I'm not sure anymore

“There are things we know that we know. There are things that we now know we don’t know. But there are also things we do not know we don’t know. So when we do the best we can and we pull all this information together, and we then say well that’s basically what we see as the situation, that is really only the known knowns and the known unknowns. And each year, we discover a few more of those unknown unknowns.” – Donald Rumsfeld

I was sure about certain things. Like the difference between male and female. And then I heard about the humiliating ordeal suffered by Caster Semenya, the 19-year old South African running phenomenon who dominates the women’s 800m race. Now I’m not sure anymore. Why was she made to undergo all sorts of tests to prove she was female?

Sports are organized according to sex. And, once upon a time, the governing bodies of sports determined sex by looking. Then they found out you can’t believe everything you see. So they started chromosome testing. And that’s when they learned why adults always tell children to stop asking too many questions.

Here’s Ariel Levy of The New Yorker:

“In normal human development, when a zygote has XY, or male, chromosomes, the SRY—sex-determining region Y—gene on the Y chromosome ‘instructs’ the zygote’s protogonads to develop as testes, rather than as ovaries. The testes then produce testosterone, which issues a second set of developmental instructions: for a scrotal sac to develop and for the testes to descend into it, for a penis to grow, and so on. But the process can get derailed. A person can be born with one ovary and one testicle. The SRY gene can end up on an X chromosome. A person with a penis who thinks he is male can one day find out that he has a uterus and ovaries….

“All sorts of things can happen, and do. An embryo that is chromosomally male but suffers from an enzyme deficiency that partially prevents it from ‘reading’ testosterone can develop into a baby who appears female. Then, at puberty, the person’s testes will produce a rush of hormones and this time the body won’t need the enzyme (called 5-alpha-reductase) to successfully read the testosterone. The little girl will start to become hairier and more muscular. Her voice may deepen, and her testes may descend into what she thought were her labia. Her clitoris will grow into something like a penis. Is she still a girl? Was she ever?”

Levy goes on but I guess you get the drift. If not then read the Rumsfeld quote above.

So let’s leave Levy and go to the RH bill.

Rep. Anthony Golez observed recently, “The country is divided on the definition of when life begins, either during fertilization or implantation period. If the country is divided as to the definition of when life begins, then it is to be presumed that the choices used for fertility are not yet certain whether they are lawful or unlawful as provided for by our Constitution as to the protection of life from moment of conception.”

When does life begin?

Golez said Congress must answer that question before it passes a reproductive health bill. That’s the way it should be. And yet I’m afraid.

Congress might end up like the IAAF, the governing body of athletics. It lifted Semenya’s suspension after tests showed she was female but it did not lay to rest questions about what the testing accomplished in the first place. Did it lead to a better and fairer way of organizing athletics and, for that matter, sports? Similarly, how will the answer to Golez’ question insure equal protection for the rights of both the mother and the zygote or the blastocyst, as the case may be?

Blame it all on an old Italian. Everything was fine until he built a telescope to spy on his neighbor’s daughter and aimed it at the stars while waiting for her to get home.

Manuel Buencamino

Buencamino was a weekly columnist for Today and Business Mirror. He has also written articles in other publications like Malaya, Newsbreak, "Yellow Pad" in Business World, and "Talk of the Town" in the Inquirer. He is currently with Interaksyon, the news site of TV5. MB blogged for Filipino Voices, blogs for ProPinoy and maintains a blog, Uniffors.com. Game-changers for him, as far as music goes, are Monk, Miles, Jimi, and Santana.

  • baycas2

    Uh-oh, by “sex education” I mean a comprehensive one.

  • baycas

    Medical Science, incidentally, already pegged the beginning of pregnancy at the completion of implantation, i.e., around two weeks from the union of sperm and egg. Fertilization is a necessary but still insufficient step when talking about the path to pregnancy is concerned.

  • baycas

    This one has to be carefully considered just to safeguard would-be mothers:

    Emergency Contraception (use of strong pills with or without copper IUD; IUD, by the way, was also proven to be effective in preventing fertilization) must be regulated and must be available only when extremely necessary. This post-sexual intercourse scenario, by its label, involves unprotected sex. Timely intervention (within 24 hours probably) is of utmost importance here because there is a chance of fertilization and therefore abortion is likely to happen. (Unprotected sex, or unsafe sex, is contrary to the plan of preventing unintended pregnancies and STDs. Therefore it has to be emphasized that unprotected sex, especially by males, should be strictly avoided.)

  • baycas

    Our Constitution forbids the State to promote or prohibit religion and its practices. (The Separation of Church and State)

    Offer natural family planning and artificial methods.

