The Reproductive Health bill, popularly known as the RH bill, is a Philippine bill aiming to guarantee universal access to methods and information on birth control and maternal care. The bill has 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 theReproductive Health Act 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.
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. Miriam Defensor Santiago 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.
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.”
According to the Senate Policy Brief titled Promoting Reproductive Health, the history of reproductive health in the Philippines dates back to 1967 when leaders of 12 countries including the Philippines' Ferdinand Marcos signed the Declaration on Population. The Philippines agreed that the population problem be considered as the principal element for long-term economic development. Thus, the Population Commission (Popcom) was created to push for a lower family size norm and provide information and services to lower fertility rates.
Starting 1967, the USAID started shouldering 80% of the total family planning commodities (contraceptives) of the country, which amounted to US$ 3 Million annually.
In 1975, the United States adopted as its policy the National Security Study Memorandum 200: Implications of Worldwide Population Growth for U.S. Security and Overseas Interests (NSSM200). The policy gives "paramount importance" to population control measures and the promotion of contraception among 13 populous countries, including the Philippines to control rapid population growth which they deem to be inimical to the socio-political and economic growth of these countries and to the national interests of the United States, since the "U.S. economy will require large and increasing amounts of minerals from abroad", and these countries can produce destabilizing opposition forces against the United States. It recommends the US leadership to "influence national leaders" and that "improved world-wide support for population-related efforts should be sought through increased emphasis on mass media and other population education and motivation programs by the U.N., USIA, and USAID."
Different presidents had different points of emphasis. President Marcos pushed for a systematic distribution of contraceptives all over the country, a policy that was called "coercive," by its leading administrator. The Cory Aquino administration focused on giving couples the right to have the number of children they prefer, while the Ramos presidency shifted from population control to population management. Estrada used mixed methods of reducing fertility rates, while Arroyo focused on mainstreaming natural family planning, while stating that contraceptives are openly sold in the country.
In 1989, the Philippine Legislators’ Committee on Population and Development (PLCPD) was established, "dedicated to the formulation of viable public policies requiring legislation on population management and socio-economic development."
In 2000, the Philippines signed the Millennium Declaration and committed to attain the MDG goals by 2015, including promoting gender equality and health. In 2003, USAID started its phase out of a 33 year old program by which free contraceptives where given to the country. Aid recipients such as the Philippines faced the challenge to fund its own contraception program. In 2004, the Department of Health introduced the Philippines Contraceptive Self-Reliance Strategy, arranging for the replacement of these donations with domestically provided contraceptives.
In August 2010, the government announced a collaborative work with the USAID in implementing a comprehensive marketing and communications strategy in favor of family planning called "May Plano Ako" (I Have a Plan).
House Bills 101 and 513, and Senate Bill 2378 define the term "reproductive health care" as follows:
House Bill 96 replaces "have a satisfying and safe sex life" with "enjoy responsible and safe sex" but is otherwise identical in its definition. House Bill 1160 omits "a satisfying and" but is otherwise identical. House Bill 3387 omits the word "complete" before physical, and replaces "attain" with "are afforded," but is otherwise identical.
Reproductive Rights are defined by House Bills 101, 513, 1160, 3387, and Senate Bill 2378 as follows:
House Bill 96 replaces "other decisions" with "allied decisions," but is otherwise identical.
The opposition says that by supporting such definitions, the country will guarantee this same right of having "a satisfying and safe sex life" and the freedom of decision to unmarried children and teenagers, since they are "people" and "individuals." They argue that this will lead to promiscuity among the young. They say that the terminology is part of deceptive "verbal engineering" since RH is not in favor of reproduction, and contraceptives are not healthy, but RH is presented as something good.
The basic content of the Consolidated Reproductive Health Bill is divided into the following sections.
The bill mandates the government to “promote, without bias, all effective natural and modern methods of family planning that are medically safe and legal.”
Although abortion is recognized as illegal and punishable by law, the bill states that “the government shall ensure that all women needing care for post-abortion complications shall be treated and counseled in a humane, non-judgmental and compassionate manner.”
The bill calls for a “multi-dimensional approach” integrates a component of family planning and responsible parenthood into all government anti-poverty programs.
Under the bill, age-appropriate reproductive health and sexuality education is required from grade five to fourth year high school using “life-skills and other approaches.”
The bill also mandates the Department of Labor and Employment to guarantee the reproductive health rights of its female employees. Companies with less than 200 workers are required to enter into partnership with health care providers in their area for the delivery of reproductive health services.
Employers are obliged to monitor pregnant working employees among their workforce and ensure they are provided paid half-day prenatal medical leaves for each month of the pregnancy period that they are employed.
The national government and local governments will ensure the availability of reproductive health care services, including family planning and prenatal care.
Any person or public official who prohibits or restricts the delivery of legal and medically safe reproductive health care services will be meted penalty by imprisonment or a fine.
