NOTE: “Leadership Reflections” shares views of the different members of the University Leadership Council on matters related to campus life and the operations of the University. As well, it features opinions on issues of national and/or international relevance.
RH Bill: A Boon or Bane to Society?
By Dr. Maria Cecilia M. Genove, Dean, College of Mass Communication If there is a strong argument on the passage of the Reproductive Health (RH) Bill, it is the ever-growing population of the Philippines. According to the latest statistics on the country’s demographical data, there are now 96 million Filipinos, a considerable increase in the last 10 years or so, or a growth rate of at least four to six percent every year. Translated to more significant data, five to six babies are born in the country every minute, a staggering information considering that the Philippines is, until today, still referred to by its neighboring countries as a developing economy.
Thus, the latest proposed legislation in both the Senate and the House of Representatives has left the Filipino people extremely polarized. A lot of considerations have emerged in several discussions essentially because the staunchest opposition to the passage of the RH Bill comes from the Catholic Church. This is understandable because the Philippines remains to be the only Christian nation in the Far East and with the colonization of Spain for almost four centuries, Catholicism is widespread and prevalent.
Some sectors contend that the RH Bill boils down to the freedom of choice among couples and those who are sexually active. Others reason out that procreation is God’s legacy to His people. On the other hand, women – who bear the brunt of childbirth and its perils – say that they have the right to choose what is best for them, meaning, if their bodies could not withstand the rigors of childbirth, then they have all the right to take care of their own bodies.
Examining closely the advantages and disadvantages of the RH Bill, the former far outweighs the latter, that is, there are more benefits that the majority of Filipinos can get compared to not having such a bill passed for legislation in the country.
What is needed in the RH Bill is widespread information and dissemination of the various family planning methods and contraceptives that are available for couples. While the rich, educated couples understand the choices that they have, the poor folk – who comprise the majority – hardly have any knowledge on their options because they lack education. But, the lack of education is going to be another story or, on the contrary, the lack of education may be related to the passage of the RH Bill.
The poor comprise the majority of Filipinos. Because they are poor, they necessarily lack education or have no education at all. Who, then, will teach and guide these people about their choices, especially in the number of children that they can have or are able to support? Again, because of a dearth of knowledge, these people simply just leave it to fate if it happens that the wife gets pregnant almost every year.
The issue is not abortion at all. It is a totally different aspect of the entire discussion. The issue is giving the people a choice of whether they will adapt the family planning methods that have been suggested for them. It is for them to take it or leave it. If the people so desire that they would choose from among the artificial family planning methods available, then it is their choice. The bottomline is that these information should be made available for everyone and explained to them, most especially those who have no capacity to learn and understand. These people are the ones most vulnerable.
It is about time that family planning be included as part of the curriculum in schools and universities. The inclusion of sex education has been practiced in the past, but was phased out because of some opposition. Let this be revived today because of the need of the youth to be informed about their rights as a human being. Parents should also help the schools in making their children understand the pitfalls of early marriage or teen pregnancy. If the people are properly informed, then they would be able to make intelligent choices for their own betterment. In the process, they would be empowered.
It is interesting to note the latest statistics coming from the Social Weather Station under the supervision of Mr. Mahar Mangahas, which revealed that in the June 2011 survey, only 30 percent agreed and 51 percent disagreed that the use of condoms constitutes abortion. Furthermore, only 29 percent agreed and 51 percent disagreed that the use of IUDs constitutes abortion. Also, only 29 percent agreed and 52 disagreed that the use of birth control pills constitutes abortion. The results of the survey likewise revealed that the balances from 100 percent, roughly 2 out of every 10 adult Filipinos, were unable to take a stand.
Let us take a more discerning look at the RH Bill. There may be more than meets the eye with the passage of this controversial legislation.
The advantage of Reproductive Health Bill in the Philippines is that hopes to provide midwives for skilled attendance to childbirth and emergency obstetric care, even in geographically isolated and depressed areas. Thus, the one of the causes of maternal mortality, that arising from unattended births, will be addressed.
