Author Archives | Alfredo R. Melgar

Double Standards – Contraceptives and Medicines

Imagine a woman warned by her doctor to refrain from having a fifth pregnancy for medical reasons. She decides to use natural family planning (NFP). Will the bishops of CBCP and their allies question her decision?

Certainly not. As early as 1951, Pope Pius XII in his Allocution to Midwives specifically accepted medical reasons as a justification for birth control. He said:

Serious motives, such as those which not rarely arise from medical, eugenic, economic and social so-called “indications,” may exempt husband and wife from the obligatory, positive debt for a long period or even for the entire period of matrimonial life. From this it follows that the observance of the natural sterile periods may be lawful, from the moral viewpoint: and it is lawful in the conditions mentioned.

Now imagine another woman with exactly the same medical reasons who chooses contraceptive pills. To be consistent with their own teachings, one would expect the bishops to simply say: right reason, wrong method. But no, they are now on a war path and have branded the use of contraceptives as treating pregnancy like a disease. In their desire to destroy the status of contraceptives as medicines and its value to public health, it seems they are willing to stigmatize pregnancy prevention as inherently immoral.

In his “contraception is corruption” speech, Archbishop Villegas said: “A contraceptive pill is to be considered an essential medicine. If it is a medicine, what sickness is it curing? Is pregnancy a sickness?” Weeks later, Senator Enrile echoed the same line: “In the case of a contraceptive pill, is pregnancy a disease that needs to be cured? Why do we need to prevent it?”

Sure, pregnancy is not a disease. But pregnancy and childbirth can lead to diseases or injuries. Even bishops must be aware of this fact, which makes their argument sound so contrived. The World Health Organization has a whole chapter listing such diseases and injuries in its International Statistical Classification of Diseases and Related Health Problems. Obstetricians exist to prevent or treat these conditions.

If the bishops of CBCP and the anti-RH camp are not yet convinced that they are stirring up double standards in morality, they should try asking this to any user of NFP: “Is pregnancy a disease to be cured? Why do you need to prevent it?”

A double standard in law is also being pushed by the anti-RH camp. The claim that medicines must cure a disease, or must not prevent normal bodily functions like pregnancy is not supported by our laws.


Anti-coagulants and contraception

As far back as the Food, Drug and Cosmetic Act of 1963, drugs have been defined as articles intended “for use in the diagnosis, cure, mitigation, treatment, or prevention of disease,” or “to affect the structure or any function of the body.” The above phrases are retained in the latest version of that law, the Food and Drug Administration (FDA) Act of 2009. And in case the anti-RH camp will try to claim that medicines are different from drugs, they should read the Universally Accessible Cheaper and Quality Medicines Act of 2008 which defined drugs and medicines the same way, and included “drugs and medicines indicated for prevention of pregnancy, e.g., oral contraceptives” as part of the “List of Drugs and Medicines that are Subject to Price Regulation.”

Many substances classified as medicines without any controversy expose the hollowness of the “pregnancy is not a disease” argument. Blood clotting or coagulation is not a disease. Yet we have anticoagulant medicines, commonly used to reduce the risk of heart attacks and strokes. A functioning immune system is not a disease, yet we have medicines that suppress the immune system, a standard fare to prevent organ transplant rejection. Having gastric acid is not a disease, yet we have antacids to manage indigestion.

People do choose to avoid normal or even desirable activities to prevent possible future harm. I’m pretty sure even bishops and anti-RH campaigners do it. We avoid too much sun; avoid too much food; avoid too much reading; avoid crossing streets when overpasses are available. When the path towards harm is clear enough, stigmatizing people who steer away violates plain common sense. Unless the bishops have another brand new standard of common sense.

Double standard in action is my final beef with the “pregnancy is not a disease” argument. In that memorable August 16 Headstart episode [1], TV host Karen Davila asked Senator Tito Sotto if his wife has had a tubal ligation, and this in part is what he said:

She has to be ligated. Because, yes, because she had, how many pregnancies. … She had four cesarean operations. … So, pagkatapos noon, sinabi ng [obstetrician], “You have to be ligated.”

