The debate over reproductive health and population control through the lenses of the state and the Catholic Church in Philippine history
Jennifer Sta. Ana X PAMPUBLIKO
It has been a long and grueling process for proponents of Reproductive Health (RH) initiatives in the Philippines. “It took 14 years and a tortuous struggle before the Reproductive Health Law was finally passed in 2012 despite attempts by conservative groups and the Catholic Church to derail the measure.”1 However, despite its passage into law, opponents of the RH bill continue to find ways to challenge its implementation.
Earlier this month we discovered that senators had succeeded in defunding P1 billion from the RH fund. “The budget cut of P1 billion denies these women (and impoverished couples) access to medically safe, nonabortifacient and effective RH services and commodities, because the fund was earmarked by the Department of Health for free supplies of condoms, IUDs and birth control pills.”2 This cut also leaves us to rely unsustainably on private and foreign donors to make contraceptives freely available.
According to the United Nations Population Fund (UNFPA) the population growth rate has successfully decreased from 1.9% in 2010 to 1.7% in 2015, as has maternal mortality ratio.3 Yet, from 102.4 million people in 2015, our country’s population is projected to rise to 104 million this year.4 The Philippines still has one of the highest fertility rates among its neighbors, and well above the world average.
Figure 1: Fertility Rate (1960-2012)5
Population control has been central to the global economic development discourse since the 1960s and family control and reproductive health have been central to the women’s and human’s rights discourse since the same period. What has the localization of these global discourses looked like in the Philippines? What is the history of our policy attempts and contending perspectives in this matter that can give us a roadmap for how this debate will continue to play out in the Philippines?
1. Marcos’s progressive population policy efforts
Since reproduction health was introduced into the public sphere under the rubric of population control, the Catholic Bishops’ Conference of the Philippines (CBCP) has vehemently protested against it. Reproductive health care policies in the Philippines began during the 1960s wave of international population policy development. At the time, Ferdinand Marcos served as President and was attuned to the international concern that social, economic, and developmental problems were affiliated with the rise in population. The regulation of population size and initiatives for family planning were situated as top priorities in his political agenda. In 1967, he joined other signatories by endorsing the United Nations Declaration on Population. Two years after, Marcos set up the Commission on Population (POPCOM) to manage and conduct studies on population growth. At his 1970 State of the Nation, the President announced that national family planning was to become official policy, consisting of educating the public about the dangers of rapid population increases, relaying information about birth control, and providing reproductive services, especially in the rural pockets of the country.5
The abuses of Marcos’ regime have overshadowed his progressive reforms on population control and RH.
Once martial law was declared in 1972, Marcos expanded the program by strengthening the POPCOM, raising its annual funds from 4.5 million pesos to 15 million pesos.6 Presidential Decree No.79 ordered health professionals trained and authorized by POPCOM to provide sanctioned contraceptives to patients seeking them.7 Marcos embedded his initiatives in Article 15, Section 10 of the 1973 Constitution, which declares, “It shall be the responsibility of the State to achieve and maintain population levels most conducive to the national welfare.”8 In the years following, Marcos aggressively implemented other steps, such as amending the Internal Revenue Code to allow tax exemptions for those who have four children or under, permitting the use of sterilization, lifting custom duties on family planning supplies, mandating private employers to provide family planning services for female employees, allowing for oral contraceptives to be available without a prescription, requiring those seeking a marriage license to receive education on family planning, and authorizing local governments to pay for all projects dealing with population and responsible parenthood. In the midst of all these activities, the CBCP denounced the government for advocating practices antagonistic to natural family planning.9
The abuses of Marcos’ despotic regime have overshadowed the ruler’s progressive reforms on population control and reproductive health. While Marcos’s policies are tainted by his regime’s overall corruption and abuses, the CBCP as one of the central protagonists of the People Power Revolution earned political clout that would give it renewed power in the debates to follow over reproductive health policies. This would be seen in its influence during the Arroyo presidency, over the International Conference on Population and Development (ICPD) and the Fourth World Conference on Women (FWCW), and in the 2010-2012 debates over reproductive health bills in Congress.
