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Reproductive Health
Having the Balls To Stand Up For Reproductive Health and Rights Print
Reproductive Health
Monday, 20 April 2009 16:33
HAVING THE BALLS TO STAND UP FOR REPRODUCTIVE HEALTH AND RIGHTS
(Speech delivered by REP. EDCEL C. LAGMAN
during the Philippine Urological Association’s Midyear Convention
on 17 April 2009 at the Avenue Plaza Hotel, Naga City)


In Roman times, men customarily placed their right hands over their testicles and swore by them before testifying in court. This is not strange given that the Latin word testis meant “witness”.

This practice is seen even in the Bible in the Book of Genesis where Abraham told his most trusted servant who was on a mission to find a wife for his son Isaac to “place your hand under my thigh” which is a euphemistic way of instructing the servant to swear upon the testicles of his master.

It seems that then, as now, the balls are a symbol of moral fiber, truthfulness and courage. Since this area of the male anatomy falls under the domain of urologists, I thought it would be enlightening to trace the etymological roots of this body part that has much to do with the practice of your branch of medicine even as I hope that the traits that the testes symbolize – honesty, straightforwardness and moral fortitude – would also characterize our discussion of the RH bill.

Each time I begin a talk on House Bill No. 5043 or the Reproductive Health bill, I make it a point to first disabuse the minds of the audience by underscoring that reproductive health as a concept is not about sex. Neither is it about religion. Nor is the bill primarily about condoms and pills. This seems to surprise most people who continue to equate reproductive health with sex, contraceptives, hedonism and promiscuity.

Reproductive health is fundamentally about health, rights and sustainable human development. The bill is fully transparent. There are no caveats and the authors have no hidden agenda. 

As urologists, you are directly involved in ensuring male reproductive health and I am heartened your association sees the impact a bill such as House Bill 5043 will have on sexual dysfunction in men and in ensuring that this will be both treated and prevented.

RH is a fundamental human right


The RH bill is anchored on the principle that everyone has the right to reproductive self-determination – meaning the right to decide when and how often one becomes a parent or the right not be a parent at all. Should a couple decide that they want to plan and space their children, the State must be able to provide them with relevant and timely information on all methods of family planning which are legal and medically safe. Once the couple has decided on the method best suited to their needs, personal convictions and religious beliefs, then the State must once again be prepared and equipped to provide them with quality reproductive health and family planning services.

Moreover, should a woman decide to become a mother, the State must be able to provide her with the services she needs for safe motherhood.

At the heart of the bill is freedom of informed choice. Neither the State nor the Church has the authority to tell the people or the faithful what family planning method to adopt. The choice belongs to couples, particularly to women because they put their lives at risk every time they bear children.

The essence of the RH bill is to provide an enabling environment that will protect and promote the right of individuals and couples to make informed decisions when it comes to planning their families; the right to have healthy babies and provide adequately for their families; and the right to reproductive health, an enjoyable and safe sex life, and reproductive self-determination.

Right to RH remains illusory for poor Filipinos


Although reproductive health has long been considered a basic human right, this remains illusory for millions of Filipinos, especially the poor. Consider the following:

1.    2.6 million Filipino women would like to plan their families but lack information and access to do so. (Family Planning Survey 2006)
2.    The poorest Filipinas are still having an average of 6 children  which almost 3 times their desired number. (FPS 2006)
3.    44% of the pregnancies of the poorest women are unwanted. (FPS 2006)
4.    According to the latest study of the Guttmacher Institute of New York in collaboration with the UP Population Institute, more than half of the Philippines’ 3.4 million pregnancies are unintended and 92% of them occur to women who either use no method or use a traditional method.
5.    Among the poorest women who would like to avoid pregnancy, at least 41% do not use any contraceptive method because of lack of information or access.

What the RH bill is all about


1. The bill is pro-poor, pro-women and pro-life. The principal beneficiaries of this bill are the poorest of the poor and the marginalized. RH and family planning significantly improves maternal health and lowers maternal morbidity. Having the ability to plan and space children will afford women more employment and educational opportunities and will significantly lower abortion rates. The bill will also prevent infant and child deaths. Family planning will also mean larger investments in health and education and better health outcomes for children.

2. The bill promotes safe motherhood and better health for infants and children. The WHO and the UNFPA assert that correct and consistent use of contraceptives will prevent one-third of all maternal deaths and family planning helps prevent 1 million infant deaths worldwide.

3. The bill will promote sustainable human development. The UN stated that “family planning and reproductive health are essential to reducing poverty” and “countries that invest in reproductive health and family planning and in women's development register slower population growth and faster economic growth”.

4. The UNICEF underscores that “family planning could bring more benefits to more people at less cost than any other single technology now available to the human race.” The return of investment in family planning and contraceptive use is high. In fact, it leads to net government savings as medical costs associated with unintended pregnancies would fall from P3.5-B to P600-M.

5. Expanding access to contraception could result in 800,000 fewer unplanned births; 500,000 fewer induced abortions; 200,000 fewer miscarriages; and 2,100 less maternal deaths.

Clarifying misconceptions: what the RH bill is not


Misconception 1: the bill is anti-life.

•    It is pro-quality life. It will ensure that children will be blessings to their parents since their births are planned and wanted.

•    The bill is not against the birth of children. It does not advocate that women and couples stop having children. What it only aims to do is to help women and couples achieve their fertility goals.

Misconception 2: Bill is biased for modern methods of FP.

•    The bill does not favor modern methods of family planning over the natural methods preferred by the Catholic Church. Section 3(a) of the bill provides: “In the promotion of reproductive health, there should be no bias for either modern or natural methods of family planning.”

