Contact Details

Rm. N-411, House of Representatives, Quezon City, Metro Manila, Philippines
+63 2 931 5497, +63 2 931 5001 local 7370

Reproductive Health
REPRODUCTIVE HEALTH AND
CORPORATE SOCIAL RESPONSIBILITY
(Keynote Speech delivered by REP. EDCEL C. LAGMAN at the American Chamber Foundation Philippines on 30 September 2008)

In business and industry circles, the acronym CSR means Corporate Social Responsibility. However, among women’s organizations and reproductive health advocacy groups, the term CSR has a different meaning. It means Contraceptive Self-Reliance.

As dissimilar as Corporate Social Responsibility and Contraceptive Self-Reliance may seem at first, they are in fact interrelated.

The meaning of Corporate Social Responsibility has changed from simply connoting “good corporate citizenship” which translated mainly to the payment of correct taxes to the government by companies; ensuring that employers do not shortchange their workers on their wages and benefits; and other similar principled business practices. It has since evolved to mean companies, like member companies of the American Chamber of Commerce in the Philippines, taking proactive steps and undertaking projects that will make a definitive positive difference in people’s lives.

In pursuit of fulfilling its corporate social responsibility, the American Chamber Foundation, Inc., the socio-civic arm of the American Chamber of Commerce, has found innovative ways of giving back to Filipino communities. AmCham Foundation has concentrated on education, health and poverty reduction programs and it is precisely in the promotion of the right to education, health and a life free of poverty where the similarities between Corporate Social Responsibility and Contraceptive Self-Reliance become more obvious.

Both CSRs deal with health, rights and development, especially of the marginalized. It is obvious how Corporate Social Responsibility, particularly the kind that AmCham is practicing, is directly linked with promoting genuine human development. But how is Contraceptive Self-Reliance linked with ensuring progress and improvement of human lives?

Contraceptive Self-Reliance is firmly anchored on the concept that all governments must be self-sufficient when it comes to ensuring something as basic and essential as providing its citizens with legal and medically safe family planning methods and quality contraceptives. This is because family planning, as a component of reproductive health, does not only help improve lives. Family planning also saves the lives of mothers and infants.

Moreover, reproductive health and rights are inextricably linked to sustainable human development. Providing women and couples with information and access to all forms of legal and medically safe family planning methods, as espoused by House Bill 5043 or the “Reproductive Health, Responsible Parenthood and Population Development Act”, will not only guarantee Contraceptive Self-Reliance for the country. More importantly, it will ensure that women and couples will have the chance to plan their families and if they chose to do so, government will be prepared to help them meet their fertility goals by providing much needed RH services.

This will lead to a dramatic decrease in fertility and lower population growth, which will enable government to address more fully crucial determinants of human development such as education, healthcare, food security, employment, housing and environmental protection.

It should be underscored that the social ills directly linked to poverty – ignorance, disease, unemployment, environmental destruction, the low status of women – simply cannot be overcome without also directly confronting the issue of reproductive health and population.

The State and Church need not clash on the issue of population and reproductive health because both modern and natural methods of family planning have a common objective – to prevent unplanned pregnancies.

According to the National Statistics Office there are 12.9 million married women of reproductive age in the country. Of this number, 4.6 million use modern methods compared to 1.75 million who use natural family planning and traditional methods.

But there are 2.6 million women who would like to plan and space their children but are unable to do so for of lack of information and access to FP services. The balance of approximately 4.0 million women do not use or do not care to use any family planning method.

Our total contraceptive prevalence rate remains at a low of 50.7% and the contraceptive unmet need of the poorest Filipino women is a high of 26.7%

I am therefore heartened that AmCham Foundation’s programs are currently concentrating on reproductive health education of the youth by helping them “make the right decisions as they fulfill their dreams” through Peer Education Programs and Information, Education and Communication Sessions.

Moreover, the AmCham’s Leonard Benjamin Program Development Center provides reproductive health services including family planning counseling and referrals to Filipinos who need them most.

Critics of the bill claim that “overpopulation” is a myth being perpetuated by western nations, particularly the United States because the “depopulation” of Third World nations supposedly ranks high in US foreign policy. They also allege that the United States is pushing for population and family planning programs in developing countries like the Philippines because it is afraid that these nations will not as easily succumb to western dominion if their populations continue to increase. I have heard this argument against HB 5043 so many times and I have yet to decide whether to laugh or cry.

It is ironic that the authors of House Bill 5043 have been accused of promoting Western interests, particularly that of the United States, by championing the reproductive health rights of Filipinos. I say ironic because since I have been in politics, I have always espoused purely the interests of the Filipino people and the Filipino nation. And I am certain that this is also true for another principal author of HB 5043, the Hon. Risa Hontiveros-Baraquel of Party-list Akbayan, like invariably all of our co-authors.

In fact this is the first time I have ever addressed an American organization.

If all nations which have strong population policies are in effect subservient to American and western interests, then the biggest lapdog of Uncle Sam would be China which has a stringent and punitive one-child policy!

Levity aside, we should bear in mind that if the Philippines can effectively promote and protect the reproductive health of its citizens and it succeeds in sensibly managing its population, it shall have healthier, more prosperous, and certainly more educated, critically-aware and issue-oriented citizens who cannot be muzzled or cowed by interventionist foreign countries or any dominating power.

HB 5043 is primarily about health, rights and human development. It seeks to enact a comprehensive, rights-based and adequately-funded national policy creating an enabling environment for couples and women to exercise freedom of informed choice in planning the number and spacing of their children.

Family planning is more than just a tool to help women and couples to responsibly plan their families. Its principal benefits are:

(1) Lower maternal mortality;

(2) More benefits for children since smaller-sized families assure they will be better nourished and will receive better health care;

(3) Higher human capital investment at the family level that would lead to bigger investments in health and education;

(4) Increased income generating and educational opportunities for women that will, in turn, benefit them and their families; and

(5) Significantly lower abortion rates.

The World Health Organization (WHO) report “Reducing the Risks of Pregnancy – the Role of Contraception” declared with absolute certainty that “increased use of contraception would also have an obvious and direct effect on the number of maternal deaths” simply by reducing the number of unplanned pregnancies.

The WHO estimates that around 515,000 women die each year from complications of pregnancy, childbirth and unsafe abortion. It reports that 90% of all maternal deaths worldwide happen in developing countries like the Philippines.

It concludes that with the correct and consistent use of contraceptives “the fall in maternal mortality is likely to be even greater than the fall in the pregnancy rate.” This would imply that the risk associated with each individual pregnancy is reduced.

Together with the UNFPA and the medical journal Lancet, the WHO also asserts that family planning can reduce maternal deaths by one-third and 1 million infant deaths worldwide can be avoided if women and couples are given the opportunity to use safe and effective contraceptives.

