- Reproductive Health
(Speech delivered by REP. EDCEL C. LAGMAN during the
10th National Summit of the Lady Local Legislator’s League of the Philippines
at the Diamond Hotel on 23 January 2009)
I filed the first version of the reproductive health bill in July 2004 and in the almost five years since then, I am still amazed at the intense and passionate response people have towards the bill. It does not matter if they are for or against the measure – a lukewarm response is not forthcoming when it comes to the issue of RH and family planning. People are almost always either fervently supportive or rabidly opposed to the bill.
But despite the unrelenting protestations and vocal criticisms of some sectors of the Catholic hierarchy and their lay organizations, the reaction of ordinary people to the RH bill has always been overwhelmingly positive. In particular, the support the bill has from women is especially strong.
The issue of reproductive health and population development are indeed issues close to the hearts of women who bear the brunt not only of pregnancy and childbirth but also of childrearing. Invariably, women seem to know instinctively that the lack of family planning information and options will have negative effects on their lives.
Being local legislators, I am certain that you have seen firsthand the deleterious outcomes of unremitting pregnancies on the health of both mothers and children in particular and sustainable human development in general.
As women, I am sure that you want concrete and lasting solutions to the problems of maternal and infant mortality and morbidity and better chances for women to lead dignified and meaningful lives.
Poverty in the Philippines Wears a Woman’s Face
The story of ill-health and poverty in the Philippines wears a woman’s face. The feminization of hardship and suffering cannot be denied. Women, who already have significantly less opportunities for remunerative work and quality education, are doubly burdened because they have to bear and give birth to children; feed, bathe, medicate and care for them; manage the family’s finances and do the housework on top of their jobs outside the home. A woman is not only mother and wife. She is also a nurse, cook, maid, laundrywoman, tutor, handyman and accountant rolled into one.
It is no wonder then that Filipino women have expressed tremendous support for the RH bill. They know that it is pro-poor, pro-women and ultimately, pro-life. It will give them and their partners the opportunity to have only the children that they can afford to bring up into healthy, educated and productive citizens.
human development indicators
But unless women and couples have the opportunity to plan their families and meet their fertility goals, it will be extremely difficult for them to ensure the future wellbeing of their children.
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 on reproductive health, responsible parenthood and population development will help ensure that women and couples will achieve their desired number of children.
The RH Bill = Freedom of Informed Choice
The heart and soul of House Bill 5043 is the creation of an enabling environment wherein women and couples will not only have information on and access to all forms of family planning methods from the modern to the natural but also the opportunity to freely choose which method is best suited to their needs, personal convictions and religious beliefs.
Contrary to the claims of its critics that the bill favors modern methods of family planning over natural methods, the bill in fact democratizes family planning because it will make available to couples all possible family planning methods and not just NFP methods preferred by the Catholic Church.
It is important to underscore that 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.
Moreover, neither the Church nor the State can impose its will or preference on couples. Neither are these institutions allowed to intrude into the private bedrooms of women and couples and interfere with their family planning decisions. The final decision rests on the women or couples themselves.
Forty years ago, the International Conference on Human Rights in the Proclamation of Teheran articulated unequivocally that “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.
But even up to now, this right remains illusory for 2.6 million Filipino women who, according to the 2006 Family Planning Survey, would like to plan their families but lack information and access to do so.
With the poorest of our sisters still having an average of six children, which is almost three times their desired number of children, and with 44% of their pregnancies unwanted, it is clear that the most poverty-stricken women in the country are denied their basic human right to plan their families.
HB 5043 will help protect and fulfill the right of all Filipinos to decide when and how often they want to become parents.
The miracle of life must not mean death for mothers
The persistent negative reports that 11 Filipino women die daily of causes related to pregnancy and childbirth underscore the critical immediacy of enacting the RH bill.