Misconception 3: Bill legalizes abortion.

•    The bill underscores that abortion is illegal, criminal and punishable, and is not part of the menu of legally permissible and medically safe family planning methods.

•    The bill will not lead to the eventual legalization of abortion. Catholic countries like Panama, Guatemala, Brazil, Chile, Columbia, Dominican Republic, El Salvador, Paraguay and Ireland all prohibit abortion as a family planning method even as they vigorously promote contraceptive use.

•    Contraceptive use and abortion have an inverse correlation: regular and correct use of contraceptives reduces abortion rates since unplanned and unwanted pregnancies are avoided. The RH bill is in fact anti-abortion.

Misconception 4: Bill endorses abortifacients.

•    Pills and IUDs are BFAD-approved, medically safe and legal.

•    The WHO declares that contraceptives “cannot be labeled as abortifacients”.

•    Critics of the bill have been claiming that contraceptives prevent the implantation of a fertilized egg which they equate with abortion. But according to the Department of Reproductive Health and Research of the WHO not only are contraceptives not abortifacients, “there is no evidence to date that has supported the hypothesis that these lead to the disruption of implantation.”

Misconception 5: Contraceptives kill.

•    Medical risks connected with contraceptives are infinitely lower than the risks of an actual pregnancy and everyday activities.

(a)    Risk of dying within a year of riding a car is 1 in 5,900.
(b)    Risk of dying within a year of using pills is 1 in 200,000.
(c)    Risk of dying from a vasectomy is 1 in 1 million.
(d)    Risk of dying from using an IUD is 1 in 10 million.
(e)    Risk of dying from condom use is absolutely zero.
(f)    But the worldwide risk of dying from a pregnancy is 1 in 10,000.
(g)    In the Philippines, the lifetime risk of dying from maternal causes is an alarming 1 in 100.

Misconception 6: Bill claims to be panacea to poverty.

The bill simply recognizes the verifiable link between a huge population and poverty. Unbridled population growth stunts socio-economic development and aggravates poverty. Consider the following:

•    The Philippines is the 12th most populous country in the world but we rank 102nd out of 179 countries in the Human Development Index of the United Nations Development Program.

•    According to the Asian Development Bank, a large population is one of the major causes of poverty in the country.

•    Large family size is a significant factor in keeping families poor across generations. (Phil. Institute for Development Studies)

Misconception 7: Sexuality education will promote promiscuity.

•    Age-appropriate RH education promotes correct sexual values, which is the antithesis of promiscuity.

•    International empirical studies document the following benefits of sexuality education among the young: (1) understanding of proper sexual values is promoted; (2) initiation to sexual relations is delayed; (3) abstinence before marriage is encouraged; (4) multiple sex partners is avoided; and (5) spread of sexually transmitted diseases is prevented.

Ensuring Male Reproductive Health and the RH Bill

I would like to underscore that there is more to RH than just family planning. It encompasses several other equally important elements such as the promotion of breastfeeding; infant and child health and nutrition; prevention and treatment of STDs and reproductive tract and breast cancers; prevention of abortion; sexuality education for the young; and providing assistance to couples with infertility problems and sexual dysfunction, among others.

The last element – treatment and prevention of infertility and sexual dysfunction – is a primary concern of urologists. Although impotence is not a deadly disease, it can be a precursor to or a sign of potentially fatal health problems. In a society where a macho culture still unfortunately prevails, HB 5043 will be a great help in encouraging men to talk about impotence and erectile dysfunction and will be indispensable in making them seek actual treatment.

In the United States, it is reported that at least 20 million American men have some degree of erectile dysfunction (ED). This is equivalent to roughly 1.3% of all American men. Assuming that this data is reflective of worldwide trends, this would translate to approximately 585,000 Filipino men with some form of ED. This, certainly, is no laughing matter, even if ED is not life-threatening.

The problems of erectile dysfunction and sterility have far reaching effects on the lives of men and cannot be ignored or pushed aside simply because no one has yet died due to the inability to have an erection or impregnate one’s wife.

The RH bill aims to help remove the stigma associated with male infertility and erectile dysfunction by encouraging honest discussions on its prevention and treatment and ensuring that men in particular become more aware that ED and infertility are serious problems that require proper treatment from specialists.

Vox populi, vox Dei


The people have spoken – they favor family planning and want the RH bill passed.

The latest SWS national survey reveals that 71% of Filipinos are in favor of the RH bill; 76% 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 that compels government to distribute contraceptives.

A Pulse Asia survey released early this year also shows similar statistics – 93% of Filipinos consider it important to have the ability to plan their families; 82% believe government should give people information and access to all family planning methods; and 63% want the RH bill to be passed with only 8% against.

It is important to underscore that more Catholics favor the bill’s passage as compared to non-Catholics. Seventy-one percent of Catholics support its enactment versus only 68% of non-Catholics who endorse the bill (SWS). Clearly, an overwhelming majority of the Catholic faithful believe that using contraception does not make them bad Catholics.

Indeed, if the voice of the people is the voice of God, then there is no reason the RH bill will not be ultimately enacted into law.

Male involvement in reproductive health


The urgency of passing a national policy on RH and family planning is reflected in maternal mortality figures – 11  Filipino mothers die each day in the process of giving life. Although we are men, not one of us will be here if not for our mothers. We have also wives, sisters and daughters and we cannot stand idly by and let the miracle of life mean death for so many mothers.  Studies from the WHO, UNFPA and other international organizations have consistently revealed that contraceptive use actually promotes health and saves lives because they prevent unintended and high risk pregnancies.

Alarming maternal death rates also expose deplorable gender disparities because there is no single health hazard to men aged 15 to 49 which approximates the horror and pervasiveness of maternal mortality and disability.