    Our Constitution also dictates the State to protect the mother and the unborn from conception.

    Prevent unintended pregnancies and sexually transmitted diseases. Prevent abortion.

    Prevent unintended pregnancies and STDs by appropriate sex education across all reproductive age groups. (Sexual or coital debut is reported at 13 years old. Start sex education 1-2 years earlier than that. Responsible parenthood, aside from sex education, needs to be stressed for the adults.)

    The surest way to prevent abortion is by not allowing the sperm to fertilize the egg. The benchmark here by natural process is abstinence from sexual intercourse. (It is a behavioral process, we must accept, that is not to everyone’s liking.)

    How to approximate such process artificially? Combine barrier method (e.g., condom for male) and hormonal drug (e.g., injectable contraceptive for female) during and before sexual intercourse, respectively.

  • baycas

    Though Bacolod representative Dr. Golez is “constitutionally” right in his belief that life begins at fertilization*, I may have some reservations (in the interest of the State’s responsibility to both mother and the unborn) in his other assertion.

    The problem with Dr. Golez’s media pronouncements is that, through all the years they are legally available in the market, the pill (or the OC) and the injectable hormonal contraceptives will finally be proved to be “contrabands” after he (and Congress) determines that life begins at fertilization. It is because he adheres to the idea, as “conceptionists” or pro-lifers do, that the hormonal contraceptives are abortifacients as they prevent uterine implantation of the resultant blastocyst.

    I believe the State must consider that a woman, because she may become a mother equally protected by our Constitution as the unborn, ought to be given an informed choice. Hormonal contraceptive, with correct and consistent use, is not an abortifacient by itself for it has been proven to be highly effective in preventing ovulation and in preventing the sperm to “swim” effectively to meet the egg. Not only that, for there is another mechanism…it is also good in preventing fertilization by making the egg impervious to penetration by the sperm. So, strictly speaking, a woman will not abort anything.

    But Dr. Golez said it works that way in 97% only. How about the 3% chance? I don’t know his stats but probably he means 3% accidental pregnancies from use of hormonal contraceptives alone.

    This slim a chance, mostly attributed to improper and inconsistent use of the contraceptive, could now be addressed by my suggestion…

    —–
    *[“This is reflected in one of the exchanges during the debate. Since the protection of the unborn was to begin from conception, Reverend Cirilo Rigos asked when the “moment of conception” was. Commissioner Bernardo Villegas, who was the principal sponsor of the provision, answered that the conception took place with fertilization since “it is when the ovum is fertilized by the sperm that there is human life.” When Commissioner Fely Aquino observed that at that point there would only be biological life, Bishop Teodoro Bacani did not contradict her but said that there would already be biological human life even if there was as yet no “person.”

    From this it can be seen that the intention is to protect the “life” even before implantation in the uterus, that is, from the moment biological life begins. The constitutional intent, in other words, is to play it safe lest human life be destroyed and to impose the protection even before implantation in the uterus.”]

    http://zglaw.com/blog/church-constitution-and-the-rh-bill.html

  • Bert

    “So how does Congress settle the question without just coming up with an arbitrary answer?”-MB

    If biological scientists cannot settle the question, it would be easy to assume that Congressmen can’t either. Which means that Goles is a stooge of the CBCP, out to torpedo the passage of the RH bill.

  • manuelbuencamino

    Baycas,

    So there you go, we know what it is but we can’t tell exactly when it happens. So how does Congress settle the question without just coming up with an arbitrary answer?

  • baycas2

    MB,

    It’s really nice to know the exact moment of fertilization (or conversely, the exact moment of abortion). But Rumsfeld’s “unknown unknowns” recurrently flash back to our minds.

    [“Many times they meet and then go their separate ways.“]

    Yes, but this is only a part of Rumsfeld’s “known unknowns.” There is male ejaculation inside a woman but sometimes you are firing blanks. Other times, the millions of sperms are not the Michael Phelps kind. Thus, they fail to have even a glimpse of the egg.

  • baycas2

    Oops, reading again the CDC Guidelines I cited…I believe Emergency Contraception (EC) with BOTH oral contraceptive pills and Copper IUD could equal the 100% abstinence success rate of preventing the sperm to fertilize the egg. No fertilization, no abortion!

    This, I think, should be considered in the context of protecting the mothers who are unfortunately burdened by UNINTENDED pregnancies.

  • manuelbuencamino

    Baycas,

    Wouldn’t it be easier to identify the exact moment of fertilization if a green light came on? Absent the green light, we don’t know for sure if something happened after the sperm met the egg. Many times they meet and then go their separate ways.

