A year and a half after the passage of a comprehensive reproductive health bill by Philippine lawmakers, the country’s Supreme Court has finally given the government a green light to carry out the measure, although it was shorn of a couple of key provisions. Although passage of the birth control bill is considered revolutionary, the job of actually implementing it is just starting. It will be difficult. The government is faced with taking on complex tasks in remote communities and poverty-ridden slums. Geography is problem enough. Of the 7,000 islands that make up the Philippine archipelago, about 2,000 are inhabited. Reaching poor and superstitious villages will be difficult. Considered one of the capstones of the presidency of Benigno S. Aquino III, the measure had been stalled in the legislature for 14 years by the bitter enmity of the Catholic Church, which continued to fight it in the courts after its passage on Dec. 30, 2012, filing a blizzard of lawsuits that took it through the legal system to the Supreme Court. On both national and local levels, given centuries of indoctrination by the Catholic Church, many local officials, lawmakers and physicians will have to be pushed to give reproductive health care to the country’s young families. And the court has given them the right to opt out over conscientious objections. The Supreme Court did gut some important provisions. In addition to striking down a provision that would have punished health workers who refuse to distribute contraceptives or family planning information, it also voided a provision that would allow pregnant minors or ones who already have a child to receive contraceptives and family planning information without parental consent. Even before it can be implemented, according to Clara Rita A. Padilla, executive director of EnGendeRights, an NGO that fought for passage of the law, it will trigger a budgetary fight in the legislature from pro-Church lawmakers who will fight appropriation. It is a law that is badly needed. According to admittedly out of date statistics, Padilla said, 560,000 illegal abortions take place in the Philippines every year, with 90,000 of them resulting in complications that require hospitalization. At least 1,000 women die every year from the effects of illegal abortions. The country continues to have one of the highest birthrates in Asia. At a time when Thailand, Taiwan, South Korea, Hong Kong and major cities in China have slipped below replacement level of 2.1 children per family, the Philippines total fertility ratio remains at 3.10 live births per woman of childbearing age. The population continues to zoom upward at a 1.7 percent annual rate. It is now somewhere near 100 million. Today, Padilla said, in a telephone interview, despite the fact that abortion and birth control devices are now legal in the Philippines, some doctors will opt out of the process, citing conscientious objection to providing care. In addition, she said, “local priests are a huge obstacle. They are leaning on local governments not to implement the programs. We need to implement clear programs, some local governments claim they provide access to contraceptives, but if you look at their records, it doesn’t show that they are doing so.” EnGendeRights and other NGOs are seeking to counter longstanding objections by going into local communities through schools and local organizations to tell people they can have access to family planning materials. The scope of that effort is daunting. “We have to find people who are amenable,” Padilla said. “We are telling young adults that if they are faced with providers who refuse to provide care, they must try to look for providers who will not use conscientious objection as an excuse. We need intensive sexual education to inform providers and teachers that it is important to have access to birth control methods.” Aquino’s administration, in an attempt to mollify the church, has stressed that the law is not a population control measure. It doesn’t mandate the use of contraception, it simply makes it more available and provides greater information to poor people who want it. The anecdotal evidence is that women who have children they already can’t feed don’t want any more and will jump at the chance to stop getting pregnant. In a bid to outflank those who will refuse to implement the measure, the health department plans to focus on facilities, not individual health workers, giving local clinics the chance to find staff members willing take on tasks related to contraception distribution. The department believes it won’t be difficult since most health workers who work with poor women are eager to get them help with family planning because they are sympathetic to their plight. Nonetheless, Padilla said, there are many doctors who will refuse. Today, she said, doctors routinely refuse to provide help women who have suffered from the ill effects of illegal abortions. Department officials also believe a solution can be found to provide help to young pregnant girls who can’t get parental consent via finding a relative or other adult to act as legal guardian with authorization to give parental consent, according to an analysis of the matter by Pacific Strategies & Assessments, a Manila-based country risk firm. PSA quoted an official as saying if pregnant minor shows up at a government clinic, she will not be refused access to the reproductive health care that she needs. She will be helped, one way or another. One of the most powerful aspects of the law, according to PSA, is that it establishes a legally-mandated budgeting mechanism for reproductive health and contraception. Previously, local officials such as mayor s could ban the sale of condoms and other forms of contraception in their cities by executive order. Under former President Gloria Arroyo, the Secretary of Health, acting on her orders, refused to fund government contraception programs. Under the provisions of the new law, budgetary calculations are to be based on the number of women of reproductive age living below the poverty line nationwide. Money will be allocated to reproductive health, including all forms of contraception, based on this calculation and must be available in every big city and small town, including teeming slum areas and remote rural communities. That is legally mandated under the new law.