Who’s afraid of reproductive health?

Who’s afraid of reproductive health?
Alicor L. Panao

The UP Forum Volume 9   Number 5    September-October 2008

Does faith come into play among Filipinos in decisions concerning reproductive health?

According to a March 2007 Ulat ng Bayan Survey conducted by Pulse Asia for the Philippine Legislative Committee on Population and Development (PCLPD), about nine in 10 Filipinos want government to finance family planning dissemination and procedures—even those that are expressly prohibited by the Catholic Church. This includes pills, IUDs, condoms, ligation, and vasectomy. The findings only confirm what Dr. Grace Cruz, director of the UP Population Institute, and her colleagues have observed in their own studies: religion is not a key factor in family planning. “Women still make decisions based on their own individual convictions and this is true across all socioeconomic and age profiles,” explains Cruz. And despite being a low-priority concern of the national administration, Filipinos clearly consider family planning important.

In Congress, the reproductive health bill has become a burning issue marked by heated exchanges, delaying tactics, and media campaigns. With a population that continues to bloat amid soaring food and fuel prices, the debates are necessary, inevitable, and ultimately, nothing new.

Dr. Grace Cruz

“The Malthusian concern of overpopulation has always been a pressing concern among economists, scientists, and development analysts and has been the crux of a number of development agenda for many years,” Cruz explains. It used to be known as family planning, but as the women’s movement gained momentum, family planning as a concern evolved into a rights-based issue now known as reproductive health.

It was women who brought the health agenda into the discussions on population, exerting a strong presence in international population conferences and making their voices heard in calls for actions to address the population boom. These advocacies were soon equated with women’s empowerment, and the perspective shifted from family planning to reproductive health, which rests on the premise that a viable population control program cannot be achieved unless women are liberated, involved, and more proactive.

Beyond faith or ideology
Reproductive health, according to the World Health Organization (WHO), is a state of physical, mental, and social well-being in all matters relating to the reproductive system at all stages of life. It entails a satisfying and safe sex life, the capability to reproduce, and the freedom to decide if, when, and how often to do so. Implicit in reproductive health is the right of men and women to have access not only to information but to safe, effective, affordable, and acceptable methods of family planning of their choice, as well as the right to appropriate healthcare services for women to go safely through the process of pregnancy and childbirth.

Reproductive healthcare, on the other hand, is defined as the constellation of methods, techniques, and services that contribute to reproductive health and well-being by preventing and solving reproductive health problems. It includes, not just counseling and care related to reproduction and sexual diseases, but sexual health geared toward the enhancement of life and personal relations.

The bottom line, according to Cruz, is the recognition of reproductive health not only as an inherent right of every woman, but as a right vested on her as a person. This right to decide freely and responsibly the number and spacing of children and to have the information, education, and means to do so was first recognized as a human right in 1968. The right to reproductive health has been endorsed and strengthened in successive international forums, particularly the International Conference on Population and Development (Cairo, 1994), the Fourth World Conference on Women (Beijing, 1995), the World Summit for Social Development (Copenhagen, 1995), and the World Conference on Human Settlements (Istanbul, 1996). At present, the right to reproductive health provides that individuals attain the highest standard of sexual and reproductive health and make reproductive choices free from coercion.

Nevertheless, Cruz believes reproductive health should not be seen merely as a women’s issue. “In the Philippines, I do not think women’s rights is an issue that needs further emphasis,” she says. Many development experts agree that the recognition of reproductive health as a human right is more urgent in countries where women are generally marginalized and confined to specific roles not only within their own household but also in the community.

“In the Philippines, however, our findings seem to indicate that a lot of decisions concerning the home are actually shared by both the husband and the wife,” Cruz notes. In fact, the 2003 demographic and health survey shows that Philippine society is actually more egalitarian in terms of gender roles than most people think.

Unfortunately, programs aimed at reducing population growth and total fertility rate have generally left men out of the picture. As principal targets of population programs, women have until recently borne much of the burden. Recognizing the vital role played by men in reproductive decision-making, some development agencies such as the UN Fund for Population Activities have reoriented their strategy toward active male involvement in the provision of core reproductive health services. Various groups of men, including Muslim religious leaders, have been sensitized to major issues, organized, and mobilized so they themselves can become program advocates.

In early 2004 the Assembly of Darul, which is composed of the biggest and most influential groups of Muslim leaders in the country, issued a national decree (fatwa) on reproductive health and family planning. The fatwa was regarded by many as a major breakthrough toward improving family planning practice in the region, consequently helping to reduce maternal and infant deaths in the typically poor communities in the South.

A question of leadership
But why have family planning efforts so far failed in the country?

“I think the success of all programs depends heavily on leadership,” says Cruz. Leadership will ultimately determine the amount of resources government will pour into population programs. Unfortunately, there is a big difference between what leaders claim and what actually takes place in the agencies or government institutions.

“It is easy to claim that the government has all the programs up and running,” says Cruz. “But if the health centers do not have the resources, that is the real problem.”

For years, the government has been inconsistent in its approach to the problem of population growth due to the pressures exerted by a very powerful Catholic Church. While some administrations did demonstrate a degree of decisiveness on the matter, their efforts were either sidelined in favor of supposedly more important legislative priorities or reduced to empty rhetoric.