The most recent report comes from the State of the World’s Children 2009 of the UNICEF which emphasizes that “having a child remains one of the biggest health risks for women worldwide.” The report underscores the fact that difference in pregnancy risk between women in developing countries like the Philippines and women in first world nations is “the greatest health divide in the world.”
With approximately 4,500 Filipino mothers dying of complications related to childbirth and pregnancy each year, the Philippines is among the worst performing countries in improving maternal health.
Moreover, based on the UNICEF Report, the lifetime risk of maternal death in the Philippines is 1 in 140, compared to 1 in 8,000 for women in developed countries. According to the report, women in developing countries are 300 times more likely to die in childbirth or from pregnancy-related complications than women in developed countries.
These are not cold statistics but disturbing and distressing figures which demand immediate remedial action from both local and national policymakers.
No woman should die giving life. As local legislators, and more importantly, as women and mothers, your support will be indispensable in the prevention of maternal mortality. The miracle of life should not mean death for so many Filipino mothers.
Family planning saves lives
Studies by the WHO, UNDP and UNFPA validate that correct and consistent use of contraceptives will prevent one-third of all maternal deaths. With 98% of maternal deaths happening in developing countries like the Philippines, it is imperative that women be given access to effective family planning methods as provided for in HB 5043.
Family planning saves lives because it will have a direct effect on maternal mortality by reducing the number of high-risk pregnancies. HB 5043 will help women who are at a higher risk of maternal death avoid unplanned pregnancies.
“Too young, too old, too many, too soon” illustrates the undesirable aspects of unplanned pregnancies and avoiding pregnancies in women who fall under this category will dramatically reduce maternal deaths.
Family planning will not only lead to a decrease in overall pregnancy rates. The WHO emphasizes that with the proper use of contraceptives, “the fall in maternal mortality is likely to be even greater than the fall in the pregnancy rate.” This means that the risk associated with each individual pregnancy had been reduced.
There are several possible ways in which this could happen:
- Fewer births to very young women. The bodies of women under 18 years are not yet ready for pregnancy and childbirth and it is for this reason that in the Philippines, 75% of maternal deaths happen to 15 to 19 year old women.
- Fewer births to older women. Similarly, women above 35 years are at an increased risk of hemorrhage, pregnancy-induced hypertension and uterine prolapse. Therefore, reducing the proportion of pregnancies among older women would decrease maternal mortality levels.
- Fewer high-parity births. Studies show that women who already have four or more children have a substantially increased risk of maternal death. Frequent pregnancies are also often associated with less prenatal care and lower likelihood of supervised delivery.
- Fewer short birth intervals. Short birth intervals are also linked to increased risk of an adverse outcome for the mother because studies show that a woman’s body needs no less than three years to recover from pregnancy and childbirth. Thus, the shorter the gap between pregnancies, the greater is the likelihood of maternal death.
It must also be underscored that family planning does not only saves lives, it is directly related to the decrease in abortion rates.
The WHO has unequivocally asserted that family planning is “the most effective intervention to prevent unintended pregnancy and abortion.”
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 Gûttmacher Institute also reveals that the use of contraceptives can reduce abortion rates by 85%.
RH and FP are essential to the achievement of key MDGs
The Philippines has committed to achieve the Millennium Development Goals (MDGs) by 2015 of which Goal No. 5 is the improvement of maternal health. MDG Goal No. 5 has recently been amended to include reproductive health. Goal No. 5 now includes the achievement of “universal access to reproductive health”.
Consequently, the following are the four new indicators for monitoring MDG No. 5 apart from maternal mortality ratio and proportion of births attended to by a skilled health professional: (1) contraceptive prevalence rate; (2) adolescent birth rate; (3) antenatal care coverage; and (4) unmet need for family planning.
It is important to underscore that six of the eight MDGs are linked to reproductive health and are covered by the elements of RH as enumerated in House Bill 5043.
RH and Goals 4 and 5 on maternal and child health and survival
An important element of reproductive health as provided in HB 5043 is maternal, infant and child health and nutrition. This is crucial to ensuring the health of mothers and infants and in the reduction of maternal and infant mortality under Goals 4 and 5.