Fewer children will also enable women to seek remunerative work and allow them more opportunities to advance their education, thus diminishing gender inequality.

Studies have also consistently shown that since any pregnancy that ends in induced abortion can be considered unwanted, the precise and regular use of reliable contraception significantly reduces abortion rates by as much as 85%.

Indeed, family planning is an indispensable element in reducing poverty and underdevelopment and a vital factor in the human development equation. It is an essential tool to help families live fuller, more meaningful lives.

In its State of the World Population Report 2002, the UNFPA states that ensuring good reproductive health is essential to reducing poverty. According to the report, had countries like the Philippines reduced its fertility by a mere five births per every one thousand women of reproductive age in the 1980s, the current poverty incidence would have been reduced by one-third.

Local studies conducted by Filipino economists and social scientists also point to the tangible connection between population and poverty.

In the 1970s, Thailand and the Philippines were virtual Siamese twins because their total population, infant mortality rate, and the life expectancy at birth were almost identical. Thailand, however, successfully implemented a serious population program whereas the Philippines continued to dillydally on the issue of family planning and population management.

Today, the Philippines has some 20 million more people than Thailand. Thailand’s poverty incidence was pegged by the Asian Development Bank at 8.5% while the Philippines’ remains at a high of 32%.

These studies show that if the Philippines had Thailand's population growth rate:

•    Poverty incidence would have been 5.5 percentage points lower.

•    The number of poor people would have been 3.3 million less.

•    Estimated savings from basic education would have amounted to P128 billion.

•    Estimated savings from basic health would have reached P52 billion.

•    The average income per person would have increased by at least 0.76 percent per year, for the period 1975 to 2000. This would have meant a cumulative increase of about 22% on the average income per person in the year 2000.

These are missed opportunities that the country will not be able to recover because of government’s long history of an appalling lack of political will in enacting a national policy on reproductive health and population development coupled with its inordinate fear of the Catholic Church.

It must be emphasized that as the population growth rate decelerates, more government resources are liberated for basic social services such as healthcare, education, food security and employment opportunities, all fundamental determinants of human development which will register marked improvement. This will result in a significantly higher standard of living and better quality of life for more people.

I am confident that we can work together in the promotion, protection and fulfillment of the basic human right of everyone to reproductive health and reproductive self-determination.

Thank you.

Reproductive Health
THE IMPORT OF REPRODUCTIVE HEALTH
ON THE MILLENNIUM DEVELOPMENT GOALS
(Speech delivered by REP. EDCEL C. LAGMAN at the
National Convention of the Philippine Nurses Association
at the Manila Hotel on 23 October 2008)

It has been said that nurses are not only at the heart of healthcare; they have become great blessings to humankind.

In a country where a large number of people live and die without even seeing a doctor, nurses have become the frontliners of the healthcare system. 

Although nurses cannot write out prescriptions, they can be counted on to dispense essential medical care, compassion and genuine care.

I am certain that those of you who have opted to stay in the country all have despairing stories to tell about the state of our healthcare system, what with the migration of trained health professionals to other nations, the lack of funds for basic equipment and medicines in hospitals, and the tremendous increase in the number of people seeking medical help.

But these problems are not unique to the healthcare sector. The education sector is also experiencing similar problems because government simply cannot keep pace with the continuously growing number of enrollees in terms of providing adequate number of classrooms, textbooks, desks and tables and even teachers.

The same is also true for the agricultural sector. It just cannot produce enough to feed the growing multitude of Filipinos. The Philippines’ Population Growth Rate (PGR) of 2.04% outpaces the country’s annual growth in rice production of only 1.9%. The menace of hunger stalks densely populated communities where the family budget for food is spread too thinly with so many mouths to feed.

In the 2008 Global Hunger Index conducted by the International Food Policy Research Institute, the Philippines was included in the 33 countries worldwide where the problem of huger and malnutrition is of critical concern.

Certainly, you are fully aware of the relevance of adequate healthcare, quality education and food security to my topic on House Bill No. 5043 or the proposed “Reproductive Health, Responsible Parenthood and Population Development Act of 2008”.

I. A Ballooning PGR Impacts Negatively on All
Human Development Indicators

We cannot achieve genuine and sustainable human development if we continue to default in addressing the population problem. It is beyond debate that a huge population growth rate impacts adversely on all indicators of human development such as health, education, shelter, food security, employment and the environment. 

Chronic poverty and high population growth rates are inextricably linked. A high PGR all but negates any progress we may achieve in terms of economic growth and cancels out government’s efforts in poverty reduction.

Government can help curb a ballooning population by simply helping women and couples realize their fertility goals. House Bill 5043 will help ensure that women and couples will achieve their desired fertility through the creation of an enabling environment where they will have information on and access to both natural and modern methods of family planning and will have the freedom to decide which method is best suited to their needs, personal convictions and religious beliefs. It is freedom of informed choice, freedom of conscience.

II. RH and the Millennium Development Goals

The Philippines has committed to achieve the Millennium Development Goals (MDGs) by 2015. The noble and ambitious objective of the MDGs is the quantifiable improvement in the lives of people through the achievement of the following human development goals:

1.    Eradication of extreme hunger and poverty;
2.    Achievement of universal primary education;
3.    Promotion of gender equality;
4.    Reduction of infant mortality;
5.    Improvement of maternal health;
6.    Combating HIV-AIDS, malaria and tuberculosis;
7.    Ensuring environmental sustainability; and
8.    Promoting global partnerships for development.

Virtually all of these goals, but especially the goals which pledge elimination of gender-based discrimination; decrease in infant deaths; safe motherhood; and the prevention of the spread of HIV-AIDS, are closely related to reproductive health and family planning which are indispensable in addressing the pressing concerns on rights, health and sustainable human development.

The interrelatedness of reproductive health to the MDGs underscores the urgent need for the passage of HB 5043 that will promote and protect the right of all Filipinos to health and development, more particularly that of women and children.

III. Reproductive Health and Family Planning
are Basic Universal Human Rights

I have always emphasized that the RH bill is not principally about pills, condoms and IUDs. It is also not about sex and certainly not about religion. It is primarily about the right to health and the right to development.

Reproductive health is a fundamental human right and was affirmed as such in the Proclamation of Tehran during the International Conference on Human Rights 40 years ago in 1968.

The right to reproductive health and family planning was subsequently reiterated in numerous other UN Conventions of which the Philippines is likewise a signatory.

IV. RH and FP are Essential to the
Achievement of Key MDGs

Reproductive health and family planning are indispensable to the promotion of gender equality; safe motherhood; the reduction of maternal and infant deaths; and the drastic decrease in abortion rates.

It is important to underscore that six of the eight MDGs are linked to reproductive health and are encompassed in its elements as enumerated in House Bill 5043.
RH and Goals 4 and 5 on maternal and child health and survival
Reproductive health also includes maternal, infant and child health and nutrition which are crucial to ensuring the health of mothers and infants and in the reduction of maternal and infant mortality.