As doctors and as enlightened men, you are indispensable in encouraging other men to be more involved in reproductive health because men are crucial in ensuring gender equality and saving women’s lives.  In societies like ours, men play a dominant role in almost every sphere of life – from private decisions like family planning to public policies on reproductive health and women’s rights. It is important to underscore that it is precisely within the realm of politics and religion – in which men play central roles – that key reproductive health decisions affecting women’s lives have been made and are being made.

We must not forget that the empowerment of women through better health, education and opportunities benefits their families in particular and society as a whole in general so let us not begrudge them the right to achieve their desired fertility goals through effective and safe family planning.

The authors of HB 5043 are counting on physicians like you to support the measure because it is genuinely pro-women, pro-poor and pro-life. We are counting on you because you are medical professionals and scientists and you know for a fact that RH is essential to people’s overall health. We are counting on you because most, if not all of you, have exercised the most basic right to plan your families and we know that you would not wish to deprive poor Filipino couples of the same right.

Having the balls to stand up for reproductive health and rights


The Philippines is the only remaining middle income country in this part of the world that does not have a national policy on reproductive health. This is not only unfortunate, it constitutes a grave social injustice because family planning and reproductive health saves the lives of women and infants, optimizes childcare; prevents the aberration of abortion, leads to remunerative work for women and gives children a fighting chance of living dignified lives.

The testes, which are found in the logo of your association, have long been symbols of men’s virility and vigor. But more than just symbols of the generative capacities of men, the testicles are also a figurative representation of daring and strength of spirit.

There is no pun intended when I say that I am certain that the officers and members of the Philippine Urological Association have the balls – the courage and fortitude – to support the passage of the RH bill and stand up for reproductive health and rights.

Be a part of the passage of the RH bill and help us achieve the dream that the birth of every Filipino child will be a cause for celebration.

 
The RH Bill: Calling A Spade A Spade Print
Reproductive Health
Monday, 20 April 2009 16:21
THE RH BILL: CALLING A SPADE A SPADE
(Speech delivered by REP. EDCEL C. LAGMAN
before members of the Inner Wheel Club on 16 April 2009)

Each time I begin a talk on House Bill No. 5043 or the Reproductive Health bill, I make it a point to first disabuse the minds of the audience by underscoring that reproductive health as a concept is not about sex. Neither is it about religion. Nor is the bill primarily about condoms and pills. This seems to surprise most people who continue to equate reproductive health with sex, contraceptives, hedonism and promiscuity.

For an issue as controversial and as important as reproductive health, we must refrain not only from trading insults with critics or meandering into peripheral subjects. Our language must be clear and unambiguous. Let us call a spade a spade – reproductive health is fundamentally about health, rights and sustainable human development. The bill is fully transparent. There are no caveats and the authors have no hidden agenda. 

I am heartened that the Inner Wheel Club, which is the largest women’s voluntary service organization in the world, has decided to hold a forum on the RH bill because the casualties of the lack of a national policy on reproductive health and family planning are primarily women, especially those who are poor and uneducated.

Inner Wheel is much more than just a ladies’ club and its history is truly instructive – it was created primarily for wives and daughters of Rotary Club members which, until 1989, was an club which excluded women from its membership.

Millions Filipino women today are still excluded from the select group of women who can freely exercise their right to reproductive health because of lack of information and pertinent services. As accomplished, educated and well-off women, you can do so much to improve the lives of your less fortunate sisters by promoting and protecting their right to reproductive health and supporting the RH bill.

RH is a fundamental human right

The RH bill is anchored on the principle that everyone has the right to reproductive self-determination – meaning the right to decide when and how often one becomes a parent or the right not be a parent at all. Should a couple decide that they want to plan and space their children, the State must be able to provide them with relevant and timely information on all methods of family planning which are legal and medically safe. Once the couple has decided on the method best suited to their needs, personal convictions and religious beliefs, then the State must once again be prepared and equipped to provide them with quality reproductive health and family planning services.

Moreover, should a woman, who bears the brunt of pregnancy and childbirth decide to become a mother, the State must be able to provide her with the services she needs for safe motherhood.

At the heart of the bill is freedom of informed choice. Neither the State nor the Church has the authority to tell the people or the faithful what family planning method to adopt. The choice belongs to couples, particularly to women.

Again, I would like to underscore that there is more to RH than just family planning. It encompasses several other equally important elements such as the promotion of breastfeeding; infant and child health and nutrition; prevention and treatment of STDs and reproductive tract and breast cancers; prevention of abortion; sexuality education for the young; and assistance to couples with infertility problems, among others.

This is the essence of the RH bill – being able to provide an enabling environment that will protect and promote the right of individuals and couples to make informed decisions when it comes to planning their families and safeguarding their right to reproductive health.

Right to RH remains illusory for poor Filipinos

The time has come for the enactment of the RH bill because although, reproductive health has long been considered a basic human right, this remains illusory for millions of Filipinos, especially the poor. Consider the following results of the Family Planning Survey 2006:

1.    2.6 million Filipino women would like to plan their families but lack information and access to do so.
2.    Poorest Filipinas are still having an average of 6 children (this is almost 3 times their desired number of children).
3.    44% of the pregnancies of the poorest Filipinas are unwanted.
4.    According to the latest study of the Guttmacher Institute of New York in collaboration with the UP Population Institute, more than half of the Philippines’ 3.4 million pregnancies are unintended and 92% of them occur to women who either use no method or use a traditional method.
5.    Among the poorest women who would like to avoid pregnancy, at least 41% do not use any contraceptive method because of lack of information or access.