  • UP nn grad

    The CBCP has to be careful, because each year that the CBCP does not press to have the doctors and nurses of Pilipinas IVF jailed for abortion, then that is another year that the CBCP says that life does not start when a sperm fertilizes an egg.

  • baycas

    Hormonal and barrier methods

    Chemical abortion, I stated, may happen from solely using oral or injectable hormonal drugs. This is because fertilization may still occur even with this form of contraception owing to the phenomenon of “breakthrough ovulation.” Breakthrough ovulations are reported to occur from 40-81%.

    Yes, there is no simple way to detect fertilization (although EPF is already known) BUT there is also no simple way to detect the perhaps millions of chemical abortions each year.

    What is known is that ovulation with possible fertilization as a consequence can still happen AFTER taking or being given hormonal contraceptives.

    Hormonal contraceptives will only act as such when they are used BEFORE a sperm meets an egg (i.e, before conception or fertilization). Beyond this stage, they are already considered hormonal (chemical) abortifacients.

    The potential for fertilization from breakthrough ovulations to occur is higher when the sperm is allowed to meet with the egg. Therefore, barrier methods must be employed in combination with hormonal contraceptives to approximate the 100% effectiveness of abstinence. Doing this will also hopefully ensure the non-occurrence of chemical abortion.

    Emergency Contraception (EC), e.g., the “morning after” pill, (sometimes with the use of IUDs) has a tendency to induce chemical abortions because start of pregnancy may also happen after UNPROTECTED sexual intercourse.

    The 2006 CDC Treatment Guidelines on STD states:

    [“Emergency use of oral contraceptive pills containing
    levonorgesterol alone reduces the risk for pregnancy after
    unprotected intercourse by 89%. Pills containing a combination
    of ethinyl estradiol and either norgestrel or levonorgestrel
    can be used and reduce the risk for pregnancy by 75%. Emergency
    insertion of a copper IUD also is highly effective, reducing
    the risk by as much as 99%. EC with oral contraceptive
    pills should be initiated as soon as possible after unprotected
    intercourse and definitely within 120 hours (i.e., 5 days).
    ”]

    Note that EC alone has a failure rate of 11% but approaches the abstinence success rate when combined with a spermicidal IUD. The chance of chemical abortion (i.e., preventing a fertilized egg from implanting into the mother’s womb) is down to 1%…well, what’s 1% among friends?

    Kidding aside, I believe this aspect of EC, or hormonal contraceptives in general, must be taken into careful consideration by the State. Using them ALONE has a potential for chemical abortion. However, using them in COMBINATION with barrier methods (like condom, diaphragm, or spermicide) will somehow protect “the life of the mother” as what is also the prevailing guarantee (equal to the right of the unborn) enshrined in our Constitution.

  • baycas

    Conception and abortion
    The beginning and the end

    Life has its stages. It starts from the beginning, i.e., conception.

    Growth and development of a fetus start from fertilization of the egg by the sperm.

    http://www.wccusd.k12.ca.us/gompers/HealthScience/BodySystems/Fertilization.jpg

    From zygote. To blastocyst. To embryo. To fetus.

    Abortion was not defined in the 1930 Revised Penal Code. We may consider the classic definition of abortion: “expulsion of the fetus before it is viable.”

    Regardless if Rep. Golez will finally have an answer to his question when life begins, abortion takes place at the fetal stage of development.

    So, whether pregnancy starts when a zygote is formed (fertilization) or when a blastocyst is implanted into a mother’s womb (implantation)…anything that will happen at these stages may NOT be considered abortion if the classic definition is applied. What is cause of concern if a woman just passes out her egg (albeit already a different kind from the one originally she produced)?

    However, our 1987 Constitution protected the life of the unborn starting from its conception thereby encompassing the explicit prohibition of aborting it early in its development.

    Abortion, regardless of its nature [chemical (sole use of oral or injectable contraceptives), surgical, or mechanical (e.g., abdominal massage or introduction of foreign objects into the uterus), will end life at all stages.

  • manuelbuencamino

    mario and bert,

    Yes, but like the sports bodies found out a long time ago “you can’t believe everything you see.”

    But you can check them out yourself if you want. And I’ll take your word for it. Promise.

  • mario taporco

    @MB,

    “…So I thought…well there’s only one way to find out…so I approached one and asked her “Wanna race?”

    per mb
    Sounds like Bert has a more substantial, and concrete ways of proving the fact. I would have to sides Berts proven techniques and methods.

  • manuelbuencamino

    Pilo,

    The problem I believe is there is no simple way of knowing when actual fertilization occurs. But that’s what Congress will have to determine.

