* House Bill # 4244 ─ An Act Providing for a Comprehensive Policy on Responsible Parenthood, Reproductive Health, and Population and Development, and For Other Purposes * Senate Bill # 2378 ─ An Act Providing For a National Policy on Reproductive Health and Population and Development While there is general agreement about its provisions on maternal and child health, there is great debate on its key proposal that the Philippine government and the private sector will fund and undertake widespread distribution of family planning devices such ascondoms, birth control pills (BCPs) and IUDs, as the government continues to disseminate information on their use through all health care centers.
On October 2012, a revised version of the same bill was presently re-named to Responsible Parenthood Act and was filed in theHouse of Representatives as a result of re-introducing the bill under a different impression after overwhelming opposition in the country, especially from the Catholic Bishops’ Conference of the Philippines. The bill is highly divisive, with experts, academics, religious institutions, and major political figures supporting and opposing it, often criticizing the government and each other in the process. Debates and rallies proposing and opposing the bills, with tens of thousands of opposition particularly those endorsed by the bishops of the Roman Catholic Church and various other conservative groups, have been happening nationwide.
Philippine Population Density Map. Darker areas mean more population. The
basic content of the Consolidated Reproductive Health Bill is divided into the following sections.
2. Declaration of Policy
3. Guiding Principles
4. Definition of Terms
5. Midwives for Skilled Attendance
6. Emergency Obstetric Care
7. Access to Family Planning
8. Maternal and Newborn Health Care in Crisis Situations
9. Maternal Death Review
10. Family Planning Supplies as Essential Medicines
11. Procurement and Distribution of Family Planning Supplies 12. Integration of Family Planning and Responsible Parenthood Component in Anti-Poverty Programs 13. Roles of Local Government in Family Planning Programs 14. Benefits for Serious and Life-Threatening Reproductive Health Conditions 15. Mobile Health Care Service
16. Mandatory Age-Appropriate Reproductive Health and Sexuality Education 17. Additional Duty of the Local Population Officer
18. Certificate of Compliance
19. Capability Building of Barangay Health Workers
20. Ideal Family Size
21. Employers’ Responsibilities
22. Pro Bono Services for Indigent Women
23. Sexual And Reproductive Health Programs For Persons With Disabilities (PWDs) 24. Right to Reproductive Health Care Information
25. Implementing Mechanisms
26. Reporting Requirements
27. Congressional Oversight Committee
28. Prohibited Acts
31. Implementing Rules and Regulations
32. Separability Clause
33. Repealing Clause
Summary of major provisions
The bill mandates the government to “promote, without bias, all effective natural and modern methods of family planning that are medically safe and legal.” Although abortion is recognized as illegal and punishable by law, the bill states that “the government shall ensure that all women needing care for post-abortion complications shall be treated and counseled in a humane, non-judgmental and compassionate manner.” The bill calls for a “multi-dimensional approach” integrates a component of family planning and responsible parenthood into all government anti-poverty programs. Under the bill, age-appropriate reproductive health and sexuality education is required from grade five to fourth year high school using “life-skills and other approaches.”
The bill also mandates the Department of Labor and Employment to guarantee the reproductive health rights of its female employees. Companies with less than 200 workers are required to enter into partnership with health care providers in their area for the delivery of reproductive health services. Employers with more than 200 employees shall provide reproductive health services to all employees in their own respective health facilities. Those with less than 200 workers shall enter into partnerships with health professionals for the delivery of reproductive health services. Employers shall inform employees of the availability of family planning services.
They are also obliged to monitor pregnant working employees among their workforce and ensure they are provided paid half-day prenatal medical leaves for each month of the pregnancy period that they are employed. The national government and local governments will ensure the availability of reproductive health care services, including family planning and prenatal care. Any person or public official who prohibits or restricts the delivery of legal and medically safe reproductive health care services will be meted penalty by imprisonment or a fine.—————-
Maternal health and deaths
Birthing services are key to solving maternal deaths
Maternal deaths in the Philippines, according to the WHO, is at 5.7 per day, not 10-11 deaths a day, as per the proponents who repeated these numbers “to drive home the point.” The proponents state that RH will mean: (1) Information and access to natural and modern family planning (2) Maternal, infant and child health and nutrition (3) Promotion of breast feeding (4) Prevention of abortion and management of post-abortion complications (5) Adolescent and youth health (6) Prevention and management of reproductive tract infections, HIV/AIDS and STDs (7) Elimination of violence against women (8) Counseling on sexuality and sexual and reproductive health (9) Treatment of breast and reproductive tract cancers (10) Male involvement and participation in RH; (11) Prevention and treatment of infertility and (12) RH education for the youth. The Department of Health states that family planning can reduce maternal mortality by about 32 percent.
