People still continue to ask why I am tirelessly advocating the passage of the reproductive health bill to the extent of my having given up the Chairmanship of the powerful Committee on Appropriations in order to devote more time to the enactment of this controversial measure.

Some ask to confirm what they already know. Others ask to resolve their doubts. And not a few ask to test or contest my premises.

I always encourage people to ask. And this forum is a way of also asking.

We have a very serious problem of a huge population growth rate (PGR) of 2.04%, the highest in Southeast Asia after the small countries of Brunei and Laos.

Our population today is more than 90 million. It is projected to reach 94.3 million in 2010. It will balloon to 141 million in 2040 if will allow our PGR to remain high.

We have finite resources which are rapidly being depleted. Our food production hardly copes with the growth in population. Poverty alleviation or reduction is a dream. It may soon become a nightmare. 

The global economic crisis has a greater toll on more populous countries. The more the people, the heavier is the burden on government in seeking relief from the worldwide meltdown.

The RH bill gives Filipino women and couples the opportunity and option to meet their fertility goals, plan their families, space the birth of their children, avoid high-risk pregnancies, improve maternal health, reduce infant mortality, and achieve a more comfortable life and better wellbeing.

In other words, this bill offers a solution, without compulsion, to reduce the huge population growth rate; to alleviate the grinding poverty across generations; to minimize unremitting pregnancies which contribute to high infant mortality and morbidity; to ease the perennial problems of overcrowded classrooms, lack of textbook and teachers, scarcity of jobs and food supply, absence of quality medical care, shortage in mass housing and despoliation of the environment. 

And the solution provided for by the RH bill will not cost the government the mega millions invested in some government projects.

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.”

I.    RH is HR: Reproductive Health is a Human Right

A.    Right to reproductive health, including the right to plan one’s family, is a vital and indispensable right of all people, but principally of women, who bear the brunt of pregnancy, childbirth and childcare.

B.    International Conference on Human Rights in the Proclamation of Teheran: “Parents have a basic human right to determine freely and responsibly the number and spacing of their children.” The Philippines is a signatory to this convention.

C.    But the fundamental human right to RH remains illusory for millions of Filipinos.

1.    2.6 million Filipino women would like to plan their families but lack information and access to do so.
2.    Poorest Filipinas are still having an average of 6 children (this is almost 3x their desired number of children and equivalent to the Total Fertility Rate in 1973).
3.    44% of the pregnancies of the poorest Filipinas are unwanted.
4.    Maternal deaths comprise 11% of all deaths in women aged 15-49.

II.    There is more to RH than simply family planning and contraceptive use – it is about health, rights and sustainable human development.

III.    Salient Features of House Bill 5043 or the proposed “Reproductive Health, Responsible Parenthood and Population Development Act
of 2008”.

A.    Family planning is only one element of RH. Reproductive health has 11 essential elements:

1.    Maternal, infant and child health   and nutrition;
2.    Promotion of breast feeding;
3.    Prevention of abortion and management of post-abortion complications;
4.    Adolescent and youth health;
5.    Prevention and management of reproductive tract infections, HIV/AIDS and STDs; 
6.    Elimination of violence against women;
7.    Counseling on sexuality and reproductive health;
8.    Treatment of breast and reproductive tract cancers;
9.    Male involvement and participation in RH;
10.    Prevention and treatment of infertility; and
11.    RH education for the youth.

B.    Midwives for skilled attendance.

1.    Only 57% of Filipino women give birth with the assistance of a trained medical professional.
2.    Bill mandates that every city and municipality shall endeavor to employ an adequate number of midwives and other skilled attendants.
3.    Skilled attendance at birth will help prevent maternal and infant mortality.

C.    Emergency Obstetric Care.

1.    Each province and city shall endeavor to ensure the establishment and operation of hospitals with adequate and qualified personnel that provide emergency obstetric care.
2.    The miracle of life should not mean death for 11 mothers daily.
3.    Importance of facilities that can provide life saving services to pregnant women cannot be overemphasized.

D.    Hospital-based family planning.

1.    Family planning methods requiring hospital services like ligation, vasectomy and IUD placement shall be available in all government hospitals.
2.    Maternal and infant mortality and morbidity are public health concerns.
3.    FP methods like ligation and vasectomy must be readily available in government hospitals – the health facilities the poor and marginalized regularly utilize.