2. Post-EDSA: Turning away from Marcos’s population policies
President Cory Aquino changed track away from Marcos's policies for population control. The presidential successor chosen by the Catholic Church during the People Power Movement, Cory Aquino's family planning initiatives faithfully adhered to the Church’s support for the natural family planning methods, as seen in the Constitution of 1987. Article 2, Section 12 states, “The State recognizes the sanctity of family life and shall protect and strengthen the family as a basic autonomous social institution. It shall equally protect the life of the mother and the life of the unborn from conception.”10 She shifted the political focus from family planning to family well-being, and placed Mita Pardo de Tavera, a staunch conservative, at the head of POPCOM. Statistics show that once Cory Aquino ascended into power, health personnel promoting family planning decreased from 10,000 to 200, and couples using birth control dropped from 45% in 1986 to 36% in 1988.11 Though Cory Aquino was pushed to partially recover family planning initiatives because USAID suspended funds in 1990 — thus motivating the Philippine government to carry more of the weight in terms of family planning12 — natural family planning was emphasized in a much higher regard than other contraceptive methods.
To preempt the forthcoming International Conference on Population and Development (ICPD) to be held in Cairo (the conference that would later go on to declare that “it is globally recognized that fulfilling the rights of women and girls is central to development”13), a pastoral letter written by the Archbishop of Manila, Jaime L. Cardinal Sin on July 25, 1994 was read across the country during mass. It stated:
Our children are being conditioned systematically to adopt a contraceptive mentality. Now they are being brainwashed to accept as normal, attractive, and even glamorous certain unnatural, abnormal and perverse sexual relationships and behavior…14
A range of 200,000 to one million people responded to the letter’s call, gathering in support at Rizal Park in Luneta on August 14, 1994.15 Attendees at the rally included: former President Cory Aquino; mayor of the capital city of Manila, Alfredo Lim; senators; celebrities; and heroes from the People Power Revolution of 1986.16 The Ramos government took great notice of this gathering and invited the Church to discuss its issues with the ICPD. After a closed-door meeting that lasted for six hours, the Church and the government came up with guidelines that would act as the basic premise for the Philippine delegation’s position at the ICPD. It was also agreed that these guidelines would shape future policies on population and reproductive health care.17
"...Couples using birth control dropped from 45% in 1986 to 36% in 1988."
To further ensure that the Philippine delegation would not counter the Church’s notions on family, the CBCP lobbied to have Macagba Tadiar and Marilen Dangulian (two delegates who supported abortion if the woman’s life were in danger, in cases of rape and incest, and if there were grave fetal malformations) removed as delegates. With Dangulian and Tadiar gone, at the actual ICPD, the Philippine delegation closely adhered to the agreed guidelines established by the Ramos administration and the CBCP. At the ICPD meeting itself, the Holy See acted as a non-state permanent observer, loudly vocalizing its protest against the rhetoric of unsafe abortion. The Vatican deemed all abortions are unsafe. The positions of the Vatican helped to keep discussions over the use of this term in Paragraph 8.25 of the ICPD Program of Action plan in three days of debate, and two days at a working group. The debate and delay over 8.25 and other sections of the ICPD’s Program of Action convey the forceful presence at Cairo that disquieted Philippine delegation from blatantly taking a stance against the Church.
A year later, bishops revived familiar tactics to display their opposition to the Fourth World Conference on Women’s (FWCW) agenda on reproductive rights, and once in Beijing, the Philippine delegation to the FWCW would again mirror the opinions of the Holy See.
