on RH bill by ateneo professors (engl 2 tf 4-5:30)

an excerpt of
CATHOLICS CAN SUPPORT THE RH BILL IN GOOD CONSCIENCE
(Position paper on the Reproductive Health Bill by individual faculty* of the Ateneo de Manila University)
link http://2010presidentiables.wordpress.com/reproductive-health-bill-5043/text-of-ateneo-professors-position-paper-on-rh-bill-5043/

The Realities of Women and Their Children

No woman should die giving life. Yet, in the Philippines, 10 women die every 24 hours from almost entirely preventable causes related to pregnancy and childbirth (POPCOM 2000). Our maternal mortality rate continues to be staggeringly high, at 162 maternal deaths for every 100,000 live births (National Statistics Office (NSO), 2006 Family Planning Survey (FPS)). More lives would certainly be saved if all women had access to good prenatal, delivery, and postpartum care.

The reality, however, is that 3 out of 10 Filipino women do not have the recommended number of prenatal care visits (at least 4); and 6 out of 10 women still deliver at home, where they rarely have access to a skilled birth attendant, or to quality obstetric services in case complications arise (NSO and ORC Macro 2004, 2003 National Demographic and Health Survey (NDHS)). Moreover, because a woman’s life and wellbeing are inextricably linked to that of her child’s, it is not surprising that the country’s infant mortality and under-five mortality ratios remain also worrisome: for every 1,000 live births, 24 children die before they reach the age of one, and 32 children die before they reach the age of five (NSO, 2006 FPS).

Aside from poor maternal care, our alarming maternal mortality rate also stems from the high incidence of induced abortions. The silence on this topic shrouds the tragedy of many Filipino women who have resorted to it in desperation. An estimated 473,400 women had induced abortions in 2000, translating to an abortion rate of 27 abortions per 1,000 women aged 14-44, and an abortion ratio of 18 abortions per 100 pregnancies (Juarez, Cabigon, Singh and Hussain 2005). Abortion not only terminates the life of an unborn child but also imperils the life of the mother, especially if performed in unsafe clandestine clinics by untrained personnel, or induced by the woman herself, as is the case of poor women who cannot afford a surgical abortion, or the services of a traditional practitioner (hilot). Of the nearly half a million women who had abortions in 2000, 79,000, or 17 percent, wound up in hospitals as a result of abortion complications (ibid.). Induced abortions accounted for 12 percent of all maternal deaths in the Philippines in 1994 (ibid.), and is the fourth leading cause of maternal deaths.

Studies show that the majority of women who go for an abortion are married or in a consensual union (91%), the mother of three or more children (57%), and poor (68%) (Juarez, Cabigon, and Singh 2005). For these women, terminating a pregnancy is an anguished choice they make in the face of severe contraints. When women who had attempted an abortion were asked their reasons for doing so, their top three responses were: they could not afford the economic cost of raising another child (72%); their pregnancy occurred too soon after the last one (57%); and they already have enough children (54%). One in ten women (13%) who had attempted an abortion revealed that this was because her pregnancy resulted from forced sex (ibid.). Thus, for these women, abortion has become a family planning method, in the absence of information on and access to any reliable means to prevent an unplanned and unwanted pregnancy. The fact is, our women are having more children than they desire, as seen in the gap between desired fertility (2.5 children) and actual fertility (3.5 children), implying a significant unmet need for reproductive health services (NSO and ORC Macro 2004, 2003 NDHS)

The importance of family planning to the lives of women and their children cannot be emphasized enough. The United Nations Population Fund (UNFPA n.d.) asserts that women’s access to effective contraception would avert 30 percent of maternal deaths, 90 percent of abortion-related deaths and disabilities, and 20 percent of child deaths. In the Philippines, however, women sorely lack adequate access to integrated reproductive health services. This stems mainly from an inconsistent national population policy which has always been dependent on the incumbent leader. For example, studies have pointed out that former President Fidel V. Ramos and then Health Secretary Juan Flavier showed strong support for family planning initiatives. In contrast, President Gloria Macapagal Arroyo appears to have an incoherent national population policy, because while she recognizes the need to reduce the country’s population growth rate, on the one hand, she relegates the responsibility of crafting, funding, and implementing population and reproductive health programs to local government units (LGUs), on the other. Thus, we are witness to uneven reproductive health and family planning policies and programs across LGUs: Whereas Aurora and the Mountain province, and Davao, Marikina, and Quezon Cities have put in place commendable RH policies and programs, a metropolitan city like Manila teeming with informal settlers had banned modern artificial methods of family planning under the administration of Mayor Joselito Atienza.

