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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.

(THE ADVOCATE of Globe Tattawards! Elizabeth Angsioco) The Palace’s amendments

It appears like the inclusion of the reproductive health/ responsible parenthood bill in the Legislative-Executive Development Advisory Council’s list of priority measures is working.

Both chambers of Congress are now in the period of interpellation. Next comes the period of amendments when legislators propose specific changes and authors decide to accept or reject such proposals. The voting happens after this.

We do not see major problems that will further derail voting on the measure. In the Senate, even the staunchest RH bill opponent, Senator Vicente Sotto, has repeatedly said that they would “dispose” of the bill. At the House of Representatives, Speaker Sonny Belmonte is publicly known to favor the bill’s passage.

Since the period of amendments is near, this piece takes a closer look at Malacañang-proposed amendments to the RH bill.

Offhand, I say that except for two, all these amendments are generally acceptable to many advocates. The ones that we do not agree with outright need some clarification. Let me go through these.

In Section 2 of the Declaration of Policy, the Palace wants to delete the words “sexual orientation” in the enumeration of bases of discrimination that should be eliminated. The reason, as relayed to us, is that the word “sex” is already there and that this should be understood as already including “sexual orientation.”

To clarify, sex and sexual orientation are related but different. Simply put, sex refers to one’s biological make up. Either, one is male or female. Sexual orientation, on the other hand, refers to a person’s expression of his/her sexuality and includes relationships outside of heterosexual ones like those of homosexuals and lesbians.

Discrimination on the basis of sexual orientation has been well documented internationally as well as in the Philippines. In response to this, the Yogyakarta Principles (www.yogyakartaprinciples.org), on the application of international human rights law in relation to sexual orientation and gender identity was crafted by human rights experts in 2006.

This document is a guide to human rights and affirms binding international legal standards with which all States must comply. Such standards include: the Universal Declaration of Human Rights, International Covenant on Civil and Political Rights, Convention on the Elimination of all Forms of Discrimination Against Women, and Convention on the Rights of the Child. The Philippines is a signatory to all these instruments and thus, should adhere to their provisions.

It is not surprising therefore, that the ones loudly objecting to this particular Malacañang-proposed amendment are those in the lesbian, gay, bisexual, transgender (LGBT) community. In fact, many of them are known allies of the President.

Sexual orientation is definitely related with RH since it deals with intimate relations between people. It has direct relationship with a number of RH elements included in the bill such as: adolescent and youth RH including education; prevention and management of reproductive tract infections (RTIs), HIV and AIDS, and other sexually transmittable infections (STIs); education and counselling on sexuality and RH; and, mental health aspect of RH care. Thus, personally, I am for retaining this phrase in the RHB.

In Section 3, Guiding Principles, Malacañang proposes these two amendments:

2.1. (a) is amended to read as, “Freedom of choice, within the limits set by the Constitution and which is central to the exercise of right, must be fully guaranteed by the State;” (underscored part is the insertion).

I consider this as not only acceptable but an improvement of the bill as it strengthens adherence to the Constitution.

In (e), the Palace wants it to become: “The State shall promote, without bias, all effective natural and modern methods of family planning that are medically safe and legal provided, that the State may provide additional funding support to promote natural methods of family planning”.

In essence, this is acceptable because from the start, RH advocates have stated that ALL family planning methods must be made available. This of course includes modern NFP methods promoted by the Catholic Church.

My minor recommendation is to further strengthen it by replacing “may” with “shall,” and, deleting “additional” in the amended portion because this may be construed as favoring the NFP methods.

In section 7, Access to Family Planning, the recommendation is, “All accredited health facilities shall provide a full range of modern family planning methods, except in the case of specialty hospitals and hospitals owned and operated by a religious group provided that these hospitals may render such on an optional basis…”

While ideally advocates prefer not to have this amendment, I, for one will not object because in reality, church-owned hospitals are mostly, if not all, private. Public health facilities are more important to us because these are the ones used by our poor citizens.

In section 16, Mandatory Age-Appropriate RH and Sexuality Education, Malacañang has two amendments. One is to change the start of such education from the original Grade “Five” to “Six,” and the other, to add the phrase “with due regard to religious affiliation” after “Values formation,” a topic included in RH education.

Both amendments are acceptable.

The Palace wants to amend Section 20 on Ideal Family Size. It should be noted that RHB authors, in their letter to the Committee on Population months ago, have already decided to totally delete the section. This was part of further amendments volunteered by the authors themselves.

In Section 28, Prohibited Acts, Malacañang proposes two amendments. These are:

The deletion of paragraph (2) under (a) that contains prohibited acts of healthcare providers. The subject paragraph presently reads as: “Refuse to perform legal and medically-safe reproductive health procedures on any person of legal age on the ground of third party consent or authorization. In case of married persons, the mutual consent of the spouses shall be preferred. However, in case of disagreement, the decision of the one undergoing the procedure shall prevail…”

We were told that the palace wants the paragraph deleted for being vague and unclear.

I, and other RH advocates oppose the deletion because this runs counter to the principle of freedom of choice clearly espoused by the RH bill.

To clarify, we, the advocates originally crafted this paragraph because of women’s reports that there are health facilities that require the written consent of their spouses before performing ligation on them. Without such consent, they are refused.

Women who decide to undergo ligation are those who already have more than the number of children they can care and provide for. Most are poor and having ligation is their way of preventing future pregnancies they no longer want or can afford.

Ideally, undergoing ligation and/or vasectomy (on the part of the male) should be a mutual decision of couples. However, many women are in unequal, even abusive relationships. To them, requiring spousal consent on this matter is added burden and reinforces the thinking that men should decide for women.

