Review of family planning policies in the Philippines

Alvin Concha, MDMA Applied Social ResearchAteneo de Davao University

Introduction

Very recently, the Ligtas Buntis Campaign of the Department of Health (DOH) rekindled an age-old debate between the government and the church around family planning.1 By DOH definition, “Ligtas Buntis” has two complementing meanings and scope of concerns. First, “Ligtas Buntis” can be short for “ligtas na pagbubuntis” or safe pregnancy and childbirth. In this sense, the DOH is referring to programs promoting regular prenatal check ups to detect high-risk pregnancies and to facilitate deliveries that are safe for both mothers and babies. Second, and more controversially, “Ligtas Buntis” may also be short for “ligtas sa pagbubuntis” or “safety from (high-)risk or unwanted pregnancy.2 In this sense, the campaign is meant to “to increase the visibility of family planning as an essential public health service, and to dramatically improve the access of men, women and couples to family planning.... services.”3 The DOH stresses that family planning as a health intervention prevents high-risk pregnancies, reduces maternal deaths and prevents abortion. Family planning also responds to the unmet needs of women (and men) of reproductive age and could be viewed as a means to attain sustainable development.4

The nomenclature, of course, carries with it a very wide space for doubts.5 Despite being very clear about its definition and scope of the program, DOH received accusations that it has been discretely promoting abortion and is not “pro-life.” The adamant stand of the Catholic Church has always been against family planning except by natural means, because it believes that “family planning by

1. Jimenez, C. (2005) Dayrit, the daunted. Internet. Accessed on 2 May 2005, available at http://partners.inq7.net/newsbreak/istories/index.php?story_id=335672

?. Department of Health. (2005). Ligtas buntis campaign 2005. Internet [lecture slides]. Accessed on 2 May 2005, available at http://www.doh.gov.ph/ligtasbuntis/LBC_presentation_files/frame.htm3

?. Department of Health. (2005). Ligtas buntis 2005 campaign. Internet. Accessed on 2 May 2005, available at http://www.doh.gov.ph/ligtasbuntis/about_LBC.htm4

?. [see reference number 2]

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artificial means” is a euphemism for abortion. Shortly after the campaign was launched, the Catholic Bishops’ Conference of the Philippines issued a pastoral letter branding Ligtas Buntis as an “assault to the family.”6 Father Roy Cimagala has often been quoted for saying that “This Ligtas Buntis campaign, while heavily sanitized and deodorized, continues to be afflicted with the basic sick idea that contraception is just okay, especially given the poverty, ignorance, blah, blah, blah of the people. When a basic moral issue is involved, the Church will not be silenced, even if it has to be crucified in public opinion.”7

For the Catholic Church, any measures supporting family planning necessarily supports abortion, as well.8 While many Philippine laws in the past have provisions pertaining to family planning and abortion, no Republic Act on reproductive health has yet been passed because of the Catholic Church’s efforts to oppose it. The most controversial points around the reproductive health bills are the provisions on family planning, because they are often (mis-)construed as promoting abortion, so I would like to concentrate on this area in this policy review. In this paper, I will review provisions on family planning in House Bill No. 16 (HB16), the latest proposed law on reproductive health. Some of these provisions in the bill necessarily cross-refer to those of abortion and reproductive health, so I will also tackle on these latter areas.

The short name for HB16 is “Responsible Parenthood and Population Management Act Of 2005”, and its long name is “An Act Providing For an Integrated and Comprehensive National Policy on Responsible Parenthood, Population Management and Human Development, Creating a Responsible Parenthood and Population Management Council, and for Other Purposes.” The whole bill is reproduced in Appendix A. The reproductive health bills have really gone through a lot of repackaging over time. The contents of the bills have also been revised several times, reflecting the various comments at the time they were proposed. HB16 could therefore be seen as a highly evolved bill that has its roots in reproductive health laws in the past. Table 1 shows the provisions in HB16 that refer to family planning.

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?. Betonio, TC. (2002). Family planning org urges congress to pass Reproductive Health Care Act. Internet. Accessed on 23 April 2005, available at http://www.mindanews.com/2002/10/2nd/arn05bill.html

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Table 1. Family planning provisions in House Bill 16, or the “Responsible Parenthood and Population Management Act of 2005.”

