76 International Family Planning Perspectives

where abortion is legally prohibited,2 thesale of hormonal drugs for emergencycontraception is permitted. Such regula-tory approval for emergency contracep-tion enables health providers, includingpharmacists, to be trained to help womenuse such methods safely and effectively.

The question of when contraception endsand abortion begins may affect how legis-lation related to emergency contraceptionis framed.3 Many countries have no legaldefinition of abortion or pregnancy. In ad-dition, reproductive health and rights ad-vocates have often sought to separate theconcepts of abortion and contraception.However, opponents of contraception andabortion can be expected to incorrectlyequate emergency contraception with abor-tion to create confusion between the two inboth the legal and political arenas.

Restrictive abortion laws are likely tohave only a limited impact on the actualuse of the most common emergencymethods (combined pills and the IUD).However, antiabortion laws could in-crease the likelihood that certain emer-gency methods will be restricted to con-trolled distribution points.

In practice, easy access to hormonalmethods in many developing countrieshas enabled women to use these drugs toprevent pregnancy on their own, despitethe presence of laws or religious edicts re-stricting their use. Policies and laws thatprohibit or curtail dissemination of healthinformation on emergency methods canalso drive women to use them withoutproper counseling from trained healthproviders or pharmacists.

Emergency contraception administeredimmediately after unprotected intercoursewould probably be legal in countries withsomewhat restrictive abortion laws that usethe medical definition of pregnancy—i.e., apregnancy is not achieved until implanta-tion is completed. (Such countries includeGermany, Liberia and New Zealand.) Thiswould be true even in cases when fertiliza-tion had most likely occurred, since pre-venting a fertilized ovum from completingthe process of implantation does not con-stitute an abortion in these countries.

Attempts at preventing implantationare not governed or restricted by abortion

Florence M. Tadiar is associate professor at the Collegeof Public Health, University of the Philippines, Manila,the Philippines. Elizabeth T. Robinson is associate directorof information programs at Family Health Internation-al, Research Triangle Park, N. C., USA.

Legal, Ethical and Regulatory Aspects of IntroducingEmergency Contraception in the PhilippinesBy Florence M. Tadiar and Elizabeth T. Robinson

Emergency contraception is the useof drugs or devices to prevent preg-nancy within a few days after un-

protected coitus. A variety of legal and political obstacles may hamper the intro-duction of emergency contraception intodeveloping countries. Many of these ob-stacles are rooted in a basic lack of knowl-edge about the mode of action of emer-gency methods, the indications for theiruse and their availability.

The most common methods of emer-gency contraception, combined oral con-traceptives (estrogen-progestin pills) andcopper IUDs, are legal for regular contra-ceptive use in most countries, and areavailable through public health services,private physicians and pharmacies. Morethan 20 countries* have licensed existingdrugs for emergency contraception; inmost developing nations, however, thereare no laws specifically governing the useof emergency contraception.

Furthermore, the legal status of otherdrugs considered safe and effective foremergency contraception—such as certainantiprogestins1 and androgens—variesmarkedly by country. These methods mustbe used within a few days of unprotectedintercourse to be effective as emergencycontraception. Such compounds must bedistinguished from various analgesics, an-timalarial drugs, antibiotics and other drugsthat women in many developing countriesuse to induce menstruation or early abor-tion, none of which have been tested forsafety or efficacy for these purposes, or asmethods of emergency contraception.

Whether regulatory agencies in a givencountry will formulate specific policies onemergency contraception depends on anumber of factors. In some countries, ap-proval of emergency contraceptives maybe dictated largely by the interpretationof abortion laws, despite their use to pre-vent pregnancy. In others, abortion’s legalstatus may have no connection to the gov-ernment’s willingness to approve emer-gency methods. In Nigeria, for example,

laws in other countries, such as the Unit-ed Kingdom,4 in part because legal proofof criminality would rest on proof of preg-nancy; physical trauma from an abortionprocedure would also be required forprosecution or conviction of criminality.5In addition, emergency contraception mayalso be legally acceptable in countrieswhere menstrual regulation (vacuum as-piration) is permitted, such as Bangladesh,or where pregnancy is defined as begin-ning as late as 35 days after intercourse.

