The fight for access to adequate family planning in the Philippines has for decades been an endless game of politics. With no shortage of vicious rhetoric on either side of the divide – a war of words which has seen President Rodrigo Duterte labelled a “modern-day Herod” – the ever-watchful gaze of the gale force that is the Catholic Church continues to grip the country and to paint in broad brush strokes the church’s declaratory motto: “Contraception is corruption”.
Rumblings of reproductive health policy were first heard in the government with the establishment of a population commission back in the 1960s as a measure of population control to manage high fertility rates and alleviate poverty. Ever since, backlash from the Catholic Bishops’ Conference of the Philippines (CBCP) has been unrelenting.
The Responsible Parenthood and Reproductive Health Act, commonly RPRH or RH for short, was passed in 2012 – 14 years after a first version of the bill was presented to congress under belligerent opposition campaigns from the CBCP. The act mandated that contraceptives be made available for free and that information about family planning be made easily accessible at public hospitals.
“We were overwhelmed with joy, of course,” said Benjamin De Leon, president of the Forum for Family Planning and Development. “After 14 years of hard struggle, we now have a population and development policy in this country. [But] it’s still a struggle in terms of making sure we achieve fertility planning.”
With ongoing pressure from the church, the bill faced two important setbacks: in March 2013, it was challenged before the Supreme Court, which delayed full implementation of the law. Only a year later was the case resolved, and, while the bill was declared “not unconstitutional”, some provisions were removed and are still void today. The axed provisions included a clause that allowed minors to access reproductive health services without the written consent of a guardian and penal measures for government officials who did not implement the law. There is also still no comprehensive sexual education curriculum taught in schools – a top priority at the Forum, according to De Leon.
In 2015, a further temporary restraining order (TRO) issued again by the nation’s Supreme Court prevented the Food and Drug Administration (FDA) of the Philippines from procuring, distributing or issuing new certificates of product registration on more than 50 different contraceptives, allowing many licences to eventually expire. The TRO was launched after the FDA registered a contraceptive implant called Implanon, which critics falsely argued could be used to induce abortion.
In January of last year, in a move that was celebrated by international human rights groups that are normally staunch critics of Duterte and his violent war on drugs, the cut-throat strongman signed an executive order that sent strict directives to all responsible parties and ensured the push for a family planning agenda to cover all families across the Philippines.
Here we feel that the anti-RH groups are very successful in propagating myths and misconceptions on family planning – that they cause cancer, that they cause abortions
Yet, what should have signalled a new stage in the battle for full access to reproductive health services could only fall flat because of the lingering TRO – and has today merely heralded a shift away from constant legal challenges from anti-family planning law campaigners towards new, more pernicious forms of resistance.
With the TRO still in effect despite the executive order, and with certifications quickly running out, a simple lack of supply of contraceptives in the market threatened to negate any policies Duterte could put in place. Only in November last year, when the implants were finally ruled non-abortifacient, was the TRO on a range of contraceptives lifted.
“The TRO, by the time it was lifted, had resulted in the unavailability of almost 80% of contraceptives in the market,” said former Health Secretary Esperanza Cabral, who now heads the National Implementation Team for the reproductive law. “If the restraining order had not been lifted, by this time, there [would have been] no hormonal contraceptives available in the market for both the public and private sector, and we would have been left with condoms and surgical contraception.”
The Implanon implant has proved popular among Filipinas, according to Cabral, because of the convenience of its three-year effectiveness period. There’s also an equally steady stream of all kinds of contraceptives returning to the market – although more rural areas still lack access, and progress is slow on all accounts, said Cabral: “[The] short answer is, the executive order has not yet had any significant impact on the implementation of the law.”
With Duterte at the helm, De Leon knows that the church is unlikely to proceed with any legal appeals to the lifting of the TRO or other challenges to the law. “We have a president whose political will is there. He’s not afraid to face the church in terms of sanctions,” he said. “Our friends from the other side have not protested legally because the TRO which has been lifted says that any appeal contrary to the recertification has to go through the office of the president. So they know that if they make an appeal, their endeavour will be wasted.”
De Leon cautions that while more and more bishops are supporting the law and the right of couples to choose the size of their family, the anti-contraceptive forces aren’t done yet: “They are monitoring us. Of course they are monitoring us.”
The country’s de-centralised form of government also means that the responsibility of imposing any legislation put in place by Duterte’s administration lies with local government actors. “Local government implementation of family planning is dependent on the priority capacities and personal beliefs of local government officials and local health officials,” said Michael Singh, national programme officer for reproductive health at the UNFPA Philippines, the UN’s reproductive health and rights agency. “So in a way, implementation is varied across the country.” Not enforcing the law results in no punishment, a provision the Supreme Court had mandated before it was removed.
Despite country-wide popular support for access to family planning – around 80%, according to a Forum survey undertaken during the height of the debate over the legislation – Singh says that the remaining reluctance to use contraceptives is borne out of a fear of side effects: “Here we feel that the anti-RH groups are very successful in propagating myths and misconceptions on family planning – that they cause cancer, that they cause abortions. And this is a major reason why many Filipinas still don’t use family planning.”
Beyond issues of morality and the politics of contraception, experts insist on the developmental benefits that family planning legislation will bring, especially important in a country with the highest HIV growth rate in the Asia Pacific, per the UN. HIV diagnoses shot up 140% to 10,500 between 2010 and 2016, according to the Health Ministry. The Philippines also registers a high number of unwanted teenage pregnancies, with one in ten women aged 15 to 19 becoming pregnant, said De Leon.
“[Filipinas] become more empowered, more autonomous, more productive members of society” when they can freely access family planning tools, said Singh. “And it addresses the social ills of society – for example, teenagers who have access to family planning are able to complete their education. Families who are able to space their births have less deaths and less sickness in their families. Families who are able to achieve their desired family size have better access to basic needs such as shelter, education [and] employment.”
It is these most vulnerable members of society who are most in need of access to services, a goal which would require $10 per women per year, estimated Cabral, to reach the poorest 60% of women in the country – not achievable with the current budget, she said, despite increases in funds since the executive order came into effect.
Manpower and resources need to be rallied to feel the effect of Duterte’s directives, said Cabral. Singh agrees that the law does not go far enough, “especially for those who are left behind – the people in the slum areas, the farmers, the fishermen, the disabled, the indigenous peoples, the people displaced by emergencies”, he said. “So there [is] still a lot of work to be done, but I think the RPRH law is a very strong anchor on which positive changes can be made in the lives of women and men in the country.”