- Reproductive Health
(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.