A few minutes before in that same interview, when asked why he was against the RH Bill, Sotto’s first response was to attack the status of contraceptives as medicines. This is what he said:

Medicine is supposed to be, must cure something. What does a condom cure? What does an injectable cure? What does an IUD cure? So they’re not medicines, they’re not essential medicines.

A tubal ligation is of course a contraceptive medical procedure, not a medicine. But women fearful of the health consequences of another pregnancy, whether using condoms, injectables, IUDs or tubal ligations to prevent the next one, would surely be hurt by the senator’s loaded questions. Sotto attacked the health benefits of contraceptives and admitted to using the health benefits of a contraceptive procedure. The double standard  is simply stunning. Perhaps Sotto should answer Enrile’s core concerns: “Is pregnancy a disease that needs to be cured? Why do we need to prevent it?”

[1] All quotes taken by the author from the video.

 

Images by Alex Brown and anqa, used under the Creative Commons license.

Posted in RH Bill49 Comments

Sotto Unwittingly Gathered Maternal Mortality Data Equivalent to 18 Deaths Per Day

Senator Tito Sotto tried to debunk the data that 11 maternal deaths occur daily, but ended up reinforcing the same with figures gathered by his own staff. Here’s what he said at the Senate

The proponents of the bill are saying that 11 Filipino women die every day when they talked about maternal mortality. They have not, however, supported this claim with accurate and consistent data. Kung tutuusin sa pinagawa ko sa mga staff ko, hindi pa nga umabot man lang sa kalahati ng 11 maternal deaths ang nakalap nila sa mga hospitals sa Pilipinas nung 2011 eh. For example, sa Nueva Viscaya Provincial Hospital, ang maternal deaths na naitala nila ay 2 lamang sa 2011. … Sa Batangas Regional Hospital, 7 out of 2584 deliveries ang naitala .27%. Hindi pa nga umabot sa 1%. … Kaya ang hirap paniwalaan ang kanilang figure na 11 mothers die every day.

Sotto’s speech delivered on August 15, 2012

Sotto failed to grasp that a small number – such as the 0.27% he calculated for Batangas and belittled – becomes large when multiplied by a huge number like the millions of births per year. If we assume that the Batangas data can be applied to all births in the country1 in 2011, the national figure becomes 2,385,000 births × 0.27% = 6,461 maternal deaths per year, or nearly 18 per day.

Put in another way, if the Batangas Regional Hospital had a maternal mortality ratio (MMR) equivalent to the country’s Millennium Development Goals target of 53 deaths per 100,000 live births, then Sotto’s staff should have counted only 1 death out of the 2,584 deliveries recorded. Six women should have survived. Malaysia and Thailand had had MMRs of 50 and below a decade or so ago.

Sotto should learn from this mistake and take the data gathered by his staff seriously, and not let his biases cover-up the tragic reality of women’s deaths.

1. As estimated by the UN Population Division; see http://esa.un.org/unpd/wpp/unpp/panel_indicators.htm

Image from Interaksyon

Posted in RH Bill2 Comments

Sotto’s Reckless Method of Legislation is Inexcusable

Senator Tito Sotto suffered a personal loss with the death of his son. We understand his grief. What we cannot understand is why he chose to rely on an unknown blogger to explain his son’s death.

Right before asserting that he lost a child due to contraceptives, Sotto said he has scientific proof about the “damaging effects to children born from mothers who were using contraceptives prior to their pregnancy.” He then went on a lengthy explanation about gut imbalance, opportunistic flora, exposure of the fetus to toxins and zinc depletion.

His scientific proof was copied entirely and almost word-for-word from an article by a blogger calling herself “Sarah, the Healthy Home Economist.”

Do the comparison yourself. See the second to the last paragraph of Sotto’s speech and Sarah’s blog.