The disadvantage of the Reproductive Health Bill in the Philippines is the undue focus being given to reproductive health and population and development, when many more urgent and important health problems need to be addressed in the country, those that cause a significant number of deaths across the country such as cardiovascular diseases and infections. Financial resources allotted by foreign donors to assist the Philippine government programs could actually be better spent towards pursuing health programs targeting communicable diseases than purchasing artificial contraceptives.
The Reproductive Health Bill is controversial, as it is being opposed by concerned citizens, especially the pro-life, pro-family and pro-God groups, regardless of creed or religion. The Roman Catholic Church expresses its opposition against the bill on many counts, most especially the procurement and distribution of family planning supplies for the whole country, when the available evidence from peer reviewed medical journals supports the hypothesis that when ovulation and fertilization occur in women taking oral contraceptives (OCs) or using intrauterine devices (IUD), post-fertilization effects are operative on occasion to prevent clinically recognized pregnancy. Hormonal contraceptives and/or IUDs directly affect the endometrium. These effects have been presumed to render the endometrium relatively inhospitable to implantation or to the maintenance of the preembryo or embryo prior to clinically recognized pregnancy. These make pills and IUDS abortifacient.
Pro-life groups, and many professionals in the medical and nursing fields, believe that physicians and policy makers should understand and respect the beliefs of patients who consider human life to be present and valuable from the moment of fertilization. Patients should be made fully aware of this information so that they can consent to or refuse the use of artificial contraceptives.
However, the position of the Catholic Church and the pro-life groups does not mean that they espouse the attitude of “natalism” at all costs, as if the “number” of children, in itself, were the unmistakable sign of authentic christian matrimonial life.
The sexual act, properly exercised within marriage only, is ordained primarily to the propagation of life. If there are reasonable motives for spacing births, such as serious medical conditions in the mother, or extreme poverty, then the Catholic Church teaches that married couples may take advantage of the natural cycles of the reproductive system and use their marriage precisely those times that are infertile (natural family planning).
Other aspects of the bill being contested by concerned citizens include the classification of family planning supplies as essential medicines when their safety/toxicity profile and legal permissibility are questionable.
Very pertinent to the debate about reproduction rights is the right to life. The Philippine Constitution says that the State “shall equally protect the life of the mother and the life of the unborn from conception. If artificial contraceptives are medically proven to induce abortion as one of their mechanisms of action, then procurement and distribution of such family planning supplies are unconstitutional and illegal.
Philippines population control and management policies
Establishment of POPCOM
In 1967, President Ferdinand Marcos joined other world leaders in adding his signature to a Declaration on Population that had been made the previous year by representatives of 12 countries (often incorrectly cited in Philippines government documents as “the UN Declaration on Population”).23 Two years later, Executive Order 171 established the Commission on Population (POPCOM), and in 1970 Executive Order 233 empowered POPCOM to direct a national population programme.24 The Population Act
The Population Act [RA 6365] passed in 1971 made family planning part of a strategy for national development.25 Subsequent Presidential Decrees required increased participation of public and private sectors, private organizations and individuals in the population programme.26 Under President Corazon Aquino (1986 to 1992) the family planning element of the programme was transferred to the Department of Health, where it became part of a five year health plan for improvements in health, nutrition and family planning. According to the Philippines National Statistics Office, the strong influence of the Catholic Church undermined political and financial support for family planning, so that the focus of the health policy was on maternal and child health, not on fertility reduction.27 The Population Management Program
The Ramos administration launched the Philippine Population Management Program(PPMP)in 1993. This was modified three years later to incorporate “responsible parenthood” policies.28 During the Philippines 12th Congress (2001-2004) policymakers and politicians began to focus on “reproductive health.”29 Responsible Parenthood and Family Planning Program
In 2006 the President ordered the Department of Health, POPCOM and local governments to direct and implement the Responsible Parenthood and Family Planning Program. The Responsible Parenthood and Natural Family Planning Program’s primary policy objective is to promote natural family planning, birth spacing (three years birth spacing) and breastfeeding which are good for the health of the mother, child, family, and community. While LGUs can promote artificial family planning because of local autonomy, the national government advocates natural family planning.30 Population policy effectiveness and outcomes
