RH Bill: Are you for or against it?

Posted at 08/04/2012 11:33 AM

The RH bill is now in the high priority list of congress and soon the representatives will be forced to decide on the issue. As of now, the battle lines are slowly being drawn as the arguments are rehashed. I’m an advocate of good governance in public health. We run initiatives in different areas and it is not new to me when people ask my opinion about the RH Bill. “Are you for or against?”, they would usually ask.

I have always evaded the question because I know debates almost end up nowhere. The conflicting values are deep-set. However, I also realized that by staying in the middle, I am not contributing to the country to be able to move forward beyond this impasse. I have read previous versions of House Bill 4244. I have also read Senate Bill 2378. Both are similar in that they cite maternal mortality as a primary basis for the law. While HB 4244 merely hints about teenage pregnancies, SB2378 explicitly states the need to mitigate high teenage pregnancy rates. Finally, HB4244 explicitly includes Population Development while SB2378 does not.

In order to have a handle on the Pro-RH Argument, and without over simplifying the rational of the proposal, it is okay to consider that the primary reason for the bill is birth deaths and over population.

On the other hand, the Anti-RH Argument primarily focuses on morality and the values of the Catholic Church.

During MY consideration, I had to sadly dismiss the argument of the Church that RH is a moral issue. I believe that putting this forth as the highest moral degradation in the country is inaccurate and being selective. I believe that if morality is the lens at which I am to argue, I would also need to argue against corruption with the same zeal - if not more. This inconsistency created double standards that occlude any sense of moral priority that the Church has. The Church’s lack of consistency in communicating and addressing moral issues and priorities regrettably diminished their ascendency in this particular matter.

Never-the-less, I cannot easily dismiss the catholic values in which my faith was founded and strongly anchored. For this reason, the values I hold serve as counterweight against the RH Bill. I delved into this and studied the RH Bill with a negative perspective against it. I needed to see a counter value for me to seriously consider endorsing this publicly and with my friends. It is something that threatens part of my identity and at some length, what it means to be a Filipino.

As I studied the RH bill, and as I immersed myself in public health development and maternal health development, I saw the counter-weighing value against what I held.

The question that stretches the social consciousness of the country is not a moral issue but an ethical dilemma. On one side is my Catholic value which I hold dear and on the other side is the genuine need to address a public health issue.

This ethical dilemma is enough motivation for me to take time to read and re-read this policy proposal. At the very least, I found, thru my reading and a few years of exposure in public health, that it would be unethical if I am dismissive of the RH Bill.

I found that the rational for the RH Bill justifies a measure to address maternal health development. Deaths due to complicated pregnancy is very high and teenage pregnancy is also high. I believe that simply going against the bill without an alternative to address the maternal health issues in the country is irresponsible.

But there is also a fundamental flaw in the the way the bill is presented. Let me sight the two issues about the RH bill that leaves a doubt in my mind.

First, the policy rationalizes maternal health needs as a primary reason for the bill. As it does, it pushes reproductive health.

By framing the need to address maternal health with a reproductive health bill, the authors of the bill have pushed population control as a twin sister in pushing for maternal health development. Consequently, any efforts that rationalize the improvement of maternal health delivery, like birthing, pre-natal check-ups will be questioned because of the controversial reproductive-health-twin-sister.

In my view, I believe that maternal health must be pushed separately from reproductive health. In my experience managing public health programs, the need for improved public and private maternal health facilities and services must be prioritized with or without the RH Bill. Though some issues in reproductive health is intertwined with woman's health, maternal care need to be approached separately from population control/development. If the framers were more sensitive to the Filipino culture, they would know better to separate the policies to give maternal health development a lead start at addressing the issues.

But I can only speculate that they packaged the two issues together because reproductive health initiatives are next to impossible to pass in our country.

In the US, they have a policy that addresses preventative care for as many as 47 million women. In this law, which is a big part of Obama's signature health care program, private health care polices must cover yearly checkups of women with no "out-of-pocket" costs. This coverage include: Pre-natal care, breast exams, cancer screening, diabetes screening, and domestic violence screening. Under Obama's health policy they will also cover breast feeding supplies as well as contraception. The contraceptive coverage provoked a political fight with the religious groups and conservatives. This issue is very important as employers renew policies. So far their proposed solution is to offer a waiver to religious employers to exclude contraceptive coverage. Just today, House Republicans argued that the federal government has gone too far with this policy. New York Representative Ann Buerkle said, "This is not about woman's health. This is the largest assault on our first amendment rights which is religious freedom." Because of this, women who need the other benefits besides contraceptives will have to wait a little while longer as the US Congress sort this out.

This is their version of the RH Bill.

Second. House Bill 4244 indicates under provision 10 that:
There shall be no demographic or population targets and the mitigation of the population growth rate is incidental to the promotion of reproductive health and sustainable human development.

However, the title of the bill is “The Responsible Parenthood, Reproductive Health and Population and Development Act of 2011.”

In my opinion, this indicates that the framers seek to skirt the issue of population control yet is compelled to frame a policy that it is because of the title. This inconsistency diminishes the intent of the law. Is this for population development and control or for maternal health development? The strongest argument of the RH Bill is the need for maternal health development but much of the content focuses on reproductive health and population development. If I were to look at this with a good governance perspective, I will have to ask these questions in order to later determine how resources will be allocated. How much funding would contraceptives have? How much money would be allocated to birthing facilities and strengthening pre-natal care?

Which now brings me back to the question: “Am I for RH or Not?”

In spite of all these questions and doubts about the RH Bill, I need to ask myself an alternative if I am oppose it. Imperfect as it is, it is still an effort to address the need in the country.

I will support the RH Bill in the absence of any alternative policy.

The good governance practice here is the journey thru the ethical dilemma to value my faith while I own the problem of maternal health development.

In supporting the RH Bill I needed to ask myself. Do I know the issues? Am I part of it? How can I help? What values do I see and put more consideration on?

I think the RH Bill is not yet the answer to the questions that stretch our understanding. The debate between our faith and the answers to problems around us will linger. I think the RH Bill is a just a start of something which will evolve and become better as we continue to engage.

As a footnote and an ending to my opinion, let me share to you the origin of the partnership of a Kaya Natin initiative in District 3, Quezon City.

The program is a public health development effort in partnership with Congressman Bolet Banal, the Parish of Sta. Maria dela Strada in Katipunan Avenue, Kaya Natin, and Merck, Sharp, and Dohme (MSD).

It started with a dialogue regarding the RH Bill in 2010. Cong Bolet was for the bill while the parish was not. They did not agree on the RH Bill but they agreed to address the problems in the community and improve maternal health care.

Now, the program is called HEALTH LEADERS FOR MOTHERS or HL4M. This program seeks to improve maternal health access for mothers in selected barangays in Quezon City. There have been almost 2,000 pregnant women that benefited from this program in just two years. By the end of 2014, we expect to reach 6,000 women.

This year, Sta. Maria dela Strada, thru the SINAG Movement is putting up a community managed lying-in facility to cater to the mid-wives and the mothers to promote birthing in maternal facilities.

Do I support the RH Bill?

Yes, I do.

But more important than supporting it, I have taken concrete actions to respond.

How do you respond to the question?

(If you wish to know more about this program watch the YouTube video, search HL4M in You Tube or visit: http://youtu.be/kgLMBJKJ3Xk , You can also search for “Health Leaders for Mothers” in Google)