Section and Title Provision

Section 3j. Guiding Principles

While the full range of family planning methods, techniques and devices shall be made available to couples and adults of reproductive age, abortion shall remain to be penalized under the Revised Penal Code and relevant jurisprudence...

Section 4a. Definition of Terms

Responsible Parenthood - the will, ability, and commitment of parents to respond to the needs and aspirations of the family and children more particularly through family planning.

Section 4b. Definition of Terms

Family Planning - a program which enables couples and individuals to decide freely and responsibly the number and spacing of their children and to have the information and means to carry out their decisions, and to have informed choice and access to a full range of safe and effective family planning methods, techniques and devices, excluding abortion which is a crime.

Section 4g. Definition of Terms

Reproductive Health Care - availability and access to a full range of methods, techniques and services that contribute to reproductive and sexual health and well-being by preventing and solving reproductive health-related problems in order to achieve enhancement of life and personal relations. The elements of reproductive health care include: (among others) Family planning information and services; prevention of abortion and management of post-abortion complications...

Section 5. Responsible Parenthood and Population Management Council

Pursuant to the herein declared policy, there is hereby constituted within thirty (30) days from the effectivity of this Act a multi-agency body to be known as the Responsible Parenthood and Population Management Council, hereinafter referred to as the Council. It shall be composed of eighteen (18) members with the Director General of the National Economic and Development Authority (NEDA) as Chairperson and the Secretary of The Department of Health (DOH) as Co-Chairperson....

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Section 6d. Functions of the Council

As the central advisory, planning and formulating body of the comprehensive and integrated policy on reproductive health relative to human development and population management, the Council shall have the following functions: (among others) d. To facilitate the involvement and participation of non-government organizations and the private sector in reproductive health care service delivery and in the production, distribution and delivery of quality reproductive health and family planning supplies and commodities to make them accessible and affordable to ordinary citizens....

Section 6e. Functions of the Council

To fully implement the Reproductive Health Care Program with the following components: (among others) Reproductive and sexual health education including but not limited to counseling on the full range of legal and medically-safe family planning methods including surgical methods; Prevention of abortion and management of post-abortion complications....

Section 9. Mobile Health Care Service

Each Congressional District shall be provided with a van to be known as the Mobile Health Care Service (MHCS) to deliver health care goods and services to its constituents, more particularly to the poor and needy, as well as disseminate knowledge and information on reproductive health: Provided, That reproductive health and sexuality education shall be conducted by competent and adequately trained persons preferably reproductive health care providers: Provided, further, That a wide range of family planning methods, both natural/traditional and modern, shall be taught.

Section 10. Mandatory Reproductive Health and Sexuality Education

Reproductive Health and Sexuality Education in an age-appropriate manner shall be taught by adequately trained teachers starting from Grade 5 up to Fourth Year High School. Reproductive Health and Sexuality Education shall commence at the start of the school year immediately following one year effectivity of this Act. The Council shall formulate the Sexuality Education curriculum, which shall be common to both public and private schools, based on the following subjects and standards: (among others) reproductive health and sexual rights; reproductive health care and services; attitudes, beliefs and values on sexual development, sexual behavior and sexual health; d. proscription and hazards of abortion and management of post-abortion complications; natural and modern family planning to prevent unwanted, unplanned and mistimed pregnancies; use and application of natural family planning methods....

Section 16. Prohibited Acts

The following acts are prohibited: (among others) Any health care service provider, whether public or private, who shall: (among others) knowingly withhold information, or restrict 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; refuse to perform voluntary sterilization and ligation and other legal and medically-safe reproductive health care services on any person of legal age on the ground of lack of third party consent or authorization: Provided, That in the case of abused minors as certified to by the Department of Social Welfare and Development, and pregnant minors, no prior parental consent shall be necessary...

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Typological analysis

Below are provisions that describe HB16 and categorize proposed family planning policies within it according to typology. For simplicity, only the section numbers of the provisions mentioned in Table 1 are placed under the column “Provision” in Tables 3a to 3d.

Table 2. Profile of House Bill 16.

