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Reproductive Health
“THE CONTROVERSY BEHIND THE
REPRODUCTIVE HEALTH BILL”
(Speech delivered by REP. EDCEL C. LAGMAN at the Graduate School of Nursing Seminar, Arellano University on 20 February 2010)


To label the RH bill controversial is both an accurate assessment and an erroneous attribution.

It is a correct observation because something which is controversial is also perceived to be divisive and problematic – so much so that during public debates, our presidentiables dread questions on whether or not they support the enactment of the RH bill or if they are for or against family planning. Such questions are cause for concern that even the most eloquent and straightforward among them fumbles for words and answers with uncharacteristic ambivalence.

It is accurate to brand the issue of reproductive health as controversial because it is highly contentious and regularly strikes a discordant note with adverse partisans. In my experience speaking in forums on the RH bill, people are either strongly supportive of the bill or rabidly against it. Most of the time, people have strongly-held opinions on the matter. There are almost no instances when people are merely lukewarm about the issue of family planning and reproductive health. They are either advocates or detractors.

But it is also an erroneous attribution to describe the bill as controversial because a controversy implies that there is something offensive and scandalous about the measure when in fact the RH bill is a rational, health and rights-based and human development oriented policy.

Reproductive Health
Reproductive Health, Maternal and Child Health
and Family Planning: The Inverse Relationship of Number of Children With Income and Quality of Life
By: REP. EDCEL C. LAGMAN


“The more, the merrier” is an adage of the past. Now, it is more apt to say “the more, the more miserable.” Likewise, “cheaper by the dozen” has lost its charm as a simple economic formula. Each new child is an additional expense poor families can ill-afford.

These two traditional sayings are not prescriptions for development.

Truly, there is an inverse relationship of number of children with income and quality of life.

Indeed, the Philippines cannot achieve sustainable development if the government and policymakers continue to default in addressing and solving with strong political will the grave population problem.

With the current total fertility rate at 3.3 children per woman, the specter of our population hitting a staggering 94 million this year is not only menacing but ominously explosive.

POPULATION AND DEVELOPMENT NEXUS

It was a Filipino, the late Rafael Salas, the first Executive Director of the United Nations Population Fund (UNFPA), who enunciated 40 years ago that there are “crucial links between population and development” and there is “a need to take population factors into account in development plans.”

Studies have consistently shown that unbridled population growth stunts socio-economic development, aggravates poverty and demeans quality of life, thus making it more difficult for government to address the problem of underdevelopment.

In 2002 the UNFPA unequivocally 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”.

The Family Income and Expenditures Surveys (FIES) from 1985 to 2000 also clearly show that poverty incidence steadily increases with each additional child in the family.

ADVERSE EFFECTS OF HIGH FERTILITY
AND LARGE FAMILY SIZE

The following are the adverse effects of high fertility and large family size, particularly on women and children:

1. High fertility impacts negatively on the lives of women. Multiparity is associated with maternal mortality because with each additional pregnancy, a woman’s lifetime risk of dying from maternal causes progressively increases.

Although pregnancy is not a disease, the fact that 11 women die daily in the Philippines from pregnancy and childbirth complications is akin to a crime. The WHO, UNFPA and Lancet are unanimous in stating that correct and consistent use of contraceptives can prevent as much as 35% of maternal deaths.

2. High fertility impacts negatively on the lives of children. Researchers conclude that “(c)hildren from large families are at significantly greater risk of living in poverty than children from small families.”

They do not only suffer from poor health, their educational opportunities are also limited. Because these children are more likely to suffer from poor nutrition and substandard childcare, they do not perform as well in school compared to children from small families. Their future and quality of life are jeopardized.

3. High fertility adversely affects quality of life – even across generations. Dr. Aniceto Orbeta asserts that large family size “has been identified as the main mechanism of the inter-generational transmission of poverty.”

The lack of education, poor nutrition and general ill-health that normally plague large families make it virtually impossible for its members to lift the family out of the quagmire of destitution. Indeed, large families perpetuate poverty across generations.

4. Large family size is a primary factor in the decline in household savings.     The costs of raising a child are high and can financially drain the family. While households with one child devote 10% of total household expenditures to childrearing, allocation for children jumps to 18% with the birth of a second child and increases to 26% for four children. Large families virtually have no savings.