    Imagine trying to prove that abortion rather than contraception occurred in a specific case involving a particular female who took a morning after pill.

    How can you say she killed a fertilized egg when you can’t even tell if it was fertilized to begin with?

    Now Congress cannot err on the side of caution here because that would violate the rights of the woman concerned as the Constitutional prohibition on abortion will not activate until conception is proven to have happened.

  • Pilo

    I dont think there is much disagreement in the scientific community about when live begins, they pretty much all agree it begins at conception.

    If a fertilized egg has from the moment it was fertilized its very own DNA code, distinct from that of the mother, it can no longer be considered just a cell that is part of the larger being.

    The cells in your mouth are small parts of the larger being, there is one being made up of many cells, all those cells share the exact same DNA code because they are only parts of the whole.

    A fertilized egg is not just a small part of the larger being, it is a new being all its own. Its the location that throws people off, the fact that this new being is growing inside of another.

  • Pilo

    Those who claim unfertilized eggs and sperm represent life are equivocating likely to blur the lines. Neither of them replicate. the life of the living organism begins at conception.

  • Bert

    MB,

    You’d used the more rigorous method which might not be accurate at all. If I were in your place, and seeing such very pleasant specimen, I will be more scientific, you know, to see is to believe, or something of that crap, so, might as well use the “intimate method”, and know for sure.

  • Bert

    “So I thought…well there’s only one way to find out…so I approached one and asked her “Wanna race?””

    MB,

    What happened next, did you find out?

  • manuelbuencamino

    Baycas,

    Thanks for that. No I don;t know anymore.

  • manuelbuencamino

    Mario,

    I used to go by your first example and then I saw the same walking objects in Bangkok and in P.Burgos in Makati. And they were not even transgenders! So I thought…well there’s only one way to find out…so I approached one and asked her “Wanna race?”

  • I know that coathangers aren’t clean or delicate, and human emotions cannot be defined by legal code.

    I think the debate about when life begins and what is a morally appropriate way to control overbirthing are largely useless mental machinations. It must be drilled into the Filipino conscience that more than two children per family will drive the country to ruin. Let the dreadful weight of this conscience descend on those who would otherwise chose to send their brothers and sisters and neighbors to ruin. A good advertising guy could spread the word easily.

    This could be done by Executive Order, so all the legal rigmarole is simply a far too typical substitution of detail for substance.

  • UP nn grad

    The CBCP should mount a strong campaign so that doctors and nurses of IVF facilities in Pilipinas are be jailed (when they discard excess conception-events).

  • mario taporco

    MB,

    Lemme try to figure this one out.
    First, Donald Rumsfeld’s quote was brilliant, he did not jeopardize himself for what he knows or don’t know, also what’s up ahead.

    Secondly, lemme briefly describe how a woman walks and runs in front of me. By my experience, seeing a woman who struts their stuff on or off the track, is very appealing to me.
    Exmaple One, a woman who walks the shopping mall with all that goody bags by her sides, and cuddling those fine Gucci and Saks 5th Avenue bags with her arms extended out and bent to one side. With all that added weight, a woman must distribute those shopping bags with precision, and a well coordinated balance. From behind, literally following her behind. A woman walks with such finess, and side to side motion. That’s a woman.

    But on the track-field, they are quite different. If I see a girl or a woman for that matter running by me like speedy gonzales, I would have to question that thought.

    Thirdly, Mr. Levy’s scientific evaluation and breakdown can be complicated to understand. Judging by my experiences, I have not seen a specimen in front of me yet. I would have to prove Mr. Levy’s definition on this matter; will see.

    Sounds Freaky…,!

    Fourthly, I would have to ask Rep. Anthony Golez when life begins. Two thing I would ask him.
    • One, does life begin with natural conception or,
    • Two, does life begin in the palm of your hand…,?

    Lastly, I need to buy one of those telescope, so that I can make a better judgment of a woman from afar; I need new glasses.

    MB, you are really confusing me. 

  • baycas

    The State, recognizing the separation of Church and State, must do what has to be done and therefore must INFORM the public of all available options as regards contraception, let them DECIDE, and if they need help, ASSIST them.

    Contraception, in our setting, is about prevention of fertilization. Without fertilization, abortion will not occur.

    I believe contraception, if ever by conviction is decided by a couple (regardless if through natural or artificial means), needs to be used BEFORE or DURING sexual intercourse. Combination of the various methods of contraception increases the chance of preventing pregnancy; possibly as close as when abstinence is behaviorally employed (or when successful sterilization was done).