E.    Contraceptives as essential medicines.

1.    RH products shall be considered essential medicines and supplies and shall form part of the National Drug Formulary.
2.    This will help the poorest of our women avoid unplanned pregnancies and maternal death.
3.    Both the WHO and UNFPA have declared that contraceptive use can prevent 1/3 of all maternal deaths.
4.    RP’s maternal mortality rate: 162 deaths out of every 10,000 live births. (FPS 2006)
5.    Filipino women have a 1 in 100 chance of dying from maternal causes in their lifetime. (FPS 2006)
6.    Modern contraceptives are included in the World Health Organization Model List of Essential Medicines.

F.    RH and Sexuality Education

1.    RH education in an age-appropriate manner shall be taught by adequately trained teachers from Grade 5 up to 4th Year High School. Subjects include:

(a)    Values formation;
(b)    Prevention and avoidance of sexual advances and molestation from acquaintances and strangers;
(c)    Parts and functions of the reproductive system;
(d)    Responsible parenthood;
(e)    Natural and modern family planning;
(f)    Proscription and hazards of abortion;
(g)    Reproductive health and sexual rights;
(h)    Abstinence before marriage; and
(i)    Responsible sexuality.

2.    Sexuality education = positive view of sexuality; information and skills about taking care of one’s sexual health; and sound decisions.

3.    Sexuality education makes adolescents more sexually responsible and adds a level of maturity to their attitudes towards sexual relations.

4.    Formal education on RH and sexuality is necessary because of the parental default at home where conversations on sex is traditionally taboo.

5.    The SWS survey released in October 2008 shows that 76% of Filipinos approve of the teaching of family planning to the youth.

IV.    Clarifying misconceptions about the RH bill.

A.    Misconception 1: the bill is anti-life.

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

2.    It will empower couples with the information and opportunity to plan and space their children.

3.    This strengthens the family as a unit and optimizes care for fewer children who will have more opportunities to be educated, healthy and productive.

4.    The capacity of people to make full use of their potentials is imperiled and impaired by a ballooning population and resultant poverty.

5.    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.

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

1.    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.”

2.    Government’s bias is actually for NFP because POPCOM has been promoting purely NFP even though only 27% of all women using family planning employ NFP and traditional methods compared to the 73% who use modern contraceptive methods. (FPS 2006)

3.    The bill in fact democratizes family planning because it will make available to couples all possible family planning methods and not just NFP which is preferred by the Catholic Church.

C.    Misconception 3: Bill legalizes abortion.

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

2.    Catholic countries like Panama, Guatemala, Brazil, Chile, Columbia, Dominican Republic, El Salvador, Honduras, Nicaragua, Venezuela, Paraguay and Ireland all prohibit abortion as a family planning method even as they vigorously promote contraceptive use.

3.    Muslim and Buddhist countries like Indonesia and Laos have likewise liberalized the use of contraceptives but still continue to criminalize abortion.

4.    Contraceptive use and abortion have an inverse correlation: regular and correct use of contraceptives reduces abortion rates since unplanned and unwanted pregnancies are avoided.

D.    Misconception 4: Bill endorses abortifacients.

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

2.    Primary mechanism is to suppress ovulation. If no egg is released, how can there be an abortion? They also prevent the sperm from reaching the egg. If fertilization is avoided, how can there be a fetus to abort?

3.    IUDs do not cause abortions because they stop fertilization.

4.    UNDP, UNFPA and WHO  Expert Opinion on the Mechanisms of Modern Contraceptives: contraceptives “cannot be labeled as abortifacients”.

E.    Misconception 5: Contraceptives kill.

1.    The WHO emphasizes that 15% of all pregnant women experience potentially fatal complications. Preventing pregnancy in high risk women through contraception significantly reduces maternal death.

2.     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.

F.    Misconception 6: Bill will promote contraceptive mentality.

1.    The bill does not prohibit pregnancy.

2.    Couples will not stop wanting children simply because contraceptives are available.

3.    Contraceptives are used to prevent unplanned pregnancies but not to stop pregnancies altogether.

4.    Human beings have the primal desire to reproduce and propagate their genes. This bill cannot undo millions of years of evolution.

