MANILA Minda is a masseuse with a difference. Her caress is used to abort fetuses.
The 50-year-old grandmother has lost count of the number of pregnancies she has terminated in this largely Roman Catholic country where abortion is illegal and strictly taboo, but where about half a million women end their pregnancies every year.
The backstreet abortions performed by healers like Minda may become more common as a United States government aid program plans to stop distributing contraceptives in the Philippines in 2008. This will leave birth control up to the government which under the influence of Catholic bishops advocates unreliable natural birth control methods rather than the pill and condoms.
Most women who seek abortions are like Remy, married with several children and too poor to afford another baby.
The petite 44-year old, who declined to give her last name, paid 150 pesos ($3) for a hilot, or traditional midwife like Minda, to crush her three-month old fetus using rough strokes and pincer-like grips on her belly.
The procedure, which can also involve pounding the lower abdomen to trigger a miscarriage, is called a massage.
"I felt guilty but I thought it was better than having another child that will only suffer because we have no food," she said in an interview in a slum on the outskirts of Manila.
Remy bled for a week after her session with the hilot, passing out with the pain. She refused to let her husband take her to the hospital because of the shame of what she had done and because they couldn't afford the medical bills.
"I just prayed to God and asked for forgiveness," she said.
Before her abortion, Remy had no access to artificial family planning. If she had, she says she wouldn't have become pregnant and resorted to the potentially life-threatening procedure.
Under President Gloria Macapagal Arroyo, a devout Catholic who relies on the support of politically powerful bishops, the central government promotes natural family planning methods such as abstinence when the woman is ovulating.
Poor people, who make up the majority of the population, rely largely on the U.S. government agency USAID, the main supplier of contraceptives in the country for the past 30 years.
But USAID has started phasing out supplies and plans to end the rest of its donation program in 2008. The agency has said its phase-out is in line with Manila's goal of self-reliance in family planning.
Officials says the central government's reluctance to take up where USAID will leave off will certainly push up the country's rate of abortions, which is already twice as high as in western Europe, where terminations are legal and easily accessible.
"Supplies (of contraceptives) have already run out in many towns and cities so the situation is rather desperate," said Dr Alberto Romualdez, a former health secretary under deposed President Joseph Estrada.
Catholic clerics in the Philippines urge their congregations to use natural family methods rather than the contraceptive pill.
"The natural family planning method is a good option, not only a good one but an effective one," Father Melvin Castro, executive secretary of the Episcopal Commission on Family and Life, told Reuters.
Over half of women who have had an abortion in the Philippines were not using any family planning and of those that were, three-quarters were using natural methods advocated by the government such as rhythm or withdrawal, according to a survey by the U.S.-based. Guttmacher Institute.
Both methods have high failure rates.
The population, currently estimated at 89 million, is expected to swell to 142 million by 2040 and the rapid arrival of new mouths to feed is already straining the country's creaking infrastructure and choking efforts to cut poverty."
Women who abort their fetuses in the Philippines risk a prison sentence of up to six years, while anyone providing help or assisting faces a similar sentence as well as the loss of any medical license.
Only one in four women have a surgical procedure according to the Guttmacher Institute. The 4,000-15,000 peso cost, usually in private clinics, is beyond the pockets of most women.
Over 30 percent ingest either cytotec, an anti-ulcer treatment they can buy in pharmacies, or herbal concoctions, often sold in stalls in front of churches.
Around 20 percent take hormonal drugs, or aspirin, as well as other medications and alcohol. Some starve themselves or fling themselves down stairs. Most women only succeed in ending their pregnancy after multiple attempts.
Among poor women seeking abortions, over 20 percent get massages from hilots or insert catheters in their vaginas.
One mother of three, who had two abortions, said the hilot's touch was agony.
"When she squeezed, it was so painful I wanted to kick her. I bit the blanket. I wanted to cry but I felt I had to contain myself," said the woman, who declined to be named.
"The pain was worse than childbirth."
The second time she had a surgical procedure in a backstreet clinic without anesthetic.
"The room was so close to the street I could hear cars and police sirens," she said. "I was afraid I was going to be arrested with my legs wide open."
Dr Junice Melgar, executive director of Likhaan, a women's health organization, said a lack of information about artificial contraception and myths about their side-effects was putting some poor people off using them.
"There is a lot of fear among the women," she said. "You have women choosing abortion before family planning because of these fears."
Ignorance and rumors, sometimes spread by pro-life groups and members of the clergy, have led some Filipinos to believe that the contraceptive pill is made from placenta and the tablets accumulate in the abdomen and cause cancer.
FEEL THE PAIN
Although abortion is rarely discussed publicly in the Philippines, nearly 80,000 women are treated in hospitals every year for complications from induced abortion, according to health reports.
Many are treated roughly by nurses and doctors who abhor what they have done. Painkillers are sometimes withheld. At least 800 women are estimated to die every year from complications.
"Doctors feel that women need to feel the pain so that they will remember and not do it again," said Melgar.
Women who have miscarried sometimes suffer the same ill-treatment because they are suspected of inducing the loss.
Gemma Apelado, a mother of one, said doctors let her bleed all night when she went to a hospital in Tondo, a poor area of Manila, after having a miscarriage at four months.
"They were all standing around me and they were saying that I took something to induce an abortion," she said. "They were telling me I didn't have any conscience."
Minda, the hilot, says her conscience has started to trouble her. The mother of nine administers pills to induce abortion and uses heavy strokes to push the fetus down.
"I worry about karma," she said. "But I also pity those having to undergo abortions".