The bill is “meant to prevent maternal deaths related to pregnancy and childbirth,” said Clara Padilla of Engender Rights. She reported that “Daily, there are 11 women dying while giving birth in the Philippines. These preventable deaths could have been avoided if more Filipino women have access to reproductive health information and healthcare.” Regarding these figures, Francisco Tatad of the International Right to Life Federation and former Senator wrote that “If correct, experience has shown (as in Gattaran, Cagayan and Sorsogon, Sorsogon) that the incidence of maternal death arising from such complications could be fully mitigated and brought down to zero simply by providing adequate basic and emergency obstetrics care and skilled medical personnel and services,” without any need for a law on the distribution of contraceptives.
The key to solving maternal deaths, according to the Senate Policy Brief on reproductive health, is the establishment of birthing centers. The Philippine Medical Association or PMA stated in their Position Paper that the goal of reducing the rise of maternal and child deaths “could be attained by improving maternal and child health care without the necessity of distributing contraceptives. The millions of funds intended for the contraceptive devices may just well be applied in improving the skills of our health workers in reducing maternal and child mortality in the Philippines.” Magna Carta for Women of 2009
There have been comparisons made with the 2009 Law called the Magna Carta for Women and the RH Bill. The Magna Carta for Women contains the following provisions in Section 17 and 19: * Prenatal and postnatal care
* Information regarding all types of family planning methods * Access to family planning methods as long as they are ethically and medically safe
* Sex education
* Obstetric and gynecological care regarding pregnancy complications and the prevention of AIDS, HIV, STD, and the like * Spouses have the right to decide to space their children The Implementing Rules and Regulations of the Magna Carta directs the Commission on Women under the Office of the President to oversee that the provisions are implemented by the Department of Health, the Department of Local Governments, the Commission of Human Rights, the Department of Education, Department of Social Welfare, Department of Labor, the Commission on High Education. In the IRR, it also states that in order for the law to be successful, the government should tie up with all LGUs so that midwives, doctors, birthing facilities should be put in place to take care of the health needs of all to ensure that we minimize maternal and child deaths. Because of these provisions, Senator Majority Floor Leader Tito Sotto said that the RH Bill is redundant.
Catholic Church: A large family is a sign of God’s blessings (CCC2373) The Catholic Church teaches the necessity of responsible parenthood and correct family planning (one child at a time depending on one’s circumstances), while at the same time teaching that Every birth is a gift from God; every new life, a blessing. The RH bill intends to help couples to have government funded access to artificial contraception methods as well.
One of the main concerns of the proponents is the perceived lack of access to family planning devices such as contraceptives and sterilization. The bill intends to provide universal access through government funding, complementing thus private sector initiatives for family planning services, such as those offered by the International Planned Parenthood Federation (IPPF) which supports the Family Planning Organizations of the Philippines and the 97 organizations of the Philippine NGO Council. The opposition argues that “Access to contraceptives is free and unrestricted” and that the proposed law is pushing an open door.
They say that these family planning items are available to the citizens and many local government units and NGOs provide these for free. Congressman Teddyboy Locsin argued, echoed by a Business Mirror editorial, that the poor can afford condoms since they can pay for other items such as cellphone load. Opponents also argue that Philippine government is not a welfare state, and taxpayers are not bound to provide for all the wants and desires of its citizenry, including their vanity needs, promiscuous actions and needs artificially created by elitist, imperialist and eugenicist forces; nor should taxpayers pay for drugs that are objectively dangerous (carcinogenic) and immoral. They argue that the Philippines should give priority to providing access to medicines that treat real diseases.
