Health issues rarely get to steal the national spotlight from urgent economic and political concerns. But today, family planning is coming under intense scrutiny as the proposed reproductive health (RH) bill inches closer toward legislation, and its potential consequences have raised questions not only of feasibility, but also of conscience.
If approved, the proposed Responsible Parenthood, Reproductive Health, and Population Development Act of 2011 (House Bill No. 4244) will promote the nationwide availability of reproductive health care. According to the consolidated version of the bill, this term encompasses not only family planning information and services, but also issues such as maternal and child care, adolescent and youth care and education, general education and counseling on sexuality and reproductive health, violence against women, male responsibility and participation, and treatment of infertility and sexual dysfunction.
Expectedly, its more controversial points have been heavily criticized the Roman Catholic Church, which proscribes the use of artificial contraceptives as these are believed to run counter to God’s will for procreation. And with nearly four-fifths of the population declaring membership in the church, the men of the cloth wield considerable influence over the RH bill’s acceptance in the country.
On January 30, the Catholic Bishops’ Conference of the Philippines released a pastoral letter that decried the bill as “a major attack on authentic human values.” It contended that the proposed law does not promote reproductive health because contraceptives are “anti-life,” and the prevention of a child’s conception is considered just as “fatal” as abortion.
Supporters of the bill, on the other hand, subscribe largely to secular definitions of birth control and abortion–that no human is killed if he or she is not conceived in the first place. Their aim is to prevent the unwanted pregnancies that are often the reason for abortion. According to Dr. Edelina dela Paz, leader of the Catholics for Reproductive Health movement, this difference in conceptual frameworks is a reason why both sides continue to clash.
“[From their viewpoint], anything that prevents procreation is a form of abortion. Even if you say you do not have abortion in the bill because you do not promote the killing of a fetus, which is the [technical] meaning of abortion, they do not take it at that,” she said in an interview. “We say that the RH bill is anti-abortion, because we don’t want unwanted pregnancies, the cause of abortion, to go on.”
If passed, the provision will require employers, local government units, and healthcare facilities both public and private to make reproductive health care information and services available at all times, with poor patients receiving government assistance. Advocates believe that this would benefit Filipino women in particular. “It uplifts their dignity because it recognizes that they can make informed choices, and at the time they need services, it will be within reach.”
The 2008 National Demographic and Health Survey conducted by the National Statistics Office found that Filipino women across the board desire an average of two to three children. But poorer, less educated mothers as well as those in rural areas tend to have more due to a lack of physical and financial access to reproductive health resources. This gap may have even direr consequences, as the World Health Organization links these circumstances to higher maternal mortality.
The bishops’ letter, however, contests the “misguided” idea “that women have power over their own bodies without the dictation of any religion.” It also states that one’s conscience must be enlightened by religious teaching, but fails to acknowledge that not all belief systems agree with the Church’s view that a person’s body is merely on trust from God.
“How can you impose a Catholic belief on someone who is not Catholic?” Dr. dela Paz asked. “We may teach them our values, our concept of sanctity, but we cannot impose it on them. I think it is the responsibility of the state to address the needs of the entire nation, not just the Catholic [citizens].”
Another point of conflict is the RH bill’s mandate of age-appropriate education on reproductive health and sexuality in both public and private schools, from the fifth grade to the fourth year of high school. Its suggested topics include: values formation, self-protection against discrimination, sexual violence and abuse, teen pregnancy, puberty, children’s and women’s rights, fertility awareness, STIs and HIV/AIDS, population and development, responsible relationships, family planning methods, proscription and hazards of abortion, gender, and responsible parenthood.
Amidst the perception that sex education will promote promiscuity among young people, Dr. dela Paz, who teaches at the College of Medicine, University of the Philippines-Manila, says that students “also know that there are values to uphold. In Catholic schools, they uphold the value of marriage. If you continue to teach that and your students will uphold that, I don’t see any [reason for this] fear.”
Dr. Melgar says that reproductive awareness will also help children detect sexual nuances as they enter puberty and adolescence. “[This will allow them to] differentiate, for example, between an abusive touch and an innocent gesture. The bill is very much about self-protection,” she said.
Still, critics of sex education find that it violates certain constitutional rights. Renelyn Tan, regional director of the World Youth Alliance Asia Pacific, said, “We are guided by Section 12, Article II of the Philippine Constitution, [which guarantees that the state will protect the family as a basic autonomous social unit, and the parents’ primary duty to instill moral character in the child]. For some parents, this [mandate] can be coercive.”
One reason the World Youth Alliance opposes the passage of the bill in its current form is its ambiguity towards the option of elders and educators to opt out of the sex education curriculum should they find it unsuitable. This is according to a position paper published on the WYA website.
The teaching modules forwarded by the bill’s proponents to the Department of Education include communication skills, such as learning to say no, and problem-solving, or how vulnerable youths may solve emotional problems without resorting to sex.
According to Ms. Tan, however, not everyone has had the benefit of a sneak peek. “We’ve been present in the House committee hearings on the RH bill. Some lawmakers are not familiar with the content of the sex education modules. We feel that the consultation on these was not enough.”
Another potential imposition is the “referral requirement.” Under the proposed law, the objection of a healthcare provider based on religious or ethical beliefs will be respected, but they must still refer the person seeking care to another facility willing to serve them.
“We don’t want the providers to be forced to perform a procedure that’s against their conscience. For some health providers, mere act of giving [a patient] information that’s against their beliefs is already a violation of their freedom,” Ms. Tan said.
Among the prohibited acts listed in the bill, the criminalization of speech that “maliciously engages in disinformation” about the intent or provisions of the law is something that makes the WYA “very concerned.” “Anyone who says anything against the RH bill can be penalized. We haven’t seen a law that’s as coercive,” she added.
While Ms. Tan, Dr. dela Paz, and Dr. Melgar may find themselves on opposing sides, they all seem to agree that maternal health should receive more attention than the current controversies over family planning. Ms. Tan said, “If we really want to address the problem of maternal health issues in the country, we’d like to focus on two essential things: the presence of skilled birth attendants and investment in infrastructure. Many provinces still lack roads to and from remote areas.”
According to the World Health Organization (WHO), only 66% of women in developing countries–where 99% of all maternal deaths occur–benefit from access to skilled care during childbirth. Eighty percent of all maternal deaths are due to severe bleeding after birth, infections during birth, high blood pressure during pregnancy, obstructed labor, and unsafe abortion–all of which are preventable. “More women die from pregnancy and childbirth than from cancer,” Dr. Melgar pointed out.
But Ms. Tan insists that, “Maternal health requires access to healthcare facilities, emergency obstetric care and mobile healthcare service–all of these can be implemented as part of the regular DOH program even without any legislation.”
Dr. dela Paz, for her part, voiced concern for mothers under the strain of caring for too many untimed children. “Maybe it’s a strain for both parents to look for financial resources, but physically, emotionally, and mentally, it’s still the mother who carries the burden. Having many children can be God’s gift to us, and you should be happy with God’s gift, but you can manage it in such a way that it does not become a burden, [where] quality of life is no longer there.”