5. Large families are more vulnerable to external economic shocks. Without adequate savings, large families are ill-prepared for the loss of employment or sickness or disability in the family. They will have more difficulty coping with the unexpected because they lack the buffer funds needed to tide them over hard times.

6. Large number of children is associated with decreased incomes and less investment in human capital. Pernia, et al. also documented that mean education spending per student per year drops from P1,787 for a family of four to P682 for a family size of 9 and above. Moreover, average health spending per sick family member falls from P1,464 to P756 over the same family size range.

7. Rapid population growth and high fertility impact negatively on economic growth. Population and poverty are intertwined in a vicious cycle. Excessive population growth exacerbates poverty while poverty spawns rapid population growth. They are the negative tandem of the “low level equilibrium trap”. 

The foregoing adverse effects are mainly due to and are further aggravated by lack of RH and FP information and services, particularly to poor and marginalized couples and communities.

RH IS ESSENTIAL TO DEVELOPMENT,
OVERALL HEALTH AND WELLBEING

RH is essential to women’s and children’s overall health. If it is neglected, primary aspects of their general welfare would be irrevocably compromised.

RH and FP reduce maternal and infant mortality and improve the health status of mothers and children. Contraceptive use leads not only to a decrease in pregnancy rates but also an even greater decrease in maternal mortality, simply by reducing the number of high-risk pregnancies according to the WHO.

The death of a mother has untold effects on her children. According to the UNFPA, “saving a mother’s life usually means saving the life of her newborn and older children. Children who have lost their mothers are up to ten times more likely to die prematurely than those who haven’t.”

Thus, preventing maternal death through effective family planning will also be a significant step in protecting children and ensuring a better quality of life for them.

Lower fertility would mean more educational
and employment opportunities for women

Providing women the chance to plan and space their children will give them more opportunities to finish their education and secure productive work as they are liberated from unremitting pregnancies. Lower fertility ensures maternal health and frees women to pursue opportunities in education and employment and thus will enhance their self-esteem and uplift their social and economic status and that of their families.

FROM VICIOUS CYCLE TO VIRTUOUS CYCLE: CHILDREN REAP THE BENEFITS OF THEIR MOTHERS’ FAMILY PLANNING DECISIONS

We are currently trapped in a vicious cycle of high fertility and poverty – poor people continue to be impoverished because the cost of having many children drains their already depleted resources and at the same time poor people have more children than they can afford precisely because their being poor denies them access to family planning information and services.

But there is also a so-called “virtuous cycle” linking the family planning decisions of mothers with their children. It emphasizes the benefits reaped by children whose mothers practiced family planning.

Women who are able to avoid unplanned pregnancies will be able to give their children quality childcare, invest more in their education and ensure that they are better-fed and healthy. As adults, these children will also be better prepared to manage their own fertility and be more responsible parents themselves; be gainfully employed; and will be more equipped to ensure a better future for their own children.

To be able to jumpstart this virtuous cycle, policymakers must stop dillydallying on House Bill 5043 because RH, FP, population and human development are all intertwined and should be integral components of government’s development plans and poverty alleviation programs.

It is therefore imperative that Congress enacts public policies that help people better manage their fertility and have good reproductive health, especially the poorest women who have almost three times more children than they want.

Affording parents the right to freely and responsibly determine the number and spacing of their children will certainly have positive multiplier effects on the lives of the most vulnerable members of society – poor mothers and their children.

Reproductive Health
PHILIPPINE ACTION PLAN ON
IMPROVING MATERNAL HEALTH
(Speech delivered by REP. EDCEL C. LAGMAN at the Inter-Country Parliamentarian’s
Meeting on Maternal Health of the Asian Forum of Parliamentarians for Population
and Development [AFPPD] in Bali, Indonesia on 14 August 2009)

 

In their article “Calling a Spade a Spade: Maternal Mortality as a Human Rights Violation”, Luisa Cabral and Morgan Stoffregen lamented that “being pregnant should not be a game of Russian roulette. But for too many women around the world, it is.”

The failure to protect maternal death violates a number of women’s fundamental human rights, including the rights to life, health, equality, information, freedom from discrimination and the right to decide the number and spacing of their children.