Family planning is central to maternal and child health because the WHO states that “birth-to-pregnancy (BTP) intervals of six months or shorter are associated with elevated risks of maternal mortality” and “BTP intervals of 18 months or shorter are associated with elevated risk of infant, neonatal and perinatal mortality, low birth weight, small size for gestational age, and pre-term delivery.”

The WHO underscores that 99% of all maternal deaths happen in developing countries like the Philippines. This is why a national policy on reproductive health is crucial in order to drastically lower maternal mortality rates in the country.

The worst inequity is maternal death. The miracle of life should not result in the death of a woman. Although pregnancy is not a disease, it is ironic that 500,000 women die annually worldwide of causes related to pregnancy and childbirth. In the Philippines, 10 women die daily of such causes.

HB 5043 is also very clearly anti-abortion. Its objective is to ensure that women and couples have access to all methods of family planning in order to prevent unplanned pregnancies. According to the 2003 NDHS, 44.3% of all pregnancies in the country are unplanned principally because of the lack of information on and access to family planning services. It is for this reason that the incidence of induced abortion in this country is 500,000 annually.

Contraceptive use and abortion have an inverse correlation. The more women use effective contraception, the less likely they have unwanted pregnancies that will be terminated through abortion. Research by the Guttmacher Institute also reveals that the use of contraceptives can reduce abortion rates by 85%.

RH and Goals 2 and 3 on universal primary education and gender equality

In the Philippines, childcare is still considered primarily the role of mothers and/or older sisters. Therefore, it is not uncommon for girls to drop out of school because they are forced to care for siblings as the family continues to expand. Family planning, as an essential element of reproductive health, will help ensure gender parity in school and foreclose this inequity being foisted on girls.

Another element of RH is the elimination of violence against women which will not only promote the basic human right to live a life free of violence but is also central to achieving gender equality.

Moreover, family planning will lead to bigger investments in health and education, improved quality of childcare and more educational and employment opportunities for women. All these will go a long way in achieving Goal 2 on universal primary education and Goal 3 on promoting gender equality.

RH and Goals 6 and 7 on HIV-AIDS and the environment

Still another element of reproductive health is the prevention of HIV-AIDS and other sexually transmitted diseases. Renewed efforts to curb the spread of HIV-AIDS and other STDs as advocated in the RH bill will help government achieve part of Goal No. 6 on combating HIV-AIDS.

Slower population growth through family planning will also relieve the strain that a burgeoning population exerts on an environment increasingly threatened by human activity and will help us attain Goal No. 7 on environmental sustainability.

RH and Goal No. 1 on poverty and hunger

Guaranteeing the right of women and couples to reproductive self-determination through the family planning method of their choice will also ultimately help government achieve Goal No. 1 on the eradication of hunger and poverty.

A decline in fertility rates will help open a demographic window of economic opportunity similar to what happened in South Korea, Singapore, Malaysia and Thailand. With fewer dependent children relative to the working-age population, these countries made additional investments on health, education, food security and other basic social services which spurred economic growth and helped reduce poverty.

Clearly, by promoting and protecting the right to reproductive health, government would have a better chance of achieving the MDGs, specifically the goals pertaining to the alleviation of hunger and poverty; improved access to primary education; better health for mothers; reduction of infant deaths; holding back the spread of HIV-AIDS; and the preservation of our fragile environment.

V. RH is an Indispensable Development Tool

The empirical nexus between reproductive health and sustainable human development is consistently and clearly established.

According to the UN State of the World Population Report 2002, “family planning and reproductive health are essential to reducing poverty”. The report declares that “countries that invest in reproductive health and family planning and in women's development register slower population growth and faster economic growth”.

The annual UN Human Development Studies also show that countries with higher population growth will invariably score lower on important aspects of human development such as income, physical and emotional well-being, life expectancy, literacy and employment.

Last year, the Philippines, as the 12th most populous country, ranked No. 84 out 171 countries in the Human Development Index rankings made annually by the United Nations. This year, we are down to No. 90. Among Southeast Asian countries, the Philippines fared the worst in the latest rankings. Singapore remained in the 25th slot, Indonesia improved by 1 rank and Vietnam and Brunei each improved their position by four levels. But while Malaysia, Myanmar and Cambodia all slipped two ranks and Thailand fell down by four slots, the Philippines went down by six points.

In a recent study of poverty and its causes in the Philippines, the Asian Development Bank listed an expanding population is one of the major causes of poverty in the country.

Data from the NSO for over a decade demonstrates that there is indeed greater incidence of poverty in larger families. Large families are prone to poverty with 57.3% of Filipino families with seven children mired in poverty while only 23.8% of families having two children live below the poverty threshold.

It should be emphasized that any poverty reduction program that would be undertaken by government must include the reduction of our population growth rate for it to be effective and sensible.

A clear, comprehensive and rights-based policy on reproductive health like House Bill 5043 is just as important to the attainment of sustainable human development as good governance, the eradication of graft and corruption and the redistribution of wealth in the country.

VI. The RH Bill has overwhelming support inside
and outside the House of Representatives

Despite the intensified black propaganda launched against RH bill, it now has 113 coauthors in the House of Representatives.

Notwithstanding the all-out opposition of some members of the Catholic Church hierarchy, House Bill 5043 is now in the period of plenary debate. This is the farthest any bill of this nature has reached since similar measures were filed in 2001.

Public support for the bill is also overwhelming. Just last week the SWS released its 3rd Quarter Social Weather Survey that revealed that 71% of Filipinos support the passage of the RH bill and 76% approve of the teaching of family planning to the youth.

This survey only confirms what opinion polls for the past two decades have been telling policymakers – Filipinos approve of family planning and want an RH law to be enacted. They are also telling lawmakers that religion is not a factor in their family planning decisions because according to the SWS survey, 71% of Catholics are in favor of the bill compared to 68% of non-Catholics.

The bill has likewise received tremendous multi-sectoral support from groups as varied as scientists, professors from UP and Ateneo, and religious organizations such as the Iglesia ni Cristo and Jesus is Lord Movement to labor unions and employers’ associations, human rights groups and medical associations like the Philippine Obstetrical and Gynecological Society, and the vast NGO community.

Indeed, support for the RH bill transcends professions, social class, political orientation and religious affiliations. 

VII. The RH bill will be enacted because it is necessary, beneficial and practicable

Pills and condoms may be available in drugstores but their being physically available does not mean that they are accessible to the women and couples who want and need them most.

This is also true for those who want to utilize natural family planning methods. Women and couples who opt for NFP must be properly trained and provided with modules to help them correctly utilize their method of choice.

