The Reproductive Health Bill

Public opinion is the aggregate of individual dispositions and beliefs with regards to important issues. Public opinion holds great importance in democracies because a democracy, by its very definition, connotes a form of government that is responsive to the people. Democracy is most often defined as a set of procedures and institutions intended to make the holders of political power directly responsible to the electorates. The quality of democratic government is measured by the responsiveness of public policymakers to the preferences of the mass public. For that reason, public opinion will always play an important role in policy-making process in the Philippines, a democratic country. Views and opinions of the general public should be taken into consideration in formulating, passing and implementing a policy. Hence, stakeholders and interests groups’ roles are very vital in affecting policy outcomes since stakeholders and interest groups are the means through which public opinion is brought in the Halls of the Congress. In view of this, the government is faced with the need to balance the conflicting views of different stakeholders, interest and pressure groups in the decision-making process. This is clearly exemplified in the controversial Reproductive Health bill.

This paper studies the different stakeholders involved in the Reproductive Health Bill and the degree in which they affect policy outcome based on the resources and resource mobilization capacities they have. The first part of this paper includes definition and the presentation of health and population situation in the Philippines. The second part focuses with the provisions, debates and proponent of RH bill. The third part provides an analysis of the different stakeholders and resources and resource mobilization capacity that they have. Lastly, the examination of how these stakeholders and interest groups can actually affect policy outcome and the degree on which they affect it.

The controversy of RH bill led to many implications. Reproductive health is now a byword that enthralled the public attention. Therefore, there is a need to define the term based on a standard definition. “Reproductive health addresses the reproductive processes, functions and system at all stages of life. Reproductive health implies that people are able to have a responsible, satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so” (World Health Organization).

Although this appears to be the only definition of the term in any international document, the definition implicitly implies that reproductive health includes the right of men and women to be informed of and to have access to safe, effective, affordable and acceptable methods of fertility regulation of their choice, and the right of access to appropriate health care services that will enable women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant (International Conference on Population and Development, 1994).

Of the eight Millennium Development Goals, achieving universal access to reproductive health by 2015 is one of the two targets of Goal 5, Improving Maternal Health. Due to this, a comprehensive study of the reproductive health in the Philippines is greatly needed and in turn, to develop and actually implement a policy that will give Filipinos equal chances to the right to reproductive health and develop programs that will seek to address problems related to reproductive health in the country.

Over the past 30 years, developing countries’ population have rise up almost twice the rate of those in the developed and advanced countries. As an effect, a number of people have caught up with high infant mortality, low life expectancy, disease, malnutrition and illiteracy. Rapid population growth causes difficulties in managing economic and social changes, including the balancing of the fruits of economic development efforts (Leverage International, 2011).

Governments of the Third World countries and as well as of those developed nations recognized that the measurement of economic development is not based only on economic indicators such as income distribution but also by the quality of life of its people (Leverage International, 2011).

Philippines, as a developing country, experiences rapid population growth. According to the 2007 Census by the National Statistics Office (NSO), the Philippine population was 88.57 million and the estimated population as of 2010 is 94.3 million and this made the country as the 12th most populous country in the world. This high population results to high infant mortality rate which is 19.94% in 2010. In addition to this, the lifetime risk of maternal death in the Philippines is 1 in every 140, according to United Nations International Children Emergency Fund’s State of the World’s Children 2009 report. Each day, about 11 Filipino mothers – or 4,500 each year – die because of hypertensive disorders, severe hemorrhage or other labor- or abortion-related problems. The country is also part of a group of 68 countries where 97% of worldwide maternal, neonatal and child health deaths occur.

Moreover, the county is witnessing the fastest spread of the human immunodeficiency virus (HIV) in its history. Five new HIV cases are recorded everyday according to the National Epidemiology Center of the Department of Health.