This article describes the complex influ-ences of regulatory laws, religion, politicsand ethics on the provision of emergencycontraception in one large developing na-tion—the Philippines, which has no lawspecifically governing the use of emergencycontraception. Although emergency meth-ods are little-known in the country, sever-al factors suggest that they may be wellsuited to the Philippines.

Philippine Legal ContextIn the Philippines, estrogens, progestinsand their combinations are included in theNational Drug Formulary’s EssentialDrug List, which specifies routes of ad-ministration, pharmaceutical forms andstrengths.6 These drugs are also includedin the reference manual for prescribingpharmaceutical products commonly usedby physicians and pharmacies. There isnothing specific to bar a physician fromprescribing combined pills in the higherdosages necessary for emergency use. IUDinsertion for emergency contraceptionwould probably also be acceptable froma legal standpoint, as long as it could notbe established that fertilization had oc-curred. (Of course, pregnancy is a con-traindication for all contraceptives, in-cluding emergency methods.)

In addition, it is unlikely that women’saccess to the pill and IUD could be reduced.Since 1973, pills, IUDs and other fertilityregulation methods have become general-ly available through the Philippine familyplanning program in public and private

*These countries include Bulgaria, the Czech Republic,Ecuador, Finland, Hong Kong, Hungary, Jamaica, Kenya,Malaysia, the Netherlands, Nigeria, Pakistan, Poland,Russia, Singapore, Slovakia, Thailand, the United King-dom, Uruguay and Vietnam.

77Volume 22, Number 2, June 1996

from sales clerks—by requesting pam-paregla. No questions were asked or pre-scriptions required.

The most popular remedy prescribed fortreating delayed menstruation (especial-ly in areas outside the city limits) was anoral contraceptive brandcontaining mestranoland norethindrone(Gestex, manufacturedby the drug companyMedichem). This drug isalso indicated for treat-ment of secondaryamenorrhea of short du-ration; doctors prescribeit and other formula-tions upon request.These pills are often referred to as “preg-nancy test pills” because of the notion—among both women and doctors—that ifsuch pills do not successfully bring onmenstruation, then a woman must bepregnant.

Thus, Philippine women use pills suchas Gestex to induce menses, deliberatelytaking twice the prescribed dosage ormore. The two women investigators werenever informed by pharmacists or doctorsabout the compound’s contraindicationsor its possible effects on a developing fetus.Some of these drugs are relatively inex-pensive. (Gestex, for example, costs US$1.00–$1.50 per tablet.) Other mestranol-norethindrone combinations are far cost-lier, however, with one (marketed as Pro-seckon) costing US $4.50–$7.80 per tablet.Some pharmacy clerks, especially thoseworking in poorer areas, also prescribedherbal potions and remedies for delayedmenstruation.

Anecdotal evidence suggests that prosti-tutes take other drugs, such as Fansidar (anantimalarial drug) and Methergine (used tocontrol uterine bleeding), which are ru-mored to be effective for inducing menses.An over-the-counter remedy for stomach-aches (Esencia Maravillosa), whose activeingredient is unknown, is also said to becommonly used by low-income women be-cause it is cheap and easy to obtain.

According to a community-based studyin Davao conducted among urban poorwomen, nearly 71% said they had evertried to induce menstruation.9 Most hadused high doses of combined pills; othershad tried prostaglandins such as miso-prostol, an antiulcer drug that is used insome countries with mifepristone in med-ical abortion, as well as analgesics and bit-ter herbal concoctions.

Our examination of the medical recordsof women attending a clinic in Metro

hospitals, clinics and pharmacies. The factthat these methods are so accessible towomen and represent the standard optionin the public and private sectors suggeststhat it would be difficult to prevent theiruse for emergency contraception.