Sotto’s speech

Actually, these contraceptives are not just detrimental to women and the unborn. They are scientifically proven to have damaging effects to children born from mothers who were using contraceptives prior to their pregnancy too. According, to Dr. Natasha Campbell-McBride MD, the use of the pill also causes severe gut dysbiosis. What is worse, drug induced gut imbalance is especially intractable and resistant to treatment either with probiotics or diet change. 1 Gut imbalance brought on through use of the pill negatively impacts the ability to digest food and absorb nutrients. As a result, even if a woman eats spectacularly well during pregnancy, if she has been taking oral contraceptives for a period of time beforehand, it is highly likely that she and her baby are not reaping the full benefits of all this healthy food as the lack of beneficial flora in her gut preclude this from occurring. 2 Pathogenic, opportunistic flora that take hold in the gut when the pill is used constantly produce toxic substances which are the by-products of their metabolism. These toxins leak into the woman’s bloodstream and they have the potential to cross the placenta. Therefore, gut dysbiosis exposes the fetus to toxins. 3 Not well known is also the fact that use of the pill depletes zinc in the body. Zinc is called “the intelligence mineral” as it is intimately involved in mental development. 4

Sarah’s blog

1 According, to Dr. Natasha Campbell-McBride MD, use of other drugs such as the Pill also cause severe gut dybiosis. What’s worse, drug induced gut imbalance is especially intractable and resistant to treatment either with probiotics or diet change.

2 gut imbalance brought on through use of The Pill negatively impacts the ability to digest food and absorb nutrients. As a result, even if a women eats spectacularly well during pregnancy, if she has been taking oral contraceptives for a period of time beforehand, it is highly likely that she and her baby are not reaping the full benefits of all this healthy food as the lack of beneficial flora in her gut preclude this from occurring.

3 Pathogenic, opportunistic flora that take hold in the gut when The Pill is used constantly produce toxic substances which are the by-products of their metabolism. These toxins leak into the woman’s bloodstream and guess what, they have the potential to cross the placenta! Therefore, gut dysbiosis exposes the fetus to toxins

4 Not well known is the fact that use of The Pill depletes zinc in the body. Zinc is called “the intelligence mineral” as it is intimately involved in mental development.

Sotto should know that Sarah has also written several articles against vaccination, with a summary piece entitled “Six Reasons To Say NO to Vaccination” having these two wild and reckless claims:

  • ALL Vaccines are Loaded with Chemicals and other Poisons
  • Fully Vaccinated Children are the Unhealthiest, Most Chronically Ill Children I Know

Sotto should also have read Sarah’s disclaimer on her site which says: “The information on this website is provided for informational purposes only and is not intended to substitute for the advice provided by your doctor or other health care professional. … The nutritional and other information on this website are not intended to be and do not constitute health care or medical advice.”

Sotto ignored decades of studies and declarations by the World Health Organization and the Department of Health that contraceptives are safe, only to rely on an unknown blogger making wild claims. He even ignored the blogger’s disclaimer. Sotto’s reckless method of legislation is inexcusable.

Posted in Politics, RH Bill130 Comments

Paalam, Soledad

Paalam, Soledad

Based on true events, “Paalam, Soledad” follows the struggles of Sister Soledad with her faith and her principles amidst the realities of Santa Clara, a small town ruled by closed minds, false hopes and repressed sexuality. [YouTube’s block has been resolved; this video is now viewable.]

Scene Selection

Group song welcoming people to Santa Clara (3:12)

First Act: Baptism (11:28)

Priest sings about sacrifice and the original sin (22:19)

Sister Soledad sings about the morality of changing and loving our bodies (24:50)

Second Act: Marriage (31:22)

Four women confront Sister Soledad about how society unfairly blames women (40:08)

Third Act: Funeral (46:49)

A happy, naughty song about the IUD (47:52)

Priest and mayor sing about their mutually beneficial partnership (1:05:05)

Finale: people sing about their hopes for Santa Clara (1:16:11)

Credits (1:20:24)

Posted in Religion, Society, Video6 Comments

Anti-RH Spin to Make Your Head Spin

Anti-RH Spin to Make Your Head Spin

Fr. Melvin Castro, an official of the Catholic Bishops’ Conference of the Philippines (CBCP), argues that the RH bill is not needed since maternal deaths have declined significantly, and the government only needs to improve existing reproductive health services for women. For the past few weeks, anti-RH campaigners were also arguing that the RH bill is not needed since it duplicates existing laws, policies and programs of government.

