In Roman times, men customarily placed their right hands over their testicles and swore by them before testifying in court. This is not strange given that the Latin word testis meant “witness”.

This practice is seen even in the Bible in the Book of Genesis where Abraham told his most trusted servant who was on a mission to find a wife for his son Isaac to “place your hand under my thigh” which is a euphemistic way of instructing the servant to swear upon the testicles of his master.

It seems that then, as now, the balls are a symbol of moral fiber, truthfulness and courage. Since this area of the male anatomy falls under the domain of urologists, I thought it would be enlightening to trace the etymological roots of this body part that has much to do with the practice of your branch of medicine even as I hope that the traits that the testes symbolize – honesty, straightforwardness and moral fortitude – would also characterize our discussion of the RH bill.

Each time I begin a talk on House Bill No. 5043 or the Reproductive Health bill, I make it a point to first disabuse the minds of the audience by underscoring that reproductive health as a concept is not about sex. Neither is it about religion. Nor is the bill primarily about condoms and pills. This seems to surprise most people who continue to equate reproductive health with sex, contraceptives, hedonism and promiscuity.

Reproductive health is fundamentally about health, rights and sustainable human development. The bill is fully transparent. There are no caveats and the authors have no hidden agenda. 

As urologists, you are directly involved in ensuring male reproductive health and I am heartened your association sees the impact a bill such as House Bill 5043 will have on sexual dysfunction in men and in ensuring that this will be both treated and prevented.

The RH bill is anchored on the principle that everyone has the right to reproductive self-determination – meaning the right to decide when and how often one becomes a parent or the right not be a parent at all. Should a couple decide that they want to plan and space their children, the State must be able to provide them with relevant and timely information on all methods of family planning which are legal and medically safe. Once the couple has decided on the method best suited to their needs, personal convictions and religious beliefs, then the State must once again be prepared and equipped to provide them with quality reproductive health and family planning services.

Moreover, should a woman decide to become a mother, the State must be able to provide her with the services she needs for safe motherhood.

At the heart of the bill is freedom of informed choice. Neither the State nor the Church has the authority to tell the people or the faithful what family planning method to adopt. The choice belongs to couples, particularly to women because they put their lives at risk every time they bear children.

The essence of the RH bill is to provide an enabling environment that will protect and promote the right of individuals and couples to make informed decisions when it comes to planning their families; the right to have healthy babies and provide adequately for their families; and the right to reproductive health, an enjoyable and safe sex life, and reproductive self-determination.

Although reproductive health has long been considered a basic human right, this remains illusory for millions of Filipinos, especially the poor. Consider the following:

1.    2.6 million Filipino women would like to plan their families but lack information and access to do so. (Family Planning Survey 2006)
2.    The poorest Filipinas are still having an average of 6 children  which almost 3 times their desired number. (FPS 2006)
3.    44% of the pregnancies of the poorest women are unwanted. (FPS 2006)
4.    According to the latest study of the Guttmacher Institute of New York in collaboration with the UP Population Institute, more than half of the Philippines’ 3.4 million pregnancies are unintended and 92% of them occur to women who either use no method or use a traditional method.
5.    Among the poorest women who would like to avoid pregnancy, at least 41% do not use any contraceptive method because of lack of information or access.

1. The bill is pro-poor, pro-women and pro-life. The principal beneficiaries of this bill are the poorest of the poor and the marginalized. RH and family planning significantly improves maternal health and lowers maternal morbidity. Having the ability to plan and space children will afford women more employment and educational opportunities and will significantly lower abortion rates. The bill will also prevent infant and child deaths. Family planning will also mean larger investments in health and education and better health outcomes for children.

2. The bill promotes safe motherhood and better health for infants and children. The WHO and the UNFPA assert that correct and consistent use of contraceptives will prevent one-third of all maternal deaths and family planning helps prevent 1 million infant deaths worldwide.

3. The bill will promote sustainable human development. The UN stated that “family planning and reproductive health are essential to reducing poverty” and “countries that invest in reproductive health and family planning and in women's development register slower population growth and faster economic growth”.

4. The UNICEF underscores that “family planning could bring more benefits to more people at less cost than any other single technology now available to the human race.” The return of investment in family planning and contraceptive use is high. In fact, it leads to net government savings as medical costs associated with unintended pregnancies would fall from P3.5-B to P600-M.

