This article was originally published in Women’s Health Magazine September 2010 issue.
Eleven Filipinas die every day due to childbirth complications. The country’s population expands at a rate that is unsustainable for its limited resources, exacerbating poverty. Hopes are high for the passage of the Reproductive Health bill that can save mothers’ lives and jumpstart economic development, writes Ana Santos.
Lina, 36, a scavenger who lives in Manila, and her kids get by on the measly earnings she and her tricycle driver-husband can scrape together. On good days, they can make as much as P250 a day.
“Ayoko na sana mabuntis. Gusto ko sana apat lang. Pumunta ako sa health center pero ayaw nila ako bigyan ng Pills. May ruling dawn a pro-life [methods] lang ang puwede,” says Lina.
Dory*, 34, a housewife, met news of her sixth pregnancy with dread. She tried to induce an abortion by banging her stomach against a window pane. When that didn’t work, she went to a quack doctor. She hemorrhaged from the procedure and had to be hospitalized.
At the hospital, instead of calling her by her name, she was referred to as “Ms. Abortionist” and openly treated with disdain.
Jeremy*, 18, just delivered her second baby this July. She gave birth to her first child at home when she was 16. Her husband is 21. Neither of them work. Neither of them know about artificial contraception, or their options as far as birth control is concerned.
Three different women. Three different stories. All could have been helped by one bill that’s languished in Congress for two decades—the Reproductive Health Bill, known popularly as the “RH Bill.”
In the Philippines, there are 3.1 million pregnancies every year, says The Guttmacher Institute, a US-based think tank that specializes in reproductive health care research. About half of those, or an estimated 1.43 million, are unplanned, it adds.
Such a figure adds to the alarming growth rate of the Philippines’ population, which now stands at roughly 92 million and is tipped to hit 100 million by 2015, says the World Bank.
“Population impacts all other aspects of human development indicators such as housing, education, health care services,” says Rep. Edcel Lagman of Albay, one of the principal authors of this comprehensive RH Bill that aims to expand and standardize health services for women in the country.
“Rapid population growth makes it difficult to spread out already limited resources to a large number of constituents,” says Lagman.
Because the RH Bill, formally designated as the proposed Reproductive Health and Population Development Act, has yet to be passed, there are no set guidelines and standards for reproductive health care, and each city government is allowed to set its own rules, usually to the detriment of the women living in those areas.
In Manila, where Lina lives, a city ordinance implemented by the former mayor Lito Atienza in 2000 banned all forms of modern contraception and services such as tubal ligation. This is in contrast to Quezon City which offers family planning services to its residents for free.
But Filipinas only stand to gain from the passage of the RH Bill which advocates the following principles:
- Information and access to both natural and modern family planning methods which are medically safe and legally permissible. Women and couples will have the freedom of informed choice to decide on the mode of family planning they want to adopt based on their needs, personal convictions and religious beliefs.
- Hospital-based family planning. Family planning methods requiring hospital services like ligation, vasectomy, and IUD insertion shall be available in all national and local government hospitals.
- Contraceptives as essential medicines. Reproductive health products shall be considered essential medicines and supplies mandating government hospitals to include these products in their essential inventory.
- Reproductive health education. This will be taught by adequately trained teachers from Grade 5 to 4th year high school in an age-appropriate manner. Core subjects will include responsible parenthood, natural and modern family planning, the hazards of abortion, reproductive health and sexual rights, abstinence before marriage, and responsible sexuality.
Filipinos recognize the need for a reproductive health law in the country. A survey conducted by the Social Weather Stations in 2008 shows that 71 percent of Filipinos favor the passage of the RH Bill and 66 percent of adult Filipinos want family planning education in the public schools.
No Woman Should Die Giving Life
The Philippines, with its 230 deaths of mothers per 100,000 live births, according to the United Nations Children Fund, pales in comparison to other Asian countries like Japan with 6 deaths per 100,000 births ratio, or Thailand with its 110 per 100,000 ratio. Most birthing complications are preventable with adequate pre-natal care and access to timely emergency intervention.
“The progress that we have made is not enough,” says the former health secretary Esperanza Cabral. “It is time that we recognize that reproductive health is a public health concern. We should recognize that our people, when given access to information and services will not act like animals, but as responsible citizens,” she adds.
