Family Planning in Asia and the Pacific - International Council on ...

Family Planning in Asia and the Pacific - International Council on ... Family Planning in Asia and the Pacific - International Council on ...

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track ong>theong> distribution, storage ong>andong> utilization of supplies.The new order contaong>inong>s explicit language that ong>theong> nationalgovernment will directly fong>inong>ance or ensure ong>theong> fong>inong>ancong>inong>g ofFP ong>andong> RH commodities, not as an option of last resort,but as part of its regular role to build safety nets for ong>theong>poor.Abortion overtakong>inong>gcontraception ong>inong> regulatong>inong>gfertilityIn a 2008 study, Cabigon adopted Bongaarts’ proximatedetermong>inong>ants to decompose ong>theong> contribution of marriage,contraception, ong>inong>duced abortion ong>andong> post-partumong>inong>fecundability*12 to ong>theong> slow fertility change, usong>inong>g ong>theong>1993, 1998 ong>andong> 2003 NDHSs. The analysis was done atong>theong> national ong>andong> regional levels, with ong>theong> national updatong>inong>gof earlier work, usong>inong>g all surveys carried out before 1993.The study clearly demonstrated that, overall, contraceptionhas been ong>theong> primary factor explaong>inong>ong>inong>g ong>theong> deceleratong>inong>gdeclong>inong>e ong>inong> fertility from ong>theong> 1960s to early 1990s but hasbeen outranked by ong>inong>duced abortion song>inong>ce ong>theong> late 1990s.The mong>inong>or fertility-ong>inong>hibitong>inong>g effect of marriage ong>andong> ong>theong>counteractong>inong>g effect of breastfeedong>inong>g from ong>theong> 1960s toearly 1990s were reversed ong>inong> ong>theong> most recent period.Broader issues that haveimpacts on family plannong>inong>gLegal issues on abortion,contraception ong>andong> ong>theong> 1987ConstitutionOne of ong>theong> major legal issues holdong>inong>g up ong>theong> passageof a reproductive health law is a provision ong>inong> ong>theong> 1987Constitution: “[ong>theong> State] shall equally protect ong>theong> life ofong>theong> moong>theong>r ong>andong> ong>theong> life of ong>theong> unborn from conception”.This is commonly ong>inong>terpreted as merely a safeguardagaong>inong>st any future attempt to change ong>theong> strict clauses ong>inong>ong>theong> penal code which crimong>inong>alize abortion without anyexplicit exception. 50 However, Catholic representatives ong>inong>ong>theong> Constitutional Commission ong>inong>terpret ong>theong> phrase asencompassong>inong>g even contraceptives that ong>theong>y suspect actagaong>inong>st a fertilized ovum – ong>theong> “unborn from conception”. Fr.Joaquong>inong> Bernas, a Catholic priest, ong>inong>fluential constitutionallaw expert ong>andong> member of ong>theong> Commission, argued thisposition clearly: 51Our constitutional provision wasdiscussed ong>andong> crafted at a time whenmany were aware of ong>theong> United StatesSupreme Court decision ong>inong> Roe v. Wadewhich allowed abortion up to ong>theong> sixthmonth of pregnancy. This is contrary toboth our Penal Code ong>andong> Canon Law.The prevention of ong>theong> adoption of ong>theong>doctrong>inong>e ong>inong> Roe v. Wade was certaong>inong>lyone of ong>theong> purposes of ong>theong> provision. ButCommission deliberations ong>inong>dicate thatong>theong> provision goes beyond Roe v. Wade.The unborn’s entitlement to protectionbegong>inong>s “from conception,” that is, from ong>theong>moment of conception. The moment ofconception is popularly understood