As healthcare providers, I am certain you fully recognize the importance of family planning to the health and wellbeing of women and children. The WHO, UNFPA and the medical journal Lancet are unanimous in asserting that correct and consistent use of contraceptives can help prevent one-third of maternal deaths. Studies conducted by the WHO also conclude that proper birth spacing reduces the risk of death for newborns and infants by 50%.

We need to institutionalize by statute a national policy on RH and population development because it will ensure that despite regular changes in national and local leadership, women and couples will always receive relevant information and have access to family planning services.

HB 5043 will benefit the millions of Filipino women who want to plan their families and meet their fertility goals. According to the 2003 National Demographic and Health Survey, the poorer the woman, the larger the gap is between her wanted and actual fertility. The poorest women still have an average of 6.5 children while the richest women consistently meet their fertility goal of 2.5.

The 2006 Family Planning Survey results also show that among the poorest women who want to avoid another pregnancy, at least 41% do not use any contraceptive method because they lack information on and access to family planning methods.

Finally, the bill is practicable because its primary beneficiaries have made it clear in surveys conducted over a period of almost 20 years that they approve of contraceptive use and want to be able to responsibly plan their families.

The support of a professional group as well respected as the PNA will be invaluable in our crusade for the enactment of the reproductive health bill. Majority of you are women and mothers and I know that in your hearts you realize that this bill is necessary and will benefit millions of women and children.

You are in a profession that is in the vocation of saving lives. Please help our legislators enact a bill that will truly be responsive to the health needs of Filipinos by taking a stand and supporting the RH bill because it is pro-poor and pro-women and because ultimately, family planning does save lives.

Reproductive Health
HB 5043: PROMOTING AND PROTECTING THE RIGHT TO HEALTH AND DEVELOPMENT
(Speech delivered by REP. EDCEL C. LAGMAN at the Interfaith Symposium
on Reproductive Health at the Sulo Hotel on 21 November 2008)

The crusade for the passage of House Bill No. 5043 or the “Reproductive Health, Responsible Parenthood and Population Development Act of 2008” has been difficult not because it lacks merit since the bill is truly meritorious as it is necessary, beneficial and practicable.

The enactment of the bill faces roadblocks not because it is deprived of popular support because survey after survey reveals that the RH bill enjoys the solid support of an overwhelming majority of Filipinos regardless of social class and religion. The latest SWS survey shows that 71% of all Filipinos endorse the passage of the reproductive health bill or even a higher 84% of those who were previously aware of the bill before the last survey.

Neither is the passage of the bill delayed because of lack of supporters in the House of Representatives. In fact, as of today, House Bill 5043 has a total of 113 coauthors, more than a majority of the requisite quorum to approve a bill.

The campaign for the enactment of the RH bill has been made difficult because of the deliberate misinformation campaign being launched against the bill by its critics and the dilatory maneuvers being contrived by its oppositors.

I am therefore thankful for this opportunity to explain the salient provisions of the measure and the chance to counter the misinformation and half-truths being peddled by those against the bill.

I am also eager to emphasize the other elements of RH which have been overlooked since the beginning of the RH debates both within and outside the Halls of Congress.

The current plenary debates in the House of Representatives on House Bill 5043 are instructive and reveal the bigotry and intolerance of its oppositors – normally reasonable and coherent human beings whose personalities turn 180 degrees when the issue being discussed is reproductive health. It is almost incredible to witness their inordinate tenacity in imposing their beliefs on the rest of the populace.

While the RH bill assures an enabling environment where women and couples have the freedom of informed choice on the mode of family planning they want to adopt based on their needs, personal convictions and religious beliefs, RH is certainly not only about contraceptives and family planning.

It is ironic that while the critics of the bill continue to condemn the use of contraceptives as “intrinsically evil”, imagine the downfall of the Filipino family and traditional Filipino values and the predict rise of a “contraceptive mentality”, they are the ones who are in fact guilty of “contraceptive mentality”. They see the RH bill as nothing but a surfeit of pills and condoms.

They are culpable of the very thing they fear – this so-called contraceptive mentality” – because they insist on delimiting, even diminishing, the issue of reproductive health to contraceptives alone when RH is much, much more than merely condoms and pills.

ELEMENTS OF RH - The RH bill is not principally about contraceptives. It is certainly not about religion. It is about health and rights and this can be seen clearly in the coverage of reproductive health, as proposed in the bill.

Family planning is only one element of reproductive health. Equally important are the other elements of RH which include: (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.

It is a pity that the debate has been confined to family planning because the other elements of RH, which will similarly protect and promote the right to health and reproductive self-determination, have been largely ignored.


STRENGTHENING OF POPCOM - The POPCOM shall be reoriented to promote both natural and modern family planning methods. Few people know that POPCOM, which is the government agency central to the country’s family planning program, is only promoting for sometime now natural family planning even though only 29% of all women using family planning employ NFP and traditional methods compared to the 71% who use modern contraceptive methods.

MIDWIVES FOR SKILLED BIRTH ATTENDANCE – The bill supports safe motherhood. It proposes that every city and municipality shall endeavor to employ an adequate number of midwives and other skilled attendants. Skilled attendance at birth will help prevent maternal and infant mortality which are both alarmingly high in the country. Currently, only 57% of Filipino women give birth with the assistance of a trained medical professional.

EMERGENCY OBSTETRIC CARE - Each province and city shall endeavor to ensure the establishment and operation of hospitals with adequate and qualified personnel that provide emergency obstetric care. If we are to make headway in our commitment to the Millennium Development Goals (MDGs) to lower infant mortality and improve maternal health, it is imperative to provide emergency obstetric care to those who need them. The miracle of life should not mean death for 10 mothers daily and the importance of facilities that can provide life saving services to pregnant women cannot be overemphasized.

HOSPITAL-BASED FAMILY PLANNING - Family planning methods requiring hospital services like ligation, vasectomy and IUD placement shall be available in all government hospitals. Maternal and infant mortality and morbidity are public health concerns that government can address if effective and long-term methods such as IUDs and permanent methods like ligation and vasectomy are readily available in government hospitals – the health facilities the poor and marginalized regularly utilize.

CONTRACEPTIVES AS ESSENTIAL MEDICINES - Reproductive health products shall be considered essential medicines and supplies and shall form part of the National Drug Formulary. The classification of contraceptives as essential medicines will help the poorest of our women, who continue to have an average of six children, avoid unplanned pregnancies and maternal death. Both the WHO and UNFPA have declared that contraceptive use can prevent 1/3 of all maternal deaths.

Our maternal mortality rate which is pegged at 162 deaths out of every 10,000 live births is both alarming and insidious. Fourteen percent of all deaths in the female population can be attributed to pregnancy and childbirth-related causes (DOH and NDHS 2003). This is unacceptable. No woman should die giving life to another human being.