High infant mortality rate, high maternal mortality rate and a number of HIV cases are not the only problems that the Philippines is experiencing in relation to reproductive health. Because of the lack of a concrete reproductive health and family planning policy and program in the country, unwanted pregnancy incidences become high. Due to this, Filipino women are forced to undergo induced abortion as one of the methods that they use to meet their reproductive goals. Although abortion is illegal in the Philippines, and despite the potential harmful consequences of an unsafe abortion for women’s health and life, many women resort to abortion to meet their family-size goals or to space births (The Guttmacher Institute, 2003).

The Incidence of Induced Abortion in the Philippines: Current Level and Recent Trends (2005), a study conducted by Fatima Juarez, Josefina Cabigon, Susheela Singh, and Rubina Hussain for the Guttmacher Institute revealed the following:

Six in 10 Filipino women say they have experienced an unintended pregnancy at some point in their lives. About 1.43 million pregnancies each year–nearly half of all pregnancies in the Philippines–are unintended.

Some 54% of women who have ended an unintended pregnancy by abortion were not using any family planning method when they conceived. Of those who were practicing contraception, three-fourths were using a traditional method.

The average Filipino woman wants 2.5 children. In order to achieve that goal, she must spend more than 19 years using effective contraceptive methods. However, nearly half of all married women of reproductive age have an unmet need for effective contraception–that is, they are sexually active, are able to have children, do not want a child soon or ever, but are not using any form of contraception or are using traditional methods, which have high failure rates.

Aside from induced abortion that can lead to deaths, other problem due to the lack of reproductive health policy is the risk of acquiring cervical cancer. The Human Papillomavirus (HPV) is a sexually-transmitted, wart-forming virus that has been implicated in causing cancer of the cervix. This is the most common cancer in women secondary to breast cancer (Department of Health, 2008).

Due to these findings and other statistics such as high infant and mortality rates, these imply that there is an immense need for a policy to ensure the right to reproductive health in the Philippines. Although reproductive health has long been considered a basic universal human right, this right remains elusive and illusory for millions of Filipinos, especially the poor.

The first comprehensive version of reproductive health bill, House Bill 8110 or “The Integrated Population and Development Act of 1999” was filed in the 11th Congress. Twelve years after, the country still does not have a reproductive health policy and the issue of the current reproductive health bills remains a heated and controversial issue as the first RH bill.

Today, the struggle of RH advocates still continues for the passage of a comprehensive reproductive health bill.

House Bill 4244 or “The Responsible Parenthood, Reproductive Health and Population and Development Act of 2011” is the most recent version of a reproductive health bill that was filed in the 15th Congress. H.B. 4244 is popularly known as the consolidated RH bill in substitution to the other reproductive health bills that are pending in the Congress. The other reproductive health bills are as follows:

House Bill 96 (Rep. Edcel Lagman)

“An Act Providing for a National Policy on Reproductive Health, Responsible Parenthood and Population Development and for Other Purposes”

House Bill 101 (Rep. Janette Garin)

“An Act Providing for a National Policy on Reproductive Health and Population Development and for Other Purposes”

House Bill 513 (Reps. Kaka Bag-ao and Warden Bello of Akbayan Partylist)

“An Act Providing for a National Policy on Reproductive Health and Population and Development and for Other Purposes”

House Bill 1160 (Rep. Rodolfo Biazon)

“An Act Providing for a National Policy on Reproductive Health and for Other Purposes”

House Bill 1520 (Rep. Judy Syjuco)

“An Act to Protect the Right of the People to Information on Reproductive Health Care”

House Bill 3368 (Rep. Luzviminda Ilagan and Emmi de Jesus of Gabriela Women’s Party)

“An Act Providing for a National Policy on Reproductive Health for Women and Development and for Other Purposes”

H.B 4244’s objectives are as follows:

To uphold and promote respect for life, informed choice, birth spacing and responsible parenthood in conformity with internationally recognized human rights standards.

To guarantee universal access to medically-safe, legal and quality reproductive health care services and relevant information even as it prioritizes the needs of women and children.