Proponents argue: (1) Economic studies, especially the experience in Asia, show that rapid population growth and high fertility rates, especially among the poor, exacerbate poverty and make it harder for the government to address it. (2) Empirical studies show that poverty incidence is higher among big families. Smaller families and wider birth intervals could allow families to invest more in each child’s education, health, nutrition and eventually reduce poverty and hunger at the household level. (3) Ten to eleven maternal deaths daily could be reduced if they had access to basic healthcare and essential minerals like iron and calcium, according to the DOH; (4) Studies show that 44% of the pregnancies in the poorest quintile are unanticipated, and among the poorest women who would like to avoid pregnancy, at least 41% do not use any contraceptive method because of lack of information or access. and "Among the poorest families, 22% of married women of reproductive age express a desire to avoid pregnancies but are still not using any family planning method," (5) use of contraception, which the World Health Organization has listed as essential medicines, will lower the rate of abortions as it has done in other parts of the world, according to the Guttmacher Institute.(6) An SWS survey of 2008 showed that 71% of the respondents are in favor of the bill, (7) at the heart of the bill is the free choice given to people on the use of reproductive health, enabling the people, especially the poor to have the number of children they want and can care for.
Opponents of the bill (in which Catholic Church is acting as the main pressure group) argue that: (1) "The world's leading scientific experts" have resolved the issues related to the bill and show that the "RH Bill is based on wrong economics" as the 2003 Rand Corporation study shows that "there is little cross-country evidence that population growth impedes or promotes economic growth". (2) The bill takes away limited government funds from treating many high priority medical and food needs and transfers them to fund harmful and deadly devices. The latest studies in scientific journals and organizations show that the ordinary birth control pill, and the IUD are abortifacient to fertilized eggs: they kill young human embryos, who as such are human beings equally worthy of respect, making the bill unconstitutional. (3) Leading secular social scientists like Nobel prize winner, George Akerlof and US National Defense Consultant, Lionel Tiger, have shown empirical evidence that contraceptives have deleterious social effects (abortion, premarital sex, female impoverishment, fatherless children, teenage pregnancies, and poverty (Note: There are 1.5 millions street children in Philippines. Studies found since there is no divorce laws 16% of the couples are in 'live-in' relationship). Harvard Director Edward Green concluded that the "best studies" show that more condoms promote the spread of AIDS. Combined estrogen-progestogen oral contraceptives (the most common type prescribed globally) are carcinogenic, and confers other serious health risks. The increased usage of contraceptives, which implies that some babies are unwanted, will eventually lead to more abortion. (4) People's freedom to access contraceptives is not restricted by any opposing law, being available in family planning NGOs, stores, etc. The country is not a welfare state: taxpayer's money should not be used for personal practices that are harmful and immoral; it can be used to inform people of the harm of BCPs. (5) A 2009 survey showed that 92% rejected the bill when informed of its detailed provisions and penalties. (6) The penal provisions constitute a violation of free choice and conscience, and establishes religious persecution.
President Aquino stated he was not an author of the bill. He also stated that he gives full support to a firm population policy, educating parents to be responsible, providing contraceptives to those who ask for them, but he refuses to promote contraceptive use. He said that his position "is more aptly called responsible parenthood rather than reproductive health."
The Philippines's population growth rate is 2.04 (2007 Census), 1.957% (2010 est. by CIA World Fact Book), or 1.85% (2005-2010 high variant estimate by the UN Population Division, World Population Prospects: The 2008 Revision) coming from 3.1 in 1960. The 2010 total fertility rate (TFR) is 3.23 births per woman, from a TFR of 7 in 1960. In addition, the total fertility rate for the richest quintile of the population is 2.0, which is about one third the TFR of the poorest quintile (5.9 children per woman). The TFR for women with college education is 2.3, about half that of women with only an elementary education (4.5 children per woman).
Congressman Lagman states that the bill "recognizes the verifiable link between a huge population and poverty. Unbridled population growth stunts socioeconomic development and aggravates poverty."
The University of the Philippines' School of Economics presented two papers in support of the bill: Population and Poverty: the Real Score (2004), and Population, Poverty, Politics and the Reproductive Health Bill (2008). According to these economists, which include Solita Monsod, Gerardo Sicat, Cayetano Paderanga, Ernesto M. Pernia, and Stella Alabastro-Quimbo, "rapid population growth and high fertility rates, especially among the poor, do exacerbate poverty and make it harder for the government to address it," while at the same time clarifying that it would be "extreme" to view "population growth as the principal cause of poverty that would justify the government resorting to draconian and coercive measures to deal with the problem (e.g., denial of basic services and subsidies to families with more than two children)." They illustrate the connection between rapid population growth and poverty by comparing the economic growth and population growth rates of Thailand, Indonesia, and the Philippines, wherein the first two grew more rapidly than the Philippines due to lower population growth rates. They stressed that "the experience from across Asia indicates that a population policy cum government-funded [family planning] program has been a critical complement to sound economic policy and poverty reduction."
In Population and Poverty, Aniceto Orbeta, Jr, showed that poverty incidence is higher among big families: 57.3% of Filipino families with seven children are in poverty while only 23.8% of families who have two children live below the poverty threshold. Proponents argue that smaller families and wider birth intervals resulting from the use of contraceptives allow families to invest more in each child’s education, health, nutrition and eventually reduce poverty and hunger at the household level. At the national level, fertility reduction cuts the cost of social services with fewer people attending school or seeking medical care and as demand eases for housing, transportation, jobs, water, food and other natural resources. The Asian Development Bank in 2004 also listed a large population as one of the major causes of poverty in the country, together with weak macroeconomic management, employment issues, an underperforming agricultural sector and an unfinished land reform agenda, governance issues including corruption.