Crossing a busy street and testing one’s agility against vehicles has inherent risks. To minimize these risks, we create structures and social rules such as traffic lights, pedestrian lanes, speed bumps and so on. We also minimize the frequency of exposure to risks. Using overpass walkways, avoiding unnecessary trips and creating better planned neighborhoods are some of the ways we reduce the number of times people and vehicles cross paths.
The reproductive health (RH) bill’s approach to reducing maternal deaths follows the same dual strategy: minimize risks and minimize exposure to risks.
A woman’s lifetime risk of maternal death is a product of two factors: the risk of death from each pregnancy and birth, and the number of times she gets pregnant. The most successful countries in the world have managed to bring down both, and some of our ASEAN neighbors are on the way to making maternal death a rare possibility in a woman’s lifetime (see chart below).
To reduce the risk of death from each pregnancy, the RH bill mandates:
- sufficient number of skilled birth attendants (SBAs, referring to midwives, nurses or doctors) that can provide antenatal, birthing and postnatal services (Sec. 5 in both House and Senate versions);
- enough facilities, equipment, supplies and health personnel to provide emergency obstetric and neonatal care (Sec. 6 in both House and Senate versions);
- the maximum level of PhilHealth benefits for women with obstetric complications (Sec. 14 in House version and 11 in Senate); and
- a review process to learn lessons from maternal deaths that do occur (Sec. 9 in House version and 8 in Senate).
Opponents of RH have expressed mixed reactions to this aspect of the bill. Some have accepted it as beneficial and have focused instead on their key issues of contraception, abortion and sex education. Others have branded it as unnecessary or a mere sweetener because the government has been doing maternal health programs without a law; or maternal death is not among the top-10 causes of deaths; or both. To check these claims, let us look at a key indicator of safety during pregnancy and birth: skilled birth attendance.
If women lack access to SBAs, they rely on the hilot (traditional birth attendants) to manage their childbirth and the immediate period after delivery. Unfortunately, around three quarters of all maternal deaths occur during these critical times. A hilot does not have the skills or resources to save women from the usual complications like severe bleeding, convulsions, sepsis and obstructed labor. How a hilot can totally mess up with diagnosing a complication and acting promptly to forestall death can be seen in the documentary Olivia’s Story. Only 37 years old, she died on May 2, 2009 in a poor community in Malabon (yes, hilots ply their trade even in a city in the country’s metropolis) after delivering her tenth child at home.
In 1999, a special session of the UN General Assembly agreed to work towards raising the use of SBAs to 80% by 2005, 85% by 2010 and 90% by 2015. What has the Philippines achieved? In 2008, actual use of SBAs by all women was only 62%, and the poorest women had use rates of only 26% (see chart below).
Source: Macro International Inc, 2011. MEASURE DHS STATcompiler.
http://www.measuredhs.com, June 14 2011.
Was the UN target too ambitious? No. Some of our ASEAN neighbors have proven that middle-income countries can attain the goal. Malaysia, Thailand and Vietnam have met or exceeded the target. Indonesia is behind but has performed better than the Philippines (see chart below).
Source: WHO, Women and Health, Health Service Coverage,
Global Health Observatory Data Repository, June 16, 2001.
The average Filipina receives less skilled maternal care than some of her ASEAN neighbors. Those who are poor receive hardly any care at all.
Yes, the country does have a maternal care program which has been in place since perhaps the elder Aquino government, which merely reinforces the point that “business as usual” won’t be enough. Having something going on does not mean policymakers cannot make it better funded and more effective, equitable and enforceable. It would be both wise and charitable for the anti-RH forces to concede this issue in the RH bill debates.
why not give OCPs or condoms to our wannabe Olympians (as Wes refers to them), if they do get hit and killed, at least they won't be leaving a baby that needs to be taken cared of by their relatives or the state.
The author's traffic analogy is a good metaphor for the RH Bill's multiple strategy towards responsible family planning.
1) Educate the public – like teaching proper road etiquette and safety, this should be the primary method. But it has its limitations – it only works for people who have the self-control and discipline to follow the rules, thus plan B…
2) Physical barriers – like the pasaway jaywalkers who like to cross the street, risking life and limb to run across busy highways even with huge signs that read "HUWAG TUMAWID, NAKAMAMATAY", the government has to resort to to erecting physical barriers to enforce road safety (even then, you'd still see Olympic wannabes leaping over 4-foot barriers because they're too lazy to use the overpass).
The use of contraceptives is the means of last resort, but suitable for the extremely undisciplined pinoy mentality. As a nation, we have ZERO SELF-CONTROL. If we cannot even follow simple road rules, how can one even expect techniques like natural family planning to work in this country? The solution should fit the situation.
If anti-RH advocates are questioning the government expenditure towards contraceptives, they should likewise protest against spending for traffic safety structures and just pray that people "abstain" from jaywalking and follow road rules "naturally".
I just hope they can sleep at night knowing the lives lost due to their "natural" methods.
