This post first came out in my other blog Politika-et-Kultura on February 23, 2011. The original RH Bill discussed below had revisions since then, but the current version that was eventually passed as The Responsible Parenthood and Reproductive Health Act of 2012 (informally known as the RH Law) by Congress and the Senate, is for me just as unsatisfactory as the original. I believe it's provisions are unethical and detrimental to all stakeholders involved. The implementation of the RH Law was put on hold by the Supreme Court early last year and will be decided on April, this year. Because of this, I decided to copy it here on my health/ethics blog, with the sole purpose of reminding myself, why I am against the RH Law.
There is a lot of conflict going on today regarding the the RH Bill and so many people pro and con talk about it, asks my opinion, that I felt I should put on record where I stand. First, I want to be clear that I am for family planning and responsible parenthood. I agree that reproductive health, especially maternal and child care are important. But I do not agree with the way the RH Bill is worded and made. So simply put, I do not support the RH Bill...which one?...frankly, I don't know anymore which RH bill people are talking about because there are so many. So I will just limit myself to the one I am familiar with and that is RH Bill No. 5043, 2008 version. As someone coming from the health sector and familiar with the DOH programs on reproductive, maternal and child health, one does not need to read further to see and understand the real purpose of this so called "new" bill. I could take it apart point by point.
From it's very title...AN ACT PROVIDING FOR A NATIONAL POLICY ON REPRODUCTIVE HEALTH, RESPONSIBLE PARENTHOOD AND POPULATION DEVELOPMENT, AND FOR OTHER PURPOSES. The other purposes here being: to promote gender equality, women empowerment and human rights, specifically reproductive health rights.
But what about Republic Act 6365 which is AN ACT ESTABLISHING A NATIONAL POLICY ON POPULATION, CREATING THE COMMISSION ON POPULATION AND FOR OTHER PURPOSES ... doesn't it state that it is a "national policy" as well? and there's PRESIDENTIAL DECREE No. 79 December 8, 1972 REVISING THE POPULATION ACT OF NINETEEN HUNDRED AND SEVENTY-ONE. There is also Republic Act 7600 which is The Rooming-In and Breastfeeding Act of 1992 and Executive Order 209 or THE FAMILY CODE OF THE PHILIPPINES as well. Plus the RA 9710 or The Magna Carta for Women, as well as the Violence against Women and Children laws.
Is there a difference between these laws and the RH Bill? If you read through all of them, I would say not much and fact is, the RH bill more less just summarizes them all. All the above previous laws addresses population, gender equality and equity, reproductive health care, et al. Now I am not a lawyer, nor do I profess to know the law but in my layman's opinion, this RH Bill actually reads more like an inadequate and ambiguous IRR of all of the above laws rather than a law itself! It is redundant to say the least.
I find the following sections coercive and dictatorial. Are we not allowed conscientious objection here?
SEC. 9 of the RH Bill states: Hospital-Based Family Planning. -Tubal ligation, vasectomy, intrauterine device insertion and other family planning methods requiring hospital services shall be available in all national and local government hospitals, except: in specialty hospitals which may render such services on an optional basis. For indigent patients, such services shall be fully covered by PhilHealth insurance and/or government financial assistance.
So, what happens if the government doctors do not want to do these procedures?
And SEC. 10 states: Contraceptives as Essential Medicines. – Hormonal contraceptives, intrauterine devices, injectables and other allied reproductive health products and supplies shall be considered under the category of essential medicines and supplies which shall form part of the National Drug Formulary and the same shall be included in the regular purchase of essential medicines and supplies of all national and local hospitals and other government health units.
This one does not even need to be included here. WHO has already listed contraceptives, IUDs, injectable hormonal contraceptives in their model list of essential drugs. My issue on this is simple. Why in heavens name should hospitals include contraceptives in their regular procurement of essential drugs when they cannot even provide the complete course of antibiotics and other life-saving medicines? Why should our taxes pay for contraceptive use which is basically cheap and available over the counter when our hospitals are in dire need of upgrading their facilities and services? Why should I, a taxpayer pay for other people's birth control?
And then, this...
SEC. 21. Prohibited Acts. – The following acts are prohibited:
a) Any health care service provider, whether public or private, who shall:
1. Knowingly withhold information or impede the dissemination thereof, and/or intentionally provide incorrect information regarding programs and services on reproductive health including the right to informed choice and access to a full range of legal, medically-safe and effective family planning methods;
I interpret this as meaning that if I advise the patient on family planning/ responsible parenthood programs that I adhere to and not on other methods, then I am violating this law. Whatever happened to my rights?
2. Refuse to perform voluntary ligation and vasectomy and other legal and medically-safe reproductive health care services on any person of legal age on the ground of lack of spousal consent or authorization.
Very indiscriminate and random! So, if a 21 year old with 2 children whose ages are 1 and 3 wants to undergo tubal ligation, this should be done just because?
3. Refuse to provide reproductive health care services to an abused minor, whose abused condition is certified by the proper official or personnel of the Department of Social Welfare and Development (DSWD) or to duly DSWD-certified abused pregnant minor on whose case no parental consent is necessary.
What exactly does "reproductive health services" constitute here?