However, some legislators who oppose“artificial” family planning on religiousgrounds have made repeated attempts,through bills and resolutions submitted inthe Philippine congress, to classify all oralcontraceptives and IUDs as abortifacients.Thus, methods used for emergency con-traception are clearly vulnerable to the samelegal challenges as regular contraceptives.

Given this background, it may be use-ful to examine the Philippine experiencewith the use of oral contraceptives con-taining estrogen and progestin to inducemenses. Many Filipino women have themistaken belief that such drugs can act asabortifacients: A number of studies haveshown that Filipino women sometimesdevise their own remedies for protectionfrom unwanted pregnancy through thewidespread use of very high doses of com-bined oral contraceptives.7 These studiesalso revealed that women and healthproviders distinguish between contra-ception, induction of delayed menstrua-tion (before pregnancy status is deter-mined) and abortion, although the samedrugs in varying amounts may be usedwith varying degrees of efficacy for thesedifferent purposes.

In 1992, a survey was conducted of theavailability of, use of and regulations im-posed on combined pills in the city ofDavao and its surrounding areas, in thesouthern Philippines.8 The survey wasconducted about one year after the Philip-pine government passed the GenericDrugs Act, which requires that oral con-traceptives containing estrogen and prog-estin be prescribed only by a doctor. Theprescription must indicate the genericname of the active ingredients and the spe-cific chemical form (and brand name, ifdesired), the dosage, the delivery modeor system and the appropriate dosefrequency.

To collect the data in this survey, twowomen (one dressed poorly, the otherwell-dressed) posed as clients in need ofa substance to induce menstruation (lo-cally known as pamparegla) and sought as-sistance from pharmacies and doctors inthe Davao area. Even though the Gener-ic Drugs Act restricts prescription re-sponsibility to doctors, the women easilyobtained a variety of combined pills (Ges-tex, Duphaston, Femenal, Promolut N andProseckon) from pharmacies—and even

Manila in 1994 confirmed this practice oftaking combined pills to induce men-struation (in the belief or hope that theamenorrhea was not caused by pregnan-cy) or an abortion (when a pregnancy wasstrongly suspected or confirmed). Among

the 237 women who wanted to inducemenstruation or terminate their preg-nancy, 40% had already attempted to doso. (Sixty percent had done nothing.)Among the 40%, 12% said they had triedcombined pills (and this proportion wasprobably larger, since some women re-ported having injected or ingested an un-known compound); 9% had resorted toabdominal massage or acupressure and7% had taken misoprostol. The remaining11% had taken a variety of other drugs (in-cluding analgesics and antibiotics) orherbal medicines. Most of these women(75%) had used more than one of thesemethods to induce bleeding.

These studies suggest that both womenand health providers in the Philippineswould welcome having the option ofemergency contraception. They also in-dicate that there would likely be little com-pliance with any law restricting emer-gency contraception in case of potentialclaims that it is an abortifacient.

Barriers to Emergency MethodsAlthough emergency methods may bewell suited to the Philippines, their intro-duction will doubtless encounter a num-ber of obstacles, including those relatedto the country’s laws, the influence of for-eign agencies, medical barriers, a widerange of ethical issues and the Philippinepolitical situation.

Regulatory ObstaclesThe Philippine government’s reaction tothe widespread use of misoprostol to in-duce menstruation and abortion may il-lustrate how regulations could restrictemergency contraceptives. In June 1994,newspapers reported that the Bureau ofFood and Drugs had confirmed the drug’sabortion-inducing effect.10 The secretaryof health then directed the bureau to con-

“Easy access to hormonal methods in manydeveloping countries has enabled women touse these drugs to prevent pregnancy ontheir own, despite the presence of laws orreligious edicts restricting their use.”

78 International Family Planning Perspectives

Legal, Ethical and Regulatory Aspects

dicated method of emergency contracep-tion might be expected to pave the way forpossible approval in other countries. Onthe other hand, some products may besuitable for one population but not for oth-ers, given the cultural, social and even bi-ological variations in populations. Sup-port for locally-based research on specificissues related to emergency contraceptionwould probably be helpful to local regu-latory processes.