as ong>theong>moment of fertilization which takes placeoutside ong>theong> moong>theong>r’s womb. The ong>inong>tentionof ong>theong> Constitution is to protect life fromits begong>inong>nong>inong>g, ong>andong> ong>theong> assumption is thatong>theong> gradual development of human lifebegong>inong>s at conception ong>andong> that conceptiontakes place at fertilization (even if medicalliterature seems to see conception as ong>theong>moment of implantation). …The practical implication of this isthat ong>theong>re may be a need to analyzescientifically what kong>inong>d of contraceptivemeans are now beong>inong>g dispensed todetermong>inong>e wheong>theong>r ong>theong>y are merelycontraceptive or already have ong>theong> effect ofpreventong>inong>g implantation ong>andong> consequentloss of a fertilized zygote.While Fr. Bernas concedes that scientific analysis ofcontraceptives is needed before declarong>inong>g which onesmay be prohibited by his ong>inong>terpretation of ong>theong> 1987constitution, Catholic bishops have already made up ong>theong>irmong>inong>ds on which ones are “abortifacients”. Bishop TeodoroBacani, a Constitutional Commission member ong>andong> oneof ong>theong> maong>inong> authors of “ong>theong> unborn” clause, defong>inong>es ong>andong>identifies “abortifacients” as follows: 52316

If [fertilization of ong>theong> egg by ong>theong> sperm] beong>theong> correct understong>andong>ong>inong>g of conception,ong>theong>n abortifacients can be defong>inong>ed asdevices or drugs whose action prevent ong>theong>conceptus (ong>theong> conceived unborn) fromcomong>inong>g to term. …All ong>theong> measures which impair ong>theong>viability of ong>theong> zygote at any timebetween ong>theong> ong>inong>stant of fertilization ong>andong>ong>theong> completion of labour constitute, ong>inong>ong>theong> strict sense, procedures for ong>inong>ducong>inong>gabortion.Hence, ong>theong> IUD, ong>inong>jectables like Depo-Provera, ong>andong> ong>theong> emergency contraceptivepill (mornong>inong>g after pill) Levonorgestrel,RU-486, ong>andong> implants like Norplantshould be classified as abortifacients, forong>theong>y do not only prevent fertilization(conception), but also prevent ong>theong>implantation of ong>theong> fertilized ovum.A bill called ong>theong> “Protection of ong>theong> Unborn Child Act of2010” is currently filed at ong>theong> House of Representativesong>andong> ong>theong> Senate. It defong>inong>es conception as fertilization;gives human personality ong>andong> protection to an “unbornchild” from fertilization; ong>andong> declares that anythong>inong>g whichong>inong>terferes with its natural development from fertilizationuntil birth is an act of abortion, punishable with ong>inong>creasedprison terms. This bill is currently supported by formerPresident Arroyo, now a representative ong>inong> Congress, ong>andong>by ong>theong> president of ong>theong> Senate.“Middle ground” proposals are also beong>inong>g floated toapprove an RH bill mong>inong>us “abortifacients”, which typicallypoong>inong>t to hormonal contraceptives ong>andong> IUDs. If passedong>inong>to law, millions of current users of ong>theong>se methods willbe affected.Health devolutionFrom ong>theong>ir establishment ong>inong> ong>theong> early 1900s until 1991,public health services ong>inong> ong>theong> Philippong>inong>es have always beenled ong>andong> managed by a corps of medical professionals ong>andong> civilservants, where policies, personnel ong>andong> resources emanatefrom a central body. 53 With ong>theong> 1991 Local GovernmentCode, more than 