5.    The bill’s authors recognize the importance of ensuring that children are born healthy and wanted.

G.    Misconception 7: Sexuality education will promote promiscuity.

1.    Age-appropriate RH education promotes correct sexual values.

2.    Benefits of sexuality education: (1) under-standing of proper sexual values; (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.

3.    Parents who do not allow their children to attend RH and sexuality education classes will not be prosecuted and jailed.

H.    Misconception 8: Bill claims to be panacea to poverty.

1.    The authors of HB 5043 have never claimed that the bill will be a cure-all for poverty and underdevelopment in the country. The bill simply recognizes the verifiable link between a huge population and poverty.

2.    Unbridled population growth stunts socio-economic development and aggravates poverty.

(a)    UN Human Development Reports show that countries with higher population growth invariably score lower in human development.
(b)    Philippines is the 12th most populous country in the world and ranked 102nd out 179 countries in the United Nations Human Development Index 2008.
(c)    Asian Development Bank: a large population is one of the major causes of poverty in the country.
(d)    Large family size is a significant factor in keeping families poor across generations. (Phil. Institute for Development Studies)

3.    UN: “family planning and reproductive health are essential to reducing poverty”.

I.    Misconception 9: The bill will lead to a demographic winter.

1.    A “demographic winter” or a zero population growth rate is the marked decrease in the number of births in a country and this aging of the population is being experienced in varying degrees by some highly industrialized nations.

2.    Given the excruciatingly slow decrease in our Total Fertility Rate, demographers and other experts assert that a so-called “demographic winter” is a scare tactic which fails to comprehend the dynamics of population momentum.

(a)    UP Economics professors have declared in a paper entitled “Population and Poverty: The Real Score” that a so-called demographic winter will not happen in the country for “at least another 100 years”.
(b)    National Statistics Coordination Board, replacement fertility of 2.1 children will be achieved only by 2040 but effects of “population momentum” or the continuous increase in population will go on for another 60 years by which time the population of the country would have reached 240 million.

J.    Misconception 10: We don’t need an RH law.

1.    It is a myopic view that since contraceptives are available in the market, there is no need to enact a law on reproductive health and family planning.

(a)    Availability of contraceptives does not mean access.
(b)    Availability does not assure adequate and accurate information.

2.    There are 12.86 million currently married women of reproductive age in the country but contraceptive prevalence rate is only 50.6% (2006 Family Planning Survey).    

3.    Critics claim that instead of allocating billions to RH and family planning, more government funds should be appropriated to help curb heart disease, malaria, TB and other causes of mortality among women.

4.    But if we divide the amount allocated to RH and family planning in the 2008 budget among the 12 million plus women of reproductive age, it would translate to 42 centavos per woman per day. This is hardy extravagant.

5.    Maternal deaths and infant mortality continue to be alarming and these are public health issues that deserve immediate action from government.

(a)    DOH: 400,000 cases of maternal morbidities in 2005. It is the most common cause of illness for women in RP.
(b)    But more than half of the cases involving maternal morbidity could be prevented through effective family planning (UNICEF, WHO and UNFPA).
(c)    Proper birth spacing reduces the risk of death in infants by half.
(d)    Around 8,000 infant deaths each year could be prevented through family planning.

K.    Misconception 11: The bill is unconstitutional.

1.    House Bill No. 5043 is being faulted for being violative of the Section 12, Article II of the Constitution which reads:

“The State recognizes the sanctity of family life and shall protect and strengthen the family as a basic autonomous social institution. It shall equally protect the life of the mother and the life of the unborn from conception. The natural and primary right and duty of parents in the rearing of the youth for civic efficiency and the development of moral character shall receive the support of the Government.” (underscoring supplied).

2.    The constitutional challenge is baseless for the following overriding reasons:

(a)    Bill does not violate or intrude on the “sanctity of family life”. On the contrary, it discharges the obligation of the State to protect and strengthen the family.