Short title “Responsible Parenthood and Population Management Act of 2005.”Long title “An Act Providing For an Integrated and Comprehensive National Policy on

Responsible Parenthood, Population Management and Human Development, Creating a Responsible Parenthood and Population Management Council, and for Other Purposes.”

Proponents Representatives Edcel C. Lagman, Josefina M. Joson, Juan C. Ponce Enrile, Jr., Loretta Ann P. Rosales, Ferjenel G. Biron, M.D., Eduardo V. Roquero, M.D., Dr. Janette L. Garin, Renato "Ka Rene" B. Magtubo, Glenda B. Ecleo, Lorenzo R. Ta–ada III, Ronaldo B. Zamora, Jose Carlos V. Lacson, Emilio C. Macias II, Clavel A. Martinez, Pedro M. Pancho, Solomon R, Chungalao, Del R. de Guzman, Gerardo J. Espina, Jr., Gilbert C. Remulla, Jesus Crispin C. Remulla, Antonio M. Serapio, Jose G. Solis, Nerissa Corazon Soon-Ruiz, Danilo E. Suarez, Rozzano Rufino B. Biazon, Arthur D. Defensor, Rodolfo T. Albano III, Hussin U. Amin, Antonio H. Cerilles, Emmylou "Lala" J. Tali–o-Santos, Luis R. Villafuerte, Ma. Amelita C. Villarosa, Rodante D. Marcoleta, Matias V. Defensor Jr., Rodolfo G. Valencia, Liza Largoza-Maza, Lorna C. Silverio, J.R. Nereus O. Acosta, Darlene R. Antonino-Custodio, Arthur "Dodo" Y. Pingoy, Jr., M.D., Carmen L. Cari, Guillermo P. Cua, Mario "Mayong" Joyo Aguja, Ana Theresia "Risa Hontiveros-Baraquel, Edwin C. Uy, Mauricio G. Domogan, Elias C. Bulut, Jr., Luis P. Bersamin, Jr., Faysah Maniri-Racman Dumarpa, Jesli A. Lapus, and Leonila V. Chavez

Read on Thirteenth CongressYear 2005

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Table 3. Typology of policies within in House Bill 16.

A. By intent Provision Description

Substantive policies

Section 3j - declares that family planning methods, techniques and devises shall be made available to intended users- declares that the bill supports existing stand of the state on abortion as expressed in the Revised Penal Code

Sections 4a, 4b and 4g

- the definitions of “responsible parenthood,” “family planning” and “reproductive health care direct the interpreters of the law to delimit their interpretations within the respective descriptions of the concepts

Section 5 (first sentence)

- orders for the creation of the Responsible Parenthood and Population Management Council

Section 6d - directs the Responsible Parenthood and Population Management Council to enjoin organizations to participate in their work

Section 16 - orders the prohibition of specific acts relating to family planning and other reproductive health care services

Procedural policies Section 5 (second sentence)

- stipulates how the Responsible Parenthood and Population Management Council shall be created- stipulated who are going to chair and co-chair the council

Section 6e - specifies how the Reproductive Health Care Program should be carried out by enumerating its components

Section 9 - describes how a congressional district should carry out reproductive health services

Section 10 - describes how Reproductive Health and Sexuality Education should be carried out

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B. By function Provision Description

Distributive policies

Section 3j - specifies which particular populations should receive family planning methods, techniques and devices

Section 5 - describes the creation of the Responsible Parenthood and Population Management Council that can be benefited from by everyone through its functions

Section 6d - specifies some of the functions of the council that involves delivery of reproductive health care

Section 6e - enumerates the inclusions of the services to beneficiaries within the Reproductive Health Care Program

Section 9 - stipulates the provision of Mobile Health Care Service vans and several other services to each congressional district

Section 10 - orders for the provision of Reproductive Health and Sexuality education to certain populations

Regulatory policies Sections 4a, 4b and 4g

- limits interpretation of rest of policies within the definitions of certain concepts

Section 16 - prohibits some acts in relation to service provision of reproductive health care and family planning

C. By form Provision Description

Material policies Section 5 - provides for a multi-agency body that shall oversee the implementation of the programs within the bill

