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Will RH be a priority?

OUTSIDE, the entire metropolis, it seemed, was caught up in the feverish enactment of a “make-believe” scenario of “The Big One,” the long-overdue major earthquake hitting Metro Manila.

But inside the Century Park Hotel, adherents were gathered to discuss another sort of emergency altogether—the implementation of the Responsible Parenthood and Reproductive Health (RPRH) Law. More important, they were there to reflect on the accomplishments achieved since the law took effect, as well as the many barriers that still stand in the way of reaching the millions of Filipino women, men and children who stand to benefit from it.

Some might think the word “emergency” is a bit of an overkill to describe the country’s reproductive health situation. But what else do you call the death of about 12 women every day due to causes related to pregnancy and childbirth? If we are not alarmed by so many deaths of women to easily preventable causes, what does that say about the value we put on the lives of women, of mothers?

And along with the deaths of the mothers, we must also reckon with the deaths of newborns or children under five, for the death of a mother often results in the death of the child born to her as well. Other deaths we can include in the toll of a poor reproductive health situation are the deaths of people living with HIV/AIDS, women dying from cancers of the breast or of the cervix (the top two cancer killers of women in the Philippines); and women dying, or whose health are compromised, due to sexually-related violence at home and in the streets.

That these don’t count as “emergencies” speaks as much about popular attitudes toward motherhood and the status of women in our society, as it does about the health system and access of individuals, especially the poor, to life-saving medicines, drugs, devices and services.

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AT THE launch of the Second Popularized Report on the Implementation of the RPRH Law, Health Secretary Janette Garin stressed that “reproductive health should not stop with the law or with talking about it. (The need for it) is felt by every woman, every family, every community.”

She guided the audience through the “difficult voyage” to the passage of the law in 2012, describing it as a “dirty, dirty game” in which she was called out—as one of its prominent champions—for “promoting dissension in Congress.” Not only that, during the midterm elections of 2013, critics, including Catholic clerics, took to branding her as an “abortionist.” And while she was attacked regularly from the pulpits during Sunday Masses, as the election approached, the attacks escalated to daily harangues not just in churches but over Church-owned or influenced radio stations.

Even as the full implementation of the law was delayed for many months by a petition filed by opponents in the Supreme Court, Garin who had by then been appointed health secretary, was determined to fast-track and systematize the implementation of the law. She formed the “National Implementation Team” (NIT) to coordinate the efforts of agencies concerned with maternal and family health, together with the Population Commission and Dr. Yoly Oliveros of the Department of Health.

Former health secretary Esperanza Cabral was appointed NIT chair, while Dr. Junice Demetrio Melgar, recruited from the NGO sector, was appointed director of the Family Health Office which is tasked to carry out NIT’s programs.

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THE tandem of Garin and Cabral, said Melgar, “made possible the swift implementation of the law,” with P20 billion allotted for the programs under the 2015 budget.

Under the NIT, policies were first ironed out after a national evaluation, providing “strategic leadership” focused on Melgar, called “the most critical issues of the day.”

The areas covered by the NIT began, of course, with maternal health and mortality, then moved on to addressing issues of adolescent health, HIV/AIDS, and gender-based violence.

One strategy, Melgar noted, was to not just involve but also harness the energies of civil society groups working together with government health providers and the private health sector.

The recent Supreme Court ruling temporarily preventing the DOH from providing implants and issuing licenses for all other forms of contraception (even those with existing permits) has proven to be a hindrance but, said Melgar, “it has never stopped the team from doing what it can.”

Aside from greater funding from the DOH (despite efforts by legislators to cut the flow of money for contraceptives), the NIT also counted on funding support from PhilHealth. Altogether, the public health insurance provider made possible P97 billion in reimbursements for those accessing RH services.

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CERTAINLY, challenges remain for the “new team” taking over the DOH and the reproductive health program. But it certainly helps that the secretary-to-be, Dr. Paulyn Ubial, is a longtime DOH insider who has long been involved in maternal and child health, although she is at present assistant secretary in charge of the Office of Health Regulations.

Foremost of these is the existing TRO issued by the Supreme Court against the implants and the issuance of permits for all forms of contraceptives. Not only does the order present a large challenge to the program—for what is a reproductive health program without available contraceptives?—it also has, as Garin put it, “a chilling effect” on local governments who may be leery to provide any sort of RH service for fear of running into trouble with the law.

If President-elect Rodrigo Duterte holds as much commitment to maternal and child health as he does to eradicating criminality, he should put RH among the top of his agenda while in office.

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