3. Debates over the RH Bills of 2010 and 2011
In 2010 and 2011, the CBCP aggressively campaigned against two bills — House Bill No. 4244 or ‘An Act Providing for a Comprehensive Policy on Responsible Parenthood, Reproductive Health, and Population and Development, and For Other Purposes,’ and Senate Bill No. 2378 or ‘An Act Providing For a National Policy on Reproductive Health and Population and Development’ — which together were known as the ‘RH Bill.’ The CBCP reprised the tactic of rally gathering to show opposition against the RH, and using rhetoric in mass, billboards, on television and the radio against the policies. Its official statement released on January 2011, evidences such rhetoric. The pastoral letter, “Choosing Life, Rejecting the RH Bill” states:
Simply stated the RH Bill does not respect moral sense that is central to Filipino cultures. It is the product of the spirit of this world, a secularist, materialistic spirit that considers morality as a set of teachings from which one can choose, according to the spirit of the age. Some it accepts, others it does not accept. Unfortunately, we see the subtle spread of this post-modern spirit in our own Filipino society.18
When the government has supported reproductive health initiatives, international involvement served as the main catalyst. For example, the University of the Philippines Population Institute (UPPI) was established in 1964, with initial support from the Ford Foundation. By 1969, USAID started to fund 80% of contraceptives in the Philippines, amounting to US $3 million per year under the Marcos regime.20 As the government restricted reproductive health projects after the Marcos dictatorship, the Philippines witnessed a rise in NGOs advocating reproductive health programs. In 1986, the Philippine NGO Council on Population, Health, and Welfare (PNGOC) formed, which consists of 17 NGOs with the joint objective of “becoming the voice of population and development advocates within the NGO, government and funding circles and to respond to the growing demand for NGO services in population, reproductive and sexual health and development.”21 These organizations distribute information on sexual health, provide counseling, and offer contraception (when available). A few organizations train health professionals in counseling procedures, and others even clandestinely disclose where backdoor abortions are available.22
“For both parties, the sense of social order is threatened.”
For both parties, the sense of social order is threatened. To the CBCP, a contraceptive mentality tempts bodies towards a grave moral sin. To human and women’s rights proponents, women are denied freedom from the chains of paternalism. In each case, the health of the human body (both in terms of spiritual and physical/mental health) is pathologized and problematized. Both camps provide corrective measures to “heal” the poor state of the body. They are executed either by a politics exercised through deep-seated and historic political influence or through international funding and/or provisions offered by NGOs. Because of the historical connection with the state, the CBCP channels its influence directly into government. Conversely, international funding and NGOs work outside government to combat the heavy influence of Church actors on the state.
The debate amongst the citizenry was very fierce and deeply fought. As two scholars Nicole Curato and Jonathan Ong recount, “Name-calling has been prevalent, with some bishops labelling proponents of the bill as ‘modern-day Herods,’ ‘fascists’ and ‘mass murderers’ while pro-RH advocates call the bill’s opponents as ‘extremists’ and ‘Talibans.’ Demonization is equally evident in threats of excommunication from the anti-RH camp and RH advocates’ labelling of the religious as ‘stuck in the dark ages’ or simply ‘stupid.’”23 On the side of the critics of the RH Bill were not only those who sided with the Catholic Church’s stance but those who believed that the bill failed to take into account the specificity of place and culture and instead blindly acceded to a globalized trend. “The Philippines should not be forced to fall in line with what developed nations perceive as the answer to world population problems without regard to the context of the Philippines or any other developing nation for that matter,” wrote Carmen Pedrosa in The Philippine Star.24 Others argued that the RH Bill misrepresented overpopulation as the root cause of poverty and famine, when in fact the root cause is bad government and bad economic policies, and that in a list of countries ranked in order by population density, there is no correlation with poverty and starvation.25 The developmental agenda of the bill was questioned even by feminists who were in support of the bill overall. Indeed, “Representative Emmi de Jesus chose to present a qualified position. She argued that while the bill is important in upholding women’s rights, women’s wombs are not to be blamed for economic underdevelopment but the government’s refusal to establish an equitable and just economic program that evenly redistributes wealth and supports public services.”26 Unfortunately, as Nicole Curato and Jonathan Ong point out, the perspectives of the masa whom the fate of this bill most deeply affected were represented in the public debate in only the most limited ways.