Millennium Development Goal 5, which aims to reduce maternal mortality by three-quarters between 1990 and 2015, is the MDG least likely to be achieved.

In the Philippines, the Maternal Mortality Ratio was 209 per 100,000 live births in the early 90s. In 1998, MMR fell to 172 but has stagnated thereafter to 162 till 2006. At this pace of reduction, the target of reducing MMR to 52 by 2015 seems unattainable.

Cabral and Stoffregen concluded: “Half a million maternal deaths each year are more than an unfortunate tragedy – they are a scandalous social injustice. Fortunately, women’s right to survive pregnancy and childbirth is firmly protected under international law. The challenge facing the human rights community today is ensuring that governments protect this right.”

It is for the above unassailable reasons that the principal objective of the Philippines’ country plan is to approximate, if not achieve, the target of attaining MDG 5 on improvement of maternal health, and in the process also endeavor to achieve MDG 4 on the reduction of infant mortality.

Reproductive Health
GOALS AND CHALLENGES IN LEGISLATING AN RH LAW
(Speech delivered by REP. EDCEL C. LAGMAN at ICPD 15 National Conference Workshop at the Summit Hall, PICC,
Pasay City on 26 August 2009)

I am no stranger to controversy. In my more than two decades as a legislator, I have sponsored controversial bills on issues as varied as genuine agrarian reform that will truly benefit our landless farmers; the repeal of the archaic practice of the death penalty; a sensible but authentic Magna Carta of Students; innovative ways to reduce our foreign debt and; the enactment of a law that will finally give all Filipino women and couples the right to fully exercise their fundamental human right to plan and space their children in accordance with their convictions and religious beliefs.

But I have to admit that among all these controversial measures, nothing can beat the RH bill in terms of the uproar it has created and the passionate debates that have ensued from its filing – both within and outside the Halls of Congress.

However, I am not one to back out from a good fight. In fact, those whom I’ve worked closely with, like the Catholic hierarchy, in the enactment of RA 9346 prohibiting the imposition of capital punishment and more recently, Republic Act 9700 extending the land acquisition and distribution (LAD) component of the Comprehensive Agrarian Reform Program, would testify that I even relish a good fight.

The struggle to finally enact a law that will help safeguard the future of millions of women and their families and will have a host of positive multiplier effects on the health and lives of women and children will certainly more than qualify as a good fight.

ACHIEVABLE GOALS OF THE RH BILL

For a bill that has created such tumult, the goals of the RH bill are actually quite simple, which are all ICPD-MDG related.

First, the RH bill will help give parents the opportunity to exercise their right to freely and responsibly plan the number and spacing of their children. The bill mandates the provision of all forms of family planning to women and couples as long as they are legal and medically-safe, and preferably truly effective.

This means that a family planning method does not need the seal of approval of the Catholic Church for it to be offered in government health centers or directly to acceptors.

This bill is progressively rights-based.

Second, it will help improve maternal, newborn and child health and nutrition and reduce maternal, infant and child mortality. The bill is primarily a health measure. It will promote maternal and infant health even as it will help prevent the deaths of thousands of mothers and babies annually.

Both the WHO and the UNFPA have unequivocally asserted that a third of all maternal deaths could be avoided if women who wanted to use contraception were given the opportunity to do so. Proper birth spacing through family planning also significantly increases infant survival and has a positive effect on newborn and infant health.

Third, the RH bill will give women more opportunities to finish their education and secure productive work. Access to family planning information and services ensures maternal health and frees women to pursue opportunities in education and employment and thus will enhance their social and economic status and that of their families.

A woman who has the chance to finish her education and look for remunerative work will have more power to make decisions to improve her own and her children’s lives and contribute more meaningfully to her community. Thus, she would more likely be a productive member of society.

Fourth, it will help reduce poverty and achieve sustainable human development. It is necessary to enact a clear, comprehensive and rights-based national policy on reproductive health because it is an indispensable development tool.

The United Nations has declared that 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.”

It was a Filipino, the late Rafael Salas, the first Executive Director of the United Nations Population Fund, who pioneered and concretized the import of realizing the “crucial links between population and development and the need to take population into account in development plans.”

