“Cytotec is a Life-Saving Essential Medicine” by Clara Rita A. Padilla

Quezon City, August 21, 2009 – “Yesterday, August 20, thousands worth of cytotec were seized by the Philippine National Police (PNP) in Quiapo. Contrary to what fundamentalists and the misinformed say, cytotec, with generic name misoprostol, is considered by the World Health Organization (WHO) as “a life-saving device.” In April 2009, the WHO announced the inclusion of misoprostol to its Model List of Essential Medicines based on its proven safety and efficacy for the treatment of incomplete abortion and miscarriage,” said Atty. Clara Rita “Claire” A. Padilla, Executive Director of EnGendeRights.

The inclusion to the Model List of Essential Medicines was made by an expert committee that evaluated available evidence, which includes several guidelines and numerous randomized and comparative clinical trials for this indication.

In the proposal submitted by Gynuity Health Projects to the WHO, it state the following evidence and considerations:
• “Misoprostol is effective for this purpose. More than a dozen randomized or comparative trials have been carried out, the most recent showing that misoprostol has a success rate of about 90-100% for treatment of incomplete abortion and miscarriage.
• Medical evacuation of the uterus with misoprostol offers an alternative to surgical treatment, which in low-resource settings is often unavailable and may be associated with significant morbidity.
• Misoprostol is inexpensive and so offers a low-cost but safe and effective means of treating this common obstetrical condition.
• Misoprostol is safe. More than 600 studies have been published on the use of misoprostol in obstetrics and gynecology that have involved well over 90,000 women.
• Incomplete abortion contributes disproportionately to maternal morbidity and mortality in much of the developing world.”
The WHO Model Essential Medicine List guides the development of national and institutional essential medicine lists. The Model List has led to a global acceptance of essential medicines to promote health equity.
Atty. Padilla said, “The denial of access to safe life-saving medicines such as cytotec is not only contrary to international human rights law and international medical standards but will further compound a major public health crisis in the country involving half a million unsafe abortion procedures every year, 79,000 hospital admissions for complications from unsafe abortion and 800 deaths.”
“Twelve percent of maternal deaths in the Philippines are due to unsafe abortion. The latest Philippine statistics on abortion also show the following profile of women who induce abortion: nine in ten women are married or in a consensual union; more than half have at least three children; two-thirds are poor; nearly 90% are Catholic,” Atty. Padilla continued.

“Our national statistics reveal that criminalizing abortion does not eliminate abortions; it only makes it dangerous for women who undergo clandestine and unsafe abortion. No one wants women to be in a circumstance where they have no choice but to seek an abortion. But the reality is that unequal power relations prevent women from having control over their bodies and their reproductive decisions,” added Atty. Padilla.

“Furthermore, in the Philippines the full range of contraceptive methods is unavailable, which directly contributed to the high rate of unwanted pregnancy and pushes women to resort to unsafe abortions that in many cases result in death. The obligation to provide access to information and family planning methods as a means of reducing abortion has been recognized by the Committee on the Elimination of Discrimination against Women (CEDAW Committee) and the Beijing and Cairo Conferences consensus documents,” said Atty. Padilla.

Recognizing the need of women for misoprostol, organizations like Women on Waves and Women on Web have come out with guidelines on its use for medical abortion up to nine weeks of pregnancy.

Atty. Padilla continued, “Predominantly Catholic countries around the world have long separated fundamentalist Catholic Church doctrine with the states’ policies. A classic example is Spain, whose colonial rule in the Philippines converted many Filipinos to become Catholics, which allows abortion on certain grounds[2]. Other predominantly Catholics countries that allow abortion are Belgium, France, Italy,[3] Hungary,[4] Mexico,[5] Portugal,[6] Poland,[7] and Colombia[8]. While Spain and other predominantly Catholic countries have liberalized their laws to protect human rights and ensure social justice, we Filipinos have been left to contend with the vestiges of our outdated colonial laws and values.”