Section 6e and 10

- provides for Reproductive and Sexual Health education and specifications on how to carry it out

Section 9 - provides for Mobile Health Care Services to each congressional district

Section 16 - restricts certain actions in relation to reproductive health care service provision

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Symbolic policies Section 3j - states the principles that guide legislators in making further stipulations around family planning and abortion

Section 4a, 4b and 49

- delineates that scope of some concepts as they relate to other stipulations within the bill

D. By scope Provision Description

Local policy Section 9 - stipulates that provision of Mobile Health Care Service is locally based at the congressional district

National policies Sections 3j, 4a, 4b, 4g, 5, 6d, 6e 10, 16

- there is an implied national scope of these provisions because of the absence of clauses that limit the services locally

Policy trail

Since 1970 up to the present, there have been one Republic Act, two Presidential Decrees, one Executive Order, one Department of Health Circular, one Department of Health Order, two Department of Interior and Local Government Memoranda, one Board Resolution and four House Bills that refer to family planning. HB 4110 was read twice (and therefore had two versions) within the Twelfth Congress. Table 4 shows the laws and house bills according to chronology.

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Table 4. Laws and house bills with provisions on family planning.

Year Type of law and number Title or subject

1970 Department of Health Circular No. 16

Department of Health's National Comprehensive Maternal and Child Health Family Planning Program

1971 Republic Act No. 6365 Short: Population Act of the PhilippinesLong: An act establishing a national policy on population, creating the commission on population and for other purposes

1972 Presidential Decree No. 79 Revised Population Act of the Philippines

1988 DILG Memorandum Circular No. 88-47

Provision of Support to the Philippine Population Program (PPP)

1988 DILG Memorandum Circular No. 88-48

DILG Role in the Philippine Population Program (PPP)

1992 Department of Health Order No. 39-B, Series of 1992

Management of Family Planning Program

1993 Board Resolution No. 02, Series of 1993

Operational Guidelines for a Decentralized Implementation of the Population Program

1995 House Bill No. 2136 Short: "New Population Act of 1995"Long: An Act Establishing a New Population Policy, Strengthening the Population Commission and for Other Purposes

1996 Executive Order No. 307 Implementing Family Planning Program at the Local Government Level

1997 Presidential Decree No. 1204 Amending Certain Section of Presidential Decree No. 791999 House Bill 8110 Short: "Integrated Population and Development Act of

1999"Long: An Act Establishing An Integrated Population And Development Policy Strengthening Its Implementing Structures and Appropriating Funds Therefor

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2001 House Bill 4110a Short: "The Reproductive Health Care Agenda Act of 2001"Long: An Act Establishing a Reproductive Health Care Act, Strengthening Its Implementing Structures, Appropriating Funds Therefor and for Other Purposes

2002 House Bill 4110b Short: "The Reproductive Health Care Act of 2002"Long: An Act Providing for Reproductive Health Care Structures and Appropriating Funds Therefor

2005 House Bill No. 16 Short: "Responsible Parenthood And Population Management Act Of 2005".Long: An Act Providing For an Integrated and Comprehensive National Policy on Responsible Parenthood, Population Management and Human Development, Creating a Responsible Parenthood and Population Management Council, and for Other Purposes

Appendix B shows the policies on family planning since 1970. At the start, policies in family planning started to appear when the Department of Health created the Comprehensive Maternal and Child Health Family Planning Program in 1970. During that time, family planning was seen solely as a health issue. The policies in the Department of Health Circular No. 16 ordered for both the provision of family planning services and family planning education by rural health units, government hospitals and city health centers. Shortly thereafter, the Population Act of 1971 (RA 6365) was passed, which started a long history of family planning policies being subsumed under “population laws.” The Population Commission was created by virtue of this Republic Act.

Thereafter, issuances that followed were either amendments of RA 6365 or directives regarding its implementation. Presidential Decree 79 operationalized “family planning” as the use of contraceptives. Notably, this decree was also the first to explicitly exclude abortion as a contraceptive method: “...to make available all acceptable methods of contraception, except abortion, to all Filipino citizens desirous of spacing, limiting or preventing pregnancies...” (PD 79, Section 4).

