite studies showing that banning abortion does not deter women from seeking it, and that abortions are safe in countries where they are legal, but dangerous in countries where they are banned and performed underground.

The group of doctors themselves knows that many oppose what they’re doing, but in FAQ answers, they take the criticism with sharp wit.

Question number 20 on the FAQ sheet reads, “Why are you abortion doctors doing the ‘work of the Devil’?”

To this, the group responded, “The Devil does not know how to do an abortion properly. He never went to medical school. If you allow the Devil to do it you might die (like one of those more than 2,000 Filipinas DYING EVERY YEAR after FAILED attempts to abort with the help of fake/quack doctors, hilots, and petty sellers of fake abortion drugs) and go meet him earlier than expected.”

“We do not want to see you in one of our Emergency Rooms fighting to stay alive because one of the Devil's workers sold you fake drugs or performed improperly a surgical abortion therefore we would rather help you properly before the Devil does and takes you,” the doctors said, referring to backstreet abortionists.

They added, “In fact we are helping God do His work in population control. 50% of all human conceptions end in spontaneous abortion usually without a woman even knowing that she is pregnant. And 20% of all observed pregnancies end in miscarriage. So God is an abortionist.”

But the group also provides a more medical reason to explain why they do what they do.

“The WHO has long approved induced abortion. Our country though a member of WHO is still in the Dark Ages,” the doctors wrote.

They also quoted the WHO’s definition of health: “Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”                                     

“Interpretation of the definition with respect to abortion: if a woman is still desperate for an abortion after all means to change her mind to keep the pregnancy then give her the abortion otherwise her mental, physical, and eventually social state will be affected and she (by the WHO definition) will not be healthy,” they said.

Indeed, an analysis of the reviews shows that the doctors are not out simply to terminate pregnancies, but also to ensure the mental well-being of Filipino women – whatever their choice may be.

Changing minds

Rappler found various reviews in the forum wherein the doctors consistently asked the women before the procedure whether they were sure about undergoing an abortion.

She tried to convince me to continue the pregnancy and even said that I can afford to raise the child and just to drop-off from school one semester,” user krissy wrote of her experience with her doctor.

While many choose to continue with the abortion, a choice the doctors ultimately respect as long as it is safe, Rappler counted 10 women who, after speaking to their doctors, decided to go through with the pregnancy instead of aborting. Rappler counted no such circumstances with backstreet abortionists.

Username Sienna, in her post on November 2015, shared how one of the group’s doctors helped her.

“I'm into my third trimester now and it was a miracle that a doctor accepted my case. I was also alone and requested for a nurse, but I didn't get one for the same reason,” she said.

“Around 3 am, the doctor came and we discussed my case. He asked me a few questions and explained what would happen. He also explained that it would be very painful for me, not only physically but emotionally as well. He gave me options for adoption and said he'd give me some contact numbers for adoption agencies if I want to,” she wrote.

“He even offered that if I could wait for a few more weeks, he'd be the one to do the procedure for a normal delivery in my own residence. This way, the baby would have a greater chance of surviving as long as she's healthy at the time of delivery.”

She said the doctor joked that in exchange, all he asked for was to be invited to the baby’s first birthday.

Sienna said that their conversation convinced her to keep the baby, and asked the doctor if he could also help convince her boyfriend. The doctor agreed, and planned to meet Sienna and her partner later that afternoon.

But after the doctor left, Sienna changed her mind yet again, compounded by her boyfriend’s persistent refusal to keep the baby. She decided she would go through with the abortion.

By the time the doctor returned, Sienna said she had made up her mind.

“I changed my mind for the last time and said I'd continue the pregnancy and take his offer. I immediately felt happy the moment I told him that, it was like a way to seal the deal and finalize it,” she wrote.

“He said that I made a good decision, and even pointed out that nowadays, women are never really ready to have a child. He said that in ten years, my baby would be running around and I could run around with her too.”

The woman’s username, it turned out, was not her real name but the name she planned for her baby.

“So now, Sienna would stay for a little while inside until she's healthy enough to be born,” she said. “I'm getting a pre-natal checkup soon to see how she's doing, and would have to do everything to keep her as healthy as possible.” She said her boyfriend also ultimately accepted and supported her choice.

“I would like to express my deepest gratitude to my doctor for helping me reach this decision. I wouldn't be happy otherwise. I still get very emotional, especially now as I'm writing this," she wrote.

"I hope that someday, your group's efforts would be recognized and you no longer need to conduct this under the table. When that time comes, I'm pretty sure you'd be able to help out a whole lot more.”

She ended her post by addressing the other women in the forum: “If you are reading this, you probably are in the same predicament as those who wrote numerous posts in this site.”

“My heart goes out to you, and I do hope that you make the best choice in the end.” – with reports from Frances Roberto and Cesar Garcia/Rappler.com