What the RH bill is all about

So much has been said about what the RH bill is all about, most of which are completely false and even bordering on malicious misinformation. It would be best then to get the facts straight from the horse’s mouth:

1. The bill is pro-poor, pro-women and pro-life. The principal beneficiaries of this bill are the poorest of the poor and the marginalized. RH and family planning significantly improves maternal health and lowers maternal morbidity. Having the ability to plan and space children will afford women more employment and educational opportunities and will significantly lower abortion rates. The bill will also prevent infant and child deaths. Family planning will also mean larger investments in children’s health and education and better health outcomes for children.

2. The bill promotes safe motherhood and better health for infants and children. The WHO and the UNFPA assert that correct and consistent use of contraceptives will prevent one-third of all maternal deaths and family planning helps prevent 1 million infant deaths worldwide.

3. The bill will promote sustainable human development. The UN stated in 2002 that “family planning and reproductive health are essential to reducing poverty” and “countries that invest in reproductive health and family planning and in women's development register slower population growth and faster economic growth”.

4. The UNICEF underscores that “family planning could bring more benefits to more people at less cost than any other single technology now available to the human race.” The return of investment in family planning and contraceptive use is high. In fact, it leads to net government savings as medical costs associated with unintended pregnancies would fall from P3.5-B to P600-M.

5. Expanding access to contraception could result in 800,000 fewer unplanned births; 500,000 fewer induced abortions; 200,000 fewer miscarriages; and 2,100 less maternal deaths.

Clarifying misconceptions: what the RH bill is not

Now that I’ve discussed the core concepts of the proposed measure or what the RH bill is all about, it would also be enlightening to talk about what the bill is not about which will effectively clarify the numerous misconceptions about HB 5043.


Misconception 1: the bill is anti-life.

•    It is pro-quality life. It will ensure that children will be blessings to their parents since their births are planned and wanted.

•    The bill is not against the birth of children. It does not advocate that women and couples stop having children. What it only aims to do is to help women and couples achieve their fertility goals.

•    It promotes safe pregnancy and safe childbirth since high risk and unintended pregnancies are avoided.

Misconception 2: Bill is biased for modern methods of FP.

•    Section 3(a) of the bill provides: “In the promotion of reproductive health, there should be no bias for either modern or natural methods of family planning.”

•    The bill will even democratize family planning because it will make available to couples all possible family planning methods and not just natural family planning methods preferred by the Catholic Church and which are currently the only methods promoted by the Commission on Population.

Misconception 3: Bill legalizes abortion.

•    The bill underscores that abortion is illegal, criminal and punishable, and is not part of the menu of legally permissible and medically safe family planning methods.

•    Promoting contraceptive use will not lead to the eventual legalization of abortion. Numerous Catholic countries like Panama, Guatemala, Brazil, Chile, Columbia, Dominican Republic, El Salvador, Paraguay and Ireland all prohibit abortion as a family planning method even as they vigorously promote contraceptive use.

•    Contraceptive use and abortion have an inverse correlation: regular and correct use of contraceptives reduces abortion rates since unplanned and unwanted pregnancies are avoided. The RH bill is in fact anti-abortion.

Misconception 4: Bill endorses abortifacients.

•    Pills and IUDs are BFAD-approved, medically safe and legal.

•    The WHO declares that contraceptives “cannot be labeled as abortifacients”.

•    Critics of the bill have been claiming that contraceptives prevent the implantation of a fertilized egg which they equate with abortion. But according to the Department of Reproductive Health and Research of the WHO not only are contraceptives not abortifacients, “there is no evidence to date that has supported the hypothesis that these lead to the disruption of implantation.”

Misconception 5: Contraceptives kill.

•    Medical risks connected with contraceptives are infinitely lower than the risks of an actual pregnancy and everyday activities.

(a)    Risk of dying within a year of riding a car is 1 in 5,900.
(b)    Risk of dying within a year of using pills is 1 in 200,000.
(c)    Risk of dying from a vasectomy is 1 in 1 million.
(d)    Risk of dying from using an IUD is 1 in 10 million.
(e)    Risk of dying from condom use is absolutely zero.
(f)    But the worldwide risk of dying from a pregnancy is 1 in 10,000.
(g)    In the Philippines, the lifetime risk of dying from maternal causes is an alarming 1 in 100.

Misconception 6: Bill claims to be panacea to poverty.

The authors of the bill do not claim that it is a magic wand that will solve all our problems.

•    The bill simply recognizes the verifiable link between a huge population and poverty.

•    Unbridled population growth stunts socio-economic development and aggravates poverty.

(a)    The Philippines is the 12th most populous country in the world but we rank 102nd out of 179 countries in the Human Development Index of the United Nations Development Program.
(b)    According to the Asian Development Bank, a large population is one of the major causes of poverty in the country.
(c)    Large family size is a significant factor in keeping families poor across generations. (Phil. Institute for Development Studies)

Misconception 7: Sexuality education will promote promiscuity.

Most of you here today are mothers and I am certain that regardless of the topic, you fully realize the necessity of honesty and frankness when it comes to talking to children. In fact, I am sure that you will agree with me that children have the remarkable ability of responding with equal candor and when they feel that adults are being honest.

Correct and timely information on sexuality is crucial if we are to help our children and young people become sexually responsible adults.

•    Age-appropriate RH education promotes correct sexual values, which is the antithesis of promiscuity.

•    International empirical studies document the following benefits of sexuality education among the young: (1) understanding of proper sexual values is promoted; (2) initiation to sexual relations is delayed; (3) abstinence before marriage is encouraged; (4) multiple sex partners is avoided; and (5) spread of sexually transmitted diseases is prevented.

