Reproductive health on hold in the Philippines

Abstract

Health workers are awaiting the outcome of a Supreme Court hearing, which will decide if the Philippines can finally implement comprehensive reproductive health services. Yu-Tzu Chiu reports. Filipinos took the polls this week to elect senators to make up the 16th Congress of the Philippines. The protection of women's sexual and reproductive rights was a divisive issue in the run-up to the elections. Ahead of polling day, different groups publicly endorsed candidates who voted for or against the Responsible Parenthood and Reproductive Health Act of 2012 (RHA), signed by President Bebigno S Aquino last December. The RHA was the end of a debate, lasting more than 10 years, covering issues such as the country's increasing maternal mortality rate (MMR), unwanted pregnancies, and the poor quality of maternal health care. However, the passage of the RHA, which orders local government units to implement standardised reproductive health-care services, drew several petitions from Filipino Catholic groups. Their opposition has led to the Supreme Court's issue of a status quo ante order that temporarily halts the government from implementing the Act. The Court will hear arguments on June 18. On April 30, ahead of the Senate elections, some 100 civil groups for the Purple Ribbon for RH (Reproductive Health) Movement, led by former Health Secretary Esperanza Cabral, endorsed seven senators for their support for the law rather than their political alliances. Meanwhile, the White Vote Movement, led by the Catholic group El Shaddai endorsed nine senatorial candidates who opposed the RH Act. The Purple Vote campaign urged Filipino voters to elect candidates who not only support the law but also who support its implementation. They hoped to gain backing from 80% of Filipino voters, Catholic or non-Catholic. Felicitas Rixhon, Executive Director for the Philippine Center for Population and Development, tells The Lancet that this is the first election that the Catholic Church gave voters specific names of candidates. “They really came out. Their power over the vote will be tested”, Rixhon says. As The Lancet went to press, early results suggested that the Purple Vote candidates would win most senatorial seats. “Before the elections, the anti-RH movement boasted that they would mobilise the Catholic vote to reverse the RH Law. The election results show, there is no Catholic vote”, says Junice Melgar, Executive Director of Likhaan Center for Women's Health, a non-governmental organisation engaged in establishing and running community-based primary health-care centres for poor women and one of groups for the Purple Vote. The delay in implementation of the RHA worries medical professionals who argue that the three pillars of maternal health (access to contraception, provision of skilled attendance at birth, and high quality emergency obstetric care) needed to support a drop of pregnancy-related deaths can not be established without it. According to Melgar, the MMR was high at 162 per 100 000 livebirths in 2006 and it increased to 221 in 2011. “It's unusually high and it's not coming down”, she says. Melgar also stressed the necessity of contraception and family planning services because 54% of all pregnancies are unintended. According to Melgar, the abortion rate in the Philippines (27%) is even higher than that for the rest of southeast Asia (22%). “It's unusual for a Catholic country”, she said. Regarding the Philippine Supreme Court's decision to temporarily halt the implementation, pro-RHA campaigners believe that the Court will eventually vote for full implementation. Romeo Dongeto, Executive Director of the Philippine Legislators Committee on Population and Development Foundation, says: “Almost all the issues against the bill, whether legal, cultural, medical, scientific, and even moral have all been discussed during the 14 years of protracted debate on this policy measure in Congress. We maintain that the law can withstand legal scrutiny.” Human-rights groups say the delay means that thousands of Filipino women will continue to have to contend with long-standing barriers that have stopped them from having access to sexual and reproductive health care, information, and services. According to Amnesty International, the status quo ante order means that the divisive debate on the law continues beyond its promulgation, becoming a decisive issue in the May elections. “Beyond the politicisation of the RH law, it is vital to acknowledge that the government officials who will be elected in May, particularly local government officials, will play a crucial role in implementing the RH law and ensuring that all Filipinos have access to sexual and reproductive health care, information and services, as mandated in the law”, says Amnesty. For more on the Reproductive Health Act of 2012 see http://www.gov.ph/2012/12/21/republic-act-no-10354/ For more on the Reproductive Health Act of 2012 see http://www.gov.ph/2012/12/21/republic-act-no-10354/