100 years of practice was changed almostovernight, ong>andong> ong>theong> health sector is still copong>inong>g with ong>theong>new set-up. After 16 years of full implementation, basicproblems like limited capacity, lack of priority ong>andong> varyong>inong>gong>inong>terpretations of responsibility abound, as described bya 2010 evaluation of ong>theong> health sector by ong>theong> Departmentof Health: 54The implementation of national healthprograms at ong>theong> local level has becomecomplex due to devolution. Althoughsome LGUs have accepted ong>theong> challengewith mong>inong>imal assistance from ong>theong> nationalgovernment, a majority have limitedfong>inong>ancial ong>andong> technical capacity to managehealth withong>inong> ong>theong>ir catchment areas. Somelocal chief executives prioritize projectswith results that can [be] seen by ong>theong>irconstituents. Some LGUs are unawareof ong>theong> kong>inong>d of health services that LGUsshould deliver. For ong>inong>stance, RHUsong>inong> Ilocos Sur have not been providong>inong>gcommunicable ong>andong> non-communicablecontrol services because health workersassumed that such programs were ong>theong>responsibility of ong>theong> DOH.Health fong>inong>ancong>inong>g by local governmentunitsUnder ong>theong> Local Government Code (LGC), funds fromnational revenues are transferred to LGUs without anyearmarkong>inong>g, except for ong>theong> general proviso that at least 20per cent be devoted to “local development projects”. In its2005-2010 National Objectives for Health, ong>theong> Departmentof Health set a target that LGUs should shoulder 32 percent of ong>theong> country's total health expenditures by 2010,from a baselong>inong>e of a 17.5 per cent share ong>inong> 2003. Thiswould ong>theong>n help reduce out-of-pocket health spendong>inong>g to20 per cent by 2010, from 44 per cent ong>inong> 2003. Instead ofong>inong>creasong>inong>g, however, ong>theong> share of LGUs actually went downto 13.3 per cent ong>inong> 2007, makong>inong>g ong>theong> target impossible tomeet (see Figure 17). Evidence from ong>theong> national healthaccounts ong>inong>dicates that LGUs as a group may have beenunderspendong>inong>g for health.Under ong>theong> LGC, family plannong>inong>g is listed as a “basic service”of municipalities ong>andong> cities. Provong>inong>ces are supposed toprovide “population development” services ong>andong> hospital317

track <str<strong>on</strong>g>the</str<strong>on</strong>g> distributi<strong>on</strong>, storage <str<strong>on</strong>g>and</str<strong>on</strong>g> utilizati<strong>on</strong> of supplies.The new order c<strong>on</strong>ta<str<strong>on</strong>g>in</str<strong>on</strong>g>s explicit language that <str<strong>on</strong>g>the</str<strong>on</strong>g> nati<strong>on</strong>algovernment will directly f<str<strong>on</strong>g>in</str<strong>on</strong>g>ance or ensure <str<strong>on</strong>g>the</str<strong>on</strong>g> f<str<strong>on</strong>g>in</str<strong>on</strong>g>anc<str<strong>on</strong>g>in</str<strong>on</strong>g>g ofFP <str<strong>on</strong>g>and</str<strong>on</strong>g> RH commodities, not as an opti<strong>on</strong> of last resort,but as part of its regular role to build safety nets for <str<strong>on</strong>g>the</str<strong>on</strong>g>poor.Aborti<strong>on</strong> overtak<str<strong>on</strong>g>in</str<strong>on</strong>g>gc<strong>on</strong>tracepti<strong>on</strong> <str<strong>on</strong>g>in</str<strong>on</strong>g> regulat<str<strong>on</strong>g>in</str<strong>on</strong>g>gfertilityIn a 2008 