From the foregoing, it is easy to understand why the contraceptive prevalence rate of the Philippines is only 50.6 percent (NSO, 2006 FPS). This means that only a little over half of married women use any family planning (FP) method, whether traditional FP (14.8%), modern natural or NFP (0.2%), or modern artificial FP (35.6%). And yet an overwhelming majority of Filipinos (92%) believe that it is important to manage fertility and plan their family, and most (89%) say that the government should provide budgetary support for modern artificial methods of family planning, including the pill, intra-uterine devices (IUDs), condoms, ligation, and vasectomy (Pulse Asia, 2007 Ulat ng Bayan survey on family planning). In another survey, the majority (55%) of respondents said that they are willing to pay for the family planning method of their choice (Social Weather Stations, 2004 survey on family planning).

The evidence is clear: Our women lack reproductive health care, including information on and access to family planning methods of their choice. Births that are too frequent and spaced too closely take a delibitating toll on their health, so that many of them die during pregnancy or at childbirth. Some of them, despairing over yet another pregnancy, seek an abortion, from which they also die and along with them, their unborn child too.

The sanctity of human life and the dignity of the human person
The Catholic Church proclaims that every human person is created in the image and likeness of God, as well as redeemed by Christ. Therefore, each person’s life and dignity is sacred and must be respected. “Every violation of the personal dignity of the human being cries out in vengeance to God and is an offense against the creator of the individual,” according to Christifideles Laici (1988, no. 37). Indeed, we should measure every institution by whether it threatens or enhances the life and dignity of the human person whether that individual is a woman agonizing over her ninth pregnancy, or an unborn child in a mother’s womb.

The RH Bill as pro-life and pro-women
We support the RH Bill because it protects life and promotes the wellbeing of families, especially of women and their children. Contrary to what its detractors say, the RH Bill is not “pro-abortion,” “anti-life,” or “anti-women.” With “respect for life” as one of its guiding principles (sec. 2), the bill unequivocally states that it does not seek to “change the law on abortion, as abortion remains a crime and is punishable” (sec. 3.m). It can be argued, in fact, that in guaranteeing information on and access to “medically-safe, legal, affordable and quality” natural and modern family planning methods (sec. 2), the bill seeks “to prevent unwanted, unplanned and mistimed pregnancies” (sec. 5.k) the main cause of induced abortions. The RH Bill is also pro-life and pro-women because it aims to reduce our maternal
mortality rate, currently so high (at 162 maternal deaths per 100,000 live births) that the government has admitted that it is unlikely to meet the Millennium Development Goal target of bringing it down by three-fourths (to 52 maternal deaths per 100,000 live births) by 2015 (NEDA and UNCT 2007). For example, section 6 of the bill enjoins every city and municipality to endeavor “to employ adequate number of midwives or other skilled attendants to achieve a minimum ratio of one (1) for every one hundred fifty (150) deliveries per year.” Section 7 instructs each province and city to seek to establish, for every 500,000 population, “at least one (1) hospital for comprehensive emergency obstetric care and four (4) hospitals for basic emergency obstetric care.” Section 8 mandates “all LGUs, national and local government hospitals, and other public health units [to] conduct maternal death review.”

Moreover, the RH Bill’s definition of “reproductive health care” goes beyond the provision of natural and modern family planning information and services, to include a wide array of other services (sec. 4.g). These include: maternal, infant, and child health and nutrition; promotion of breastfeeding; prevention of abortion and management of post-abortion complications; adolescent and youth health; sexual and reproductive health education for couples and the youth; prevention and management of HIV/AIDS and other sexually transmittable infections (STIs); treatment of breast and reproductive tract cancers and other gynecological conditions; fertility interventions; elimination of violence against women; and male involvement and participation in reproductive health. We therefore ask, How then can the RH Bill be violative of human life and dignity?