Thus, we hope that this provision will be retained.

Malacañang proposes that (b) of the same section be amended to read as: “Any public official charged with the duty to implement the provisions of this Act, who personally or through a subordinate, prohibits or restricts the delivery of legal and medically-safe RH care services, including family planning, or forces, coerces or induces any person to use such services.”

This amendment is acceptable as it puts focus on responsible government officials.

Undoubtedly, these Malacañang amendments are meant to placate objections against the RHB. I have to say though that most are reasonable. Still, I, together, with other advocates hope that our position on the two ‘problematic’ amendments will still be considered by our legislators.

After all, we all want an RH law that will be truly responsive to the needs of our people.

*****

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The reproductive health baby

I feel like a pregnant woman about to give birth. I feel anxious, excited, happy, even as I experience the pains of giving birth. This 16-year pregnancy has been problematic but at last, the baby is about to be born.

Together with the thousands of reproductive health bill advocates, we are about to give birth to the RH law.

In labor, even as we cry out because of the pain, women have to push to help bring out the baby. Relative to the RH bill, the past weeks have been exciting because most of the needed push happened.

Sen. Miriam Defensor-Santiago delivered her powerful three-part RH sponsorship speech that virtually quashed all arguments against the RH law’s birth.

The Social Weather Stations’ June national survey results again proved that the overwhelming majority of the Filipino people WANT government to implement and fund a comprehensive family planning program. This was another vital push.

And finally, RH made it to the Legislative-Executive Development Advisory Council’s list of priority measures! This is the one of the big push steps necessary for the RH law to be born.

This last development particularly caused jubilation among RH advocates because the implication is, both the Executive and Legislative branches consider the RH bill a priority. After all, the Ledac is composed of these two branches of government.

This Ledac decision is historic. In its 16 years, this is the first time that RH made it to the priority list. Now, we expect Congress to move fast, vote on, and pass the RH bill into law.

I’ve said this before and I’ll say it again (with more conviction): the RH law may be President Aquino’s and Congress’ Christmas gift to the nation, especially to women in poverty.

In the latest meeting of the House of Representatives’ RH authors, we got glimpses of how the Ledac meeting went. We were told that of the 13 bills in the priority list, President Aquino asked Cabinet members to discuss the 12 BUT defended the RH/responsible parenthood bill himself!

As expected, anti-RH legislators like Cebu Rep. Pablo Garcia raised objections. These were responded to by the President directly and firmly. Anti-RH senators like Enrile and Sotto, upon seeing the President’s disposition, reportedly just kept quiet.

People said that from P-Noy’s words and body language, there was no doubt that he wants the RH bill passed soon.

Ben de Leon, President of the Forum for Family Planning, Inc., told me that before the Ledac, in Cabinet meetings with the President, it was Department of Health Secretary Enrique Ona who primarily took the cudgels for the RH bill. It was Ona who asked for its inclusion in the list of priorities and was supported by other Cabinet members.

The Health Secretary did not stop there. He sought a one-on-one meeting with PNoy to further explain the bill’s importance. The meeting took place in the morning of the day before the Ledac. The rest, we already know.

Ona’s and other Cabinet members’ efforts for the RH bill are deeply appreciated.

The President’s actions on the other hand, showed that he listens to what people say and takes note of realities he sees on the ground. The 16-year old girl with kids he met in one of the most depressed areas of Manila apparently made a huge impression on him. He reportedly mentioned this again in defending the bill during the Ledac meeting.

We must commend President Aquino for his decision to push for the RH bill’s passage and particularly, for including the bill in Ledac’s priorities. On this, he clearly showed regard for the needs of poor women, political will, and leadership. Saludo ako sa iyo dito PNoy!

Predictably, those who are against the bill raised a howl.

Senator Vicente Sotto said that Senate would trash the bill. Big words, but even the Senate President who is also against the bill chose his words carefully. Senator Juan Ponce Enrile only said that he did not see smooth sailing for the bill in the Senate.

Sotto’s statement runs counter to the sentiments of other Senators we have spoken with and who think that the Senate will pass the RH bill.

After the last sponsorship speech of Senator Defensor-Santiago, Sotto, as chairman of the committee on rules, said that contrary to what others say, they would want to discuss and DISPOSE of the RH bill.

My opinion is, he had to schedule the plenary discussion because of the Ledac decision and the fact that he has run out of excuses to further delay interpellation.

Perhaps I would have believed Sotto if I did not know of steps he took to delay the bill. It was he who, before discussing the RH bill, wanted to first decide on a so-called citizens’ petition against it submitted to his committee.

He even scheduled a hearing but had to cancel because his committee was questioned for doing something beyond its powers. The committee on rules only deals with procedural, NOT substantive matters.

It was also Sotto who objected to having Senator Pia Cayetano’s RH sponsorship speech earlier because hearings on bills protecting the unborn have yet to be called. This despite the fact that said bills are distinct and separate from the RH bill and, therefore, need not be discussed together with the latter.

Moreover, Sotto never officially informed Sen. Defensor-Santiago’s office of his committee’s decision on her recommendations for a more efficient process of interpellation. Sotto committed to respond during the plenary that heard Defensor-Santiago’s first sponsorship speech.

Really, does Sotto want to expedite the RH bill process?

Like in a pregnancy, care needs to be taken during birthing. On RH, we still expect obstacles. We cannot be complacent and we need to continue pushing. The big ones have been delivered and the final push – the voting – is near.

Citizens should likewise strongly push their legislators to vote for RH so we can celebrate and say, “Congratulations! The RH law is born!”

I will take up Malacañang’s proposed amendments next week.

(Statements in bold, for emphasis, are ours :))

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