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Living with sin: the Catholic hierarchy and reproductive rights in the Philippines.

TEXT MESSAGING HAS BECOME the lobby tool of choice in the latest battle between reproductive health advocates in the Philippines and their anti-choice opponents. The battleground is around a piece of legislation: the Reproductive Health Care Act, better known as House Bill 4110 (and a lesser-known counterpart in the Senate).

For months, text messages have been circulating calling for "prayers and lobbying" against the draft HB4110 which its opponents claim will legalize abortion. (Abortion is illegal under current Philippine law, under all circumstances--not even when necessary to save a woman's life.) The law's punitive attitude towards both the women seeking abortion and the abortion provider is shared by the Filipino public, at least as can be gleaned from the findings of public opinion surveys.

As the hearings on the bill began, the text messages increased in frequency and stridency. Linking separate provisions protecting the right of adolescents to reproductive health information and services, on one hand, and penalizing those who would withdraw or refuse services to anyone based on gender, age or marital status, the messages warned parents: "If HB4110 is passed, a 13-year-old can have sex, and if she gets pregnant, she can have an abortion without her parents' permission. If her parents try to stop her, they can be imprisoned."

When the campaign against HB4110--also waged with the use of more "traditional" weapons such as pastoral letters and letters to the editor, summonses (to the legislators involved) from Catholic bishops, streamers, posters of aborted fetuses and assemblies in Catholic schools--failed to stop the bill on its tracks, the opponents stepped up their attacks. Just before the third committee hearing, this new message made the rounds: "Congress will act on HB4110 or the legalization of abortion on May 13, the feast of Our Lady of Fatima. Your networking for prayers are needed."

(Talk about hitting two birds with one stone: the message capitalizes on the stigma against abortion and on Filipinos' Marian devotion!)


Despite the firestorm of controversy that the Reproductive Health Care Act has set off, that such a piece of legislation has been filed at all, and gone as far as it has, must be counted as a step forward for the cause of reproductive health and rights in the Philippines.

Advocates immersed in the struggle since the late 1970s and 1980s know only too well how often their cause has teetered perilously close to defeat--as it does now under the present Macapagal-Arroyo dispensation.

"Birth control" and later "family planning" first emerged in the public consciousness in the 1970s when the Martial Law regime of Ferdinand Marcos enthusiastically embraced the concept and the program. With foreign aid, most notably from the US Agency for International Development, the Marcos government poured massive resources into a family planning program, establishing a national network of community-based "motivators" supervised by the Commission on Population (PopCom). The government-controlled media were soon suffused by messages about the "ideal" family size and the link between population and poverty, though Filipinos didn't seem to need much prodding before embracing the ideal of smaller families.

While the program was deemed a success (average family size was effectively halved within a decade), questions were raised about the coercive nature of some campaigns, fueled by a system of "incentives" for its proponents, as well as the safety of some methods and clinical trials that used Filipinos as guinea pigs. Indeed, as political opposition to Marcos grew in the early 1980s, women's organizations allied with antiabortion groups in opposing the more coercive aspects of the program.

But what effectively derailed the family planning apparatus was the appointment of a bureaucrat belonging to Opus Dei as head of the national economic planning authority. In this capacity, he became chair of the PopCom. With Marcos's attention diverted by post-Aquino assassination protests, the Commission's new head emasculated his own organization, squeezing off funding and trimming its personnel complement (starting with the community motivators) until it was but a shadow of its former self.


Things would only get worse with the departure of the Marcoses and the ascension to power of Cory Aquino following the first "People Power" Revolt in 1986. The Catholic hierarchy, under the leadership of Cardinal Jaime Sin, the archbishop of Manila, gained extraordinary political influence through its staunch opposition to the dictatorship and the full backing it gave Ms. Aquino. The bishops lost no time converting their power into changes in policy.