It should be underscored that modern contraceptives are included in the World Health Organization Model List of Essential Medicines. Their inclusion in the National Drug Formulary will enable government to purchase contraceptives and not merely rely on unpredictable donations.

REPRODUCTIVE HEALTH EDUCATION – RH education in an age-appropriate manner shall be taught by adequately trained teachers from Grade 5 up to 4th Year High School. As proposed in the bill, core subjects include responsible parenthood; natural and modern family planning; proscription and hazards of abortion; reproductive health and sexual rights; abstinence before marriage; and responsible sexuality, among others.

Sexuality education seeks to assist young people in cultivating a positive view of sexuality; provide them with information and skills about taking care of their sexual health; and help them make sound decisions now and in the future. It has also has been shown to make adolescents more sexually responsible and adds a level of maturity to their attitudes towards sexual relations.

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

Moreover, an SWS survey released only last month shows that 76% of Filipinos approve of the teaching of family planning to the youth. Family planning encompasses reproductive health and sexuality education.

IDEAL FAMILY SIZE - The State shall encourage two children as the ideal family size. This is neither mandatory nor compulsory and no punitive action may be imposed on couples having more than two children. This also approximates the desired number of children by women and couples which is 2.5 children. This is also consistent with the desire of the youth to have only two (2) children (Youth and Adolescent Fertility Survey, 2002).

EMPLOYERS’ RESPONSIBILITIES - Employers shall respect the reproductive health rights of all their workers. Women shall not be discriminated against in the matter of hiring, regularization of employment status or selection for retrenchment. Employers shall provide free reproductive health services and commodities to workers, whether unionized or unorganized.

These are all restatements and improvements of existing provisions of the Labor Code and prevailing Collective Bargaining Agreements (CBAs).

CAPABILITY BUILDING OF COMMUNITY-BASED VOLUNTEER WORKERS - Community-based workers shall undergo additional and updated training on the delivery of reproductive health care services and shall receive not less than 10% increase in honoraria upon successful completion of training. This will improve the ability of our barangay health workers to deliver relevant RH information and services.

CERTIFICATE OF COMPLIANCE - No marriage license shall be issued by the Local Civil Registrar unless the applicants present a Certificate of Compliance issued for free by the local Family Planning Office certifying that they had received adequate instructions and information on family planning, responsible parenthood, breastfeeding and infant nutrition.

PROHIBITED ACTS – The following persons, and no one else, shall be held liable for prohibited acts, as follows:

1. Public and private health care providers who:    

(a) Knowingly (with malicious intent) withhold or impede the dissemination of information about the programs and services provided for in this Act or intentionally give out incorrect information;

(b) Refuse to perform voluntary ligation and vasectomy and other legal and medically-safe reproductive health care services on any person of legal age on the ground of lack of spousal consent or authorization;

(c) Refuse to provide reproductive health care services to an abused minor and/or an abused pregnant minor, whose condition is certified to by an authorized DSWD official or personnel, even without parental consent which is not necessary when the parent concerned is the perpetrator;

(d) Fail to provide, either deliberately or through gross or inexcusable negligence, reproductive health care services as mandated under this Act; and

(e) Refuse to extend reproductive health care services and information on account of the patient’s civil status, gender or sexual orientation, age, religion, personal circumstances, and nature of work: Provided, That all conscientious objections of health care service providers based on religious grounds shall be respected: Provided, further, That the conscientious objector shall immediately refer the person seeking such care and services to another health care service provider within the same facility or one which is conveniently accessible: Provided, finally, That the patient is not in an emergency or serious case as defined in RA 8344 penalizing the refusal of hospitals and medical clinics to administer appropriate initial medical treatment and support in emergency and serious cases.

2. Any public official who prohibits or restricts personally or through a subordinate the delivery of legal and medically-safe reproductive health care services, including family planning (inaction is not culpable).

3. Any employer who shall fail to comply with his obligation under Section 17 of this Act or an employer who requires a female applicant or employee, as a condition for employment or continued employment, to involuntarily undergo sterilization, tubal ligation or any other form of contraceptive method.

4. Any person who shall falsify a certificate of compliance as required in Section 14 of this Act.

5. Any person who maliciously engages in disinformation about the intent or provisions of this Act.

Now that I have discussed the most relevant provisions of the RH bill, I would like to answer some of the misconceptions about the measure.

The bill is not 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. It will empower couples with the information and opportunity to plan and space their children. This will not only strengthen the family as a unit, it will optimize care for fewer children who will have more opportunities to be educated, healthy and productive.

The bill does not favor modern family planning methods over NFP. Both natural and modern family planning techniques are contraceptive methods. Their common purpose is to prevent unwanted pregnancies and the bill does not impose a bias for either method.

The bill does not legalize abortion and will not lead to its legalization. It is false and malicious to claim that the RH bill legalizes abortion. 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.

It is likewise misleading and inaccurate to claim that the use of contraceptives will eventually lead to the legalization of abortion. 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. Muslim and Buddhist countries like Indonesia and Laos have likewise liberalized the use of contraceptives but still continue to criminalize abortion.

Moreover, there is an inverse correlation between contraceptive use and abortion. The regular and correct use of contraceptives drastically reduces abortion rates since unplanned and unwanted pregnancies are avoided. Consequently, women do not have to resort to abortion and the State will find no need to legalize abortion.

The bill does not endorse abortifacients. Hormonal contraceptives are BFAD-approved, medically safe and legal. The primary mechanism of pills and injectables 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? Articles in peer-reviewed medical journals testify that IUDs do not cause abortions because they stop fertilization. A recent study revealed that not a single fertilized egg was recovered from the fallopian tubes of women using IUDs proving that they are amazingly successful in preventing fertilization.

In fact, the UNDP, UNFPA and WHO have submitted to the House of Representatives an expert opinion on the mechanisms of modern contraceptives and they state that contraceptives “cannot be labeled as abortifacients” as none of these methods have been shown to cause abortions.

The bill is truly anti-abortion. It will tremendously reduce the incidence of abortion in the country which in 2002 has been recorded to be about 470,000 and the UN estimates that it has reached 800,000 today. Data also show that it is not single women and teenagers but poor, married, Catholic women in their 20s who most often undergo abortions because they cannot afford another child.

Contraceptives do not have life threatening side-effects. Medical and scientific evidence show that all the possible medical risks connected with contraceptives are infinitely lower than the risks of an actual pregnancy and everyday activities. The risk of dying within a year of riding a car is 1 in 5,900. The risk of dying within a year of using pills is 1 in 200,000. The risk of dying from a vasectomy is 1 in 1 million and the risk of dying from using an IUD is 1 in 10 million. The probability of dying from condom use is absolutely zero. But the risk of dying from a pregnancy is 1 in 10,000.