study, Cabig<strong>on</strong> adopted B<strong>on</strong>gaarts’ proximatedeterm<str<strong>on</strong>g>in</str<strong>on</strong>g>ants to decompose <str<strong>on</strong>g>the</str<strong>on</strong>g> c<strong>on</strong>tributi<strong>on</strong> of marriage,c<strong>on</strong>tracepti<strong>on</strong>, <str<strong>on</strong>g>in</str<strong>on</strong>g>duced aborti<strong>on</strong> <str<strong>on</strong>g>and</str<strong>on</strong>g> post-partum<str<strong>on</strong>g>in</str<strong>on</strong>g>fecundability*12 to <str<strong>on</strong>g>the</str<strong>on</strong>g> slow fertility change, us<str<strong>on</strong>g>in</str<strong>on</strong>g>g <str<strong>on</strong>g>the</str<strong>on</strong>g>1993, 1998 <str<strong>on</strong>g>and</str<strong>on</strong>g> 2003 NDHSs. The analysis was d<strong>on</strong>e at<str<strong>on</strong>g>the</str<strong>on</strong>g> nati<strong>on</strong>al <str<strong>on</strong>g>and</str<strong>on</strong>g> regi<strong>on</strong>al levels, with <str<strong>on</strong>g>the</str<strong>on</strong>g> nati<strong>on</strong>al updat<str<strong>on</strong>g>in</str<strong>on</strong>g>gof earlier work, us<str<strong>on</strong>g>in</str<strong>on</strong>g>g all surveys carried out before 1993.The study clearly dem<strong>on</strong>strated that, overall, c<strong>on</strong>tracepti<strong>on</strong>has been <str<strong>on</strong>g>the</str<strong>on</strong>g> primary factor expla<str<strong>on</strong>g>in</str<strong>on</strong>g><str<strong>on</strong>g>in</str<strong>on</strong>g>g <str<strong>on</strong>g>the</str<strong>on</strong>g> decelerat<str<strong>on</strong>g>in</str<strong>on</strong>g>gdecl<str<strong>on</strong>g>in</str<strong>on</strong>g>e <str<strong>on</strong>g>in</str<strong>on</strong>g> fertility from <str<strong>on</strong>g>the</str<strong>on</strong>g> 1960s to early 1990s but hasbeen outranked by <str<strong>on</strong>g>in</str<strong>on</strong>g>duced aborti<strong>on</strong> s<str<strong>on</strong>g>in</str<strong>on</strong>g>ce <str<strong>on</strong>g>the</str<strong>on</strong>g> late 1990s.The m<str<strong>on</strong>g>in</str<strong>on</strong>g>or fertility-<str<strong>on</strong>g>in</str<strong>on</strong>g>hibit<str<strong>on</strong>g>in</str<strong>on</strong>g>g effect of marriage <str<strong>on</strong>g>and</str<strong>on</strong>g> <str<strong>on</strong>g>the</str<strong>on</strong>g>counteract<str<strong>on</strong>g>in</str<strong>on</strong>g>g effect of breastfeed<str<strong>on</strong>g>in</str<strong>on</strong>g>g from <str<strong>on</strong>g>the</str<strong>on</strong>g> 1960s toearly 1990s were reversed <str<strong>on</strong>g>in</str<strong>on</strong>g> <str<strong>on</strong>g>the</str<strong>on</strong>g> most recent period.Broader issues that haveimpacts <strong>on</strong> family plann<str<strong>on</strong>g>in</str<strong>on</strong>g>gLegal issues <strong>on</strong> aborti<strong>on</strong>,c<strong>on</strong>tracepti<strong>on</strong> <str<strong>on</strong>g>and</str<strong>on</strong>g> <str<strong>on</strong>g>the</str<strong>on</strong>g> 1987C<strong>on</strong>stituti<strong>on</strong>One of <str<strong>on</strong>g>the</str<strong>on</strong>g> major legal issues hold<str<strong>on</strong>g>in</str<strong>on</strong>g>g up <str<strong>on</strong>g>the</str<strong>on</strong>g> passageof a reproductive health law is a provisi<strong>on</strong> <str<strong>on</strong>g>in</str<strong>on</strong>g> <str<strong>on</strong>g>the</str<strong>on</strong>g> 1987C<strong>on</strong>stituti<strong>on</strong>: “[<str<strong>on</strong>g>the</str<strong>on</strong>g> State] shall equally protect <str<strong>on</strong>g>the</str<strong>on</strong>g> life of<str<strong>on</strong>g>the</str<strong>on</strong>g> mo<str<strong>on</strong>g>the</str<strong>on</strong>g>r <str<strong>on</strong>g>and</str<strong>on</strong>g> <str<strong>on</strong>g>the</str<strong>on</strong>g> life of <str<strong>on</strong>g>the</str<strong>on</strong>g> unborn from c<strong>on</strong>cepti<strong>on</strong>”.This is comm<strong>on</strong>ly <str<strong>on</strong>g>in</str<strong>on</strong>g>terpreted as merely a safeguardaga<str<strong>on</strong>g>in</str<strong>on</strong>g>st any future attempt to change <str<strong>on</strong>g>the</str<strong>on</strong>g> strict clauses <str<strong>on</strong>g>in</str<strong>on</strong>g><str<strong>on</strong>g>the</str<strong>on</strong>g> penal code which crim<str<strong>on</strong>g>in</str<strong>on</strong>g>alize aborti<strong>on</strong> without anyexplicit excepti<strong>on</strong>. 50 However, Catholic representatives <str<strong>on</strong>g>in</str<strong>on</strong>g><str<strong>on</strong>g>the</str<strong>on</strong>g> C<strong>on</strong>stituti<strong>on</strong>al Commissi<strong>on</strong> <str<strong>on</strong>g>in</str<strong>on</strong>g>terpret <str<strong>on</strong>g>the</str<strong>on</strong>g> phrase asencompass<str<strong>on</strong>g>in</str<strong>on</strong>g>g even c<strong>on</strong>traceptives that <str<strong>on</strong>g>the</str<strong>on</strong>g>y suspect actaga<str<strong>on</strong>g>in</str<strong>on</strong>g>st a fertilized ovum – <str<strong>on</strong>g>the</str<strong>on</strong>g> “unborn from c<strong>on</strong>cepti<strong>on</strong>”. Fr.Joaqu<str<strong>on</strong>g>in</str<strong>on</strong>g> Bernas, a Catholic priest, <str<strong>on</strong>g>in</str<strong>on</strong>g>fluential c<strong>on</strong>stituti<strong>on</strong>allaw expert <str<strong>on</strong>g>and</str<strong>on</strong>g> member of <str<strong>on</strong>g>the</str<strong>on</strong>g> Commissi<strong>on</strong>, argued thispositi<strong>on</strong> clearly: 51Our c<strong>on</strong>stituti<strong>on</strong>al provisi<strong>on</strong> wasdiscussed <str<strong>on</strong>g>and</str<strong>on</strong>g> crafted at a time whenmany were aware of <str<strong>on</strong>g>the</str<strong>on</strong>g> United StatesSupreme Court decisi<strong>on</strong> <str<strong>on</strong>g>in</str<strong>on</strong>g> Roe v. Wadewhich allowed aborti<strong>on</strong> up to <str<strong>on</strong>g>the</str<strong>on</strong>g> sixthm<strong>on</strong>th of pregnancy. This is c<strong>on</strong>trary toboth our Penal Code <str<strong>on</strong>g>and</str<strong>on</strong>g> Can<strong>on</strong> Law.The preventi<strong>on</strong> of <str<strong>on</strong>g>the</str<strong>on</strong>g> adopti<strong>on</strong> of <str<strong>on</strong>g>the</str<strong>on</strong>g>doctr<str<strong>on</strong>g>in</str<strong>on</strong>g>e <str<strong>on</strong>g>in</str<strong>on</strong>g> Roe v. Wade was certa<str<strong>on</strong>g>in</str<strong>on</strong>g>ly<strong>on</strong>e of <str<strong>on</strong>g>the</str<strong>on</strong>g> purposes of <str<strong>on</strong>g>the</str<strong>on</strong>g> provisi<strong>on</strong>. ButCommissi<strong>on</strong> deliberati<strong>on</strong>s <str<strong>on</strong>g>in</str<strong>on</strong>g>dicate that<str<strong>on</strong>g>the</str<strong>on</strong>g> provisi<strong>on</strong> goes bey<strong>on</strong>d Roe v. Wade.The unborn’s entitlement to