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.
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.
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.