In 1995, during the Tenth Congress, House Bill No. 2136 was proposed as the “New Population Act of 1995.” It was the first bill to mention the concept of “reproductive health services.”

Purposes and Objectives. In the implementation of the foregoing policy and in accordance with the provisions of this Act, the government shall: (among others) invest in programs specifically directed at women's increased access to information, education, skills development, employment opportunities, and high quality reproductive health services in order to enable them to effectively contribute to and benefit from economic growth and sustainable development... (HB 2136, Section 3)

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The phrase “family planning” was never mentioned in the draft, but the bill took on the tradition of the population laws before it. “Reproductive health services” remained a symbolic pronouncement in the bill and had no operationalized provisions for it in other sections of the bill, save for the reiteration of the roles of the Population Commission. What was remarkable, though, was the fact that “reproductive health services,” along with employment opportunities, increased access to education and skills development of women, started to be regarded as necessary elements for “economic growth and sustainable development.” In this regard, “family planning” (or “reproductive health services,” for that matter) ceased to be viewed as solely a health issue or a means to control the population, and came to carry more noble purposes of promoting not only “economic growth” but, more importantly, “sustainable development” as well.During the Eleventh Congress, HB 2136 was repackaged as the “Integrated Population and Development Act of 1999,” or House Bill 8110. The latter bill was not very different in concept from the previous one in the sense that it “integrated” the principle of “population” with that of “development.” HB 8110 was, however, elaborated “reproductive health services” by mentioning the components of the services, which include family planning services.

Declaration of Policy and Objectives. In furtherance of the above declared principles and policy, the State hereby adopts the following as its integrated and interrelated objectives: (among others) to ensure that a full range of basic health and reproductive health care information and services, including those that provide and promote safe motherhood, family planning, responsible sexual behavior to avoid unwanted pregnancy and abortion... (HB 8110, Section 2)

The mention of abortion in HB 8110 was aimed to stress that it is something that should be avoided, like unwanted pregnancy. There is an implied (but not explicit) declaration that abortion is not a method of family planning, but rather, that it is something that can be prevented through the employment of family planning methods. In a way, this is an improved depiction of the relationship of family planning and abortion, compared to that in PD 79.

In the succeeding congress, the Twelfth Congress, the “Integrated Population and Development Act of 1999” underwent further repackaging and was now called “The Reproductive Health Care Agenda Act of 2001.” During the second reading of the bill, the title was shortened to “The Reproductive Health Care Act of 2002.” At face value, the bill title again portrays a solely health perspective of the subsumed policies. However, the Declaration of Principles within the bill stated that reproductive health is actually regarded as a human right.

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Declaration of Principles. The State recognizes and guarantees the human rights of all persons including the right to equality and equity, the right to development, the right to reproductive health, the right to education and the right to choose and make decisions for themselves in accordance with their religious convictions, cultural beliefs, and the demands of responsible parenthood. (HB 4110, Section 2 – First Regular Session)

While the first draft of HB 4110 contextualized reproductive health and family planning within the concepts of “population” and “development,” the second draft was virtually silent about these concepts.

The policies in the latter draft of HB 4110 could therefore be taken as an aggregate statement that reproductive health services, including family planning, should be promoted “not for anything else” but by virtue of its being a human right. Incidentally, it was around this time that the Catholic Church intensified its efforts in opposing the bill.9, 10

This present repackaging of the reproductive health/family planning bill (HB 16) really reflects full integration of the health, population, development and human rights approach to the issue, and more. This time, the concept of “responsible parenthood” is also capitalized, and could in fact be considered as the “priority” point of view that the bill takes, as can be noticed in its long title: “An Act Providing for an Integrated and Comprehensive National Policy on Responsible Parenthood, Population Management and Human Development, Creating a Responsible Parenthood and Population Management Council, and For Other Purposes.” The bill declares that “responsible parenthood” can be obtained through a family planning program that promotes “family planning methods, techniques and devices.”

