Reproductive
Health Challenges
in the Philippines
Esperanza I. Cabral, M.D.
Outline of Presentation
• State of Reproductive Health in
the Philippines
• Challenges of Reproductive
Health in the Philippines
Reproductive Health
rights-based approach
Reproductive health is a state of complete
physical, mental, and social well being and not
merely the absence of disease or infirmity, in all
matters related to the reproductive system and to its
functions and processes.
It includes sexual health, which means having a
responsible, satisfying and safe sex life free from
disease, injury, violence, disability, unnecessary pain or
risk of death.
adapted from FWCW Platform 94, 97; ICPD 7.2
The State of Reproductive Health in the
Philippines
• Women and young people face huge social
and economic barriers to RH
• 3 million couples do not have access to family
planning services.*
• Over 5,000 women die from complications of
pregnancy and child birth each year (14
mothers everyday)**
*2008 NDHS
**2011 FHS
State of Reproductive Health in the
Philippines cont’d.
• Over 33,000 children die in the first month of
life.*
• Over 15,000 reported cases of HIV/AIDS since
1984.**
• RH problems account for 20 % of the burden
of health among women of reproductive age
and 14% for men
* 2009, DOH, Philippine Health Statistics
** 2013, DOH National Epidemiology Center
The State of Reproductive Health
in the Philippines
•
•
•
•
10.5 million women of reproductive age
5.9 million women at risk of pregnancy
3.37 million pregnancies
1.82 million unintended pregnancies annually
• 90% occurred in women using no or traditional methods
(e.g., NFP) of contraception
• 2.25 million births
• Almost 1 million unwanted or mistimed births
Unintended pregnancy is a major public health
problem that affects individuals and society
www.guttmacher.org/pubs/MWCNPmethodology.pdf
Having babies.
Not necessarily
more fun in the Philippines.
Under-five Mortality Rate
Deaths per 1000 live births
60
54
48
50
40
40
34
30
28
20
26.7
10
0
1993
1998
2003
2008
NDHS Survey Year
MDG target is 26.7/1,000 live births by 2015
2015
Infant Mortality Rate
40
Deaths per 1,000 live births
35
34
35
29
30
25
25
22
20
19
15
10
5
0
1993
1998
2003
2008
NDHS Survey Year
MDG target is 19/1,000 live births by 2015
2015
Little Progress in MDG 5 –
the Goal we are least likely to meet
222
Sources:
1993 NDHS,
1998 NDHS, 2003 NDHS, 2011 FHS,
Sources: 1993 NDS,
1998 NDHS,
2006 FPS
Contraceptive Use Among Currently
Married Women
Contraceptive
Prevalence Rate
Modern Contraceptive
Prevalence Rate
2003
2008
49%
51%
33%
34%
NDHS (2003, 2008)
 Most commonly used modern method is the pill,
followed by sterilization
 Modern natural family planning: 0.5% use in 2008
 mucous/billings/ovulation method,
 standard days, and
 lactational amenorrhea method
Rise in unintended pregnancy risk
Trad. Method
Users
Unmet Need
17
18
16
20
17
1998
2003
% of married women of reproductive age, NDHS surveys
22
2008
Reproductive Health in the Philippines
The averages tell only part of the story
The Poor and Access to Health
"For unto every one that hath
shall be given, and he shall
have abundance: but from him
that hath not, shall be taken
away even that which he
hath."
Matthew 25:29, King James Version.
Inequity nowhere more evident than
in reproductive health care
Reproductive Health Situation,2008
Key Reproductive Health
Indicator
National
By Wealth
Quintile
Poorest
Richest
3.3
2.8
0.5
5.2
3.1
1.7
1.9
1.6
0.3
33.2
26.1
30
44.1
40.5
13.1
34
26
43
Age at first marriage, yrs
22.2
19.8
23.3
Unmet need for FP(MWRA), %
22.3
28.2
20.5
Actual fertility, births per woman
Wanted fertility, births per woman
Difference in actual vs wanted births
Birth Interval, months
Early childbearing, %
Contraceptive use (modern methods), %
Source: 2008 National Demographic and Health Survey. NSO.
Inequity Due To Poverty
Reproductive Health Indicators by Wealth Quintile, 2008
By wealth
% SHP
quintile Deliveries
%
Facilitybased
delivery
% by
CPRCaesarean Modern
section
(married )
% women
(15-24)
started
childbearing
Poor(est)
26
13
1.7
26
44
Rich(est)
94
84
20.3
43
13
National
62
44
10
34
26
NSO-NDHS 2008
Inequity in Health Outcomes
Overall Average Fertility Rate - 3.3 (2008)
Average Fertility Rate by Income Quintiles
Income Group
A
B
C
D
E
Source: NDHS 2008
Average Fertility
Rate (Desired)
1.9 (1.6)
2.7
3.3
4.2
5.2 (3.1)
Consequences of poor
women’s inability to access
modern family planning
methods
 >800,000 unintended births
 >560,000 abortions
 > 5,100 maternal deaths
 other health, economic
and social costs
Source: Guttmacher Institute 2009
Broken promise:
"Contraceptive Self-Reliance Strategy"
"Government, to include
national and local levels,
shall act as
'guarantor of last resort'
assuring that contraceptives
remain available for current users
who depend on
donated supplies…."
