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RH, the economy, and critical lessons

Yellow Pad by Lila Ramos Shahani

Debates on the controversial Reproductive Health (RH) bill have become increasingly heated in recent months. In a nutshell, anti-RH votes are impelled by a combination of conservative moral doctrine and realpolitik considerations. RH advocates study, with deepening concern, our worsening economic performance and the crushing poverty throughout the archipelago.

While all politics may ultimately be local, there is still much to be gained by examining what has worked for our Association of Southeast Asian (ASEAN) neighbors with smaller family sizes and lower incidences of poverty.

Three such neighbors — Thailand, Indonesia, and Vietnam — offer us important lessons. In all three, there was a latent public demand for reproductive health assistance from the government: laws were passed establishing government RH policies, and grassroots organizations formed fairly quickly to help enact them.

As Walden Bello has demonstrated, Thailand remains a favored comparison because, back in the 1970s, Thailand and the Philippines shared remarkably similar circumstances. Both nations had populations of about 36.7 million growing at around 3% per annum; by 2007, however, our growth rate was still at a high 2.04 %, while Thailand’s was already as low as 0.8 %. By 2008, there were 90 million Filipinos and only 66.5 million Thais.

Consider that this difference (about 25 million) is almost the entire population of Malaysia. Had we addressed population growth at the same time that Thailand did, we might now be a net exporter of rice, with an estimated surplus of three million metric tons.

In Vietnam, we observe consistent government policy and grassroots organization on the issue. Their population in 1989 — 64.7 million to our 60.1 million — was 88.2 million by 2010, compared to 94.01 million Filipinos that year.

The RH bill opponents would have us believe that poverty can be addressed by promoting economic growth and reducing social inequality alone. Vietnam’s experience demonstrates that this isn’t necessarily so: the early 1990s saw Vietnam shift from traditional, centralized socialism to modern, market-based socialism. But its inequality level, as reflected in the Gini Index, has consistently remained the lowest in ASEAN. All factors considered, Vietnam’s case suggests that focusing solely on social inequality, far from ensuring economic growth, can do little more than redistribute poverty. In fact, without an RH policy, Vietnam’s population estimates for today would be closer to 104.4 million.

In Indonesia, we see a combination of top-down leadership effectively combining with grassroots organization, but we also observe additional points of instruction. As in the Philippines, Islamic leaders did not oppose family planning. More surprising to us here, neither did the Catholic Church. Instead, they deemed family planning to be a moral choice best made on the basis of information — in fact, the attitude of the Catholic hierarchy was clearly discernible when it approved the distribution of a government family planning booklet describing different methods of artificial contraception.

But perhaps the greatest lesson from Indonesia is the danger of wavering support: the Asian financial crisis of 1998 saw a reduction in their RH budget, which may have been responsible for the country’s abortion numbers rising to a high 1.2 million annually, leading President Yudhoyono to seek increased government resources specifically for reproductive health.

At 3.3%, the Philippines has a significantly higher fertility rate than Thailand (1.8%), Indonesia (2.2%) or Vietnam (2.1%). Besides the highest birth rate in Asia, our abortion statistics are nothing short of alarming.

The Philippines sees approximately 500,000 induced abortions annually. According to a recent UC Berkeley report, 68% of Filipinas who undergo induced abortions are poor; 91% are married; 57% have more than three children; and 87% are Catholic.

These facts are grim indeed: in 2000, 78,901 women were hospitalized for injuries from unsafe abortions and 961,000 for unintended pregnancies brought to term.

All told, the World Health Organization estimates that 19% of all maternal deaths in Southeast Asia in any given year are due to unsafe abortions. Of course, no ASEAN country endorses abortion as a method of family planning. But numerous studies demonstrate that the availability of family planning methods and information can reduce the number of abortions by almost half. Indeed, many Catholic countries prohibit abortion as a family planning method, while promoting contraceptive use.

There are more pressing questions: Are we willing to remain one of the top 10 political and environmental hot spots in the world simply because we’ve neglected to craft a forward-looking and realistic family planning policy?

Can we live with being the world’s 12th most populous nation, 5th in global hunger, and 4th in the number of child prostitutes?

Perhaps, once and for all, we could finally begin to learn from our neighbors in the region, many of whom have progressed by leaps and bounds while, dismally, we continue to trail far behind.

Lila Ramos Shahani is assistant secretary of the National Anti-Poverty Commission. She is also adjunct faculty of the Center for Development Management at the Asian Institute of Management and a doctoral candidate at Oxford University.

"WHAT’S THE BIG DEAL?" a sexhibit. 
Oct 14, 2011 (Friday) 1pm-12mn 
A-Venue Open Grounds in Makati Avenue. View high resolution

"WHAT’S THE BIG DEAL?" a sexhibit. 

Oct 14, 2011 (Friday) 1pm-12mn 

A-Venue Open Grounds in Makati Avenue.

Entitled “In the Philippines, Giving Birth Kills: Maternal Mortality in the Philippines,” this video documentary was produced as part of the Students for Development Program of the University of Montreal’s Faculty of Education and Department of Political Science, in cooperation with the UP Third World Studies Center.

This documentary gives a general overview of current practices in reproductive health in the Philippines. It gives a special focus on the state of public health services provided for Filipino mothers.


Students Nicolas Descroix and Audrey-Maud Tardif from the University of Montreal and Barbie Jane L. Rosales and Cherry E. Sun from the University of the Philippines-Diliman constituted the production team for this documentary.