4. Fail to provide, either deliberately or through gross or inexcusable negligence, reproductive health care services as mandated under this Act, the Local Government Code of 1991, the Labor Code, and Presidential Decree 79, as amended; and
What can I say....we cannot provide what we do not have in terms of skills, manpower and facilities. Does that constitute deliberate, gross or inexcusable negligence on our part or the government's?
5. Refuse to extend reproductive health care services and information on account of the patient’s civil status, gender or sexual orientation, age, religion, personal circumstances, and nature of work; Provided, That all conscientious objections of health care service providers based on religious grounds shall be respected: Provided, further, That the conscientious objector shall immediately refer the person seeking such care and services to another health care service provider within the same facility or one which is conveniently accessible: Provided, finally, That the patient is not in an emergency or serious case as defined in RA 8344 penalizing the refusal of hospitals and medical clinics to administer appropriate initial medical treatment and support in emergency and serious cases.
Ask ko lang....since when did contraception fall under emergency medicine? Meron ba? Has there ever been a case of "contraceptive emergency"? SO WHAT FALLS UNDER "EMERGENCY AND SERIOUS CASES"? Maybe in cases of bleeding due to an IUD but otherwise, seeking reproductive health service specifically for tubal ligation, IUD insertion, et al... are all classified under elective procedures. There are already laws addressing emergency cases and penalties for doctors and hospitals refusing to treat such cases. This provision will only result in arbitrary interpretations and can create confusion.
b) Any public official who prohibits or restricts personally or through a subordinate the delivery of legal and medically-safe reproductive health care services, including family planning;
c) Any employer who shall fail to comply with his obligation under Section 17 of this Act or an employer who requires a female applicant or employee, as a condition for employment or continued employment, to involuntarily undergo sterilization, tubal ligation or any other form of contraceptive method;
d) Any person who shall falsify a certificate of compliance as required in Section 14 of this Act; and
e) Any person who maliciously engages in disinformation about the intent or provisions of this Act.
SEC. 22. Penalties. – The proper city or municipal court shall exercise jurisdiction over violations of this Act and the accused who is found guilty shall be sentenced to an imprisonment ranging from one (1) month to six (6) months or a fine ranging from Ten Thousand Pesos (P10,000.00) to Fifty Thousand Pesos (P50,000.00) or both such fine and imprisonment at the discretion of the court. If the offender is a juridical person, the penalty shall be imposed upon the president, treasurer, secretary or any responsible officer. An offender who is an alien shall, after service of sentence, be deported immediately without further proceedings by the Bureau of Immigration. An offender who is a public officer or employee shall suffer the accessory penalty of dismissal from the government service. Violators of this Act shall be civilly liable to the offended party in such amount at the discretion of the proper court.
The Department of Health have programs in place for reproductive health, responsible parenthood, population development for the longest time. The problem is efficient implementation and budget. A new law to address all these is unnecessary and redundant. Take a look at these DOH programs:
- Family Planning
- Breastfeeding Program / Mother and Baby Friendly Hospital Initiative
- Natural Family Planning
- Child Health
- Adolescent and Youth Health and Development Program
- Safe Motherhood and Women's Health Project
- Newborn ScreeningMoreover, the rate of population growth in the Philippines decreased from 3.1% in 1960 to 1.8% in 2009. This rate remained comparatively steady, and was consistent with the decrease in population growth rate worldwide. A paper published in 2003 asserted that the population program was "ineffectual," not because of lack of population programs and policies but because of "inadequate institutional and financial support".
(Retrieved from http://www.consciencelaws.org/issues-legal/legal055a.html)
And what about the Catholic Church?
The argument by pro-RH people is that the reason why responsible parenthood is (as they perceive) not working is because of the Catholic Church. Huh? What is the evidence for that pronouncement? I invite you to visit the OB wards in hospitals and you will find that 75 to 80% of mothers giving birth in the hospital does not regularly attend mass, do not know their priest, have not gone back to confession since their first confession, are totally unaware of what actions the Church is doing against the RH bill. So what has the Church got to do with the failures of the population program? In fact surveys show that Catholic women are very much aware of family planning methods and only a mere 5% has cited religion as their reason for not using contraception. This just tells me that the Church is actually ineffective in advancing Catholic teaching on contraception and sterilization.
So, is there a need for the RH Bill? For me, a definite No.
The RH Bill is something our lawmakers and government is pushing for to cover up for past failures in the implementation of their population program. It is also a way of diverting attention from the real problems of this country. If they are serious about population management, then they should realize that what is needed is proper implementation, enough budget, committed health workers who will make these family planning services available during all working days of the week. Information, accessibility, and availability of services is the key to success...not a new law. People who want to avail of the services should have access to them.
A older friend told me that the law is needed to ensure implementation...that LGU's will now be compelled to implement the law...in other words, the country needs an enabling law. I think otherwise. This country has too many health laws already and more often than not, it is implementation that is sadly lacking. What is needed is political will and the commitment to make any health program work. What is needed is...good education, accessibility to the poor of effective health services, transparency in governance and no to graft and corruption. Only then can we minimize poverty...and then, the problem of overpopulation becomes moot and academic
This law is not about empowering women, but rather it disrespects them.