Overwhelming case for the RH bill

WOMEN gather in front of the Commission on Elections building in Intramuros, Manila, to commemorate the Filipino women’s 74th year of exercising the right to vote and to push for the passage of the RH bill. GRIG C. MONTEGRANDE

To its critics, the Responsible Parenthood and Reproductive Health (RH) bill is the devilish product of a foreign conspiracy. The principal plotters in this conspiracy are three: the United Nations, the goal of which is allegedly to legalize abortion; the United States, which seeks to control the populations of developing countries in line with the so-called Kissinger Doctrine; and “Big Pharma,” or the Western transnational firms that stand to make tremendous profits from the sale of contraceptives.

In this scenario painted by  anti-RH groups, the United Nations, United States and Big Pharma have somehow managed to bribe, intimidate or fool people like President Aquino, Senators Pia Cayetano and Miriam Santiago, Rep. Edcel Lagman and the over 100 authors of the RH bill in the House of Representatives to do their bidding.

How it has come about that some of the strongest critics of the United States and transnational corporations have been transmogrified into the latter’s stooges is unexplained, prompting some wags to liken the anti-RH plot line to that of the Hollywood film “Invasion of the Body Snatchers.”

Denialists

Not only are the anti-RH propagandists conspiracy theorists.  They are “denialists,” much like the people that claim climate change is not real.  Like the climate change denialists, no amount of evidence can seem to convince them of the facts.

Take the authors of the piece “No Need for an RH bill, Now or Ever,” that appeared in the Inquirer on Sept. 16.  Despite the fact that survey after survey have shown a great majority of people favor family planning, these authors dismiss the results because the surveys were allegedly “funded by the international agencies advocating contraception and abortion.”

The survey firms accused of deliberately disseminating false results presumably include Social Weather Stations (SWS) and Pulse Asia, which have achieved a well-deserved sterling reputation for accuracy and methodological rigor.

The correlation and causal relation between inability to plan family size and poverty are among the most solidly established findings in demography. The population denialists say, however, that no such causal relation exists, dismissing the consistently replicated results of careful research, such as the World Health Organization’s finding that 22.3 percent of Filipino couples want to limit their families to escape poverty but are prevented by lack of access to contraceptives and lack of familiarity with family planning from doing so.

Then, there is the denial that effective family planning is positively correlated with economic growth, a claim they say finds support in the findings of the Growth Commission headed by Nobel laureate Michael Spence. This is a strange claim inasmuch as Spence’s short list of 13 exemplary states in terms of development are China, Hong Kong, Indonesia, Korea, Singapore, Taiwan and Thailand.

Springboard of takeoff

All of these countries conducted intensive family planning programs early on in their development history, the success of which allowed the state to channel resources from immediate consumption of an expanding population to investment in education, infrastructure and health that served as the springboard of economic takeoff.

Indeed, if one looks at just three of our economically successful Southeast Asian neighbors—Indonesia, Thailand and Vietnam—there are no substantial differences between them and the Philippines when it comes to variables such as levels of corruption, macroeconomic policy, subjection to structural adjustment policies and income distribution.

There is, however, one very distinctive feature that separates the Philippines from its neighbors: unlike our country, Vietnam, Indonesia and Thailand managed, early on in the development process, to rein in the growth of their populations through effective state-sponsored family planning programs. And while successful family planning is not the whole story, economists and demographers have a consensus that it is an essential element in the narrative of economic advance in our neighboring countries.

Finally, there is the denial that condoms have contributed to arresting the AIDS epidemic, a key concern of the proponents of the RH bill. This denial simply flies in the face of the facts.  In Thailand, owing to an aggressive campaign to promote condom use, new HIV cases dropped from 150,000 in 1991 to less than 14,000 in 2008.

As for South Africa, according to The Economist, “the tally of new cases each year has tumbled by half since 1999 —thanks largely to a dramatic increase in the use of condoms.”

Even as condoms and sex education have effectively stemmed the spread of AIDS in South Africa and our neighbors in Southeast Asia, the resistance to condom use and sex education that is championed by anti-RH groups has led to the sharp increase in AIDS cases in the Philippines, making it one of only seven countries in the world where the incidence of the disease is rising rather than falling.

Central issue: Reproductive freedom

By claiming the idea that the RH bill is being foisted on the country by foreign conspirators, by promoting this denialist strategy, by equating contraception to abortion and by distorting the views of authorities like Michael Spence, the anti-RH forces have tried hard to obfuscate the issues that are at stake.

But that they have not succeeded in fooling the population is clear, since more people now favor family planning than ever before.  In 1990,  61 percent of respondents in an SWS survey  agreed with the statement that “the choice of family planning method is a personal choice of couples, and no one should interfere with it.” By 2011, the percentage rose to 82 percent.

What is the RH bill really all about?

The RH bill, first of all, is about the right of women to control their own bodies. It is about choice, especially the primordial choice of a woman, together with her partner, to determine the size of her family.

Today, most poor families  cannot really exercise free choice in planning their families since they do not have access to the means of doing so.  The RH bill would enable families to exercise real freedom of choice by placing these means at their disposal should they choose to take advantage of them.

Step toward gender equality

Reproductive rights are central to the improvement in the economic status of women and their families. As a paper by the World Health Organization put it, “The reproductive revolution—the shift from six births, of whom several might die, to around two births, nearly all of whom survive—represents the most important step toward achievement of gender equality by boosting women’s opportunities for nondomestic activities.”