To realize these goals, the consolidated RH Bill has the following key provisions:

Mandates the Department of Health (DOH) and Local Health Units in cities and municipalities shall serve as the lead agencies for the implementation of this act.

Mandates the Population Commission, to be an attached agency of the Department of Health, shall serve as a coordinating body in the implementation of this Act.

Provides for the creation of an enabling environment for women and couples to make an informed choice regarding the family planning method that is best suited to their needs and personal convictions.

The LGUs and the DOH shall ensure that a Minimum Initial Service Package (MISP) for reproductive health, including maternal and neonatal health care kits and services will be given proper attention in crisis situations such as disasters and humanitarian crises.

Provides for a maternal death review in LGUs, national and local government hospitals and other public health units to decrease the incidence of maternal deaths.

Products and supplies for modern family planning methods shall be part of the National Drug Formulary and the same shall be included in the regular purchase of essential medicines and supplies of all national and local hospitals and other government health units.

Ensures the availability of hospital-based family planning methods such as tubal ligation, vasectomy and intrauterine device insertion in all national and local government hospitals, except in specialty hospitals.

Provides for a Mobile Health Care Service in every Congressional District to deliver health care goods and services.

Provides Mandatory Age-appropriate Reproductive Health Education starting from Grade 5 to Fourth Year High School to develop the youth into responsible adults.

The Department of Labor and Employment (DOLE) shall ensure that employees respect the reproductive health rights of workers.

Mandates private and nongovernment reproductive health care service providers to provide at least forty-eight (48) hours annually of reproductive health services free of charge to indigent and low income patients, especially to pregnant adolescents.

Mandates cities and municipalities to provide sexual and reproductive health programs for persons with disabilities (PWDs).

Mandates the inclusion of the topics on responsible parenthood, family planning, breastfeeding and infant nutrition as essential part of the information given by local Family Planning office to all applicants for marriage license.

Mandates no less than 10% increase in the honoraria of community-based volunteer workers, such as the barangay health workers, upon successful completion of training on the delivery of reproductive health care services.

Creation of Congressional Oversight Committee (COC) which shall be composed of five (5) members each from the Senate and from the House of Representatives which shall monitor and ensure the effective implementation of this Act, determine the inherent weakness and loopholes in the law, recommend the necessary remedial legislation or administrative measures and perform such other duties and functions as may be necessary to attain the objectives of this Act.

Penalizes the violator of this Act from one month to six months imprisonment or a fine ranging from ten thousand to fifty thousand pesos or both such fine and imprisonment at the discretion of the Court.

H.B 4244 covers all other six pending RH bills in the Congress but despite the clear purpose of the bill, the enactment of RH bill is long overdue.

On the other hand, RH bill advocates see the passage of the consolidated RH bill in the 15th Congress since it was already approved by the House Committee on Population and Family Relations last February 1 and it was also approved by the Committee on Appropriations with a vote of 20-3. Last March 8 which is incidentally the International Women’s Day, RH bill reached the plenary. Biliran Representative Rogelio Espina, chairman of the Committee on Population and Family Relations, delivered his sponsorship speech on Committee Report 664. Three of the six sponsors of the bill also delivered speeches urging for its passage – Minority Leader and Albay Representative Edcel Lagman, Gabriela partylist Representative Luz Ilagan and Akbayan partylist Representative Arlene “Kaka” Bag-ao.

Meanwhile, President Benigno Aquino III ordered Health Secreaty Enrique Ona to draft the Responsible Parenthood Bill that would perhaps serve as a “middle ground” between RH advocates and the Church. Moreover, the President did also not include RH bill as part of his list of policy priorities after the Church issued a pastoral letter entitled Choosing Life, Rejecting RH Bill. Though Rep. Lagman believes that the Malacañang-sponsored version of the RH bill would not be able take the place of a more comprehensive RH bill since it is limited to the issue of family planning and responsible parenthood. Moreover, Health Secretary Ona is a known advocate of reproductive health and family planning. His public pronouncements have confirmed that he, like his predecessor Sec. Espie Cabral, is unwavering in his belief that RH is a basic human right. Because of this, Cong. Lagman believes that the crafting of the Responsible Parenthood bill would and should not delay the passage of the consolidated RH bill.

