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

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