•    The family is more than a natural unit. It is a social institution whose well-being is impressed with public interest and concern. It is not immune from legislation. It has to be amenable to the State’s exercise of police power for its protection and development.
•    Hence, there are relevant laws like the Civil Code of the Philippines; Family Code of the Philippines (EO 209); the Child and Youth Welfare Code (PD 603); and the Special Protection of Filipino Children Against Child Abuse, Exploitation and Discrimination Act (RA 7610), among others.

(b)    The bill does not supplant the primary right of parents in the “… development of moral character” of the youth even as it proposes the mandatory teaching of age-appropriate reproductive health and sexuality education in all schools from Grade 5 to Fourth Year High School.

•    This gives support, as required by the Constitution, to parents, particularly to the vast majority who have defaulted in imparting reproductive health and sexuality education to their children simply because discussing sex at home is generally taboo.
•    Consequently, the young get their information on sexuality from polluted and inaccurate sources – peer groups, entertainment media and the internet. Therefore, there is critical need for formal reproductive health and sexuality education in schools.

(c)    The use of legal and medically-safe contraceptives, which are not abortifacients, and which are tested and registered by the Bureau of Food and Drugs (BFAD), does not violate the constitutional provision on the obligation of the State “to equally protect the life of the mother and the life of the unborn from conception.”

•    The purpose of this provision is to preempt the Congress and the Supreme Court from legalizing abortion. This bill definitely does not legalize abortion.
•    The proceedings of the Constitutional Commission show that there was no intention to ban contraceptives which are not abortifacient.

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

A.    SWS:
1.    71% of Filipinos are in favor of the RH bill.

2.    76% of Filipinos agree that there should be a law requiring government to teach family planning to the youth.

3.    68% believe that there should be a law requiring government to distribute legal contraceptives like condoms, pills and IUDs

B.    PULSE ASIA:

1.    93% of Filipinos consider it important to have the ability to plan their families.

2.    82% of Filipinos believe government should teach couples about all methods of family planning.

3.    Another 82% of Filipinos say that it is the government’s duty to provide the people with knowledge, services, and materials on all methods of family planning.

4.    A considerable majority of Filipinos (63%) want the RH bill to be passed into law with only 8% expressing opposition to the measure.

VI.    Catholics have spoken – they support the use of contraceptives and the enactment of the RH bill.

A.    68% of Catholics believe that government should distribute free contraceptives to those who want them (SWS).

B.    76% of Catholics agree that there should be a law requiring government to teach family planning to the youth (SWS).

C.    71% of Catholics favor the passage of the RH bill versus only 68% of non-Catholics who endorse the bill (SWS).

D.    Religion ranks 9th out of 10 reasons why women do not use contraception (FPS 2006).

VII.    We have to enact HB 5043 because it promotes and protects:

A.    The right to health.

B.    The right to informed choice.

C.    The right to reproductive self-determination.

D.    The right to sustainable human development.

VIII.    Women must be given the chance to make responsible family planning decisions.

A.    When given the opportunity to plan and space their children, women almost always decide to have smaller families.

B.    They will invariably have children who are healthier, better-educated and have at least a fighting chance at living full and dignified lives.

C.    Without this ability to plan their families, most women will often find it more difficult to finish their education, find remunerative work or have a say in their own future.

IX.    The RH bill is genuinely pro-women, pro-poor and pro-life.

A.    It is essential to the promotion of women’s overall health.

B.    If RH is neglected, primary aspects of women’s general welfare and wellbeing will be irrevocably compromised.

C.    Educated and well-off women have always exercised the right to family planning.

D.    Poor Filipinas should not be deprived of the same right enjoyed by their more prosperous sisters. 

X.    There is no reason for any of us to be afraid of the RH bill.

A.    But there are 4,500 reasons to support the bill - the 4,500 Filipino mothers who die every year from causes related to pregnancy and childbirth.

B.    There are additional 8,000 reasons to fight for reproductive rights – the 8,000 babies who annually do not survive their first month of life.

C.    And another 2.6 million reasons to stand up for the bill – the 2.6 million poor Filipinas who want to plan their families but are unable to do so because they lack information on and access to family planning services.

Clearly, there are more than enough reasons to fight for HB 5043 because family planning indeed saves lives; reproductive health is essential to women’s overall health and its protection and promotion will determine whether or not a woman will have a say in her own future.