The dynamics of this process are reflected in the statistics that show that poverty incidence in the Philippines in 2000 was 9.8 percent for families with one child, 31.1 percent for families with five children, 48.7 percent for families with seven and 57.3 percent for families with nine or more children.

The RH bill is about promoting women’s health.  As Michelle Goldberg writes in her landmark book, “The Means of Reproduction: Sex, Power and the Future of the World:” “At an even more elemental level, for far too many women, pregnancy is either deadly to debilitating. Putting off childbearing until their bodies are mature enough protects mothers, as does spacing their pregnancies several years apart and having only as many children as they choose.”

The mortality rate for Filipino mothers increased from 162 per 100,000 live births in 2009 to 221 per 100,000 in 2011. One major factor that contributes to maternal mortality is illegal abortion, of which there are now some 400,000 to 500,000 a year. It is estimated that 12 percent of maternal deaths result from abortion and that one out of six women undergoing abortion will suffer complications.

Not only does the RH bill recognize that abortion is illegal.  By making contraceptives and reproductive education available to poor women, it would  contribute to radically reducing the incidence of abortion.

Rational management

A decline in the fertility rate at the macro level is an incidental result of family planning at the micro level, but it is a very important incidental result.  By using the scare words “population control,” the anti-RH forces have tried to eliminate from debate the necessity of a rational management of the country’s population in the service of economic growth, social stability, environmental integrity and peace.

Citizens, however, recognize the need to manage population growth: in an October 2008 Pulse Asia survey, 90 percent of respondents said it was important to “have the ability to control fertility or plan a family” for the “welfare of the country.”

The population growth rate currently stands at 1.9 percent, which is high compared with our successful neighbors. The high rate is caused mainly by a slow decline in the fertility rate. The Total Fertility Rate in the Philippines, which stands at a high 3.11 today, will continue to be much above the replacement level of 2.1 in the next few decades.

According to the UP Population Institute, had the country attained replacement level fertility in 2010, the population would still continue to grow and reach 150 million in 2060, after which it would stabilize. If the replacement level fertility is achieved in 2030—which is more realistic, according to demographers—the population will stabilize at 200 million in 2080.

Under a less optimistic scenario of replacement level fertility being attained even later, say in 2050, the population will stabilize at more than 250 million toward the last years of the century!

Carrying capacity, crisis

A population of 200 million to 250 million would be far above the country’s carrying capacity, which refers to the number of people a region can support without suffering significant environmental degradation. When carrying capacity is outstripped by population growth, an ecological crisis develops.

There are strong indications that the Philippines was either close to or pushed beyond its carrying capacity as early as the mid-’80s, when the population was around 55 million. With the countryside unable to support a rapidly expanding population, migration to urban areas, especially Metro-Manila, escalated.  And with uncontrolled expansion of shantytown communities, waterways were clogged and polluted, with the Pasig River nearing biological death and Laguna Lake in irreversible ecological decline by the mid-’90s.

But there were two features that were new with the population shifts that began in the late ’70s and early ’80s. Before that period, the direction of internal migration had been from the depressed rural areas to the cities. Since then, however, internal migration also moved to the upland areas, open access forests and artisanal fisheries. Deforestation accelerated, with the country losing, by 2005, over a third of its already much-reduced forest cover of about 10 million hectares in 1990.

The second new feature of the population movements at the end of the late ’70s and the ’80s was the massive exodus of Filipinos to work in foreign climes that kicked off during that period.  The labor export program was originally a small affair involving 50,000 workers when it was instituted in 1975. But with unrestrained population growth outstripping the economy’s capacity to produce jobs, labor export exploded, with the overseas work force today possibly numbering as many as 12.5 million.

Social conflict

Poverty and environmental degradation are two major consequences of unrestrained population growth. Another is social conflict.   Beginning in the 1950s, there were state-sponsored and spontaneous migrations from overpopulated Luzon and the Visayas to relatively underpopulated Mindanao—known in the 1960s as “virgin land.”

Policymakers of that period routinely pronounced Mindanao as a “safety valve” for demographic pressure as the population-to-land ratio declined from 1 cultivated ha per worker in the agricultural hinterland in the 1950s to 0.5 ha by the early 1980s.

The resulting mass migrations to the “agricultural frontier” intensified conflicts over land and territory, with Muslims and indigenous peoples marginalized from their lands by Christian settlers and becoming a minority in their own homeland.

The Mindanao conflicts, propelled partly by demographic factors as in Rwanda, have not only claimed thousands of lives; they have doomed a once promising region to underdevelopment, with the World Bank estimating the total economic costs to surpass $10 billion.

Empowerment, development

To sum up, the RH bill is about empowering women to make decisions on family size and family welfare that would allow them to escape poverty and build a brighter future for their children. The micro effects of the RH bill at the family level, replicated in millions of families across the land, would have the effect at the macro level of slowing down population growth, allowing the country to divert more resources from consumption to investment, especially investment in a skilled work force, thus creating the conditions for economic takeoff.

At the same time, a lower rate of population growth would significantly reduce stress on the environment and lead to less social conflict.

(The authors are among the main sponsors of House Bill No. 4244, better known as the Responsible Parenthood and Reproductive Health bill.)