The Reproductive Health Bills, popularly known as the RH bill, are Philippine bills aiming to guarantee universal access to methods and information on birth control and maternal care. The bills have become the center of a contentious national debate. There are presently two bills with the same goals: House Bill No. 4244 or An Act Providing for a Comprehensive Policy on Responsible Parenthood, Reproductive Health, and Population and Development, and For Other Purposes introduced by Albay 1st district Representative Edcel Lagman, and Senate Bill No. 2378 or An Act Providing For a National Policy on Reproductive Health and Population and Development introduced by Senator Miriam Defensor Santiago.
While there is general agreement about its provisions on maternal and child health, there is great debate on its key proposal that the Filipino taxpayer and the private sector will fund and undertake widespread distribution of family planning devices such as birth control pills (BCPs) and IUDs, as the government continues to disseminate information on their use through all health care centers. Private companies and the public and private elementary and secondary school system will be required to participate in this information and product dissemination as a way of controlling the population of the Philippines.
The bill is highly controversial, with experts, academics, religious institutions, and major political figures both supporting and opposing it, often criticizing the government and each other in the process. The issue is so divisive that at one point, the Catholic Bishops Conference of the Philippines threatened to excommunicate the President, Benigno Aquino III if he supported the bill.
Background
The first time the Reproductive Health Bill was proposed was in 1998. During the present 15th Congress, the RH Bills filed are those authored by (1) House Minority Leader Edcel Lagman of Albay, HB 96; (2) Iloilo Rep. Janette Garin, HB 101, (3) Akbayan Representatives Kaka Bag-ao & Walden Bello; HB 513, (4) Muntinlupa Representative Rodolfo Biazon, HB 1160, (5) Iloilo Representative Augusto Syjuco, HB 1520, (6) Gabriela Rep. Luzviminda Ilagan. In the Senate, Sen. Michael Angelo F. Perolina has filed her own version of the RH bill which, she says, will be part of the country’s commitment to international covenants. On January 31, 2011, the House of Representatives Committee on Population and Family Relations voted to consolidate all House versions of the bill, which is entitled An Act Providing for a Comprehensive Policy on Responsible Parenthood, Reproductive Health and Population Development and for Other Purposes.
Stated purpose
One of the main concerns of the bill, according to the Explanatory Note, is that population of the Philippines makes it “the 12th most populous nation in the world today”, that the Filipino women’s fertility rate is “at the upper bracket of 206 countries.” It states that studies and surveys “show that the Filipinos are responsive to having smaller-sized families through free choice of family planning methods.” It also refers to studies which “show that rapid population growth exacerbates poverty while poverty spawns rapid population growth.” And so it aims for improved quality of life through a “consistent and coherent national population policy.”
There are 6 bills pertaining to reproductive health and/or population management that have been filed for deliberation in both the House of Representatives and the Senate for the 15th Congress.
The most controversial of these bills is House Bill No. 96 authored by Rep. Edcel Lagman. House Bill No. 96, also known as the proposed "Reproductive Health and Population and Development Act of 2010," will cover the following areas:
- midwives of skilled attendance
- emergency obstetric care
- access to family planning
- maternal death review
- family planning supplies as essential medicines
- benefits for serious and life-threatening reproductive health conditions
- mobile health care service
- mandatory age-appropriate reproductive health and sexuality education
- responsibility of local family planning office and certificate of compliance
- capability building of barangay health workers
- ideal family size
- employers' responsibilities
- multi-media campaign
- implementing mechanisms
- reporting requirements
- prohibited acts
- penalties
The bill is controversial, as it is being opposed by concerned citizens, especially the pro-life, pro-family and pro-God groups, regardless of creed or religion. The Roman Catholic Church expresses its opposition against the bill on many counts, most especially the procurement and distribution of family planning supplies for the whole country, when the available evidence from peer reviewed medical journals supports the hypothesis that when ovulation and fertilization occur in women taking oral contraceptives (OCs) or using intrauterine devices (IUD), post-fertilization effects are operative on occasion to prevent clinically recognized pregnancy. Hormonal contraceptives and/or IUDs directly affect the endometrium. These effects have been presumed to render the endometrium relatively inhospitable to implantation or to the maintenance of the preembryo or embryo prior to clinically recognized pregnancy. These make pills and IUDS abortifacient.