The bill will not promote contraceptive mentality. The bill does not prohibit pregnancy. Critics are mistaken in claiming that because contraceptives would be readily accessible, people would prefer to have no children at all. Couples will not stop wanting children simply because contraceptives are available. Contraceptives are used to prevent unwanted pregnancies but not to stop pregnancies altogether. Timely pregnancies are assured.

Sexuality education will not spawn “a generation of sex maniacs” nor promote promiscuity. Age-appropriate RH education promotes correct sexual values. It will not only instill consciousness of freedom of choice but responsible exercise of one’s rights. The UN and countries which have youth sexuality education document its beneficial results like understanding of proper sexual values; initiation to sexual relations is delayed; abstinence before marriage is encouraged; multiple sex partners is avoided; and spread of sexually transmitted diseases is prevented.

Parents who do not allow their children to attend RH and sexuality education classes will not be prosecuted and jailed. The provision on Prohibited Acts does not include parents who raise objections.

The bill does not claim that family planning is the panacea to poverty. It simply recognizes the verifiable link between a huge population and poverty. Unbridled population growth stunts socio-economic development and aggravates poverty. The connection between population and development is well-documented and empirically established.

UN Human Development Reports show that countries with higher population growth invariably score lower in human development. Last year, the Philippines, as the 12th most populous country, ranked No. 84 out 171 countries in the Human Development Index rankings made annually by the United Nations. This year, we are down to No. 90. Among Southeast Asian countries, the Philippines fared the worst in the latest rankings. Singapore remained in the 25th slot, Indonesia improved by 1 rank and Vietnam and Brunei each improved their position by four levels. But while Malaysia, Myanmar and Cambodia all slipped two ranks and Thailand fell down by four slots, the Philippines went down by six points.

The Asian Development Bank in 2004 also listed a large population as one of the major causes of poverty in the country. Recent studies also show that large family size is a significant factor in keeping families poor across generations.

However, the authors of the bill do claim that the bill will help promote sustainable human development. The UN has stated that “family planning and reproductive health are essential to reducing poverty” The UNICEF also asserts that “family planning could bring more benefits to more people at less cost than any other single technology now available to the human race.”

Family planning will not lead to a demographic winter. The proposition that the use of modern family planning will wipe off the Filipino race in a catastrophic “demographic winter” is a scare tactic which fails to comprehend the dynamics of population momentum wherein the country’s population will continue to grow even if the population growth rate is increasingly reduced to below replacement levels.

Experts led by UP Economics professors have declared in a paper entitled “Population and Poverty: The Real Score” that given the excruciatingly slow decrease in our Total Fertility Rate, a so-called demographic winter will not happen in the country for “at least another 100 years”.

According to the projections of the National Statistics Coordination Board, if our TFR continues to decrease by 0.2 children every five years, replacement fertility of 2.1 children will be achieved only by 2040. However, the 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.

An RH law will not be superfluous. 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. This contention overlooks that availability does not mean access, particularly to those who are uninformed or could not afford to buy reproductive health supplies. Availability does not assure adequate and accurate information on family planning and reproductive health which are basic universal human rights.

There are 12.86 million currently married women of reproductive age in the country. But we have a contraceptive prevalence rate of only 49.3% (2006 Family Planning Survey).

For those who are using any form of contraception, 26.2% use supply methods like condoms, pills and IUDs; 9.5% use permanent methods like ligation and vasectomy; 13.2% use traditional methods such as withdrawal and calendar-rhythm and only 0.4% use modern natural family planning like Standard Days Method, Mucus/Billings/Ovulation Method and Lactational Amenorrhea Method.

The 2006 FPS also reveals that a staggering 2.6 million women do not want to get pregnant but are not using any form of family planning for lack of information and access. This belies the claims of the measure’s critics that the RH bill will be superfluous because contraceptives are readily available.

Moreover, when the poorest Filipino women still have an average of six children, which almost three times their desired fertility, and 44% of their pregnancies is unwanted, it is clear that the most poverty-stricken women in the country are denied their basic human right to family planning.

Family planning, as a vital component of reproductive health, does not only ensure the health of mothers and children. Family planning saves lives. The WHO and UNFPA have declared that close to 200,000 maternal deaths and 1 million infant deaths worldwide could be avoided annually if women use contraception.

We need to enact HB 5043 because it promotes and protects the right to health, the right to informed choice, the right to reproductive self-determination, the right to voluntary motherhood and the right to sustainable human development.

I have been a legislator for more than 20 years and no bill I had filed has garnered more attention and merited more invitations to speak before groups ranging from seminarians and teenagers to physicians and professors than the RH bill. This issue has truly elicited a passionate response and heartfelt reactions from both those strongly supporting and rabidly denouncing the bill.

Long before plenary debates on HB 5043 began, forums and discussions on the bill were already being held in classrooms, churches, boardrooms, in marketplaces and factories and even in cyberspace.

The Catholic Church hierarchy is on an all-out campaign against the RH bill. Consistent with its obsolete precepts, the Catholic Bishops’ Conference of the Philippines (CBCP) together with its lay proxies, has activated the archaic meaning of the word “campaign” as “war”.

In the face of the Bishops’ rampage, are we going to suffer being trampled in their warpath?

Let us all stand up and be counted. Let us fiercely and fearlessly do battle for “Choice, Women and Life”!

Let us be vigilant crusaders and join the other RH advocates in the plenary gallery of the House of Representatives every Tuesday and Wednesday afternoon until evening to express steadfast support and be part of our impending victory.

Reproductive Health
REPRODUCTIVE HEALTH IS ABOUT RIGHTS
(Speech delivered by REP. EDCEL C. LAGMAN before the
Philippine Bar Association on 15 October 2008)

I cannot recall having filed a non-controversial bill. Perhaps, bills of genuine national import are controversial ab initio or subsequently become controversial.

Among my highly controversial bills were the comprehensive agrarian reform bill, the debt cap bill which proposed to limit our foreign debt service to 15% of the country’s export receipts, the bill abolishing the death penalty and the bill which modernized the practice of optometry and dismantled the corporate practice of the profession.

Except for the debt cap bill, all of these measures were eventually enacted into law.

My advocacy for the debt cap, agrarian reform and abolition of the death penalty had an enduring partner: the Roman Catholic Church hierarchy, which is still a partner with respect to the pending extension of the land acquisition and distribution (LAD) component of the Comprehensive Agrarian Reform Law (CARL), of which I am the principal author and sponsor.

However, many Catholic bishops vilify the reproductive health bill because it challenges the orthodoxy of the Church on family life and the procreative function of marriage.

The Catholic hierarchy must abandon its antediluvian doctrines or suffer isolation from the mainstream of Philippine society. It must heed the faithful who are overwhelmingly in favor of reproductive health and family planning.

Considering that I speak before fellow lawyers, I shall underscore the relevance of reproductive health to the protection and promotion of people’s rights as well as the constitutional validity of the bill.

Reproductive health and family planning
are basic universal human rights.