•    The United Nations Population Fund asserts that these beneficial effects “become even greater when parents can talk honestly with their children about sexual and reproductive matters.”

If we want to decrease the number of teenage pregnancies and effectively combat the spread of STDs and if we truly want young people to act more responsibly, then it’s about time we adults grew up and trust young people enough that pertinent information and correct values about sex and sexuality will not make them immoral and promiscuous.

Countries whose schools teach sexuality education continue to reap the benefits of providing young people with accurate information at the appropriate age because it encourages responsible behavior and tends to delay the onset of sexual activity.

Moreover, comprehensive sexuality education has been shown to help adolescents make more sensible sexual decisions and adds a level of maturity to their attitudes towards sexual relations.

Vox populi, vox Dei

The people have spoken – they favor family planning and want the RH bill passed.

The latest SWS national survey reveals that 71% of Filipinos are in favor of the RH bill; 76% 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 that compels government to distribute contraceptives.

A Pulse Asia survey released early this year also shows similar statistics – 93% of Filipinos consider it important to have the ability to plan their families; 82% believe government should give people information and access to all family planning methods; and 63% want the RH bill to be passed with only 8% against.

It is important to underscore that more Catholics favor the bill’s passage as compared to non-Catholics. Seventy-one percent of Catholics support its enactment versus only 68% of non-Catholics who endorse the bill (SWS). Clearly, an overwhelming majority of the Catholic faithful believe that using contraception does not make them bad Catholics.

Since Ann Arbor school is located in Parañaque, let me disclose the results of the SWS survey conducted in Parañaque only last month: 87% of residents agree that there should be a law on reproductive health and family planning; 85% want schools to teach family planning; and 87% believe that government should provide contraceptives to those who want them.

Indeed, if the voice of the people is the voice of God, then there is no reason the RH bill will not be ultimately enacted into law.

Smaller families = positive effects on
women’s wellbeing

Giving women the opportunity to plan and space their children will almost always improve their general wellbeing. Studies conducted by Family Health International show that high parity or having many children has negative effects on all measures of women’s welfare. These detrimental effects encompass nutritional status, level of education, income, employment opportunities and social activities.

Smaller families indeed make for healthier, more educated, better-employed, more productive and more socially mobile women. It must be underscored that the more educated, the healthier and more financially independent a mother is, the chances that she will pass on these characteristics to her children increase markedly. 

The authors of HB 5043 are counting on enlightened academics, teachers and parents and women like you to support the measure because it is genuinely pro-women, pro-poor and pro-life. We are counting on you because you know for a fact that RH is essential to women’s overall health and if it is neglected, primary aspects of women’s general welfare and wellbeing will be irrevocably compromised. We are counting on you because most, if not all of you, have exercised the most basic right to plan your families and we know that you would not wish to deprive poor Filipino couples of the same right.

The Philippines is the only remaining middle income country in this part of the world that does not have a national policy on reproductive health. This is not only unfortunate, it constitutes a grave social injustice because family planning and reproductive health saves the lives of women and infants, optimizes childcare; prevents the aberration of abortion, leads to remunerative work for women and gives children a fighting chance of living dignified lives.

Help us pass the RH bill by helping clarify misconceptions about the measure and educating others about what it is really all about. Encourage open-minded debates on the issue and champion the rights of the millions of poor women who are consigned to lives characterized by unremitting pregnancies because of the lack of RH information and services.

The theme for Inner Wheel year 2008/2009 is “Realize your visions and make a difference.” You can do both – achieve your dreams and make a difference in the lives of women for whom dreaming has become a luxury they can ill-afford by supporting the passage of the RH bill. In doing so, you will be helping poor Filipino women fulfill their simple dream of a better life for their children.

Make an impact on the lives of others by being a part of the passage of the RH bill and helping achieve our common dream that the birth of every Filipino child will be a cause for celebration.
 
The Real Crusade: The Truth About HB 5043 Print
Reproductive Health
Wednesday, 15 April 2009 12:28
THE REAL CRUSADE: THE TRUTH ABOUT HB 5043
(Speech delivered by REP. EDCEL C. LAGMAN during a forum on the Reproductive Health Bill  sponsored by the South Manila Inter-Institutional Consortium at UP Manila on 14 November 2008)

The crusade for the passage of House Bill No. 5043 or the “Reproductive Health, Responsible Parenthood and Population Development Act of 2008” has been difficult not because it lacks merit since the bill is truly meritorious as it is necessary, beneficial and practicable.

The enactment of the bill faces roadblocks not because it is deprived of popular support because survey after survey reveals that the RH bill enjoys the solid support of an overwhelming majority of Filipinos regardless of social class and religion. The latest SWS survey shows that 71% of all Filipinos endorse the passage of the reproductive health bill.

Neither is the passage of the bill delayed because of lack of supporters in the House of Representatives. In fact, as of today, House Bill 5043 has a total of 113 coauthors, more than a majority of the requisite quorum to approve a bill.

The campaign for the enactment of the RH bill has been made difficult because of the deliberate misinformation campaign being launched against the bill by its critics and the dilatory maneuvers being contrived by its oppositors.

I am therefore thankful for this opportunity to explain not only the salient provisions of the measure but also the chance to counter the misinformation and half-truths being peddled by those against the bill.

The RH bill assures an enabling environment where women and couples have the freedom of informed choice on the mode of family planning they want to adopt based on their needs, personal convictions and religious beliefs.

ELEMENTS OF RH - The RH bill is not principally about condoms and pills. It is certainly not about religion. It is about health and rights and this can be seen clearly in the coverage of reproductive health, as proposed in the bill.