[Reduce pregnancies via provision of free contraceptives and therefore reduce maternal deaths. So why don't we go a step further and eliminate pregnancies altogether by legislation and then presto: ZERO maternal deaths. I am just kidding, of course]
You do support natural family planning willyj? Do NFP practitioners accept the principle that unplanned pregnancies should be reduced, which will reduce the number of maternal deaths? Anti-RH groups give out mixed messages on this point. Some say we should enlarge our population (even against people's wishes?) like China and India for economic development reasons.
[The RH bill should have said the poor should be provided MORE access instead of the SAME level.]
I have no problem with this type of amendment. Investments in public health facilities and personnel that provide free or low-cost goods and services do have a pro-poor built-in mechanism since folks in the upper strata usually go for private health care. One must also be careful to consider both the incidence and magnitude of poverty–low incidence regions like urban areas may have high magnitudes of poverty. But yes, strengthening further the pro-poor provisions would be an improvement. If only anti-RH legislators would exert some efforts in this area.
[One solution proposed is to bombard these areas with free condoms to finally solve the problem. On this last sentence, I am again just kidding.]
The RH bill aims to solve RH problems, not the Mindanao conflict. No kidding.
[I agree with the four points raised in this article]
Do you have or can you get the support of your anti-RH friends on this declaration?
Thanks for the comments willyj. I'm writing a part 2 on family planning as reduction of risk exposure. Maybe I can get you to agree on that as well.
err Willy77, the analogies you so jokingly made just highlighted the erroneous comparisons being made regarding the RH's stance on safe-sex. Just as it would be ridiculous to say that the best way to reduce traffic accidents is not not use the roads at all, or that the best way to reduce maternal deaths is to not have any babies at all… you can still do all those as much as you want – but do it responsibly and be aware of the consequences of doing "risky shortcuts".
Risk management says "do it right", not "don't do it".
[You do support natural family planning willyj? Do NFP practitioners accept the principle that unplanned pregnancies should be reduced, which will reduce the number of maternal deaths? Anti-RH groups give out mixed messages on this point. Some say we should enlarge our population (even against people's wishes?) like China and India for economic development reasons.]
The Church supports Responsible Parenthood, and was actually the first to coin that term. It includes responsibly planning for and spacing the number of children according to four factors: material, physical, psychological, and environment – using moral means.This much was already explicated in a close reading of Humanae Vitae. What critics of the Church unfairly accuse us of is the "go forth and multiply" thing, which is taken out of context. There were only two people on earth when that command was issued, for God's sake. The Church does not say enlarge our population, nor it does not say reduce it either. You can have 1 child or even more than a dozen, it does not matter as long as you prayerfully discern your condition according to that 4 factors that was enumerated in Humanae Vitae. Thanks for the rest of your objective comments.
Glad you got it right. Thanks!
[What critics of the Church unfairly accuse us of is the "go forth and multiply" thing, which is taken out of context. There were only two people on earth when that command was issued, for God's sake.]
WillyJ, you are barking up the wrong tree blaming "critics of the Church". Why not bark at anti-RH Rep. Bagatsing (or Reps. Garcia and Pacquiao) for spreading what in your view is a distortion of Catholic teaching? Or can it be that they are right and your interpretation is wrong. Below is a sample of Bagatsing's RH bill interpellation, from http://www.congress.gov.ph/download/congrec/15th/…
In this exchange, you and Rep. Lagman are arguing the same thing! Can you categorically say that Bagatsing was wrong (in this portion only of course)? I think you should be as clear and as loud as possible because Catholic folks like Bagatsing, Garcia and Pacquiao are the ones crafting policy in line with what they think are Catholic teachings.
REP. BAGATSING. Mr. Speaker, ang dami po ninyong kino-quote pero isa lang ang naintindihan ko. Ang sabi ng Diyos, “Humayo kayo at magparami.” “Go forth and multiply.” Hindi naman sinabi, “When an RH Bill is passed in Congress or proposed in Congress, you consider it.” I cannot be wiser and greater than the Creator. Hindi naman ako ganoon katalino kaysa sa lumikha sa akin. Ang sabi, “Go forth and multiply.” Hindi naman pupuwedeng i-interpret ko pa iyan ng higit pa sa aking Diyos. So, Mr. Speaker, napakasimple: 2,000 years old na ang teachings ng Katoliko, hindi naiiba, hindi na-a-amendahan. Ang batas ng tao, depende kung sino ang nakaupo riyan as Speaker, depende kung sino ang Presidente, depende kung sino ang mga Miyembro ng Lehislatura na mag-a-amenda at magre-repeal. Ngayon, pinakikialaman natin by way of legislation. …
REP. LAGMAN. Well, let me go back to that biblical injunction quoted by the distinguished Gentleman from Manila. He said that the injunction was, “Go forth and multiply.” He did not finish the quotation. It said, “Go forth and multiply and subdue the earth. “ In other words, at that time that this injunction was made, how many people were there?
REP. BAGATSING. So the Gentleman is questioning the wisdom of the Creator, of the Lord. So, hindi ko na kinukwestyon iyon, Mr. Speaker.