The U. S. Food and Drug Administra-tion has no explicit policy regarding spe-cific labeling for use of oral contraceptives

or copper IUDs in emer-gency contraception;thus, these methods areexported to developingcountries without a list-ing of the additional in-dication for emergencyuse. In the Philippines,the indication for anyproduct is the one ap-proved by the Bureau ofFoods and Drugs. How-

ever, no provision in the Generic DrugsAct prevents use of a drug beyond thelabel’s stated indication—as the use ofcombined pills in the Philippines for pur-poses other than their approved indica-tion attests.

But U. S. Food and Drug Administrationapproval, or the lack of it, can clearly af-fect use, as when the agency previouslywithheld approval for depot medroxy-progesterone acetate, which was subse-quently banned in the Philippines. On theother hand, if the U. S. Food and Drug Ad-ministration were to list emergency con-traception as an indication for some fam-ily planning methods, conservative forcesin the Philippines might respond by en-couraging the stricter regulation of or evenan outright ban on these contraceptives.

Medical ObstaclesPrescribing practices that hinder access tocontraceptives or that erect medical bar-riers to family planning use need to be fur-ther examined. Many current family plan-ning prescribing policies and practices,including eligibility criteria for use, arebased on findings from studies conduct-ed in the 1970s on older methods or reflectlocal experiences and beliefs. The currentlack of knowledge about emergency con-traception is not likely to be remedied un-less information and training programsimpart current data about correct use.Health providers need to be educated sothey can enable women to use hormonalemergency methods safely and correctly

duct a survey among obstetricians, gyne-cologists, drugstores and hospitals to de-termine whether misoprostol, which wasapproved only for the treatment and pre-vention of gastritis induced by anti-in-flammatory drugs, was being misused asan abortifacient.

Although the results of the survey werenever released, the sale and dispensing ofmisoprostol has since been limited to ter-tiary hospital pharmacies and big drug-store chains. These outlets are now requiredto keep a special log for prescriptions, list-ing the name and address of each patient,

the quantity dispensed and the name of thedispensing physician. The manufacturer,Searle, also agreed to regulate the distrib-ution and sale of the drug.

Any effort to legally designate oral con-traceptives as abortifacients might use aregulation similar to the one governingmisoprostol. Access to other hormonesused in emergency contraception is alreadylimited in many cases. For example, underthe Generic Drugs Act, ethinyl estradioltablets are included in the list of productsrequiring strict precaution in prescription,sale and use. Diethylstilbestrol, anotherhigh-dose estrogen that can be used foremergency contraception, is registeredunder the “complementary list” in the Na-tional Drug Formulary, which lists alternatedrugs that can be used when those classi-fied in the core or main list are ineffectiveor inappropriate. Danazol is included in thecore list of essential drugs, while other an-drogens are in the complementary list.11

Impact of U.S. PoliciesSince the Philippines, and developingcountries in general, are usually notequipped to test and approve drugs, theymust rely on assessments made in devel-oped countries. About 75% of contracep-tive research and development fundscome from the United States, which is themain donor of contraceptives to devel-oping countries and which will not sup-ply drugs unapproved by the U. S. Foodand Drug Administration.12

Thus, U. S. approval of a specifically in-

in the privacy of their home, without theneed for further intervention from healthprofessionals.

Ethical IssuesEthical issues related to the use of emer-gency contraception are particularlythorny. In a country with restrictive abor-tion laws, what is the obligation of med-ical professionals when women seek theirhelp after unprotected intercourse? Is itethical to withhold the benefits of a tech-nology that is less dangerous than eithercarrying a pregnancy to term or under-going a clandestine abortion? How can ahealth provider be guided by the ethicalprinciple of beneficence? Do the goals ofmedical intervention include not only thepromotion of health and the preventionof disease or untimely death, but also therelief of symptoms, pain and suffering?Will the use of emergency contraceptionhelp to achieve these goals?