Cong. Edcel Lagman of the First District of Albay is the principal author of the consolidated RH bill. According to him, the incidences of infant and maternal mortality in his own district are within the range of the national average. As a solution, they have set up lying-in clinics and birthing centers in the upland and island barangays of the first district of Albay so as to ensure that mothers in far flung barangays can be given emergency and basic obstetric care. However, the problem of maternal and infant mortality and morbidity goes beyond the First District of Albay. The preventable deaths of mothers and children happen on a national scale so the need to formulate a national policy on reproductive health is imperative.

Although he is a Catholic he believes that like many other Catholics in the country, they can be good Catholics and still support a measure like RH bill that puts a premium on quality of life and the protection and fulfilment of the basic human rights to reproductive health and sustainable human development. He also noted that the word “catholic” when used as an adjective means all-embracing, forward-looking and liberal. The antonym of catholic is conservative, narrow-minded and intolerant. That is why it is very ironic that the Catholic Church particularly the Catholic Bishops’ Conference of the Philippines (CBCP) strongly opposes RH bill.

Rep. Lagman is also the newly-elect chair of one of the ruling party in the country, the Lakas Kampi Catholic Muslim Democrats (CMD). However, because of the nature of the party system in the Philippines, this position in his party would not guarantee the passage of RH bill. According to him, his colleagues are free to support or oppose an issue as they see fit. Members of his party are not required to vote for or support RH bill. It is interesting to note that the former President and the incumbent representative of the second district of Pampanga, Rep. Gloria Arroyo, who is a member of the Lakas Kampi CMD is known to be a critic of RH bill.

In line with this, the conflicting views on RH bill do not only occur inside Congress. Central to the issue of RH bill is the political dynamics of the numerous actors involved in affecting the passage of the said bill. The different stakeholders and interest groups play important roles in the deliberation of the policy. This put the challenge to the legislators to balance and to be able to reconcile the conflicting views of these stakeholders and interest groups.

But how did citizens start to participate in the decision-making process?

Due to influx of information, there came a higher level of consciousness among citizens. People’s desire to participate in decision-making process amplified. People demand more of representation and participation in the government. In less complex times, elected representation was a sufficient means for most citizens to participate in government. Recently, for a number of reasons, including the diversity of citizens’ cultural heritage, needs, values, and interests, that has been changing and of course, the changes brought about by modernization, there is now a strong desire for citizens to be involved broadly in governance and directly in policy decisions.

Governments, especially in developing countries, are very vulnerable and they are being assessed based on their economic and political performance. And one of the bases of a government’s political performance is its capacity to provide venues for people’s participation and involvement. Hence, views and opinions of the general public should be taken into consideration in formulating, passing and implementing a policy. For this reason, one of the biggest challenges which government faces is the need to balance the conflicting views of different interest groups in a particular policy. This problem is very much observed in the issue of coming up with a reproductive health policy in the Philippines.

Conflicting views and opinions from numerous actors and stakeholders in the reproductive health bill have always marred the passage of the said bill. Certain sectors and segments of the population will definitely be affected upon the implementation of the said policy and they also have different views regarding the passage of RH bill. However, the stakeholders who have the resources to influence or actually determine the success or failure of the reproductive health bill are the Roman Catholic Church, the women sector and pharmaceutical companies in the country. The table below shows an analysis of the four primary stakeholders in the RH bill.

From the stakeholders listed above, the Catholic Church and organized women groups are the primary actors in the debate in adopting a reproductive health policy in the country because they are the most visible in terms of their campaign for or against the said policy.