So wrong

Arguments against the reproductive health bill have evolved. The good thing is that purely religious ones are now rarely used. These are now masked with “scientific” data. The bad thing is that these new arguments are so wrong.

We hear anti-RH legislators like Rep. Mitos Magsaysay and Senator Vicente Sotto say that a reproductive health bill is not needed because other laws and policies are already in place. They point to Republic Act No. 9710, the Magna Carta of Women as the law that allegedly contains everything the RHB wants to do.

In fact, when Magsaysay interpellated RH bill author Rep. Kimi Cojuangco, she named me as someone who helped put together the MCW and its Implementing Rules and Regulations. To be accurate, I was with the Technical Committee for the Bicameral Committee that finalized the MCW but failed to attend meetings for the IRR.

I do not know why Magsaysay singled me out but it felt like I did wrong for helping Congress pass a measure that upholds women’s rights as human rights.

Anti-RH lawmakers allege that the RH bill copied provisions from the MCW. Reviewing the bills’ history will show that the provisions referred to have been in the RH bill years before the MCW included them. Actually, MCW lifted some RH elements and integrated these in its Sec. 17, Women’s Right to Health. Since the MCW has been enacted before the RH bill, they now claim that it’s the other way around. This is so WRONG.

These lawmakers assert that the magna carta and its implementing rules render the RH bill redundant and therefore, unnecessary. I beg to disagree.

One, the MCW is for women while the RH bill will address reproductive health needs of everyone including men, young people, those who have serious conditions such as HIV and AIDS, and even persons with disabilities. Thus, in terms of people who will benefit from the law, the RH bill’s coverage is more comprehensive.

Two, our legislators know (or at least they should) that there are general and specific laws. The Magna Carta for Women is an example of a general law since it contains ALL rights of women in different sectors and circumstances. It has provisions on women’s rights to: participation and representation; equal access and elimination of discrimination in education, scholarships, and training; health; equal treatment before the law; non-discriminatory and non-derogatory portrayal in media; social protection, etc.

It also advances specific rights of women in the military, in marginalized sectors, senior citizens, in especially difficult circumstances, and others.

The RH bill is specific because it deals solely with reproductive health needs of people. Because it is RH-specific, it outlines concrete programs that are mentioned in, and those NOT in MCW.

Just like the Labor Code of the Philippines which at times becomes the basis of other labor-related laws, the MCW is in fact, a legal basis for the passage of the RHB. Since family planning services, maternal care, and youth sexuality education are already included in the listing of women’s health-related services in the MCW law, there really is no reason for objections against the RH bill.

The enactment of the RH bill is necessary so that the Magna Carta for Women can be better implemented. The former concretizes the general services in the latter.

Three, in terms of RH services, the magna carta is incomplete. Oppositors will say that the IRR contains more but scrutiny of this document will reveal that while a few related services are mentioned, they are still in general terms.

Moreover, an IRR does not carry the weight of a law. It can be easily changed depending on the temperament of current political leadership.

Some of the concrete provisions of the RH bill (House version) that are either absent from or made more specific than those in the Magna Carta for Women and its implementing rules are:

1. Midwives for skilled attendance (Sec. 5);

2. Emergency obstetric and neonatal care (Sec. 6);

3. Access to family planning (Sec. 7);

4. Maternal and newborn health care in crisis situations (Sec. 8);

5. Maternal death review (Sec. 9);

6. Family planning supplies as essential medicines (Sec. 10);

7. Integration of responsible parenthood and family planning component in anti-poverty programs (Sec. 12);

8. Benefits for serious and life-threatening RH conditions (Sec. 14);

9. Mobile health care service (Sec. 15);

10. Capability building of barangay health workers (BHWs) (Sec. 19);

11. Pro-bono services for indigent women (Sec. 22);

12. Sexual and RH programs for PWDs (Sec. 23); and

13. Prohibited acts (Sec. 28).

Clearly therefore, the RH bill is not a replica of the Magna Carta for Women and its IRR. Saying that it is redundant and unnecessary is so wrong.

Sotto repeatedly asserts that Congress no longer needs to pass the RH bill because the Department of Health is already doing the services proposed by the bill. Indeed, the present DoH leadership is much more progressive on RH matters than previous ones under former President Macapagal-Arroyo (except of course former Health Secretary Esperanza Cabral).

However, it is incorrect to say that Health Department is already doing everything it should in relation with RH. The DoH needs the law to effectively address the huge need for access to RH services especially by women in poverty.

The experience with Mrs. Arroyo, who opposed contraceptives, implemented a failed Natural Family Planning-only program, and halted the previous Congress’ RH bill deliberation is one of the strongest arguments for the passage of the RH bill.

We have also seen the effects of the Atienza order in Manila that effectively prohibits public heath providers from dispensing contraceptives and moves by other LGUs such as Barangay Ayala Alabang; Balanga, Bataan; and Cebu to curtail people’s right to RH services. These are reasons why enacting the RH bill is urgent.

The country cannot continue to be held hostage by religious beliefs of those who hold government power.

With the RH law in place, standardized programs with sufficient budgetary support will be implemented throughout the Philippines whoever the President, DoH Secretary, governors, or mayors, may be.

All these “new” anti-RH bill arguments are so wrong. It is urgent that the RH bill is passed.

eangsioco@yahoo.com

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