Two central ethical issues related to theprovision of any family planning methodare informed consent and an assessment ofthe risk-benefit ratios of different methods.It is the obligation of health professionalsto provide adequate information in termsthat the client understands; health providersmust ensure that these risks and benefits areadequately communicated to women seek-ing emergency contraception.13

•Testing and safety. The short- and long-term safety of contraceptive methods, es-pecially when these are provided to poorwomen in developing countries, have toooften been neglected by regulatory bod-ies and health service personnel. In thecase of emergency contraception, whereexisting methods are used for a differentyet important purpose, would womensuffer discomfort, side effects or any otherconsequences because of the larger dosesor changes in the mode of administration?Will the treatment be less or more dan-gerous than the condition it seeks to pre-vent (i.e. pregnancy), given that many po-tential users suffer from iron deficiencyanemia, goiter, hypertension, kidney andheart disease, and other ailments?

The further testing of emergency meth-ods, even in countries where health stan-dards are generally low, could indeed beethical. To date, nearly two dozen studieshave specifically found copper IUDs to besafe for emergency contraception14 and nolong-term complications have been re-ported for the emergency use of oral con-traceptives.15 Moreover, combined oral con-traceptives and IUDs have been extensivelystudied for regular contraceptive use, andnumerous studies have found them to be

“Since many Filipino women are alreadyusing hormonal compounds to inducemenstruation, teaching them how to prop-erly use emergency contraceptive pillswould not be difficult.”

79Volume 22, Number 2, June 1996

ligation; 46% asserted that the Church al-lows it with conditions and another 18%said that the Church had no policy aboutsterilization.19 According to a report on thesurvey, many Filipinos simply separatetheir views on family planning from whattheir religion teaches; intensity of religiousbelief does not seem to have an effect onfamily planning attitudes.

Another survey, conducted by the Uni-versity of the Philippines Population In-stitute, showed that many Filipinos do notaccept Roman Catholic teachings on fam-ily planning.20 Practically all (98%) of the400 couples interviewed said that theywere in favor of the government’s popu-lation policies, and more than three-fourths claimed that they would not beswayed by the pronouncements of theChurch on family planning.

Nonetheless, even if many Filipinowomen do not necessarily follow theChurch’s teachings on contraceptive use,the Church exerts a powerful influence ongovernment policies that affect legal ac-cess to family planning methods. Since thepill and IUD are legally available, their useas postcoital methods cannot be prevent-ed. However, the Church is likely to con-tinue, and even escalate, its campaign toban these methods. Tactics include erro-neously asserting that methods of emer-gency contraception are abortifacients andclaiming that their use (and the use of anycontraceptive) is intrinsically evil. Pres-sure will most likely continue to be exert-ed on the Department of Health, the Pres-ident, legislators (particularly thosesupported by the Church) and Catholicparishioners (through pastoral letters).•Cultural acceptability. Another importantconsideration is the cultural acceptabili-ty of emergency contraception to bothusers and providers. One reason for therelatively low prevalence of modern con-traceptive use in the Philippines—25%among married women aged 15–4921—isa fear of rumored side effects, so emer-gency one-time use may be more cultur-ally acceptable than regular, sustained use.

Filipino language also reflects a cultur-al predisposition that might incline womento use emergency contraception, since thevocabulary of pregnancy implies that lifehas not yet been created at the time of con-ception. For example, a woman is not con-sidered pregnant (buntis) in the first fewweeks after a missed period. Instead, sheis “conceiving” (naglilihi), or in the processof becoming pregnant, which takes amonth or more after a missed period. ManyFilipino women do not believe that they arepregnant until they experience quickening.

safe for appropriately screened women.•Cost. An estimated 120 million womenin developing countries do not practicefamily planning, even though they do notwant to become pregnant.16 There are noestimates, however, of the number ofwomen who might seek methods to pre-vent pregnancy after unprotected coitusif emergency contraception were availableand accessible.

