Pastor Edgardo Abraham asked the audience before him to raise their closed fists. “Look at your fists,” he boomed. “That’s how big a woman’s uterus is. But when they start to carry a child, that uterus or womb expands. That’s how amazing God is.”

Abraham is part of a slowly expanding army of government workers, NGOs and other organizations fighting to implement the Philippines’ awkwardly-named “Responsible Parenthood and Reproductive Health Law. Birth control in a country with one of the highest total fertility rates in Asia.

In fits and starts, the RH bill is starting to take hold. Elizabeth Angsioco, national chair of the Democratic Socialist Women of the Philippines (DSWP) said proponents have assessed that it will take six years before they see the full breadth of the effects of the law, arguably President Benigno S. Aquino’s signal accomplishment in six years in office. It aims to among others, provide universal access to different methods of fertility control, contraception, sexual education and maternal care. It is a law that was fought for 13 years by the Catholic Church and which, despite its passage, the church continues to fight.

Abraham, who graduated with a degree in theology, is a program assistant in the Population Commission (POPCOM), one of the main government agencies tasked to develop programs on reproductive health and family planning for a country whose population has crossed the 100-million mark. Seeing the words “God” and “RH law” in the same sentence is a shock, Pastor Abraham aside, given the opposition of the Catholic Bishops Conference of the Philippines, which continues to say it violates the right to life and encourages promiscuity among the young. The church was the first to take on its constitutionality before the Supreme Court in March 2013.

The court ruled that the law was “not unconstitutional,” but struck down eight provisions, most of which cover penalties for health providers and public officials who fail to implement it. But a court which clearly has doubts about Philippine sexuality has continued to put roadblocks in the way of reproductive freedom, issuing a temporary restraining order on the selling and distribution of contraceptive implants.

Beyond fighting opposition from some religious groups, the fate of the law now lies in sustaining its main implementing and monitoring mechanism, overriding budget cuts and convincing all national and local government bodies mandated to implement the law to do their job.

Six years

Under the law, the government must provide access to all kinds of family planning, including contraception, improve maternal health, reduce rate of sexually transmitted diseases and include sex education in the curriculum.

Findings from the preliminary report of the National Implementation Team for the law show contraceptive use has picked up slightly. The Contraceptive Prevalence Rate (CPR) national average was 55 percent, according to the 2013 National Demographic and Health Survey. The CPR shows the level of contraceptive use among women from the 15-49 age bracket.

The maternal mortality ratio (MMR) was 204 per 100,000 live births, which was not much of an improvement from the 2014 MMR of 209 per 100,000 live births. In most of the developed world it is under 10, with most of the Nordic states under 5.

One of our sources from the implementation team, who asked not to be named so as not to pre-empt the final report, said they are looking at the incidence of women who died because they were refused post-abortion care. “Under the law, they must be provided with medical treatment. But some health providers are still not receptive to it.”

The rate of those who were provided antenatal care, meanwhile, rose to 82 percent in 2015 from 78 percent in 2014. Thus while there may have been birth pains in the implementation of the law, there are improvements that cannot be ignored.

Its legislation, for example, has paved the way for people like Abraham to hold regular sets of training on family planning in different cities. Thirty women ages 18-45, a number of them with children in tow, listened to the pastor explain the cycle of fertility. “The law has provided this basic service to the people. This should not be taken away from them,” he said.

Pioneering effort

The legal victory in 2014 boosted the finalization of the law’s implementing rules and regulations, the certification of contraceptives by the Food and Drug Administration and the creation of the National Implementation Team (NIT) and its counterpart at the regional level.

The implementation team was a first of its kind in Philippine history, according to Angsioco. She explained that not only was the team the first mechanism in the history of Philippine lawmaking to be created to monitor the implementation of the law, it was also the first to “include all stakeholders,” including civil society organizations such as the DSWP.

The implementation team, headed by former health secretary Esperanza Cabral, has technical working groups working on the different components of the law. They meet every two weeks. The implementation team’s members discuss how each of them is fulfilling their respective roles in implementing the RH law.