Republic Act No. 10354 or ‘The Responsible Parenthood and Reproductive Health Act of 2012’ passed the ‘RH Law’ into effect in 2012 under President Benigno Aquino III after 14 years of struggle. Due to petitions against the law’s constitutionality, the Supreme Court halted its implementation on March 19, 2013. In April 2014 the Supreme Court declared the RH Law constitutional but struck down eight provisions partially or in full.27 The court ordered the FDA to verify whether the family planning commodities to be used are safe and do not induce abortion. In quick summary, “the law requires government health centers to hand out free condoms and birth control pills, as well as mandating that sex education be taught in schools. It also requires that public health workers receive family planning training, while post-abortion medical care is also legalized.”28 Though the RH Law is now in place, the debate must continue over how to protect and enshrine women's rights, and what role family planning and population control can play in our economic development.
“The Cruelest Cut,” Philippine Daily Inquirer, January 14, 2016, accessed on January 31, 2016, http://opinion.inquirer.net/92016/the-cruelest-cut.2
Jet Villa and Lira Dalangin-Fernandez, “UN, former lawmakers alarmed at yanking of budget for contraceptives,” InterAkyson, January 8, 2016, accessed January 31, 2016, http://www.interaksyon.com/article/122425/un-alarmed-at-yanking-of-budget-for-contraceptives.4
Mercedes B. Concepcion, The Philippines (New York: Population Council, 1970).7
Alejandro N. Herrin, “Development of the Philippines’ Family Planning Program: The Early Years, 1967-1980”, in The Global Family Planning Revolution: Three Decades of Population Policies and Programs, ed. Warren C. Robinson and John A. Ross (Washington DC: The World Bank, 2007), 280.8
Republic of the Philippines, 1973 Constitution, art. 15, sec. 10.10
Alejandro N. Herrin, “Development of the Philippines’ Family Planning Program: The Early Years, 1967-1980”, in The Global Family Planning Revolution: Three Decades of Population Policies and Programs, ed. Warren C. Robinson and John A. Ross (Washington DC: The World Bank, 2007), 280.11
Republic of the Philippines, 1987 Constitution, art 2, sec 12.12
Robert L. Youngblood, “President Ramos, the Church, and Population Policy in the Philippines”, Asian Affairs 25, no. 1 (Spring 1998): 9.13
http://www.unfpa.org/icpd (accessed January 31, 2016)15
Marilen J. Danguilan, Women in Brackets: A Chronicle of Vatican Power and Control (Manila: Philippine Center for Investigative Journalism, 1997), 49.16
Lene Sjørup, “Religion and Reproduction: The Vatican as an Actor in the Global Field”, Gender, Technology and Development 3, no. 3 (1999): 379.17
Marilen J. Danguilan, Women in Brackets: A Chronicle of Vatican Power and Control (Manila: Philippine Center for Investigative Journalism, 1997), 67.18
Nereo P. Odchimar, “Choosing Life, Rejecting the RH Bill” (Manila: CBCP), January 30, 2011.20
In the early 1970s, International Planned Parenthood Federation began to form partnerships with local Philippine organizations to build comprehensive reproductive health care services. In 1979, a network ensuring that the U.N. Convention on the Elimination of All Forms of Discrimination Against Women is upheld was established in the Philippines. [“Reproductive Health Bill Timeline (II), What’s Up in The Philippines (blog), May 20, 2011, http://bayan-natin.blogspot.com/2011/05/reproductive-health-bill-timeline-ii.html (Accessed June 6, 2011).]22