First, an auxiliary bishop of Manila was appointed a member of the Constitutional Commission, tasked with amending the more onerous aspects of the "Marcos" Constitution. The bishop, along with a Jesuit lawyer priest and conservative ConCom members, managed to insert an unprecedented "prolife" provision that mandated the state to protect the life of the unborn "from conception." (This was deemed necessary even though abortion was already a crime under the penal code.) It was only with some desperate last minute maneuvering that feminist commissioners managed to include "and the life of the woman" for some semblance of balance.

Then, a "draft" Executive Order was submitted to the president, which, if signed, would have made it illegal for all government health facilities to provide any kind of family planning services, apart from information about natural family planning. Women's groups, still recovering from the street protests of the last few years, rallied and lobbied against its signing, giving birth to the women's health movement in the process.

Even if she ultimately rejected the draft EO, President Aquino indicated where her sympathies lay when she appointed her Social Welfare Secretary as the new chair of the PopCom. In her first public statement on population, Secretary Mita Pardo de Tavera, who it turns out also had links with Opus Dei, gleefully announced the "failure" of the country's family planning program, noting how the millions that had been poured into it had failed to make a dent on demographic trends. Thus, she was "dismantling" the entire program. Furious wrangling within the Aquino government and pressure from foreign donors, including USAID which had since the 1970s been providing 80 percent of the government's contraceptive supplies, resulted in the transfer of the PopCom from Pardo de Tavera's ambit to the Department of Health. The Don was then tasked with implementing the family planning program, with the PopCom consigned to crafting policy.


Under President Fidel Ramos, President Aquino's successor, the family planning program enjoyed a brief revival, especially with the charismatic Dr. Juan Flavier appointed Health Secretary. Flavier, now a senator, used his decades of experience as a rural health doctor to promote health issues through the media, earning the ire of the Catholic bishops for his unapologetic promotion of all methods of family planning.

But while Flavier and Ramos, the country's first Protestant president, managed to dodge the bishops' influence, they could not ignore the political costs. When Ramos appointed two feminist physicians as part of the country's official delegation to the Cairo conference on population and development, he was accused of appointing "abortionists" to the panel. As a concession, Ramos withdrew the appointment of the two women and replaced them with representatives of Catholic and Muslim religious leaders. Even this concession, however, was not enough to forestall a massive rally against the Cairo conference presided over by Cardinal Sin in which the prelate called Flavier a "sinner" who should have a millstone thrown around his neck and then be thrown to the sea.

When Flavier announced that he was running for senator, all the surveys indicated that he would top the poll. When he came in fifth in a field of 12, most observers blamed the "fiasco" on the vigorous campaign that priests and bishops waged against him, denouncing him from the pulpit at every Sunday mass. While some would dispute this analysis--since Flavier was also hampered by a lack of funds and organization the election results seem to have had a dampening effect on him. Now in his second term, he has kept a puzzling and disappointing silence on reproductive health issues. He refused to even sponsor the Senate counterpart of HB4110.

President Joseph Estrada, it seems, was personally ambivalent on the issue of family planning and reproductive health, judging from his public comments and his private behavior. ("If my mother practiced family planning, I would not be alive today," he quipped early in his term.) But Estrada, who is also known as "Erap," a corruption of the slang term for "buddy," seems to have given his Health Secretary, Dr. Alberto Romualdez, a free hand to pursue the program in accordance with the new paradigm of reproductive health that the country committed to in Cairo. Erap also seemed to delight in upsetting the Catholic hierarchy, which had made no bones about its dislike and even revulsion of him during the campaign. Unfortunately, for Erap and the country, he gave the bishops and the people plenty of reasons to want him out of office. Undoubtedly, the anti-Erap protests, kicked off when Cardinal Sin said mass at the "People Power" Shrine, succeeded in large part because the Catholic church threw its full support behind it. By the time "People Power II" ended with the inauguration of Gloria Macapagal-Arroyo, Erap's Vice-president, the institutional church was once more in a position to cash in its chips.


The position of Secretary of Health was among the last to be filled in the Arroyo cabinet. Candidates short-listed by a "search committee" have confirmed that one of the reasons for the delay was that nominees had to go through a "second interview" by a Catholic monsignor, appointed by Cardinal Sin, who wanted to know only one thing: their position on family planning, adolescent sexuality and abortion.