In the Philippines, many women do notseek medical care until their health prob-lems, including those associated withpregnancy, childbirth and abortion, be-come serious. One reason for delayingcare is its cost—in terms of transportationfees, payment for medical consultationand treatment, and missed time fromhousework or paid work. Since emer-gency contraception is used by womenwho are highly motivated to prevent apregnancy, cost is unlikely to be a big con-sideration, especially if medical methodsrepresent a more effective alternative tofolk remedies. Once emergency methodsare available, women would no longerhave to spend money on popular but in-effective and dangerous remedies andmethods, and the emotional costs associ-ated with using illicit or dangerous meth-ods would also be reduced.•Infringement on women’s reproductiverights. Filipino women’s right to repro-ductive self-determination, including therights to health care and the benefits of sci-entific progress, are protected by the In-ternational Covenant on Economic, Socialand Cultural Rights.17 As a matter ofhuman rights, therefore, women exposedto unprotected intercourse should have ac-cess to emergency contraception.•Rape. In countries with restrictive abor-tion laws and where reproductive healthservices may be perceived as related toabortion, it may be helpful to focus initiallegal efforts at making emergency con-traception available to women who havebeen raped. In one Philippine national sur-vey, the 1993 Safe Motherhood Survey,about 3% of women who had ever beenpregnant reported having been raped.18

•Religious arguments. There are consider-able religious constraints to the potentialuse of emergency contraception in pre-dominantly Catholic countries such as thePhilippines, where the Church vigorous-ly opposes the use of “artificial” familyplanning methods. Despite this officialstance, however, a 1992 survey conduct-ed by the Philippine Legislators’ Com-mittee on Population and Developmentshowed that many Filipinos appeared un-aware of the Church’s opposition to tubal

Since many Filipino women are alreadyusing hormonal compounds to inducemenstruation, teaching them how to prop-erly use emergency contraceptive pillswould not be difficult. The larger, morecomplex problem would be devising waysto teach Filipino women to practice fam-ily planning regularly (and to adopt mea-sures to prevent sexually transmitted dis-eases) so they would not need to rely onemergency methods.

ConclusionsThe drafting of the 1987 Philippine Con-stitution, which involved an unsuccess-ful campaign to amend the Bill of Rightsto grant full rights to the unborn, awak-ened the need to promote women’s healthand reproductive rights. Since then, ad-vocates, including governmental andnongovernmental organizations, acade-mia and the media have worked togeth-er in many projects and programs to ad-vance women’s reproductive health andrights. However, the professional medicaland legal associations have not been as ac-tive. The challenge for the broad healthcommunity is to work effectively to enablewomen to have more control over their re-production and exercise their full rights.

Filipino women would probably wel-come any safe product or method thatwould allow them to avert an unwantedpregnancy within the first few days afterunprotected intercourse. Women have dis-covered on their own that estrogen-prog-estin drugs induce menstruation. Ex-panding providers’ knowledge aboutemergency methods and then motivatingthem to apply this knowledge could con-tribute to safer and more effective preg-nancy prevention among women exposedto unprotected intercourse.

Although legal restrictions on both fam-ily planning and abortion will certainly in-fluence the availability of emergency con-traception, this method may provecompatible with cultural norms in thePhilippines, and women and providersmay welcome its introduction. Moreover,women who are highly motivated to pre-vent pregnancy will circumvent restric-tions placed on its use, regardless of thepolitical and religious climate. The beststrategy, therefore, would be to includewomen in decisions regarding the use ofemergency contraception.

Given the controversial nature of fam-ily planning in national Philippine poli-tics, it is essential that accurate informa-tion about emergency contraception bedisseminated to women’s advocates,health providers and policymakers con-

80 International Family Planning Perspectives

Legal, Ethical and Regulatory Aspects

Research and Advocacy on Reproductive Health AmongUrban Poor Women in Davao City,” Development of Peo-ple’s Foundation, Davao City, Philippines, 1994; andWomen’s Studies and Resource Center, “A Study on theCommonly-Used Estrogen-Progestin Drugs as Aborti-facients in Davao City,” Davao City, Philippines, 1992.