5. Expanding access to contraception could result in 800,000 fewer unplanned births; 500,000 fewer induced abortions; 200,000 fewer miscarriages; and 2,100 less maternal deaths.

Misconception 1: the bill is anti-life.

•    It is pro-quality life. It will ensure that children will be blessings to their parents since their births are planned and wanted.

•    The bill is not against the birth of children. It does not advocate that women and couples stop having children. What it only aims to do is to help women and couples achieve their fertility goals.

Misconception 2: Bill is biased for modern methods of FP.

•    The bill does not favor modern methods of family planning over the natural methods preferred by the Catholic Church. Section 3(a) of the bill provides: “In the promotion of reproductive health, there should be no bias for either modern or natural methods of family planning.”

Misconception 3: Bill legalizes abortion.

•    The bill underscores that abortion is illegal, criminal and punishable, and is not part of the menu of legally permissible and medically safe family planning methods.

•    The bill will not lead to the eventual legalization of abortion. Catholic countries like Panama, Guatemala, Brazil, Chile, Columbia, Dominican Republic, El Salvador, Paraguay and Ireland all prohibit abortion as a family planning method even as they vigorously promote contraceptive use.

•    Contraceptive use and abortion have an inverse correlation: regular and correct use of contraceptives reduces abortion rates since unplanned and unwanted pregnancies are avoided. The RH bill is in fact anti-abortion.

Misconception 4: Bill endorses abortifacients.

•    Pills and IUDs are BFAD-approved, medically safe and legal.

•    The WHO declares that contraceptives “cannot be labeled as abortifacients”.

•    Critics of the bill have been claiming that contraceptives prevent the implantation of a fertilized egg which they equate with abortion. But according to the Department of Reproductive Health and Research of the WHO not only are contraceptives not abortifacients, “there is no evidence to date that has supported the hypothesis that these lead to the disruption of implantation.”

Misconception 5: Contraceptives kill.

•    Medical risks connected with contraceptives are infinitely lower than the risks of an actual pregnancy and everyday activities.

(a)    Risk of dying within a year of riding a car is 1 in 5,900.
(b)    Risk of dying within a year of using pills is 1 in 200,000.
(c)    Risk of dying from a vasectomy is 1 in 1 million.
(d)    Risk of dying from using an IUD is 1 in 10 million.
(e)    Risk of dying from condom use is absolutely zero.
(f)    But the worldwide risk of dying from a pregnancy is 1 in 10,000.
(g)    In the Philippines, the lifetime risk of dying from maternal causes is an alarming 1 in 100.

Misconception 6: Bill claims to be panacea to poverty.

The bill simply recognizes the verifiable link between a huge population and poverty. Unbridled population growth stunts socio-economic development and aggravates poverty. Consider the following:

•    The Philippines is the 12th most populous country in the world but we rank 102nd out of 179 countries in the Human Development Index of the United Nations Development Program.

•    According to the Asian Development Bank, a large population is one of the major causes of poverty in the country.

•    Large family size is a significant factor in keeping families poor across generations. (Phil. Institute for Development Studies)

Misconception 7: Sexuality education will promote promiscuity.

•    Age-appropriate RH education promotes correct sexual values, which is the antithesis of promiscuity.

•    International empirical studies document the following benefits of sexuality education among the young: (1) understanding of proper sexual values is promoted; (2) initiation to sexual relations is delayed; (3) abstinence before marriage is encouraged; (4) multiple sex partners is avoided; and (5) spread of sexually transmitted diseases is prevented.

Ensuring Male Reproductive Health and the RH Bill

I would like to underscore that there is more to RH than just family planning. It encompasses several other equally important elements such as the promotion of breastfeeding; infant and child health and nutrition; prevention and treatment of STDs and reproductive tract and breast cancers; prevention of abortion; sexuality education for the young; and providing assistance to couples with infertility problems and sexual dysfunction, among others.

The last element – treatment and prevention of infertility and sexual dysfunction – is a primary concern of urologists. Although impotence is not a deadly disease, it can be a precursor to or a sign of potentially fatal health problems. In a society where a macho culture still unfortunately prevails, HB 5043 will be a great help in encouraging men to talk about impotence and erectile dysfunction and will be indispensable in making them seek actual treatment.