Family planning, another vital element of RH, is central to maternal and child health because the WHO states that intervals of six months or shorter between childbirth and an ensuing pregnancy are associated with elevated risks of maternal mortality and intervals of 18 months or shorter are associated with elevated risk of infant mortality, low birth weight and pre-term delivery.
This is why a national policy on RH is crucial in order to drastically lower maternal mortality rates in the country.
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 will help ensure gender parity in school and foreclose this inequity being imposed 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 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.
By promoting and protecting the right to reproductive health, we will clearly have a better chance of achieving the MDGs.
Make every mother and child count
The time has come to put an end to the relegation of women and maternal health to the backburner of the national agenda. We must exert all efforts to make every mother and child count. I am confident that RH advocates in Congress can count on the support of the Lady Local Legislators League of the Philippines to actively and forcefully campaign for the enactment of a national policy on reproductive health, responsible parenthood and population development.
I am truly thankful that many local councils have passed their own versions of the RH bill like those adopted by, among others, the provinces of Aurora, Ifugao and Tawi-Tawi; the cities of Olongapo, Sorsogon and Davao, and the municipalities of Talibon in Bohol, Sagada in the Mountain Province and Lebak in Sultan Kudarat. This is clearly a reflection of the exemplary political will of local leaders.
However, the country still needs a comprehensive, rights-based and adequately funded RH statute that is national in scope.
Passing the buck to LGUs when it comes to the formulation of population policies and implementation of family planning programs is at best, impractical. At worse, it is simply bad governance.
The crafting of population policies and their effective execution cannot be relegated to LGUs for the following reasons: 1) More often than not, local leaders wait for policy directives from the national government; 2) A decrease in population growth will not be an incentive to LGUs because increases in the amount of IRA an LGU receives is directly proportional to the increase in its population; 3) If an LGU provides access to all forms of family planning methods, it can expect a surge of migrants who would want to take advantage of its FP programs to the detriment of actual residents (this is exactly what happened in Quezon City when its health centers were swamped with Manila residents who were deprived of family planning services and supplies for nine years during the incumbency of former Manila Mayor Lito Atienza); 4) The fiscal resources and technical expertise of each LGU differs; and 5) Local executives are more susceptible to the pressures that will be brought to bear by religious institutions in the implementation of RH programs and policies.
Survey after survey for the last two decades, document the increasing number of Filipinos, principally Catholics, who favor family planning, including contraceptive use. Consider the results of the latest Pulse Asia survey conducted in October 2008:
- 93% of Filipinos consider it important to have the ability to plan their families;
- 82% of Filipinos believe government should teach couples about all methods of family planning;
- 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; and
- A considerable majority of Filipinos (63%) want the RH bill to be passed into law with only 8% expressing opposition to the measure.
- 71% of Filipinos are in favor of the RH bill;
- 76% of Filipinos agree that there should be a law requiring government to teach family planning to the youth; and
- 68% believe that there should be a law requiring government to distribute legal contraceptives like condoms, pills and IUDs
- 68% of Catholics believe that government should distribute free contraceptives to those who want them;
- 76% of Catholics agree that there should be a law requiring government to teach family planning to the youth; and
- 71% of Catholics favor the passage of the RH bill versus only 68% of non-Catholics who endorse the bill.
The people have spoken. They want to be able to plan their families. They want government to give them family planning information and services. They want the RH bill passed. They need the RH bill passed.
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, and the right to sustainable human development.
A non-coercive measure that will provide accurate and reliable family planning information and services and help people become responsible parents even as it will increase their chances of improving their lives is definitely pro-poor, pro-women and pro-life.
Well-off, educated, accomplished and independent women like you have always exercised their right to responsibly plan their families. Please do not let your less fortunate sisters be deprived of the same right that you enjoy.
There is no reason for any of us to be afraid of the RH bill. 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. 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. 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.