    Combination (barrier plus hormonal methods) will address the fear of committing abortion after an unknown breakthrough ovulation and fertilization. (Besides, condom use in males may help prevent the dreaded STDs – mostly caused by viruses that are without treatment.)

    Emergency contraception (with or without IUDs), which is done AFTER unprotected sexual intercourse, should be banned. [During unprotected sex (i.e., without barrier and/or hormonal methods) there is a higher chance of ovulation and higher chance of a sperm fertilizing the egg and so there is higher chance of abortion.]

  • baycas

    But there are also things we do not know we don’t know.

    1. Breakthrough ovulation is the presence of ovulation even after performing rhythm method or even after using hormonal contraceptives. It is not synonymous to fertilization.
    2. Sexual intercourse during breakthrough ovulation may result in pregnancy (sperm fertilizing the egg). Fertilization during breakthrough ovulation may be prevented by using a condom and/or diaphragm.
    3. We do not know if breakthrough ovulation occurred so we don’t know if a sperm is able to meet an egg (fertilization).
    4. We do not know if breakthrough ovulation then fertilization occurred so we don’t know if abortion has taken place after using hormonal contraceptives alone prior to having sex.

  • baycas

    There are things that we now know we don’t know.

    1. Pregnancy may begin (a) upon fertilization (pro-life definition), or (b) upon uterine implantation (medical science). It is of no matter to discuss further the meaning of pregnancy because our Constitution already protected the unborn child UPON CONCEPTION.
    2. Early pregnancy (a) is difficult to diagnose (e.g., we need to use an expensive and still unreliable “pregnancy” test to detect the protein called Early Pregnancy Factor or EPF within 48 hours of ovulation if fertilization occurred) whereas the latter definition (b) can be easily detected by hCG (human chorionic gonadotropin) testing – the usual pregnancy test.
    3. Abortion in our setting means disrupting the natural process of life of the fertilized egg; in short, disrupting pregnancy. We will not know if fertilization has occurred but we can ascertain if implantation happened (about 6-10 days post-ovulation) by the readily-available pregnancy testing usually done when a woman missed a period or when she feels like being pregnant.
    4. We now know that pregnancy takes place after fertilization but we don’t know if any abortion will TRULY occur from immediately beyond that stage up to the implantation stage because it is not feasible to detect if actual fertilization happened. (The fertilized egg stays in the fallopian tube for 3 days before entering the uterus and begins to implant to the uterine lining.)
    5. Artificial contraception also includes hormonal methods [oral or injectable contraceptives; emergency contraception (EC)] and intrauterine methods.
    6. The pill or the injectable hormones (taken or given before sex) and the emergency contraception (using a higher dose of or a different concoction from the ordinary pill; “emergency” because it is done within 72 hours after unprotected sex) acts in four mechanisms: two ways as contraceptive (preventing fertilization) and another two as abortifacient (preventing implantation of fertilized egg).
    7. Intrauterine devices (IUDs) may be laden with spermicides (contraceptive property); other times with hormones preventing implantation (abortifacient property). Combined with EC may increase the chance of birth control and/or abortion.
    8. We now know that hormonal methods (with or without IUDs) may work as contraceptive and/or as abortifacient but we don’t know how they actually work inside the woman’s womb.

  • baycas

    There are things we know that we know.

    1. When a man had normal sexual intercourse with a woman a child may be conceived.
    2. Our Constitution protects the life of the unborn child upon conception.
    3. Conception means the sperm is able to fertilize the egg: the beginning of life.
    4. Contraception means anti-conception: the sperm does not fertilize the egg.
    5. Contraception is allowed but our Revised Penal Code criminalizes abortion.
    6. Contraception can either be natural or artificial. This is usually employed before or during sexual intercourse.
    7. Natural family planning includes symptoms-based method (e.g., Billings method), calendar-based method (e.g., rhythm method), and lactational amenorrhea (when a woman gives birth and is breastfeeding; regular menstrual cycle will not immediately return resulting in temporary female infertility)
    8. Artificial contraception includes use of barrier methods (e.g., condom or diaphragm; spermicides), sterilization (vasectomy or bilateral tubal ligation), and withdrawal method.
    9. Abstinence may or may not be considered a contraceptive method. Nonetheless, it (similar with successful sterilization) provides 100% effective birth control.
    10. The rest of the birth control methods may still give rise to conception. But if used in combination (e.g., use of condom by male and contraceptive pill by female) may achieve a higher chance of contraception close to abstinence.

  • Hi Bert,

    That’s why I’m not sure anymore

  • Bert

    Well, I know that I know it if I know it, though at times I know that I know that I don’t know the things that I don’t know. Until I know…that now I know I’m lost. Haaaay!