Reproductive health is a fundamental human right and was affirmed as such in the Proclamation of Tehran, International Conference on Human Rights 40 years ago in 1968.

The right to reproductive health and family planning was subsequently reiterated in numerous other UN Conventions of which the Philippines is likewise a signatory.

The Philippines is also committed to achieving the Millennium Development Goals, among which are the reduction of infant mortality and the improvement of maternal health. The MDGs were recently amended to underscore that family planning is indispensable to the attainment of these two goals.

Freedom of Informed Choice

Central to the RH bill is the freedom of informed choice. An enabling environment shall be created to allow women and couples to freely choose the method of family planning from the natural to the modern that they wish to adopt consistent with their personal needs and individual consciences.

The government shall conduct a massive information campaign on the benefits of family planning without any bias for or against any method. The only limitation is that the entire menu of family planning methods must be legal and medically-safe.

The government shall afford acceptors access to the family planning supplies of their choice which shall be given free to the poor and marginalized.

A sustained information campaign shall be undertaken because freedom of choice will not be meaningful if there is no prior complete and accurate information. This includes the possible side-effects and failure rates of the various methods of family planning.

It is in this sensitive campaign of giving factual and truthful information that the misinformation being peddled by the oppositors of the bill should be exposed and rebutted, like the following:

1. It is false and malicious to claim that the RH bill legalizes abortion. It does not. The measure repeatedly provides to the point of superfluity that abortion is illegal, criminal and punishable, and is not part of the menu of legally permissible and medically safe family planning methods.

2. It is likewise misleading and inaccurate to claim that the use of contraceptives will eventually lead to the legalization of abortion. Catholic and Muslim countries which have liberalized the use of contraceptives still continue to criminalize abortion. Moreover, there is an inverse correlation between contraceptive use and abortion. The regular and correct use of contraceptives drastically reduces abortion rates since unplanned and unwanted pregnancies are avoided.

Consequently, women do not have to resort to abortion and the State will find no need to legalize abortion.

3. It is utterly unchristian and grossly inhuman to assert that medical care should not be extended to women suffering from post-abortion complications because to do so would condone and encourage abortion. Like a wounded rebel in an encounter with government forces, women in distress must not be deprived of medical help.

4. The proposition that the use of modern family planning will wipe off the Filipino race in a catastrophic “demographic winter” is a scare tactic which fails to comprehend the dynamics of population momentum wherein the country’s population will continue to grow even if the population growth rate is increasingly reduced to below replacement levels.

The importance of policymaking is that policies are never cast on stone. They are flexible and reversible. Given the experiences of countries like Singapore, South Korea and Japan where there is a thinning young population and there is need to accelerate PGR, the Philippines can anticipate well in advance these eventualities without forfeiting the vast opportunity of economic growth by currently mitigating population expansion.

5. Commending labor migration as the beneficent result of “population power” is a misplaced accolade to inordinate fertility. Dollar remittances from OFWs should not blind us to the incalculable social and economic costs of labor migration.

Moreover, the so-called “population power” has just exploded in our faces as the bleak scenario unfolds with OFWs returning home because there is a depressed market for overseas employment as a consequence of the collapse of Wall Street.

6. The issue on population is not a simple matter of “population density” but more importantly, it is a question of sustainable human development. Concededly, there are still vast unpopulated areas of the country but these are places hostile to human development because there are no infrastructures in place, no schools, no hospitals, and no visible means of livelihood and employment.

Certainly, we can place the entire world’s population of 6.5 billion people in an area the size of the State of Texas. But they would end up eating each other’s sewage!

7. 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. This contention overlooks that availability does not mean access, particularly to those who are uninformed and could not afford to buy reproductive health supplies.

8.  It is grossly medically unfounded to allege that all contraceptives are life threatening and contraceptive use results to fatal diseases. This misinformation is negated by the data of medical authorities. For example, experts report that the risk of dying within a year (not actual death) is: one out of two hundred thousand (200,000) pill users; one out of one million (1,000,000) who have undergone vasectomy; one out of ten million (10,000,000) users of IUD; and zero (0) for condom users. This is compared to one out of 5,900 motor vehicle travelers and one out of ten thousand (10,000) non-high risk pregnancies.

The RH Bill is Constitutional

An inordinately huge population impacts negatively on all indicators of human development such as quality education, adequate medical care, food security, availability of employment, sufficient mass housing and a healthy ecology.

Invariably, all the more populous countries in the world rank low in human development. The Philippines, which is the 12th most populous country in the world with 88.4 million people is 84th in the 2006 UN-measured Human Development Index.

The salutary constitutional provisions on the right to quality education (Sec. 1, Article XIV); right to health (Sec. 15, Art. II); right to a family living wage and income (Sec. 3(2), Art. XV); right to a balanced and healthful ecology (Sec. 16, Art. II); and the right of children to proper care and nutrition and protection from all forms of neglect, abuse, cruelty, exploitation and other conditions prejudicial to their development, will all be illusory if the government is unable to promote reproductive health and family planning as indispensable tools to manage population growth and achieve sustainable human development.

The RH bill accords fealty to these constitutional rights and mandates.

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).

The constitutional challenge is baseless for the following overriding reasons:

1. The RH 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.

Verily, 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.

The RH bill aims to protect the family from poverty and want by helping women and couples achieve their fertility goals.

Empirical studies consistently document that larger families are almost invariably poorer than smaller families. Moreover, large family size perpetuates poverty across generations.

According to the UN State of the World Population Report 2002, “family planning and reproductive health are essential to reducing poverty.” The report declares that “countries that invest in reproductive health and family planning and in women’s development register lower population growth and faster economic growth.”

In a recent study of poverty and its causes in the Philippines, the Asian Development Bank listed an expanding population as one of the major causes of poverty in the country.

2. 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 is giving 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.

Verily, there is critical need for formal reproductive health and sexuality education in schools.

The fear that sex education would breed youthful “sex maniacs” and develop a culture of promiscuity is grossly unfounded.

Studies by the UN and progressive countries reveal the beneficent results of reproductive health and sexuality education among the young. These are:

(a)    Inculcation of correct and relevant sexual values and norms in the young which disabuses their minds of preconceived myths on sex and responsibly addresses their curiosity so much so that experimenting is foreclosed;
(b)    Initiation into sexual activity is delayed;
(c)    Multiple sexual partners are avoided;
(d)    Abstinence before marriage is encouraged; and
(e)    Spread of HIV-AIDS and sexually transmitted diseases is prevented.

3. 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 genesis of this provision in the Constitutional Commission establishes the following:

(a) 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 anti-abortion intent of this provision is admitted both by its principal proponent, Commissioner Bernardo Villegas, and Commissioner Joaquin Bernas who initially proposed a similar provision as Section I of the Bill of Rights which read: “The right to life extends to the fertilized ovum.” (underscoring supplied).