The Reproductive Health, Rights, and Ethics Center for Studies and Training (ReproCen) was founded in 1993 with funding from the Ford Foundation. In 1995, one of the most influential reproductive rights NGO in the Philippines was established – the Likhaan Center for Women’s Health. Likhaan receives many grants from international organizations, including UNFPA and USAID. In 1998, the Reproductive Health Advocacy Network (RHAN) was created. RHAN is the “largest working network of organizations and individuals advocating for RH policies and programs at the national and local levels.” [http://www.likhaan.org/rhan (Accessed June 6, 2011).] EndgendeRights was developed in 2003 with the intent “to advanc[e] women's rights through domestic and international legal and policy advocacy, research, publication, training, and impact litigation in the Philippines and in Southeast Asia.” [http://www.engenderights.org/?q=node/10]23
“Reproductive Health Bill Timeline (II), What’s Up in The Philippines (blog), May 20, 2011, http://bayan-natin.blogspot.com/2011/05/reproductive-health-bill-timeline-ii.html (Accessed June 6, 2011).24
Nicole Paula Curato and Jonathan Corpus Ong, “The RH Bill Debate and Responsible Participation,” ABS-CBN Blog, September 29, 2012, accessed January 31, 2016, http://news.abs-cbn.com/blogs/insights/09/28/12/rh-bill-debate-and-responsible-participation.25
Carmen N. Pedrosa, “‘Pro-RH’ may have won the battle, but ‘Anti-RH’ won the war,” The Philippine Star, December 22, 2012, accessed January 31, 2016, http://www.philstar.com/opinion/2012-12-22/888723/pro-rh-may-have-won-battle-anti-rh-won-war.26
Nicole Paula Curato and Jonathan Corpus Ong, “The RH Bill Debate and Responsible Participation,” ABS-CBN Blog, September 29, 2012, accessed January 31, 2016, http://news.abs-cbn.com/blogs/insights/09/28/12/rh-bill-debate-and-responsible-participation.28
“1.) Section 7, only insofar as it: (a) requires private health facilities, non-maternity specialty hospitals, and hospitals owned by religious groups to refer patients not in an emergency or life-threatening situation to another health facility which is conveniently accessible (b) provides access to family planning and RH services to minors who have been pregnant or had a miscarriage without a parental consent. The rest of Section 7, however, which provides access to family planning, was upheld by the court, notably this line: "All accredited public health facilities shall provide a full range of modern family planning methods, which shall also include medical consultations, supplies and necessary and reasonable procedures for poor and marginalized couples having infertility issues who desire to have children." 2.) Section 23-A-1, which punishes RH providers, regardless of their religious belief, who fail or refuse to dissiminate information regarding RH services and programs 3.) Section 23-A-2-i, which allows a married individual not in a life-threatening case to access RH procedures without the consent of the spouse 4.) Section 23-A-3, insofar as it punishes an RH provider who fails to refer any non-life-threatening case to another RH provider 5.) Section 23-B, insofar as it punishes any public officer who refuses to support RH programs 6.) Section 17, which mandates a 40-hour pro bono service by private and nongovernment RH service providers, including gynecologists and obstetricians, as a prerequisite for PhilHealth accreditation 7.) Section 3.01-A and J of the RH law Implementing Rules and Regulations (IRR), which defines abortifacients as "primarily" inducing abortion instead of simply inducing abortion 8.) Section 23-A-2-ii, which prohibits RH service providers from refusing to perform legal and medically-safe reproductive health procedures on minors in non-life-threatening situations without parental consent.” (Buena Bernal, “SC declares RH law constitutional,” Rappler, April 8, 2014, accessed January 31, 2016, http://www.rappler.com/nation/54946-supreme-court-rh-law-constitutional)29
Buena Bernal, “SC declares RH law constitutional,” Rappler, April 8, 2014, accessed January 31, 2016, http://www.rappler.com/nation/54946-supreme-court-rh-law-constitutional5
Fertility rate, total (births per woman). (n.d.). Retrieved February 04, 2016, from http://data.worldbank.org/indicator/SP.DYN.TFRT.IN/countries/1W-PH?display=default