The man finally appointed to DOH has impressive credentials. Dr. Manuel Dayrit is a department veteran, having served as assistant secretary during the Aquino and Ramos administrations, and is a respected epidemiologist. At first, he made all the "right" noises in support of reproductive health and rights. While he was determined to "mainstream" natural family planning in the overall family planning program, he assured the public that all other modern methods would continue to be available and accessible.

But it seems he met an immovable object in the person of his boss, the president. Even as a senatorial candidate, Ms. Macapagal-Arroyo had always said that her position on population "is the same as that of the Catholic church." As president, she has sought to translate that conviction into policy, even as it sometimes bumps heads with her training as an economist and her experience in government.

When the women's commission presented its development plan for women to the president recently, she balked at signing the plan unless a section on "reproductive health" was deleted. "I don't like the term reproductive health," she said.

Developments in the past two years under the Macapagal-Arroyo administration are ominous. In December 2001, the Bureau of Food and Drugs "de-listed" the drug Postinor, a method of emergency contraception. The ban was handed down following a petition from one group, "Gabay Pamilya (Support for the Family)," on the grounds that Postinor was an abortifacient and therefore "unconstitutional." No public hearings were held, no women's groups consulted (even if the drug was initially allowed for limited use by victims of sexual abuse) and two medical organizations asked for their opinion came up with "equivocal" positions. (The obstetricians' and gynecologists' group said, "if preventing implantation is abortion, then Postinor is abortifacient.")

The Reproductive Health Action Network (RHAN) subsequently filed a petition to reconsider the ban on Postinor, but while hearings are still ongoing, the distributor of Postinor in the Philippines has informed the government that it is voluntarily withdrawing the drug from the market.

RHAN fears that the ban on Postinor opens the door to an eventual ban on oral contraceptives that contain the common ingredient levonorgestrel. Since the pill is the most popular family planning method among Filipino women, this would be a violation of women's basic right of choice, argues Dr. Junice Melgar of Likhaan, an NGO that works on women's health issues. Already, doctors at the Philippine General Hospital say that they have received a memorandum from the DOH warning them against the use of the so-called "Yuzpe" method for emergency contraception, which involves high dosages of regular contraceptive pills to prevent pregnancy even after intercourse, since this would be a form of "abortion."

Recently, speaking before a group of reporters, Secretary Dayrit declared that he believed that IUDs are also abortifacient.


During the celebration of International Women's Day on March 8 (to the irritation and dismay of feminists), President Macapagal-Arroyo unveiled her administration's new tack on population. In summary, it's "responsible parenthood through natural family planning." NFP, under this program, has quite a narrow definition, consisting only of the sympto-thermal or Billings-BBT method.

The DOH initially promoted the "Standard Days Method," which provides a memory device (popularly known as the "necklace") to help couples keep track of "safe" and "unsafe" days. But it dropped its support after Cardinal Sin issued a pastoral letter denouncing the SDM for, among other reasons, requiring couples to abstain for more days than under the sympto-thermal method. (Which marks the first time a church official, to my mind, worried that couples were not having enough sex!)

It's believed, though, that the real reason for denouncing SDM was that the promotional literature said couples could use temporary methods of contraception (such as a condom) during a woman's fertile days. Though it's possible that couples using NFP could just as well use other methods of protection once a woman detects she's fertile.

Even as Filipino women (and men) face a scenario of severely limited contraceptive choices (as in only one) in the future, even now they are having a hard time accessing supplies and services that are still legal and available.

Responsibility for delivering basic services, including health and reproductive health, now falls largely on local governments and local executives. There have been reports of shortages of contraceptives in many provincial, city and municipal health facilities. In the nation's capital, Manila, the city council passed an ordinance preventing city health centers from providing services, supplies and even information on all methods of family planning except NFP. As if this wasn't bad enough, local authorities have even used this ordinance to harass private and non-profit family planning providers, even those serving in depressed areas.

