Now that the Responsible Parenthood and Reproductive Health (RPRH) Law has been passed and declared constitutional, can women look forward to the fulfillment of their right to optimum health, particularly in matters maternal?
When the amended Anti-Rape Law was passed in 1997, nobody really believed that we had seen the end of rape in the country. And true enough, women—and men and children—continue to be raped to this day, in the streets, in homes and bedrooms, in public, in motels, in bars, and, to put a high-tech spin to it: even online.
So it is with the RPRH Law. The law may require government health facilities to provide reproductive health services to anyone who seeks these with the possible exception of minors. But it doesn’t automatically mean that Filipino women will no longer die from causes related to pregnancy and childbirth, or that even those who troop to health centers will get health services of the quality they deserve and are guaranteed in law.
As with any piece of legislation, the RPRH Law needs the active involvement of all concerned: duty-bearers, constituents, civil society, public and private health personnel, educators, the media, even the Church, so that its goals are met. And among those goals is no less than the overall health of the nation, but with particular attention paid to the health of women—young and old, mothers and singles—as well as that of their children.
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THE CHALLENGE certainly looms large. In a global report on maternal mortality prepared by several United Nations agencies and the World Bank (cited by the NGO Likhaan), countries around the world posted remarkable records in reducing maternal mortality, with rates falling 45 percent from 1990 to 2013. Only two countries reported “no progress”: Guyana and the Philippines. And to make matters worse, the Philippines posted a 15-percent INCREASE in maternal mortality in the same period.
What makes this stark statistic even more disturbing is that in the highest quintile of the population, women enjoy a level of maternal health comparable to that of the most developed nations, with women having just one or two children on average. In poor communities, though, as had been pointed out in a column by the late former health secretary Quasi Romualdez, maternal and infant mortality rates closely resemble those in “the least developed countries of Africa and South Asia.” Poor Filipino women, on average, are having six or seven children during their reproductive years, when survey after survey has found that they want no more than two or three.
In another column of his (published in the newspaper Malaya), “Doc Quasi” cited “grave underlying problems” that compromise the health of Filipino women: widespread poverty especially severe for mothers and children, increasing teenage pregnancy, discriminatory labor practices, persistent human trafficking, and prevalent sexual violence.
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WHAT are the concerns raised by Filipino women in the post-RPRH context? Let me hazard a listing:
Quality of care: The national government, particularly the Department of Health, and local governments now have a mandate to provide “quality” RH care to all those seeking it. But what makes for “quality” health care? When we were first trying to establish the FriendlyCare foundation, we conducted focus group discussions on people’s expectations. A surprising (at least for me) finding was that poor people were willing to pay for health services provided they were treated with “respect,” and that services were provided equally regardless of social rank or their ability to “donate” for the services.
Also part of “quality care” is valuing the privacy of clients, with young people in particular expressing reluctance to visit public health facilities because the staff knew their parents or would even threaten to tell on them.
Which bring us to: services for young people. With the Supreme Court upholding the requirement for minors to seek “permission” from their parents before receiving RH services, can young women (and men) expect to receive quality, nonjudgmental and respectful care and counseling from public and private providers? What guidelines have been formulated to deal with pregnant teens, with pregnancy rates rising five times among poor teens than among those belonging to richer families? Do health providers have the right to breach a young patient’s right to privacy and confidentiality?
The RPRH Law requires “age-appropriate” sex education for students starting from Grade Five. Who determines what is appropriate for a tween or a teen? Will teachers be able to give full information and guidance and answer factually when students ask “uncomfortable” questions?
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AND SPEAKING of “discomfort,” what policies are being formulated to provide health services to the LGBT community? Philippine law doesn’t recognize Sogi (or sexual orientation and gender identity) rights yet, but undoubtedly, LGBTs do have health needs and concerns separate and different from those of heterosexuals. Are these being addressed, even in the private sector? Are they treated with respect, their privacy respected?
And what of the reproductive health needs of seniors? We may be beyond child-bearing age, but what about RH concerns like reproductive tract cancers, and the side effects of menopause and andropause? Are there parallel services to deal with aging concerns, including menopausal women’s vulnerability to heart conditions?
As with all good laws, the RPRH Law will find meaning, not in the letter of the law, but in the spirit with which it is made real.
(These are excerpts from a presentation made at the multisectoral national consultation on ICPD Beyond 2014 sponsored by the National Antipoverty Commission.)