- DOH AO 158 s. 2004
Failed NFP-focused policy
"… as many as 67.6% of currently married women stand to
benefit from using modern NFP methods." …
"[by 2006]… raise NFP use rate to 20% among
currently married women/couples who are not yet using
any method of contraception"
- DOH AO 125 s. 2002
NFP current users
0.1%
1998
0.3%
2003
% current use, married women of reproductive age, NDHS surveys
0.5%
2008
3-prong strategy to
prevent mothers/babies from dying
1. Planned Families
2. Facility based delivery by
Skilled Health Personnel
(MD, nurse, midwife)
3. Emergency
obstetric and
neonatal care
Emergency
Obstetric and
Newborn Care
• When it comes to
reproductive health – we
don’t know everything but we
know quite a bit
• The bigger challenge is
applying the solutions we
already know to the problems
at hand
• The gap between what we
know and what we do is
fundamentally political.
THE REASONS FOR THE PHILIPPINES’
POOR RH PROFILE
General Ignorance on RH Issues
Poverty
Objections from the Catholic Church
Poor Leadership and Governance
Non-recognition that we have a major problem that
puts us out of sync with development.
Weak health systems
Weakness in development issues
Poor implementation of signed conventions
Intimidated by the Catholic Church
LGU Contraceptive Ban
Ayala Alabang, 2011
NGO FP outreach using makeshift clinic, MANILA 2009
Chronology of RH Bills
RH Bill
Congress
Results
HB 120(Rep. S. Acosta)
Establishing a Population Policy
10th Congress
1995-1998
CSOs started dialogues with each
other; no movement in Congress
HB 8110(Reps. A-Castillo, L-Luistro)
Reproductive Health Policy
11th Congress
1998-2001
Public hearing
HB 4110(Rep. A-Castillo)
Reproductive Health Care Act
12th Congress
2001-2004
Committee level approval
HB 16, HB 3773(Rep. E. Lagman)
Reproductive Health
13th Congress
2004-2007
Approved by Comm. on Health,
pending at the HOR Comm. on Rules
HB 17, HB 5043, SB 3122(Rep. E.
Lagman and Sen. R. Biazon)
Reproductive Health
14th Congress
2007-2010
Approved at the Committee level at
HOR & Senate, started plenary
debates in both chambers
HB 4244, SB 2865
(Rep. E. Lagman et al, Sen. P.
Cayetano and Sen. M. Santiago)
15th Congress
2010-2013
Voted & passed on Third and Final
Reading. Now known as R.A. 10354
17 years of struggle
The right to
Informed Choice
The duty to
provide RH
information and
services
particularly to
the poor
Aim of the Reproductive Health Bill is to
achieve these outcomes equitably
• Improved maternal and newborn health
• Accessible, high quality family planning
choices
• Elimination of unsafe abortions
• Reduced incidence of HIV and STDs
• Greater awareness of sexual health and
reduced risky behavior
• Gender equality, rights, accountability and
equity.
So,
What is
WRONG
with the
RH BILL ?
D ivorce
Euthanasia
Abortion
Total Population Control
Homosexuality/
same-sex marriage
TO THE FAMILY
“Those who in principle oppose birth
control are either incapable of
arithmetic or else in favor of war,
pestilence, and famine as permanent
features of human life.”
Bertrand Russell
RA 10354 (An Act Providing for a
National Policy on Responsible
Parenthood and Reproductive Health)
Characteristics of the RH Law
• Rights-based
• Health-oriented
• Sustainable development-driven
What the RH Law Provides
1. Access to skilled health professionals before,
during, and after delivery
2. Establishment and upgrading of obstetric facilities
and training of skilled health professionals
3. Preventive and treatment services for HIV and
other Sexually Transmitted Diseases
4. Access to different family planning methods
5. Age- and development- appropriate reproductive
health education
6. Proscription of abortion & management of
abortion complications
Other Things the RH Law Provides
1. maternal, infant & child health & nutrition,
including breastfeeding
2. adolescent and youth reproductive health
3. elimination of violence against women
4. education and counseling on sexuality and
reproductive health
5. treatment of breast & reproductive tract cancers
& other gynecological conditions and disorders
6. male responsibility and participation in
reproductive health
7. prevention and treatment of infertility and sexual
dysfunction
8. mental health aspect of reproductive health care
WHAT NOW?
Threats continue
 13 petitions vs. law with the Supreme Court;
SC issued Status Quo Ante order postponing
implementation of the law for 120 days. Oral
arguments heard. 60 days to file final
memoranda.
Threats continue
 Anti-RH bills refiled in the
16th Congress.
Budget for RH services will always be a
matter of negotiations.
 Some areas are bailiwicks of the Catholic
Church and anti-RH LGU officials: Batangas,
Laguna, Bulacan, Bataan, Manila & Caloocan
Cities, Negros Occ., Bohol, Cebu, etc.
RH Challenges after the
Supreme Court rules favorably
(1)Education
(2)Adoption
(3)Implementation
(4)Sustention
Every woman empowered,
Every pregnancy safe & wanted,
Every child provided for & loved.
UNFPA
Reproductive Health Rights
Duty of the State to Work for All