In an October 6, 2007 statement, the Catholic Bishop’s Conference of the Philippines, through its president, Jaro Archbishop Angel Lagdameo, reiterated that “the church advocates Natural Family Planning as the only morally acceptable way of practicing responsible parenthood.” The clergy insists, however, that they do not forbid the advocacy of population control, as long as couples are free to exercise sexual and family morality according to their religious conviction. What they object to is the use of artificial contraception, “creating thereby a contraceptive mentality towards a culture of death.”

As statistics show, majority of Filipinos, including practicing Catholics, disagree with such an assessment. Yet President Gloria Macapagal Arroyo seems to be on the side of the clergy on this matter. “We expect the United Nations to respect the deep Catholicism of the vast majority of the Filipino people,” Arroyo said in a speech before the UN General Assemby as part of a high-level summit to review the Millennium Development Goals on September 15, 2005. “The funding given by the United Nations to our national government for reproductive health shall be dedicated to train married couples in a natural family planning technology which the World Health Organization has found effective compared to artificial contraceptives.”

Natural Family Planning (NFP), according to Institute for Reproductive Health of Georgetown University, refers to a variety of methods used to plan or prevent pregnancy by identifying the woman’s fertile days. All natural methods rely on avoiding unprotected intercourse during the fertile days to prevent pregnancy. Natural methods are also known as “fertility awareness-based methods.”

In practicing natural family planning, a woman must monitor her bodily temperature, which supposedly varies according to her fertility cycle. This entails high-level of awareness and knowledge. Local health centers do provide training on how to, say, take one’s temperature every morning and plot this in charts. The problem, according to Cruz, is that given the limited level of literacy attained by women in poor communities, they cannot really be expected to master such methods.

And then there is the reality of the dynamics between couples. “If the husband comes home drunk and forces his wife to sleep with him under threat of violence, can she refuse?” Cruz asks. “Can she argue that this is her fertile period?”

In fact, experts at the WHO suspect that among users of natural family planning, sexual risk-taking during fertile days accounts for more unintended pregnancies than the inability to accurately identify fertile periods.

According to a 2003 United Nations Population Fund (UNFPA) study, Adding it up: The benefits of sexual and reproductive health care, only three in 10 women at risk of unintended pregnancy in developing countries use no contraceptives or use traditional method; but they account for eight in 10 unplanned pregnancies.

Of course, the artificial alternative is not without its share of risks. But according to the UNFPA, even though some unplanned pregnancies still occur among women using artificial methods, their use averts an additional 52 million pregnancies each year, with 26 million pregnancies pushed to a later time, and 26 million pregnancies prevented altogether. This means the prevention of seven out of 10 unplanned births, and six out of 10 induced abortions.

Government failure
In the Philippines, for instance, the government’s failure to implement an effective family planning policy is linked to its inability to distribute and deliver. “More often, there is no money allocated for it,” Cruz laments. “Why? Because it is not really part of the administration’s priorities.”

A number of international development organizations may be willing to extend aid but they are frustrated by the way the government handles the distribution of family planning tools to the local communities. This would probably explain the proliferation of NGOs actively involved in the reproductive health initiative. If the government cannot be relied on, international donors and funding agencies may at least turn to these organizations in channeling their efforts to curb the population problem.

But even so, family planning remains out of reach for millions of Filipino couples who would have preferred fewer family members. According to Cruz, many women want to space or limit their childbearing, but the desire ends up becoming an “unmet need” for different reasons.

The 2006 Family Planning Survey (FPS) by the National Statistics Office revealed that although more women would like to use artificial birth control commodities, only a third (36 percent) of married women actually practice modern family planning.

The health centers do not have artificial contraceptives. Poor women do not have the money to buy them. They would rather spend the little money they have on food and medicine for their children.

According to Human Rights Watch, in some cities in the Philippines, local authorities have even gone as far as to prohibit the distribution of condoms in public health facilities, at times attempting to take disciplinary action against organizations that promote condoms with private funds.

“If government is really serious about reproductive health, then it must make a commitment,” says Cruz. NGOs can only do so much, she says, their resources being far more limited than the government’s.

Role of the University
This commitment includes providing more training and disseminating the right information to couples. It also demands an objective approach to the teaching of sexuality and reproductive health in schools.

Cruz believes education remains the most doable approach to curb population growth. Unfortunately, in a largely conservative society, many families still cling to the traditional idea that sex education is the responsibility of parents, not the school.

But is sex education available at home? “Being taboo among many families, parents rarely talk about these things with their children,” she says. Sex education in schools, on the other hand, tends to involve mere identification of the body’s reproductive parts and how they work, without grappling with ideas of sexuality and confronting the complexities of sexual relations.

If parents refuse to educate children about sexuality and schools barely contribute to the discussion, where will young people get their sex education? “Naturally they would turn to the media and their peers who are as misinformed as they are,” says Cruz. “And before they know it, they are pregnant. The cycle continues.”

The classroom, of course, is not the only source of education. The reproductive health debate has grabbed public attention due largely to the active advocacy of people both in support of and against the reproductive health bill.

It helps to make a little noise, says Cruz. This way, people are apprised of the pertinent issues and the government, hopefully, is pressed to listen. “But that noise must also have a sound basis,” Cruz is quick to point out. “And that is where the University should come in.”


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