Birth control pill
The UP School of Economics argues, in contrast, that there is lack of access especially for poor people, because contraceptive use is extremely low among them and “Among the poorest families, 22% of married women of reproductive age express a desire to avoid pregnancies but are still not using any family planning method.” They say that lack of access leads to a number of serious problems which demand attention: (1) “too many and too closely-spaced children raises the risk of illness and premature deaths (for mother and child alike),” (2) “the health risks associated with mistimed and unwanted pregnancies are higher for adolescent mothers, as they are more likely to have complications during labor,” (3) women who have mistimed pregnancies are “constrained to rely more on public education and health services and other publicly provided goods and services,” further complicating limited public resources, (4) families are not able to achieve their desired family size. Thus the UP economists “strongly and unequivocally support” the thrust of the bill to enable “couples and individuals to decide freely and responsibly the number and spacing of their children and to have the information and means to carry out their decisions.” Proponents argue that government-funded access is the key to breaking the inter-generational poverty that many people are trapped in.
According to the RH bill, one of its components is “prevention of abortion and management of post-abortion complications.” It provides that “the government shall ensure that all women needing care for post-abortion complications shall be treated and counseled in a humane, non-judgmental and compassionate manner.” It also states that “abortion remains a crime and is punishable,” as the Constitution declares that “the State shall equally protect the life of the mother and the life of the unborn from conception.” Opposing the bill, the Faculty of Medicine of the catholic University of Santo Tomas, the Philippine Nurses Association (with at least 368,589 members), the Bioethics Society of the Philippines, Catholic Physicians’ Guild of the Philippines stated that “the antiabortion stance of the bill is contradicted by the promotion of contraceptive agents (IUD and hormonal contraceptives) which actually act after fertilization and are potentially abortifacient agents.”
Opposition refers to a 2000 study of a scientific journal of the American Medical Association, in which a meta-analysis of 94 studies provides evidence that when a common birth control pill fails to prevent ovulation, “postfertilization effects are operative to prevent clinically recognized pregnancy.” They also point to the American Journal of Obstetrics and Gynecology (2005), which concluded that the IUD brings about the “destruction of the early embryo,” thus is deemed to kill five-day old babies. The position of the Philippine Medical Association (PMA) “is founded strongly on the principle that ‘life or conception begins at fertilization’ at that moment where there is fusion or union of the sperm and the egg and thus a human person or human being already does exist at the moment of fertilization.”
The PMA condemns abortifacients that “destroys the fertilized egg or the embryo” and “abhors any procedure … or medication that will interrupt any stage of fertilization and prevents its normal, physiological, uninterrupted growth to adulthood”. Jo Imbong, founder of the Abay Pamilya Foundation, reported that “Lagman said in a House hearing that the bill would protect human life ‘from implantation,'” and not from fertilization, noting at the same time that the Records of the Constitutional Commission state that “Human life begins at fertilization.” After referring to many standard textbooks of medicine and human embryology to affirm this as true, the anti-RH bill citizens argue that the human embryo already has the complete genetic code and is thus a distinct human life beginning its own new life cycle. They say that the embryo is an individual, self-coordinated and self-organizing subject belonging to the species homo sapiens: a human being by nature and thus a person equally worthy of respect.
5-day old human embryo called a blastocyst, which comprises 70–100 cells. Contraception and abortion relationship
Proponents argue that research by the Guttmacher Institute, involved in advancing international reproductive health, reveals that the use of contraceptives can reduce abortion rates by 85%. Proponents such as 14 Ateneo de Manila University professors, argued thus: “Studies show that the majority of women who go for an abortion are married or in a consensual union (91%), the mother of three or more children (57%), and poor (68%) (Juarez, Cabigon, and Singh 2005). For these women, terminating a pregnancy is an anguished choice they make in the face of severe constraints. When women who had attempted an abortion were asked their reasons for doing so, their top three responses were: they could not afford the economic cost of raising another child (72%); their pregnancy occurred too soon after the last one (57%); and they already have enough children (54%). One in ten women (13%) who had attempted an abortion revealed that this was because her pregnancy resulted from forced sex (ibid.).
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