Meanwhile, the president has ordered the budget department not to release any funds intended for the purchase of contraceptive supplies. Senator Flavier threatened to call for a Senate investigation when his "development fund" (otherwise known as "pork barrel"), which he assigned to the DOH to buy contraceptives, was re-aligned for "training."

Since 1999, the Philippine government and USAID have been working on the Contraceptive Interdependence Initiative (CII), supposedly to end the government's dependence on free contraceptives from the US, and to make the private sector (pharmaceuticals, medical practitioners and NGOS) bear more responsibility for distributing and marketing contraceptives, mainly by expanding the market of paying customers. In March, USAID unloaded its final shipment of condoms, while delivery of other free contraceptives will be phased out by the end of 2004.

Though some wonder if the pursuit of the CII is not somehow linked to the abrupt about-face on US policy on reproductive health under the Bush administration, current USAID officials say the plan has been in place for years, and funding support for family planning remains at the same levels, though redirected towards private sector and local government support.

When I asked President Macapagal-Arroyo if she would allocate government funds to buy contraceptive supplies in the face of USAID's re-direction of funds, the president said simply: "No." When I asked who she expected would bring in the contraceptives, she said: "NGOS."

This, then is the reproductive health situation in the Philippines. Even as the country faces a shortage of free contraceptives for the poorest Filipinos, the national government has made clear that it doesn't intend to make up for the shortfall. Instead, officials have even dropped hints about the "abortifacient" and thus illegal nature of the most popular contraceptives.


The majority of Filipino couples (57.1 percent), who are poor and on average have larger families than well-off ones, are not able to use family planning because of poor access and ineffective outreach. One-fifth of married women of reproductive age say they want and need to practice family planning but are unable to. Thirty-six percent of young women got pregnant before marriage. Almost half (45 percent) of all pregnancies are unwanted or mistimed. And for a majority Catholic country with one of the most draconian antiabortion laws, the Philippines reports a shockingly high number of induced abortions, estimated at 400,000 annually. No wonder the Philippines also reports one of the highest maternal mortality rates in the Western Pacific region.

It was precisely to rationalize national reproductive health policy that concerned legislators worked with NGOS, including the Philippine Legislators' Committee on Population and Development (PLCPD), in drafting HB4110. The bill, for one, would ensure the steady financing, through a fixed budget item, of the national reproductive health program, to free it from the vicissitudes of politics and the personal beliefs of whoever is in power. It would also make it unlawful for any government entity, including a local council, to restrict the people's right to reproductive health services. The bill, if signed into law, would also require the DOH to put into place policies on the humane and prompt treatment of women suffering from post-abortion complications, as well as on the "prevention of abortion."

And yet opponents of the measure persist in calling it the "abortion bill," and its supporters, as a congressman recalled at the last hearing: "demons, abortionists, murderers and evil."

In previous years, legislators have chosen to dodge the issue, refusing to allot funds for any item in the budget for contraceptives. In the previous Congress, when a bill similar to HB4110 was filed, the original list of over a hundred sponsors was soon whittled down to a brave few as legislators were summoned by their local bishops for a dressing down.

In the last hearing on the bill, observed Karol Ruiz-Austria, a lawyer brought in to advise the measure's sponsors, the authors were so "into it," apparently emboldened and goaded into gambling their political futures by the incessant attacks on their persons and souls. One congressman, Austria recounted, told her that he and his colleagues had reached a point "where they were no longer willing to take in the insults every single Sunday at mass."

Perhaps this time the Catholic hierarchy has reached the point of overkill. Though, given the history and slippery slope of reproductive health policy in the Philippines, it's difficult to tell just where such a point could be reached.

RINA JIMENEZ DAVID writes a daily column for the Philippine Daily Inquirer, where she often discusses issues related to gender and reproductive health and rights. She is also national chairperson of the women's group PILIPINA.
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Author:David, Rina Jimenez
Geographic Code:9PHIL
Date:Jun 22, 2003
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