Family planning is only one element of reproductive health. Equally important are the other elements of RH which include: (1) maternal, infant and child health and nutrition; (2) promotion of breast feeding; (3) prevention of abortion and management of post-abortion complications; (4) adolescent and youth health; (5) prevention and management of reproductive tract infections, HIV/AIDS and STDs; (6) elimination of violence against women; (7) counseling on sexuality and reproductive health; (8) treatment of breast and reproductive tract cancers; (9) male involvement and participation in RH; (10) prevention and treatment of infertility; and (11) RH education for the youth.

It is a pity that the RH debate has been confined to family planning because its critics primarily oppose the use of modern contraceptives which they claim are abortifacients and will lead to the deterioration of marriage and family life. It is a pity because the other elements of RH, which will similarly protect and promote the right to health and reproductive self-determination, have been largely ignored.

STRENGTHENING OF POPCOM - The POPCOM shall be reoriented to promote both natural and modern family planning methods. Few people know that POPCOM, which is the government agency central to the country’s family planning program, is only promoting for sometime now natural family planning even though only 29% of all women using family planning employ NFP compared to the 71% who use modern contraceptives.

MIDWIVES FOR SKILLED BIRTH ATTENDANCE – The bill supports safe motherhood. It proposes that every city and municipality shall endeavor to employ an adequate number of midwives and other skilled attendants. Skilled attendance at birth will help prevent maternal and infant mortality which are both alarmingly high in the country. Currently, only 57% of Filipino women give birth with the assistance of a trained medical professional.

EMERGENCY OBSTETRIC CARE - Each province and city shall endeavor to ensure the establishment and operation of hospitals with adequate and qualified personnel that provide emergency obstetric care. If we are to make headway in our commitment to the Millennium Development Goals (MDGs) to lower infant mortality and improve maternal health, it is imperative to provide emergency obstetric care to those who need them. The miracle of life should not mean death for 10 mothers daily and the importance of facilities that can provide life saving services to pregnant women cannot be overemphasized.

HOSPITAL-BASED FAMILY PLANNING - Family planning methods requiring hospital services like ligation, vasectomy and IUD placement shall be available in all government hospitals. Maternal and infant mortality and morbidity are public health concerns that government can address if effective and long-term methods such as IUDs and permanent methods like ligation and vasectomy are readily available in government hospitals – the health facilities the poor and marginalized regularly utilize.

CONTRACEPTIVES AS ESSENTIAL MEDICINES
- Reproductive health products shall be considered essential medicines and supplies and shall form part of the National Drug Formulary. The classification of contraceptives as essential medicines will help the poorest of our women, who continue to have an average of six children, avoid unplanned pregnancies and maternal death. Both the WHO and UNFPA have declared that contraceptive use can prevent 1/3 of all maternal deaths.

Our maternal mortality rate which is pegged at 162 deaths out of every 10,000 live births is both alarming and insidious. Fourteen percent of all deaths in the female population can be attributed to pregnancy and childbirth-related causes (DOH and NDHS 2003). This is unacceptable. No woman should die giving life to another human being.

It should be underscored that modern contraceptives are included in the World Health Organization Model List of Essential Medicines. Their inclusion in the National Drug Formulary will enable government to purchase contraceptives and not merely rely on unpredictable donations.

REPRODUCTIVE HEALTH EDUCATION
– RH education in an age-appropriate manner shall be taught by adequately trained teachers from Grade 5 up to 4th Year High School. As proposed in the bill, core subjects include responsible parenthood; natural and modern family planning; proscription and hazards of abortion; reproductive health and sexual rights; abstinence before marriage; and responsible sexuality, among others.

Sexuality education seeks to assist young people in cultivating a positive view of sexuality; provide them with information and skills about taking care of their sexual health; and help them make sound decisions now and in the future. It has also has been shown to make adolescents more sexually responsible and adds a level of maturity to their attitudes towards sexual relations.

Formal education on RH and sexuality is necessary because of the parental default at home where conversations on sex is traditionally taboo.

Moreover, an SWS survey released only last month shows that 76% of Filipinos approve of the teaching of family planning to the youth.

IDEAL FAMILY SIZE
- The State shall encourage two children as the ideal family size. This is neither mandatory nor compulsory and no punitive action may be imposed on couples having more than two children. This also approximates the desired number of children by women and couples which is 2.5 children.

EMPLOYERS’ RESPONSIBILITIES
- Employers shall respect the reproductive health rights of all their workers. Women shall not be discriminated against in the matter of hiring, regularization of employment status or selection for retrenchment. Employers shall provide free reproductive health services and commodities to workers, whether unionized or unorganized.

These are all restatements and improvements of existing provisions of the Labor Code and relevant jurisprudence.

CAPABILITY BUILDING OF COMMUNITY-BASED VOLUNTEER WORKERS
- Community-based workers shall undergo additional and updated training on the delivery of reproductive health care services and shall receive not less than 10% increase in honoraria upon successful completion of training. This will improve the ability of our barangay health workers to deliver relevant RH information and services.

CERTIFICATE OF COMPLIANCE
- No marriage license shall be issued by the Local Civil Registrar unless the applicants present a Certificate of Compliance issued for free by the local Family Planning Office certifying that they had received adequate instructions and information on family planning, responsible parenthood, breastfeeding and infant nutrition.

PROHIBITED ACTS
–  (1) A health care service provider who: (a) knowingly withholds or restricts the dissemination of information and/or intentionally provides incorrect information regarding RH programs and services; (b) refuses to perform or provide legal and medically-safe RH services on any person of legal age on the ground of lack of third party consent, provided that in the case of DSWD-certified abused minors and pregnant minors, no prior parental consent shall be necessary; (c) deliberately causes the failure of the delivery of RH services through negligence or neglect; and (d) refuses to extend RH services and information on account of the client’s marital status, sexual orientation, age, religion, personal circumstances, and nature of work. Objections of health care service providers based on ethical and religious grounds shall be respected but he or she shall immediately refer the person seeking such care and services to another professional as long as the person is not in an emergency condition.