9 Catholic Bishops’ Conference of the Philippines. (2003). We must reject House Bill 4110. Internet. Accessed on 15 December 2004, available at http://www.rcam.org/cbcp/hb4110statement.htm

10 Manar, MC. (2003). Catholics pray for rejection of HB 4110. Internet. Accessed on 23 April 2005, available at http://www.mindanews.com/2003/10/07nws-candles.html

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Issues and recommendations

The family planning provisions in HB 16 could be summarized as follows: 1. family planning methods, techniques and devices shall be made available; 2. education about family planning shall be made available; 3. abortion is not a family planning method; it is a crime; it should be avoided; should it happen, its medical consequences must be effectively managed; 4. a Responsible Parenthood and Population Management Council should be created; 5. locally, a Mobile Health Care Service should be in-charge of the delivery of services within the congressional district; and, 6. acts that prevent the attainment of a state of reproductive health as a human right are prohibited.

Compared to existing laws and previous bills, HB 16 extensively tackles issues that need to be elucidated for the proper implementation of the policies. The effort to integrate the multiple approaches to family planning in this latest bill is also commendable. As illustrated, it combines perspectives of health, population, development, human rights and responsible parenthood. The effect is the surfacing of multiple rationales that necessitates a law on family planning. Interpreters of the law only have to choose which point of view or combinations of such could be best evoked in justifying the implementation of the law.

While family planning provisions in HB 16 are really multiple and far-reaching, there is practically just one major problematic issue that it carries, that of the use of family planning methods other than “natural” ones. The contention of those who oppose the bill is always that “artificial” family planning methods are

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abortifacient. It is indeed notable that, while the bill operationally defines such terms as responsible parenthood, family planning and reproductive health care, no effort was ever made to enumerate and describe specific “family planning methods, techniques and devices” that are repeatedly referred to. There is no operational definition of abortion, as well, within the bill. In order to clarify doubts as to how the provisions should be interpreted, clear and explicit definitions and descriptions of “family planning methods, techniques and devices” and “abortion” should be integrated in the bill.

The Catholic Church strongly opposes any termination of pregnancy after fertilization (meeting of sperm and egg) because, then, it will be abortion. If it can be demonstrated through clear cut definitions that “family planning methods, techniques and devices” act even before fertilization,11 part of the issue could probably be resolved.

A more extreme version of opposition to the bill by the church is the rejection of any form of “artificial” methods of family planning, in support for the “natural” ones. The reason for such opposition seems to be the fact that “artificial” methods entail the use of devices which are not physically intrinsic, hence they are unacceptable and consequently, sinful. This area is really problematic because of lack of explanation from the church regarding the parallelism of “devices” and “sin.” Is enjoying the pleasure of talking to a friend via cellular phones necessarily sinful because it entails the use of “devices”?

While HB 16 actually mentions in its guiding principles that family planning choices should be based on “personal conviction and religious beliefs” (HB 16, Section 3d), there is probably a need to expound on this, if only to reiterate that family planning is all about choices, and not about impositions. It is also probably better if education on family planning be described within the policies as a process that is sensitive to religious and cultural beliefs and personal convictions.

Apart from minding the drafting of bills, it cannot be overemphasized that the advocacy arm of a family planning bill holds a very crucial role in passing the bill through the congress. There needs to be a body of lobbyists who are also capable of forging alliance and effectively negotiating with those who oppose the bill. While it is true that the bill needs to be drafted in a manner that ensures effective implementation of the resulting law, the bill should also prepare the people for law implementation through an advocacy campaign that highlights the intended

11 Department of Health. (2005). Family planning myths and misconceptions. Internet. Accessed on 2 May 2005, available at http://www.doh.gov.ph/ligtasbuntis/myths.htm

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benefits of the proposed law. More importantly, the intended benefits should also be presented to the people in a manner that espouses respect for cultural and religious beliefs and personal conviction, as declared in the guiding principles of the bill.

References

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?. Tan, ML. (2005). Language, context, politics and health. Internet. Accessed on 2 May 2005, available at http://www.inq7.net/globalnation/col_pik/2005/mar21.htm6

?. [see reference number 1]7

?. Dalisay, B. (2005). Why I left the church. Internet. Accessed on 2 May 2005, available at http://partners.inq7.net/newsbreak/common/printable.php?site_id=51&story_id=33565

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