protecti<strong>on</strong>beg<str<strong>on</strong>g>in</str<strong>on</strong>g>s “from c<strong>on</strong>cepti<strong>on</strong>,” that is, from <str<strong>on</strong>g>the</str<strong>on</strong>g>moment of c<strong>on</strong>cepti<strong>on</strong>. The moment ofc<strong>on</strong>cepti<strong>on</strong> is popularly understood as <str<strong>on</strong>g>the</str<strong>on</strong>g>moment of fertilizati<strong>on</strong> which takes placeoutside <str<strong>on</strong>g>the</str<strong>on</strong>g> mo<str<strong>on</strong>g>the</str<strong>on</strong>g>r’s womb. The <str<strong>on</strong>g>in</str<strong>on</strong>g>tenti<strong>on</strong>of <str<strong>on</strong>g>the</str<strong>on</strong>g> C<strong>on</strong>stituti<strong>on</strong> is to protect life fromits beg<str<strong>on</strong>g>in</str<strong>on</strong>g>n<str<strong>on</strong>g>in</str<strong>on</strong>g>g, <str<strong>on</strong>g>and</str<strong>on</strong>g> <str<strong>on</strong>g>the</str<strong>on</strong>g> assumpti<strong>on</strong> is that<str<strong>on</strong>g>the</str<strong>on</strong>g> gradual development of human lifebeg<str<strong>on</strong>g>in</str<strong>on</strong>g>s at c<strong>on</strong>cepti<strong>on</strong> <str<strong>on</strong>g>and</str<strong>on</strong>g> that c<strong>on</strong>cepti<strong>on</strong>takes place at fertilizati<strong>on</strong> (even if medicalliterature seems to see c<strong>on</strong>cepti<strong>on</strong> as <str<strong>on</strong>g>the</str<strong>on</strong>g>moment of implantati<strong>on</strong>). …The practical implicati<strong>on</strong> of this isthat <str<strong>on</strong>g>the</str<strong>on</strong>g>re may be a need to analyzescientifically what k<str<strong>on</strong>g>in</str<strong>on</strong>g>d of c<strong>on</strong>traceptivemeans are now be<str<strong>on</strong>g>in</str<strong>on</strong>g>g dispensed todeterm<str<strong>on</strong>g>in</str<strong>on</strong>g>e whe<str<strong>on</strong>g>the</str<strong>on</strong>g>r <str<strong>on</strong>g>the</str<strong>on</strong>g>y are merelyc<strong>on</strong>traceptive or already have <str<strong>on</strong>g>the</str<strong>on</strong>g> effect ofprevent<str<strong>on</strong>g>in</str<strong>on</strong>g>g implantati<strong>on</strong> <str<strong>on</strong>g>and</str<strong>on</strong>g> c<strong>on</strong>sequentloss of a fertilized zygote.While Fr. Bernas c<strong>on</strong>cedes that scientific analysis ofc<strong>on</strong>traceptives is needed before declar<str<strong>on</strong>g>in</str<strong>on</strong>g>g which <strong>on</strong>esmay be prohibited by his <str<strong>on</strong>g>in</str<strong>on</strong>g>terpretati<strong>on</strong> of <str<strong>on</strong>g>the</str<strong>on</strong>g> 1987c<strong>on</strong>stituti<strong>on</strong>, Catholic bishops have already made up <str<strong>on</strong>g>the</str<strong>on</strong>g>irm<str<strong>on</strong>g>in</str<strong>on</strong>g>ds <strong>on</strong> which <strong>on</strong>es are “abortifacients”. Bishop TeodoroBacani, a C<strong>on</strong>stituti<strong>on</strong>al Commissi<strong>on</strong> member <str<strong>on</strong>g>and</str<strong>on</strong>g> <strong>on</strong>eof <str<strong>on</strong>g>the</str<strong>on</strong>g> ma<str<strong>on</strong>g>in</str<strong>on</strong>g> authors of “<str<strong>on</strong>g>the</str<strong>on</strong>g> unborn” clause, def<str<strong>on</strong>g>in</str<strong>on</strong>g>es <str<strong>on</strong>g>and</str<strong>on</strong>g>identifies “abortifacients” as follows: 52316

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