Clearly, any development program which does not incorporate population issues in its agenda will be virtually useless because there is an indisputable interrelationship between population, poverty and progress in relation to sustainable human development.

Disease, ignorance, environmental destruction, unemployment, hunger and the low status of women are concrete manifestations of poverty. These social ills cannot be overcome if government continues to relegate to the background the issue of population as it relates to development.

Fifth, the RH bill will most definitely help lower the incidence of abortion by preventing unplanned, mistimed and unwanted pregnancies.

We need a national policy on RH and population development because providing women with the information and services they need to plan and space their children will prevent unwanted pregnancies and help preclude the need to resort to abortion.

WE HAVE THE SUPERIORITY OF NUMBERS

The first version of the RH bill was filed way back in the 11th Congress and every Congress since then, versions of the bill have been filed and suffered the same fate – all gathered dust in the Archives of the House of Representatives.

House Bill 5043 has not and will not gather dust. On the contrary, it has been gathering more coauthors. As of yesterday, it now has 131 coauthors and about two dozen more legislators, although not covert coauthors, have committed to support the measure when it is put to a vote.

But some would argue that this is not enough since 131 supporters do not constitute an absolute majority of the House membership. The House of Representatives currently has 268 members. An absolute majority of 50% plus one would total to 135. Are we then four coauthors short?

We are actually in excess of 45 coauthors because we do not need an absolute majority of the total membership of the House to pass HB 5043. All we need is a simple majority of the quorum on the day a vote is taken.

Ordinarily, during the roll call about 170 members are present. If during the voting 170 members are still present, only 86 votes – not 135 – would be needed to constitute a simple majority to approve the bill.

Support for the RH bill is not confined to the Halls of Congress. Public support for the RH bill is overwhelming.

For almost two decades, SWS and Pulse Asia have documented that 92% to 98% of Filipinos want to mitigate their fertility and plan their families.

In survey after survey from the cosmopolitan cities of Manila and Parañaque to the conservative communities of Cebu and Bohol, the results of the surveys have been consistently encouraging. It does not matter what age people are, what their economic status is or whether or not they are Catholic. An overwhelming majority of Filipinos support the RH bill and agree that Filipinos need information on family planning and access to reproductive health supplies and products, both of which the bill undertakes to provide.

The latest SWS survey reveals that 71% of Filipinos want to have the bill enacted into law and 76% agree that there should be a law mandating schools to teach family planning to the youth.

The RH bill enjoys multi-sectoral support coming from the academe like U.P. Economics professors and professors form the UP College of Law and 69 Ateneo University professors; interfaith partnerships like Christian churches, Muslim communities, Iglesia ni Cristo and Jesus is Lord, among others; employers groups like the Employers’ Confederation of the Philippines (ECOP); labor groups like the Bukluran ng Manggagawang Pilipino; youth organizations like the National Youth Parliament, a consortium of more than 150 student councils from state universities and colleges and sectarian institutions of higher learning; community of scientists like the National Academy for Science and Technology; and the vast NGO communities like the Reproductive Health Advocacy Network; and even Catholic organizations like the Catholics for Reproductive Health.

CATHOLIC CHURCH HELL-BENT IN OPPOSING RH

To describe the fight to have the RH bills passed by both Houses of Congress as an uphill battle is an understatement. It has been a difficult crusade but we are not short on ammunition to overcome the challenges and roadblocks being laid out by the bill’s critics.

Some bishops and lay leaders are hell-bent in opposing the measure. Their campaign is characterized by inordinate misinformation and patent lies as well as pathetic threats of excommunication for legislators supporting the bill.

But given the growing number of coauthors, it seems that it will take more than threats of eternal damnation to cow our RH advocates in Congress. Moreover, since majority of those polled in the recent surveys were Catholic, the very encouraging results of the surveys show that the policies advocated by the Church hierarchy do not reflect the diversity of attitudes and practices among the Catholic faithful themselves.

Catholic Ateneo University professors assert that Catholic women and couples can remain good Catholics even as they use contraceptives.

WE HAVE THE SUPERIORITY OF ARGUMENTS

The flawed arguments of members of the Catholic hierarchy are parroted by their allies in Congress who are critics of the bill. Plenary debates on HB 5043 actually began in September last year but because of the long-winding and repetitive questions not to mention the defective logic and faulty data used by anti-RH legislators during interpellation, the bill has not moved passed the period of sponsorship and debate.

