After long delay, Supreme Court says
comprehensive reproductive health program can go forward
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 According to admittedly out of date statistics,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.
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