Pro-life groups, and many professionals in the medical and nursing fields, believe that physicians and policy makers should understand and respect the beliefs of patients who consider human life to be present and valuable from the moment of fertilization. Patients should be made fully aware of this information so that they can consent to or refuse the use of artificial contraceptives.
However, the position of the Catholic Church and the pro-life groups does not mean that they espouse the attitude of "natalism" at all costs, as if the "number" of children, in itself, were the unmistakable sign of authentic christian matrimonial life.
The sexual act, properly exercised within marriage only, is ordained primarily to the propagation of life. If there are reasonable motives for spacing births, such as serious medical conditions in the mother, or extreme poverty, then the Catholic Church teaches that married couples may take advantage of the natural cycles of the reproductive system and use their marriage precisely those times that are infertile (natural family planning).
Other aspects of the bill being contested by concerned citizens include the classification of family planning supplies as essential medicines when their safety/toxicity profile and legal permissibility are questionable. At the same time, more importance should be given to the prevalent diseases, the top ten leading causes of morbidity and mortality in the Philippines, namely, infections such as pneumonia and tuberculosis. Financial resources allotted by foreign donors to assist the Philippine government programs could actually be better spent towards pursuing health programs targeting communicable diseases than purchasing artificial contraceptives.
Very pertinent to the debate about reproduction rights is the right to life. The Philippine Constitution says that the State "shall equally protect the life of the mother and the life of the unborn from conception. If artificial contraceptives are medically proven to induce abortion as one of their mechanisms of action, then procurement and distribution of such family planning supplies are unconstitutional and illegal.
SEC. 4. Definition of Terms. – For purposes of this Act, the following terms shall be defined as follows:
a. Responsible Parenthood – refers to the will, ability and cornmitTrient of parents to respond to the needs and aspirations of the family and children more particularly through family planning;
b. Family Planning – refers to a program which enables couple, and individuals to decide freely and responsibly the number and spacing of their children and to have the information and means to carry out their decisions, and to have informed choice and access to a full range of safe, legal and effective family planning methods, techniques and devices.
c. Reproductive Health -refers to the state of physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its funcitions and processes. This implies that people are able to have a satisfying and safe sex life, that they have the capability to reproduce and the freedom to decide if, when and how often to do so, provided that these are not against the law. This further implies that women and men are afforded equal status in matters related to sexual relations and reproduction.
d. Reproductive Health Rights – refers to the rights of individuals and couples do decide freely and responsibly the number, spacing and timing of their children; to make other decisions concerning reproduction free of discrimination, coercion and violence; to have the information and means to carry out their decisions; and to attain the highest standard of sexual and reproductive health.
e. Gender Equality – refers to the absence of discrimination on the basis of a person’s sex, in opportunities, allocation of resources and benefits, and access to services.
f. Gender Equity – refers to fairness and justice in the distribution of benefits and responsibilities between women and men, and often requires. women-specific projects and programs to eliminate existing inequalities, inequities, policies and practices unfavorable too women.
g. Reproductive Health Care – refers to the availability of and access to a full range of methods, techniques, supplies and services that contribute to reproductive and sexual health and well-being by preventing and solving reproductive health-related problems in order to achieve enhancement of life and personal relations. The elements of reproductive health care include:
1. Maternal, infant and child health and nutrition;
2. Promotion of breastfeeding;
3. Family planning information end services;
4. Prevention of abortion and management of post-abortion complications;
5. Adolescent and youth health;
6. Prevention and management of reproductive tract infections (RTIs), HIV/AIDS and other sexually transmittable infections (STIs);