(2) Any public official who shall prohibit or intentionally restrict the delivery of legal and medically-safe RH services.

(3) Any employer who shall require or cause a female applicant or employee to involuntarily submit herself to any contraceptive method as a condition for employment or continued employment.

(4) Any person who shall engage in willful disinformation with respect to reproductive health care and rights or the provisions of this Act or cause such disinformation.

Now that I have discussed the most relevant provisions of the RH bill, I would like to answer some of the misconceptions about the measure.

The bill is not anti-life. It is pro-quality life. It will ensure that children will be blessings to their parents since their births are planned and wanted. It will empower couples with the information and opportunity to plan and space their children. This will not only strengthen the family as a unit, it will optimize care for fewer children who will have more opportunities to be educated, healthy and productive.

The bill does not favor modern family planning methods over NFP. Both natural and modern family planning techniques are contraceptive methods. Their common purpose is to prevent unwanted pregnancies and the bill does not impose a bias for either method.

The bill does not legalize abortion and will not lead to its legalization. It is false and malicious to claim that the RH bill legalizes abortion. The measure repeatedly underscores that abortion is illegal, criminal and punishable, and is not part of the menu of legally permissible and medically safe family planning methods.

It is likewise misleading and inaccurate to claim that the use of contraceptives will eventually lead to the legalization of abortion. Catholic countries like Panama, Guatemala, Brazil, Chile, Columbia, Dominican Republic, El Salvador, Honduras, Nicaragua, Venezuela, Paraguay and Ireland all prohibit abortion as a family planning method even as they vigorously promote contraceptive use. Muslim and Buddhist countries like Indonesia and Laos have likewise liberalized the use of contraceptives but still continue to criminalize abortion.

Moreover, there is an inverse correlation between contraceptive use and abortion. The regular and correct use of contraceptives drastically reduces abortion rates since unplanned and unwanted pregnancies are avoided. Consequently, women do not have to resort to abortion and the State will find no need to legalize abortion.

The bill does not endorse abortifacients. Hormonal contraceptives are BFAD-approved, medically safe and legal. The primary mechanism of pills and injectables is to suppress ovulation. If no egg is released, how can there be an abortion? They also prevent the sperm from reaching the egg. If fertilization is avoided, how can there be a fetus to abort? Articles in peer-reviewed medical journals testify that IUDs do not cause abortions because they stop fertilization. A recent study revealed that not a single fertilized egg was recovered from the fallopian tubes of women using IUDs proving that they are amazingly successful in preventing fertilization.

In fact, the UNDP, UNFPA and WHO have submitted to the House of Representatives an expert opinion on the mechanisms of modern contraceptives and they state that contraceptives “cannot be labeled as abortifacients” as none of these methods have been shown to cause abortions.

The bill is truly anti-abortion. It will tremendously reduce the incidence of abortion in the country which in 2002 has been recorded to be about 470,000 and the UN estimates that it has reached 800,000 today. Data also show that it is not single women and teenagers but poor, married, Catholic women in their 20s who most often undergo abortions because they cannot afford another child.

Contraceptives do not have life threatening side-effects. Medical and scientific evidence show that all the possible medical risks connected with contraceptives are infinitely lower than the risks of an actual pregnancy and everyday activities. The risk of dying within a year of riding a car is 1 in 5,900. The risk of dying within a year of using pills is 1 in 200,000. The risk of dying from a vasectomy is 1 in 1 million and the risk of dying from using an IUD is 1 in 10 million. The probability of dying from condom use is absolutely zero. But the risk of dying from a pregnancy is 1 in 10,000.

The bill will not promote contraceptive mentality. The bill does not prohibit pregnancy. Critics are mistaken in claiming that because contraceptives would be readily accessible, people would prefer to have no children at all. Couples will not stop wanting children simply because contraceptives are available. Contraceptives are used to prevent unwanted pregnancies but not to stop pregnancies altogether. Timely pregnancies are assured.

Sexuality education will not spawn “a generation of sex maniacs” nor promote promiscuity. Age-appropriate RH education promotes correct sexual values. It will not only instill consciousness of freedom of choice but responsible exercise of one’s rights. The UN and countries which have youth sexuality education document its beneficial results like understanding of proper sexual values; initiation to sexual relations is delayed; abstinence before marriage is encouraged; multiple sex partners is avoided; and spread of sexually transmitted diseases is prevented.

The bill does not claim that family planning is the panacea to poverty. It simply recognizes the verifiable link between a huge population and poverty. Unbridled population growth stunts socio-economic development and aggravates poverty. The connection between population and development is well-documented and empirically established.

UN Human Development Reports show that countries with higher population growth invariably score lower in human development. Last year, the Philippines, as the 12th most populous country, ranked No. 84 out 171 countries in the Human Development Index rankings made annually by the United Nations. This year, we are down to No. 90. Among Southeast Asian countries, the Philippines fared the worst in the latest rankings. Singapore remained in the 25th slot, Indonesia improved by 1 rank and Vietnam and Brunei each improved their position by four levels. But while Malaysia, Myanmar and Cambodia all slipped two ranks and Thailand fell down by four slots, the Philippines went down by six points.

The Asian Development Bank in 2004 also listed a large population as one of the major causes of poverty in the country. Recent studies also show that large family size is a significant factor in keeping families poor across generations.