In the United States, it is reported that at least 20 million American men have some degree of erectile dysfunction (ED). This is equivalent to roughly 1.3% of all American men. Assuming that this data is reflective of worldwide trends, this would translate to approximately 585,000 Filipino men with some form of ED. This, certainly, is no laughing matter, even if ED is not life-threatening.

The problems of erectile dysfunction and sterility have far reaching effects on the lives of men and cannot be ignored or pushed aside simply because no one has yet died due to the inability to have an erection or impregnate one’s wife.

The RH bill aims to help remove the stigma associated with male infertility and erectile dysfunction by encouraging honest discussions on its prevention and treatment and ensuring that men in particular become more aware that ED and infertility are serious problems that require proper treatment from specialists.

The people have spoken – they favor family planning and want the RH bill passed.

The latest SWS national survey reveals that 71% of Filipinos are in favor of the RH bill; 76% agree that there should be a law requiring government to teach family planning to the youth; and 68% believe that there should be a law that compels government to distribute contraceptives.

A Pulse Asia survey released early this year also shows similar statistics – 93% of Filipinos consider it important to have the ability to plan their families; 82% believe government should give people information and access to all family planning methods; and 63% want the RH bill to be passed with only 8% against.

It is important to underscore that more Catholics favor the bill’s passage as compared to non-Catholics. Seventy-one percent of Catholics support its enactment versus only 68% of non-Catholics who endorse the bill (SWS). Clearly, an overwhelming majority of the Catholic faithful believe that using contraception does not make them bad Catholics.

Indeed, if the voice of the people is the voice of God, then there is no reason the RH bill will not be ultimately enacted into law.

The urgency of passing a national policy on RH and family planning is reflected in maternal mortality figures – 11  Filipino mothers die each day in the process of giving life. Although we are men, not one of us will be here if not for our mothers. We have also wives, sisters and daughters and we cannot stand idly by and let the miracle of life mean death for so many mothers.  Studies from the WHO, UNFPA and other international organizations have consistently revealed that contraceptive use actually promotes health and saves lives because they prevent unintended and high risk pregnancies.

Alarming maternal death rates also expose deplorable gender disparities because there is no single health hazard to men aged 15 to 49 which approximates the horror and pervasiveness of maternal mortality and disability.

As doctors and as enlightened men, you are indispensable in encouraging other men to be more involved in reproductive health because men are crucial in ensuring gender equality and saving women’s lives.  In societies like ours, men play a dominant role in almost every sphere of life – from private decisions like family planning to public policies on reproductive health and women’s rights. It is important to underscore that it is precisely within the realm of politics and religion – in which men play central roles – that key reproductive health decisions affecting women’s lives have been made and are being made.

We must not forget that the empowerment of women through better health, education and opportunities benefits their families in particular and society as a whole in general so let us not begrudge them the right to achieve their desired fertility goals through effective and safe family planning.

The authors of HB 5043 are counting on physicians like you to support the measure because it is genuinely pro-women, pro-poor and pro-life. We are counting on you because you are medical professionals and scientists and you know for a fact that RH is essential to people’s overall health. We are counting on you because most, if not all of you, have exercised the most basic right to plan your families and we know that you would not wish to deprive poor Filipino couples of the same right.

The Philippines is the only remaining middle income country in this part of the world that does not have a national policy on reproductive health. This is not only unfortunate, it constitutes a grave social injustice because family planning and reproductive health saves the lives of women and infants, optimizes childcare; prevents the aberration of abortion, leads to remunerative work for women and gives children a fighting chance of living dignified lives.

The testes, which are found in the logo of your association, have long been symbols of men’s virility and vigor. But more than just symbols of the generative capacities of men, the testicles are also a figurative representation of daring and strength of spirit.

There is no pun intended when I say that I am certain that the officers and members of the Philippine Urological Association have the balls – the courage and fortitude – to support the passage of the RH bill and stand up for reproductive health and rights.

Be a part of the passage of the RH bill and help us achieve the dream that the birth of every Filipino child will be a cause for celebration.