This Bernas proposal did not materialize. Its non-adoption unmistakably manifests that the concept that life begins at fertilization was not constitutionalized for lack of concurrence from the Commissioners.

After the deletion of the Bernas proposal in the Bill of Rights, another formulation was included in Article II on the Declaration of Principles which originally read: “The State shall protect human life from the moment of conception.”

It is important to note that under the foregoing draft, it is suggested that human life begins “from the moment of conception”, not anymore from the fertilization of the ovum.

This also confirms the thinking of the Commissioners that the “fertilization of the ovum” is not the same or synonymous to “conception”. The two refer to different stages of the reproductive process.

(b) As finally adopted, it is provided that the State “… shall equally protect the life of the mother and the life of the unborn from conception.”

There were two amendments in the approved final provision: (1) the phrase “the moment of” preceding “conception” was deleted; and (2) the phrase “the life of the mother” was included. These two amendments are very significant.

The deletion of the phrase “the moment of” was the result of the Commissioners’ uncertainty as to the precise beginning of conception. Hence, they decided to defer to medical science and subsequent legislation the determination of the start of conception.

The international scientific community and numerous medical dictionaries and textbooks define the beginning of pregnancy or conception as the moment the fertilized ovum attaches itself to the lining of the uterus. Pregnancy, therefore, starts one to two weeks after fertilization.

The American College of Obstetricians and Gynecologists defines conception as “the implantation of the blastocyst. It is not synonymous with fertilization.” The National Institute of Health/Food and Drug Administration states that “Pregnancy encompasses the period of time from confirmation of implantation until expulsion or extraction of the fetus.”

Verily, the fertilized egg has no sustainable viability outside of the uterine wall. It has to implant in the uterus to have sustainable life and for gestation to progress or for pregnancy to begin.

Consequently, the International Federation of Gynecologists and Obstetrics (FIGO) defines abortion as “the termination of pregnancy after implantation and before the conceptus has become independently viable.”

It is important to note that this international medical organization expressly states that for an act to be considered an abortion, the fertilized egg must already be implanted in the uterus.

Verily, the bill does not offend the constitutional intent proscribing abortion. In fact, it repeatedly reiterates the national policy against abortion. Moreover, the RH bill is even an anti-abortion measure because it respects the option of women and couples to use legal and medically-safe contraceptives which reduces abortion rates by 85%.

In the Philippines, it has been established that majority of those who undergo induced abortion are not teenagers or single women. They are married Catholic women with ages ranging from 21 to 29 who do not want another pregnancy or could not afford another child because of poverty or lack of resources. (State of the Philippine Population Report, 2001).

(c) The proceedings of the Constitutional Commission show that there was no intention to ban contraceptives which are not abortifacient.

Contraceptives like pills and injectables which prevent a woman from ovulating are not abortifacients because in the first place, no egg is released for fertilization. Similarly, contraceptives which weaken the sperm to incapacitate it from fertilizing an egg cannot be considered abortifacient because there is no fertilized egg for implantation in the uterine wall.

In the same token, IUDs which principally slow down the sperm to prevent them from reaching the egg are also not abortifacients. The primary action of IUDs is to “release copper ions which are toxic to sperm.”

The notion that contraceptives prevent implantation has been debunked by the UNDP, UNFPA and WHO. In their joint position paper submitted to the House of Representatives, they stated unequivocally that there is “no scientific evidence supporting this possibility. Therefore contraceptives cannot be labeled as abortifacients.” (underscoring supplied).

True to its nomenclature, a contraceptive is an antidote to conception or anti-conception. Hence, contraceptive use prevents conception. In the absence of conception, there is no life of the unborn to be protected.

(d) The importance of the second amendment which included the protection of “the life of the mother” is lost because of the undue emphasis on protecting “the life of the unborn from conception.”

The Constitution mandates the equal protection of the life of the mother and the life of the unborn.

In fact, when both the lives of the mother and the unborn are imperiled, the invariable option is to save the life of the mother if both lives could not be saved. The doctor’s primary obligation is to the mother because it is she who is the patient.

Family planning, as a vital component of reproductive health, does not only ensure the health of mothers and children. Family planning saves lives. The WHO, UNFPA and the medical journal Lancet are unanimous in declaring that the use of reliable contraceptives decreases maternal mortality by one-third. Close to 200,000 maternal deaths worldwide could be avoided annually if women use contraception.

The body of a woman needs at least three years to fully recuperate from pregnancy and childbirth. The use of contraceptives prevents unremitting pregnancies which endanger the lives of mothers and infants.

It is indubitable that based on the foregoing discussion, HB 5043 is constitutional and actualizes the people’s rights related to reproductive health and family planning.

Popular support to the RH Bill


Vox populi, vox Dei (the voice of the people is the voice of God) and vox populi est suprema lex (the voice of the people is the supreme law) are truisms most relevant to the RH campaign. Consider the following popular survey results for almost two decades:

•    96% of Catholics say it is important to have the ability to control their fertility and most approve of the use of contraceptives expressly forbidden by the Church (SWS, July 1991).

•    Pulse Asia has conducted regular surveys (1995, 2001, 2004 and 2007) on family planning and the results have consistently revealed that Filipinos believe in the importance of family planning. The 2007 results reveal:

    92% of all Filipinos believe that it is important to have the ability to control one’s fertility and plan one’s family.
    93% of all Roman Catholics surveyed said that family planning is important. This is an even higher percentage than the national average of 92%.
    89% of all Filipinos support government funding for modern methods of family planning.
    90% of all Roman Catholics surveyed agreed that government should allocate funding to modern FP methods. Again, this is an even higher percentage than the national average of 89%.
    The top three ethnic groups which support public funding for contraceptives are: Bicolanos (96%), Pangasinenses (96%) and Kapangpangans (95%).
    75% of Filipinos will support candidates who are in favor of a government budget for family planning.
    76% of Filipinos consider it important that a candidate includes family planning in his or her program of action.
    77% of Roman Catholics surveyed say that it is important that family planning be included in a candidate’s program of action. Again, this is even higher than the national average of 76%.

House Bill No. 5043 or the “Reproductive Health, Responsible Parenthood and Population Management Act of 2008” has strong support inside and outside the House of Representatives. To date, 113 members of the House have coauthored the bill even as tremendous multi-sectoral support continues to increase.

This bill has the longest gestation in Congress with precursor measures dating back to the 8th Congress (1987-1992).

Now, it has irreversibly reached the period of plenary debates. Its eventual approval is almost a certainty because it is necessary, beneficial and practicable.

And, it is also rights-based and constitutional.

Reproductive Health

SETTING THE RECORD STRAIGHT ON THE RH BILL
(Speech delivered by REP. EDCEL C. LAGMAN on 17 February 2009
at the University of Makati)

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.