But you have the assurance of your champions in Congress that we do not only have the superiority of numbers, we also have the superiority of arguments.

Unlike those who seek to defeat the measure, your advocates in Congress do not cherry pick their data to support their contentions. Neither do they fabricate their statistics in order to paint a rosier picture of maternal death rates in the country or to make it seem that the RH bill will be superfluous.

We are armed with the most recent statistics and data regarding matters pertaining to RH and family planning so we can debunk the unsound arguments of the bill’s oppositors and clarify the misconceptions on the bill that are being deliberately spread by the measure’s diehard critics.

We are committed to unmasking those who pretend to be purveyors of the truth as pretenders. We are in a situation where the truth can truly set us free. For so long as supporters of the RH bill continue to speak for the thousands of Filipino mothers who die of maternal causes and the millions of women who would like to plan and space their children but have no access to family planning information and services, they speak the truth and the truth of their words will demolish any and all false arguments against the RH bill.

LACK OF QUORUM DERAILS DEBATES ON THE BILL

The more difficult challenge to overcome is the recurrent lack of quorum in the House of Representatives. Because of the controversial nature of the bill, it is not beneath the critics of the bill in the House to raise the quorum issue if there are not enough warm bodies in the plenary hall, even if less contentious bills are routinely debated on and eventually passed by the House of Representatives without the question of quorum being raised.

Perforce, we must encourage all the coauthors of HB 5043 to be more consistent in attending sessions and to actually stay on in case the bill will be called for the continuation of the debates. If there is anything that our coauthors must try to emulate, it is the vigilance of the anti-RH camp when it comes to making sure that the bill will not be discussed if there is no quorum.

An innovation in the plenary debates has been proposed by Speaker Prospero Nograles to expedite the legislative process in enacting the RH bill. In lieu of the traditional one-on-one debates between sponsors and interpellators which is too time consuming, opposing panel debates will be innovated which could last for a maximum of three (3) session days. Let us support the Speaker’s suggestion.

PROSPECTS OF THE BILL’S PASSAGE
ARE PROMISING

House Bill No. 5043 or the proposed “Reproductive Health and Population Development Act” is a beacon of hope, a promise of a better quality of life, particularly for future generations of Filipinos.

This is why the raging debate on reproductive health and family planning refuses to die because Filipinos are now aware that they can have more comfortable lives if they can achieve their fertility goals and the population growth rate can be moderated based on their informed, effective and responsible choice on the number, spacing and timing of their children.

The challenges we face in legislating an RH law are real but not insuperable. It is my personal philosophy that there is no problem without a solution.

When it comes to the prospects of the bill’s passage, I earnestly believe that there has never been a time more promising than now.

I am confident that after a gestation period of over a decade, with your invaluable support we shall safely deliver House Bill 5043 and Senate Bill 3132 and the resulting RH law will help ensure that every pregnancy in the country will be safe and wanted and the birth of every child is a cause for celebration.

Our country’s most fitting commemoration of ICPD+15 is the passage of the RH bill!

Reproductive Health
FPOP: 40 YEARS OF DEVOTION, PASSION AND COURAGE
(Speech delivered by REP. EDCEL C. LAGMAN during the 40th Anniversary Celebration of the Family Planning Organization
of the Philippines on 01 August 2009)

 

I am truly happy and honored to be a part of the 40th anniversary celebrationof the Family Planning Organization of the Philippines (FPOP).

What FPOP is commemorating today is not only a chronology of years but a celebration of milestones of achievements in its advocacy for family planning (FP) and for sexual and reproductive health and rights (SRHR).

Ruby is the gemstone for 40th anniversaries. The ruby is the “king of gems”. No gemstone has been priced throughout history than the ruby which is much rarer than the diamond.

Rubies are thought to possess an eternal inner flame, an undying flame inside the stone which some legends say is a part of the planet Mars.

The ruby is the symbol of devotion, passion and courage. This symbolism fits FPOP to a “T”: its devotion to its advocacy; its passion for success and its courage against all odds.

We look forward to your Golden Anniversary and beyond!

Congratulations and thank you so much for your devotion, passion and courage in supporting the RH bill.