7. Elimination of violence against women;
8. Education and counseling on sexuality and sexual and reproductive health;
9. Treatment of breast and reproductive tract cancers and other gynecological conditions;
10. Male involvement and participation in reproductive health;,
11. Prevention and treatment of infertility and sexual dysfunction; and
12. Reproductive health education for the youth.
h. Reproductive Health Education – refers to the process of acquiring complete, accurate and relevant information on all matters relating to the reproductive system, its functions and processes and human sexuality; and forming attitudes and beliefs about sex, sexual identity, interpersonal relationships, affection, intimacy and gender roles. It also includes developing the necessary skills do be able to distinguish between facts and myths on sex and sexuality; and critically evaluate. and discuss the moral, religious, social and cultural dimensions of related sensitive issues such as contraception and abortion.
i. Male involvement and participation – refers to the involvement, participation, commitment and joint responsibility of men with women in all areas of sexual and reproductive health, as well as reproductive health concerns specific to men.
j. Reproductive tract infection (RTI) – refers do sexually transmitted infections, sexually transmitted diseases and other types of-infections affecting the reproductive system.
k. Basic Emergency Obstetric Care – refers to lifesaving services for maternal complication being provided by a health facility or professional which must include the following six signal functions: administration of parenteral antibiotics; administration of parrenteral oxyttocic drugs; administration of parenteral anticonvulsants for pre-eclampsia and iampsia; manual removal of placenta; and assisted vaginal delivery.
l. Comprehensive Emergency Obstetric Care – refers to basic emergency obstetric care plus two other signal functions: performance of caesarean section and blood transfusion.
m. Maternal Death Review – refers to a qualitative and in-depth study of the causes of maternal death with the primary purpose of preventing future deaths through changes or additions to programs, plans and policies.
n. Skilled Attendant – refers to an accredited health professional such as a licensed midwife, doctor or nurse who has adequate proficiency and the skills to manage normal (uncomplicated) pregnancies, childbirth and the immediate postnatal period, and in the identification, management and referral of complication in women and newborns.
o. Skilled Attendance – refers to childbirth managed by a skilled attendant under the enabling conditions of a functional emergencyobstetric care and referral system.
p. Development – refers to a multi-dimensional process involving major changes in social structures, popular attitudes, and national institutions as well as the acceleration of economic growth, the reduction of inequality and the eradication of widespread poverty.
q. Sustainable Human Development – refers to the totality of the process of expending human choices by enabling people to enjoy long, healthy and productive lives, affording them access to resources needed for a decent standard of living and assuring continuity and acceleration of development by achieving a balance between and among a manageable population, adequate resources and a healthy environment.
r. Population Development – refers to a program that aims to: (1) help couples and parents achieve their desired family size; (2) improve reproductive health of individuals by addressing reproductive health problems; (3) contribute to decreased maternal and infant mortality rates and early child mortality; (4) reduce incidence of teenage pregnancy; and (5) enable government to achieve a balanced population distribution.
Sections
The basic content of the Consolidated Reproductive Health Bill is divided into the following sections.
- Midwives for Skilled Attendance
- Access to Family Planning
- Maternal and Newborn Health Care in Crisis Situations
- Family Planning Supplies as Essential Medicines
- Procurement and Distribution of Family Planning Supplies
- Integration of Family Planning and Responsible Parenthood Component in Anti-Poverty Programs
- Roles of Local Government in Family Planning Programs
- Benefits for Serious and Life-Threatening Reproductive Health Conditions
- Mobile Health Care Service
- Mandatory Age-Appropriate Reproductive Health and Sexuality Education
- Additional Duty of the Local Population Officer
- Certificate of Compliance
- Capability Building of Barangay Health Workers
- Employers’ Responsibilities
- Pro Bono Services for Indigent Women
- Sexual And Reproductive Health Programs For Persons With Disabilities (PWDs)
- Right to Reproductive Health Care Information
- Congressional Oversight Committee
- Implementing Rules and Regulations