However, the authors of the bill do claim that the bill will help promote sustainable human development. The UN has stated that “family planning and reproductive health are essential to reducing poverty” The UNICEF also asserts that “family planning could bring more benefits to more people at less cost than any other single technology now available to the human race.”

Family planning will not lead to a demographic winter. The proposition that the use of modern family planning will wipe off the Filipino race in a catastrophic “demographic winter” is a scare tactic which fails to comprehend the dynamics of population momentum wherein the country’s population will continue to grow even if the population growth rate is increasingly reduced to below replacement levels.

An RH law will not be superfluous. It is a myopic view that since contraceptives are available in the market, there is no need to enact a law on reproductive health and family planning. This contention overlooks that availability does not mean access, particularly to those who are uninformed or could not afford to buy reproductive health supplies. Availability does not assure adequate and accurate information on family planning and reproductive health which are basic universal human rights.

An RH law is not unconstitutional. House Bill No. 5043 is being faulted for being violative of the Section 12, Article II of the Constitution which reads:

“The State recognizes the sanctity of family life and shall protect and strengthen the family as a basic autonomous social institution. It shall equally protect the life of the mother and the life of the unborn from conception. The natural and primary right and duty of parents in the rearing of the youth for civic efficiency and the development of moral character shall receive the support of the Government.” (underscoring supplied).

The constitutional challenge is baseless for the following overriding reasons:

1. The RH bill does not violate or intrude into the “sanctity of family life”. On the contrary, it discharges the obligation of the State to protect and strengthen the family.

The family is more than a natural unit. It is a social institution whose well-being is impressed with public interest and concern.

Verily, it is not immune from legislation. It has to be amenable to the State’s exercise of police power for its protection and development. Hence, there are relevant laws like the Civil Code of the Philippines; Family Code of the Philippines; the Child and Youth Welfare Code; and the Special Protection of Filipino Children Against Child Abuse, Exploitation and Discrimination Act, among others, which are all protective of family life and the welfare of children.

The RH bill aims to protect the family from poverty and ill-health by helping women and couples achieve their fertility goals.

2. The use of legal and medically-safe contraceptives, which are not abortifacients, and which are tested by and registered with the Bureau of Food and Drugs (BFAD), does not violate the constitutional provision on the obligation of the State “to equally protect the life of the mother and the life of the unborn from conception.”

The purpose of this provision is to preempt the Congress and the Supreme Court from legalizing abortion. This bill definitely does not legalize abortion.

The anti-abortion intent of this constitutional provision is admitted both by its principal proponent, Commissioner Bernardo Villegas, and Commissioner Joaquin Bernas who initially proposed a related provision as Section I of the Bill of Rights which read: “The right to life extends to the fertilized ovum.” (underscoring supplied).

This Bernas proposal did not materialize. Its non-adoption unmistakably manifests that the concept that life begins at fertilization was not constitutionalized for lack of concurrence from the Commissioners.

After the deletion of the Bernas proposal in the Bill of Rights, another formulation was included in Article II on the Declaration of Principles which originally read: “The State shall protect human life from the moment of conception.”

It is important to note that under the foregoing draft, it is suggested that human life begins “from the moment of conception”, not anymore from the fertilization of the ovum.

This also confirms the thinking of the Commissioners that the “fertilization of the ovum” is not the same or synonymous to “conception”. The two refer to different stages of the reproductive process.

As finally adopted, the Constitution provides that the State “… shall equally protect the life of the mother and the life of the unborn from conception.”

It is important to note that the phrase “the moment of” preceding “conception” was deleted. Its deletion was the result of the Commissioners’ uncertainty as to the precise beginning of conception. Hence, they decided to defer to medical science and subsequent legislation the determination of the start of conception.

Verily, the bill does not offend the constitutional intent prohibiting abortion. In fact, it repeatedly reiterates the national policy against abortion. Moreover, the RH bill is even an anti-abortion measure because it respects the option of women and couples to use legal and medically-safe contraceptives which reduces abortion rates by 85%.

The bill will address the population problem. Some critics of the bill have gone so far as to say that our problem is only population distribution. The issue on population is not a simple matter of “population density” but more importantly, it is a question of sustainable human development. Concededly, there are still vast unpopulated areas of the country but these are places hostile to human development because there are no infrastructures in place, no schools, no hospitals, and no visible means of livelihood and employment.

The bill will help foreclose the need for overseas employment. Critics of the bill commend labor migration as the beneficent result of “population power”. This is a misplaced accolade to inordinate fertility. Dollar remittances from OFWs should not blind us to the incalculable social and economic costs of labor migration.

Moreover, the so-called “population power” has just exploded in our faces as the bleak scenario unfolds with OFWs returning home because there is a depressed market for overseas employment as a consequence of the collapse of Wall Street.

Family planning, as a vital component of reproductive health, does not only ensure the health of mothers and children. Family planning saves lives. The WHO and UNFPA have declared that close to 200,000 maternal deaths and 1 million infant deaths worldwide could be avoided annually if women use contraception.

The following is a direct quote from a WHO position paper on contraceptives: “It is universally recognized that contraception is the most effective intervention to prevent unintended pregnancy, abortion, child and maternal mortality and morbidity.”

We need to enact HB 5043 because it promotes and protects the right to health, the right to informed choice, the right to reproductive self-determination and the right to sustainable human development.

As members of the academe, it behooves you to study the issue of reproductive health and take a definitive stand. We are so close to enacting a truly responsible and responsive policy on reproductive health and population development. The enactment of HB 5043 into law shall truly be precedent-setting. Be part of history and help us hasten the bill’s passage by taking a stand and publicly supporting the RH bill.
 
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