The population of the Philippines grew steadily from about 27million in 1960 to over 90 million in 2008. Starting from similar populations in 1960, Thailand, Myanmar and South Korea now have lower populations, and the disparity among them is more marked (See Figure 1). Figure 1
Population growth from 1960
However, during the same period, the rate of population growth in the Philippines and these countries decreased (See Figure 2). Moreover, the decrease in the Philippines growth rate remained comparatively steady, and was consistent with the decrease in population growth rate rate worldwide (See Figure 3). Figure 2
Rate of population growth from 1960
Rate of population growth from 1960
We do not know what would have happened had there been no population programs and policies in the Philippines. However, it is impossible to show that they have had any notable effect on population, particularly when trends in the Philippines are compared to trends elsewhere. A paper published in 2003 asserted that the population program was “ineffectual,” the result of “inadequate institutional and financial support.”31 Collateral outcomes
If the Philippines population management policies and programmes have had no measureable impact on population growth, they have produced one notable outcome. The notion that the government should manage population growth and instruct the population in fertility control and “responsible parenthood” has become part of the normal social, political and health care landscape in the Philippines. Moreover, an infrastructure of familiar government ministries, offices and officials has been established throughout the country to give effect to government policies. Influence of the Catholic Church
If the Catholic Church has enjoyed a privileged position with respect to Philippines government policies in family planning. . . it seems, nonetheless, to have been ineffective in advancing Catholic teaching on contraception and sterilization. Over 80% of Filipinos are Catholic, so it is not surprising to encounter assertions that population management infrastructure and operations “largely reflect the Catholic Church’s position on family planning which emphasizes responsible parenting, informed choice, respect for life and birth spacing.”32 The Catholic bishops of the country have been accused of opposing and hampering population management and fertility reduction policies.33 Certainly, they have forbidden Catholic hospitals to “provide facilities and services for induced abortion, contraceptive sterilization, or the administration of artificial contraceptives,” and insisted that admitting privileges are conditional on adherence to this policy.
Members of Catholic religious orders may administer or work in non-Catholic hospitals where such services are provided only if their presence is not exploited to create a public impression that they approve of them, and they do not participate in them. The bishops have advised Catholics working in hospitals where contraceptive sterilization is offered to notify management in writing “of their conscientious refusal to directly participate in such procedures.”34 However, this is not the whole story.
A 1993 survey of women aged 15 to 49 in 1993 found that over 96% were familiar with one or more methods of family planning, including modern contraceptive methods, and that over 90 percent knew where to obtain the pill, 80 percent the IUD, condom and female sterilization, and 70 percent male sterilization. Of the married women surveyed, 40% were practising some form of birth control, most often dispensed by government sources. Only 7% were using methods accepted by Catholic teaching,35 and of the non-users, less than 5% were “opposed to family planning or cited religion as a reason for not using contraception.”36 From 1992 to 2003, 70% of contraceptives used were obtained from government sources.
In 2002 over 57% of those using birth control were using modern contraceptives.38 By 2009, a prominent Filipino politician offered the following summary of the political relevance of Catholic teaching on contraception: He cites recent surveys showing majority of Catholics favoring a reproductive health law, requiring government to teach family planning to the youth, and the government distributing legal contraceptives like condoms, pills and IUDs. Religion, says Lagman, ranks only 9th out of 10 reasons why women do not use contraception. That a Catholic can still be a good Catholic and use family planning methods outside the only church-approved natural family planning methods has been expressed by a number of faculty and staff members of the Catholic institution Ateneo de Manila University, a position also held by University of the Philippines academicians. Lagman is himself a Catholic, and goes to mass when he can.39 If the Catholic Church has enjoyed a privileged position with respect to Philippines government policies in family planning, and if the Church has hampered government efforts to control fertility and reduce the population, it seems, nonetheless, to have been ineffective in advancing Catholic teaching on contraception and sterilization.