“During the August 2006 periodic review of the Philippines, the CEDAW Committee, urged the Philippine government to ‘consider the problem of unsafe abortion as a matter of high priority’ and ‘consider reviewing the laws relating to abortion with a view to removing punitive provisions imposed on women who undergo abortion and provide them with access to quality services for the management of complications arising from unsafe abortions and to reduce women’s maternal mortality rates in line with the Committee’s general recommendation 24 on women and health and the Beijing Platform for Action,’” Atty. Padilla stressed.

Atty. Padilla added, “The critical link between unsafe abortion and maternal mortality has also been a matter of concern for the Human Rights Committee, the Economic, Social and Cultural Rights Committee, and the Children’s Rights Committee. They have consistently called upon states with criminal abortion laws to review their laws as a means to ensuring women’s basic human rights.”
“In the communication K. Llantoy v. Peru[9] filed with the Human Rights Committee (HRC) where a 17-year old woman was prevented from terminating her risky pregnancy of an anencephalic fetus (a fetus with a partial brain[10]) where the infant died five days after birth and the woman fell into a deep depression,[11] the HRC found in 2005 that: forcing the woman to carry her pregnancy to a term constituted cruel and inhuman treatment in violation of article 7 of the ICCPR;[12] violated her right to privacy under article 17;[13] and violated her right to receive the special care she required as an adolescent girl from the health system under article 24.[14] The State party was recommended to provide an effective remedy to the author, including compensation, and to adopt measures to prevent similar violations from occurring in the future,”[15] Atty. Padilla continued.

“Although misoprostol (with brand name cytotec) is already in the WHO Model List of Essential Medicines, cytotec is still an unregistered drug here in the Philippines. Recognized as a life-saving device, cytotec must be registered by the Bureau of Food and Drugs (BFAD) to make it readily available to women who need it. The Philippine government must ensure that international human rights standards and medical standards are upheld in the Philippines,” concluded Atty. Padilla.


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[1] Misoprostol is already included in the 14th (2005) and 15th (2007) editions of WHO Model List of EssentialMedicines (22.1 Oxytocic) because of its proven safety and efficacy for medical
abortion and labor induction. In April 2009, WHO announced the inclusion of misoprostol to its Model List of Essential Medicines for the treatment of incomplete abortion and miscarriage.

[2]Spain permits abortion on grounds of rape and fetal impairment.

[3] Belgium, France and Italy permit abortion upon a woman’s request.

[4] Hungary’s constitution protects life from conception but permits abortion up to 12 weeks of gestation.

[5] Mexico City legalized abortion in the first trimester without restriction (April 24, 2007).

[6] Portugal allows abortion up to 10 weeks of pregnancy but with a mandatory three-day "reflection period” (up to 12 weeks if her health is at risk; up to 16 weeks if the pregnancy is a result of rape; any time during the pregnancy to save a woman's life).

[7] Poland allows abortion to protect a woman’s life and physical health; rape, incest; fetal impairment

[8] Colombia now permits abortion on the following grounds: where the woman’s life or health is in danger; the pregnancy is the result of rape; when the fetus has malformation incompatible with life outside the uterus. Colombia’s abortion law formerly outlawed the procedure under all circumstances. The law was challenged in the Constitutional Court by a Colombian citizen on April 14, 2005. The argument included the CEDAW and ICCPR monitoring bodies’ recommendations for Colombia to decriminalize abortion under the most extreme cases.

[9] K. Llantoy v. Peru, Case No. 1553/2003, U.N. Doc. CCPR/C/85/D/ 1153/2003 (2005).
[10] Id. ¶ 2.1.
[11] Id. ¶¶ 2.5 & 2.6.
[12] Id. ¶ 6.3.
[13] Id. ¶ 6.4.
[14] Id. ¶ 6.5.
[15] K. Llantoy. v. Peru, Case No. 1553/2003, U.N. Doc. CCPR/C/85/D/ 1153/2003, ¶ 8 (2005).