The Catholic Church is the main critic of the reproductive health bill because it argues that the policy is anti-life because it promotes the use of modern contraception measures. Also, it argues that RH bill does not really address poverty.

In the researcher’s interview with Archbishop Oscar V. Cruz and Carmelo Cruz, Catholic Bishops’ Conference of the Philippines’ (CBCP) News Editor, they said that the Catholic Church’s judgment in the political performance of former President Ferdinand Marcos that significantly contribute for making EDSA People Power I happened in 1986 is the same as their opposition to the six pending reproductive health bills in the Congress. Their opposition to the immoral regime of Pres. Marcos is the same as their opposition to an immoral policy, the reproductive health bill. (This was also written in CBCP’s Pastoral Letter entitled Choosing Life, Rejecting RH bill issued last January 30, 2011.)

Moreover, they believe that it is not the poor Filipino people who will benefit from the implementation of the reproductive health bill but the foreign owners of transnational pharmaceutical companies who will supply modern contraceptives. They also believe that if a reproductive health bill will be enacted into law, it will paved the way for the introduction and passage of other policies such as policies on divorce, mercy killing and same sex marriage. The Catholic Church believes that the passage of a reproductive health bill will deteriorate the authentic human values and as well as the Filipino cultural values in accordance to the teachings of the Church.

Archbishop Oscar V. Cruz said that although reproductive health bill can lessen infant and maternal mortality, he argued that the reason behind infant and maternal mortality and morbidity is poverty and inaccessible to basic health care services. According to him, health care services are inaccessible to poor families because of bad governance and corruption, services are not delivered to poor communities because public official corrupt the money that is intended for communities’ welfare. For these reasons, the solution to infant and maternal mortality in the country is not the reproductive health bill, the solution needs to focus to the root causes of the problem which is bad governance and poverty.

However, the Catholic hierarchy said that is not against the elimination of violence against women, the treatment of breast cancer, maternal and child health and nutrition and other elements of RH. It is only against making modern family planning methods available to women and couples and the teaching of sexuality and RH education to the youth. The Church believes that RH bill would violate the teachings of the Church specifically the 1968 encyclical Humanae Vitae which is the basis of the Church teaching that contraceptives are “intrinsically evil”.

The Church has been firm in its stand against RH bill. The Church is having dialogues to the current administration to turn down RH bills that are pending in Congress. Moreover, the Church through its archdioceses and dioceses consults representatives from each district for them to be convinced not to vote for RH bill. Also, the CBCP issues statements to inform the public why RH bill should not be enacted into law. And what is more important is the impact of the Catholic Church in shaping or influencing public opinion since majority of Filipinos are Catholics. Some officials are threatened that their stand regarding the issue on RH bill might affect their political careers.

Because of the strong opposition of the Catholic Church to adopt a reproductive health policy in the country and the resources it has to affect the decisions of public officials, the passage of the bill becomes impossible despite the need for a reproductive health policy in the country. Last January 30, CBCP issued a pastoral letter against RH bill. As an effect, the President did not include RH bill from among the Legislative Executive Development Advisory Council’s policy measures that probably would unduly delay again the passage of RH bill.

If the Catholic Church strongly oppose RH bill, organized women’s groups tell the other side of the story. Women’s organizations such as Gabriela Women’s Party and Likhaan Center for Women’s Health Inc. stalwartly campaign for the passage of RH bill. These RH advocate groups believe that the rights of people to reproductive health “do not depend on a few powerful men deciding the fate of women” (Likhaan, 2011). In the explanatory note of House Bill 3368 introduced by Gabriela Women’s Party, it states that “Filipino women do not have to die at childbirth just because they are poor, they do not have to suffer from undiagnosed cervical, breast, vulvar, ovarian or similar cancers of the reproductive system just because they do not have access to adequately staffed and equipped public health facilities… Women do not have to suffer from untreated uterine fibroid or such similar conditions just because diagnostic procedures are costly, women should not die at childbirth because their infants need them for optimum care, love and affection if children are to grow up to realize their full potential as productive and responsible members of our society.”