This setup allows them to assess what areas need improvement. Here’s the catch – the NIT is not explicitly mentioned in the RH law, although the law does mandate the Department of Health to form a body that will monitor the law’s implementation.

This factor makes it vulnerable to structural changes, one that can occur if the current health czar, Sec. Janette Loreto-Garin, gets replaced by the next president. The Philippines will elect new national and local leaders on May 9.

Angsioco said they hope that the next health secretary keeps it. “I hope they see the need for the NIT,” she said.

That was echoed by Elena Masilungan, program officer of the Philippine Center for Population and Development, another organization that sits in the NIT. “They should appreciate the work done by the NIT. Its work is carried out both by government and nongovernment organizations.”

They pointed out that this only further magnifies the need to have a president that is pro-RH. Among the 5 presidential contenders, 4 have been vocal in supporting the RH law. One of them, Sen. Miriam Defensor-Santiago was one of its principal sponsors.

All levels

It is not just the top leadership that matters, however. The country’s initial experience in implementing the RH law shows that legislators and heads of local government units (LGUs) can wield as much power in either weakening the law or making it work.

Senators Vicente ‘Tito’ Sotto III and Loren Legarda slashed P1 billion from the P3.2-billion budget for the RH law in 2016, saying that the DOH has not fully spent its 2015 budget for the RH law. Garin was forced to source P337.5 million from the 2015 budget to procure RH commodities.

Masilungan said it was a lesson learned. “Even if the law is already there, it doesn’t mean that you will lose your vigilance.”

Angsioco said that advocates of the law must work to elect pro-RH lawmakers. “Those who are anti-RH must be balanced out by those who support it.” This will take hard work, as Sotto, who’s seeking reelection, has been consistently topping polls.

Aside from senators, however, LGU leaders are also those that significantly influence the implementation of the law. Mayor Sally Lee of Sorsogon city issued an executive order in February 2015, barring the provision and purchase of contraceptives.

Angsioco and Masilungan said there are reports of other LGUs that are allegedly not distributing RH items such as contraceptives to the communities. “If they do not distribute them right away, the quality of the commodities will deteriorate,” Masilungan said.

There are other LGUs however, that have made a turnaround – the cities of Caloocan and Manila, for one, used to oppose the law, but they are part of those that actively implement it now. The change happened after the LGU leadership also changed.

The Napoles effect

Even as some LGUs allegedly do not distribute RH items, NGOs like DSWP have been tapped by the DOH to provide the same to their partner-communities.

In the case of DSWP, they have just provided an “RH package” consisting of pills good for three cycles and three packs of condoms to 99 women who participated in an “RH Fair” on April 9.

The access of CSOs such as the DSWP to communities is critical in reaching and penetrating as many areas as possible. DSWP had established its presence in Caloocan for more than 10 years and already has its set of community leaders such as Evangeline Farnacio.

Farnacio and her fellow community leaders conduct house-to-house RH information and education campaigns, visiting as much as 20-25 households on a weekly basis. “We aim to reach 3,000 households by August,” she said.

August is the end of the pilot period for this scheme, where CSOs oversee the training and distribution of RH wares to communities. “We assess how much the community needs and then we request for RH wares from the DOH,” Angsioco explained.

Aside from the RH wares, the DOH has set aside PHP300 million for its CSO partners. The funds will be provided on a reimbursement basis, however. Masilungan said NGOs, especially smaller ones, do not have this kind of money.

Those who want to access the fund also have to be accredited by the Department of Social Welfare and Development and must also submit a workplan and a financial plan. These requirements, Masilungan and Angsioco said, came after the pork barrel scam involving Janet Napoles. Napoles used NGOs as a front to get as much as P10-billion worth of pork barrel funds from the government.

Masilungan said not all NGOs have the capacity to comply with these requirements; consequently, PCPD decided to provide a “bridge fund” of P500,000 each to NGOs to get the ball rolling.

Angsioco said they understand why the government has to provide such restrictions, but raised that they must also officially recognize the NGOs they’ve been working with since day one, so these groups can be given the assistance they need to continue what they’ve been doing.

“It is a testing time. We can deliver. We need the support.”