To reiterate, because reproductive health is central to women’s overall health, fundamental aspects of women’s wellbeing are compromised when reproductive health is ignored. The conditions under which choices are made are as important as the actual content of women’s choices: the right to choose is meaningful only if women have real power to choose.

The Conditions of Poor Families

Poverty is a multi-faceted phenomenon caused by inter-related factors: the weak and boom-and-bust cycle of economic growth; inequities in the distribution of income and assets and in the access to social services; bad governance and corruption; the lack of priority accorded to agriculture including agrarian reform; the limited coverage of safety nets and targeted poverty reduction programs; and armed conflict. However, there is no question that poverty in the Philippines is exacerbated by our rapid population growth (Alonzo et al. 2004, Pernia et al. 2008), which, at 2.04 percent, is one of the highest in Asia. A close association exists between our country’s chronic poverty and rapid population growth, as the latter diminishes overall economic growth and blights the prospects of poverty reduction. Curbing our population growth rate is thus a requisite of sound economic policy and effective poverty reduction strategy, and needs to be undertaken with the same vigor we would exert in fighting corruption, improving governance, or redistributing resources.

Turning once again to the conditions of our people, surveys have established the strong association between household size and poverty incidence. Women aged 40-49 in the poorest quintile bear twice as many children, at six children per woman, compared to an average of three children for women in the richest quintile (NSO and ORC Macro 2004, 2003 NDHS). The same pattern is seen when one considers the woman’s educational background: women aged 40-49 with no education (invariably because they are extremely poor) give birth to an average of 6.1 children, whereas women with college or higher education have three children on average (ibid.)

The sad fact is, whereas women in the richest quintile, who have three children on average, are able to achieve their desired number of children (2.7 children), the poorest do not. Women in the lowest quintile, who bear an average of six children, have at least two children more than their ideal number (3.5). The inability of women in the poorest quintile to achieve the number of children they want stems from their high unmet need for family planning, which, at 26.7 percent, is more than twice as high as the unmet need of women in the richest quintile, at 12.3 percent (ibid.).

In addition, studies have noted an inverse relationship between family size and household wellbeing. In particular, an increase in family size is accompanied by a decrease in per capita income, a decrease in per capita savings, and a decrease in per capita expenditures on education and health. Applying standard statistical techniques to indicators of household wellbeing in the 2002 Annual Poverty Indicators Survey (APIS), Orbeta (2005) notes that small families with four members enjoy twice as much income per capita, at P18,429 per annum, compared to large families with nine or more members, at P8,935. Annual savings per capita also declines from P2,950 for a four-member household, to P1,236 for a nine or more-member household.

Expenditures on education and health are good indicators of a family’s investment on the wellbeing of its members. Based on the 2002 APIS, small households with four members spend 2 ½ times more on the education of each child in school, at P1,787 per student, compared to large households with nine or more members, where annual education expenditure per student is only P682. Similarly, four-member households spend nearly thrice as much on the health of each member, at P438, in contrast to nine or more-member households, where annual health expenditure per capita is only P150. These figures reveal that as household size increases, a family needs to spread its resources more thinly, thus investing less on the education and health of each member. This has deleterious consequences on human capital and income-earning potential (Orbeta 2005).

Moreover, as family size increases, school attendance of its members drops. The proportion of school-age members 6 to 24 years old who attend school declines from 67.9 percent for four-member households, to 65.6 percent for nine or more-member households (2002 APIS survey, cited in Orbeta 2005). The prevalence of child labor is also associated with household size. Working children’s families tend to be larger (7-11 members) than those of nonworking children (2-5 members) (Del Rosario and Bonga 2000).

In summary, poor households typically have more children than they aspired to have, as a result of a high unmet need for family planning. A large family size strains a poor family’s capacity to earn, save, and provide education and health care for its members. This diminishes children’s human capital and income-earning potential, and explains why poverty tends to be transmitted and perpetuated from one generation to the next.