Due to these reasons, access to reproductive health programs, resources and services for marginalized women needs to be guaranteed by the government. A national reproductive health policy is seen to offer health care services that will basically benefit women, especially the marginalized. Advancing reproductive health rights in a comprehensive, available, accessible, acceptable, and democratic manner is a long overdue mandate of the Philippine government to its female population given the social and economic realities in the country. Hence, the approval of legislators to pass RH bill is indispensable (Likhaan, 2011).

According to Junice Demeterio-Melgar, the executive director of Likhaan and Secretary-General of Reproductive Health Advocacy Network (RHAN), family planning will save the lives of mothers because family planning changes the composition of child-bearing. This means that pregnancies in women who are considered at a higher risk of dying from pregnancy and childbirth-related causes will be dramatically reduced. These are women who are too young, too old, have had too many children or have had unremitting pregnancies. Medical experts have stated that pregnancy in women below 18 or above 35 is considered high risk. They have also emphasized that women’s bodies need anywhere from two to three years to fully recover from the rigors of pregnancy and childbirth.

Moreover, the World Health Organization concludes that if women have information and access to contraceptives and are taught to use them properly, “the fall in maternal mortality is likely to be even greater than the fall in the pregnancy rate.”

With their struggle for the passage of RH bill, women’s groups tied up with other RH advocates to pressure legislators to pass RH bill. Reproductive Health Advocacy Network (RHAN), which has forty-three (43) national organizations with no less than 10,000 members in grassroots communities nationwide, continues to have dialogues with the President and with their recent dialogue, RHAN reminded the President about his Social Contract, which included a commitment to responsible parenthood based on informed choice and support to poor families.

RHAN, specifically Likhaan, is disappointed with the President’s decision to resort to a Responsible Parenthood Bill instead of a more comprehensive RH bill. According to them, further dialogues of the President to CBCP will trap his administration into delay and inaction, or push it to drop the freedom of choice principle in the President’s promise of responsible parenthood since the Church will always disagree to any RH bill because its opposition to RH is based on the core principle of human life, it is clear that immovable religious beliefs are the bedrock of the bishops’ opposition to RH as pointed out by the recent CBCP’s pastoral letter. Further dialogues or consultations will never change the stance of the Catholic Church.

Aside from dialogues, advocates continue to hold fora and debates on the issues of RH and human development from schools and universities to service clubs and community-based organizations. In addition, they hold mobilizations and rallies in front of Congress to pressure legislators to enact the said bill.

Both stakeholders prove to be significant and effective in their campaign for or against RH bill. However, the Church as an established and one of the most powerful institutions in the country which affect public opinion has an advantage in affecting the outcome of the said policy. However, RH advocates do not only have the superiority of numbers but they also have the superiority of arguments.

Although the Church has the capacity to influence or even shape public opinion, perhaps the case on the debate on RH bill is isolated. Recent survey results show that majority of Filipino and Filipino Catholics support RH bill. Although the RH critics say that people are only misinformed about the content of the measure, advocates say that the capacity of Filipinos to understand an issue like RH, responsible parenthood and population and development should not be underestimated. People support the RH bill because they realize how important it is to become a responsible parent. Filipinos also believe that is not only important for them to be able to plan and space their children, it is equally important that the State provide information on and access to all forms of family planning methods.

The following data are results of SWS and Pulse Asia surveys:

Social Weather Station (October 2008)

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

Pulse Asia (February 2010)

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;

75% of Filipinos consider it important that a candidate for election includes modern family planning in the program of action he will pursue;

64% of Filipinos will vote for candidates who publicly promote modern methods of family planning with only 6% saying that they will not vote for such candidates. The rest were undecided; and

A considerable majority of Filipinos (63%) want the RH bill to be passed into law with only 8% expressing opposition to the measure.

Even Catholics have spoken: They want the RH bill passed.

68% of Catholics believe that government