8. Women’s Studies and Resource Center, 1992, op. cit.(see reference 7).

9. R. D. Sanchez and M. P. Juarez, 1994, op. cit. (see ref-erence 7).

10. M. Jaymalin, “DOH Regulates Sale of Anti-UlcerDrug That Can Induce Abortion,” Philippine Star, June10, 1994, p. 10; and R. R. Requintina, “BFAD Limits Cy-totec Anti-Ulcer Drug Causing Abortion,” Manila Bul-letin, June 10, 1994, p. 12.

11. National Drug Committee, National Drug Policy Pro-gram and the Philippine Department of Health, Philip-pine National Drug Formulary, 1993.

12. Program for Appropriate Technology in Health,“RU486 in Developing Countries: Questions Remain,”Outlook, Vol. 1, No. 3, 1991.

13. R. Macklin, “Choice or Control,” Populi, Vol. 21, No.7, July/Aug. 1994, pp. 10–12.

14. J. Trussell and C. Ellertson, “Efficacy of EmergencyContraception,” Fertility Control Reviews, Vol. 4, No. 2,1995, pp. 8–11.

nected to the issue. A better understand-ing of the methods among these groupsmay increase the ability of women andtheir families to manage fertility, promotehealth and determine quality of life.

References1. A. Glasier et al., “Mifepristone Compared with High-Dose Estrogen and Progestogen for Emergency PostcoitalContraception,” New England Journal of Medicine,327:1041–1044, 1992.

2. S. K. Henshaw, “Induced Abortion: A World Review,”Family Planning Perspectives, 22:76–89, 1990.

3. R. J. Cook, “Anti-Progesterones and the Law,” IPPFMedical Bulletin, Vol. 20, No. 5, Oct. 1986, pp. 2–3.

4. A. Glasier et al., “Case Studies in Emergency Contra-ception from Six Countries,” International Family Plan-ning Perspectives, 22:57–61, 1996.

5. Department for Economic and Social Information andPolicy Analysis, Population Division, “Abortion Policies:A Global Review,” World Abortion Policies 1994—A Poster,United Nations, New York, 1994.

6. National Drug Committee, National Drug Policy Pro-gram and the Philippine Department of Health, Philip-pine National Drug Formulary, 1991.

7. R. D. Sanchez and M. P. Juarez, “Community-Based

15. J. Trussell et al., “Emergency Contraceptive Pills: ASimple Proposal to Reduce Unintended Pregnancies,”Family Planning Perspectives, 24:269–73, 1992.

16. J. Khanna, P. F. A. Van Look and G. Benagiano, “Fer-tility Regulation Research: The Challenge Now andThen,” in J. Khanna, P. F. A. Van Look and G. Benagiano,eds., Challenges in Reproductive Health Research: BiennialReport, 1992–1993, World Health Organization, Geneva,1994, pp. 34–52.

17. R. J. Cook, “Putting the ‘Universal’ into HumanRights,” Populi, Vol. 21, No. 7, 1994, pp. 15–16.

18. National Statistics Office and Macro InternationalInc., Republic of the Philippines: National Safe MotherhoodSurvey 1993, Manila, Philippines, and Calverton, Md.,USA, Oct. 1994.

19. L. A. Bautista, L. E. Abenir and G. A. Sandoval, “So-cial Attitudes of Filipinos Towards Family Planning In-terest Groups—A Survey,” Social Weather Bulletin, Vol.93, No. 2, 1993, pp. 1–10.

20. J. V. Cabigon, “Preliminary Findings on the Study ofAbortion Prevalence in Metro Manila,” mimeo, Univer-sity of the Philippines Population Institute, Manila,Philippines, 1994.

21. National Statistics Office and Macro International,Inc., Republic of the Philippines: National Demographic Sur-vey, 1993, Manila, Philippines, and Calverton, Md., USA,May 1994, p. 43.