The Philippines is a signatory to The Millennium Development Goals, a set of eight international development goals that include eradicating poverty, fighting epidemics like HIV/AIDS and reducing maternal and infant mortality.
The Philippines is committed to reduce maternal deaths by 75 percent before the 2015 year of reckoning. That means reducing maternal deaths to 52 deaths per 100,000 live births.
Without the RH Bill in place, it is unlikely that the country will meet its Millennium Development Goal commitment.
The RH Bill can help lower maternal deaths with its three-pronged approach: 1) family planning and contraception; 2) access to quality health care (which means shifting from the services of a hilot or traditional birth attendant to a qualified midwife; 3) and access to emergency obstetric care which includes care for post-abortive complications, says Junice Melgar, M.D. executive director of the Likhaan Center for Women’s Health, a leading women’s non-government organization.
“The [Catholic] Church actually lauded the last two pillars,” says Melgar. “They were really just against the contraception part. Unfortunately, you cannot have only two out of the three, as the family planning and contraception part is actually a preventive measure,” she adds.
It hasn’t been smooth sailing for advocates of the RH Bill due to the strong opposition of the Catholic Church. The Catholic Bishops Conference of the Philippines has used the pulpit to reiterate that the faith only allows natural family planning methods. Any and all forms of contraception, whether it’s that candy-condom or the innocuous Pill, are abortifacients or abortion-inducing.
The RH Bill has been heavily criticized as encouraging promiscuity and promoting abortion, a charge that its supporters vehemently object to.
“In fact, one of the primary intentions of the bill is to prevent abortions by providing information and services to women, couples and young people to avoid unwanted pregnancies,” says Rep. Jeanette Garin of Iloilo.
Garin, a doctor by profession, clarifies the provisions in the RH Bill which stipulate management of post-abortion complications. She notes that most women who resort to abortion, which is considered a crime in the country, are married with children. “This reflects the failure of many women and couples to plan their families or space their pregnancies,” Garin adds.
“There are cases where women experience complications from abortion, but are not admitted by hospitals. The provision merely guarantees that the right of women to health services is protected even if they commit illegal abortions. No woman should be denied her right to life,” she adds.
However, Beth Angsioco, head of the Democratic Socialist Women of the Philippines which is also lobbying for the passage of the RH Bill, nixes the notion of a “Catholic vote” or a Catholic bloc that can impede renewed efforts to see the RH Bill through.
“The Church’s clout is diminishing especially with recent news of abuses committed by priests. Moreover, the last elections proved that the Catholic vote is at best, a myth. All candidates actively supported by the church lost miserably,” Angsioco says.
“We already have information that a significant number of the neophytes in the House of Representatives are in favor of the [RH] bill. What needs to be done is a serious political mapping of the legislators who will guide action that advocates like us will take,” says Angsioco.
New Leadership, New Hope
Observers note that the new administration which took power in June ushers in a new set of cabinet officials who are mostly in favor of the RH Bill. Lagman, the bill’s principal author, is widely expected to become the incoming minority leader in the House of Representatives. The new Speaker of the House is former Quezon City Mayor Sonny Belmonte, a prime mover of Quezon City’s progressive reproductive health services.
Unlike Gloria Arroyo who kowtowed to the Catholic bloc and promoted only natural family planning methods, President Benigno Aquino III campaigned on a platform of “responsible parenthood.” This was reinforced by his choice for the post of health secretary, Enrique Ona, M.D.
At a recent World Population Day celebration in July, Ona ended all speculation by saying that the Department of Health would support a woman and a family’s right to informed choice when it comes to family planning.
“Couples will be given the freedom of informed choice so that they have a cafeteria of choices when it comes to planning their families,” says Ona.
Lagman is confident that the bill will be passed in this Congress. “We filed it early and so we should finish early. During the last congress we ran out of time and we always had a problem with the quorum because it was campaign period.”
“This is my last term in Congress, I will not allow myself to graduate from congress without passing the RH bill,” adds Lagman.
Had it not been sidelined by politics and morality, Lina would have been able to plan her family by gaining access to contraceptives of her choice for free at her local health clinic. Dory would have been given adequate post-abortive care without judgment or condemnation. And Jeremy would have been taught about adolescent reproductive health care to empower her with knowledge about birth spacing and family planning.
*Names of the women mentioned in this article have been changed to protect their identity.