Now let me see if I can make sense of the anti-RH side’s “not needed” arguments:

  1. the RH bill duplicates existing laws, policies and programs (LPPs)
  2. which succeeded in reducing maternal mortality
  3. therefore the government should improve existing LPPs
  4. except that the government should not pass the RH bill
  5. not because of religious objections
  6. but because… (back to #1).

Maybe the anti-RH folks enjoy creating twisted mind-benders. Or they’re just patching together anything, coherence and honesty be damned, to obscure the religious nature of their objections.

Based on official government statistics, an estimated 6.5 to 11 maternal deaths occurred per day in 2010. The anti-RH group Filipinos for Life produced a lower estimate by the simple trick of using registered births in its calculation, ignoring the warning from its source, the National Statistics Office, that the published number is lower than actual due to late or non-registration.

Using a new statistical model, the World Health Organization (WHO) did come up with a lower estimate of maternal mortality for the country in 2008: 2,100 at the middle of the range, some 5.8 maternal deaths per day. Because of the inherent difficulties in recording maternal deaths, which the WHO report extensively discusses, varying methods which come up with varying but overlapping estimates is not unusual.*

But on the crucial part of the WHO report, on what has to be done, the anti-RH groups are characteristically silent. Perhaps because at the end of the estimation exercise, the WHO advocated for enhanced commitment to RH measures, almost all of which are in the RH bill. Here’s part of what the WHO said:

The international community has been increasingly concerned about the fairly slow progress in improving maternal health. During 2010, the United Nations Secretary-General launched the Global Strategy for Women’s and Children’s Health, which seeks to catalyse action for renewed and enhanced commitments by all partners for adequate financing and policy to improve women’s and children’s health. The commitments would support the following elements to accelerate progress towards MDG 5:

  • Country-led health plans – development partners to support governments to implement country-led plans to improve access to reproductive health services.
  • A comprehensive, integrated package of essential interventions and services – women and children should have access to a package of integrated services including family planning, antenatal care, skilled care at birth, emergency obstetric and newborn care, safe abortion services (where abortion is not prohibited by law) and prevention of mother-to-child transmission of HIV services.

We have an ongoing tragedy whether 5 or 11 maternal deaths occur per day. Half of all pregnancies are unintended, which means family planning—using artificial or natural methods—can potentially prevent up to half of these deaths. To overcome the routineness of maternal deaths which anti-RH groups exploit, think of the thousands of deaths as two to four shiploads sinking every year. Half of the women do not even want to be passengers at all. And of the willing passengers, more than half can be saved with measures in the RH bill.

——————-

* WHO, using three different methods, estimated the maternal mortality ratio (maternal deaths for every 100,000 live births) for the Philippines at 120–280 in 2000, 60–700 in 2005 and 61–140 in 2008.

Image used: Enrico Rastelli, available at Wikimedia Commons

Posted in Society27 Comments

A Deadly Road for the Reproductive Health Bill

A Deadly Road for the Reproductive Health Bill

A new SWS survey confirmed old findings – most people support choice in family planning, including methods declared evil by some church leaders. But can legislators do what’s right and vote on the RH bill now, regardless of the parochial interests of their churches?

Will Congress finally do their duty, or will they be bullied once more into inaction? As Rep. Kimi Cojuangco of Pangasinan said,

I think it’s time for the House of Representatives to think, why are we there? Who do we represent? We are representatives of our constituents. We are not representatives of the Church.

Ironically, a well-known parable of Jesus celebrates the acts of a person who transcended his parochial interests and biases to simply do what’s right. He has no name, but is widely known as the Good Samaritan.

The story goes that a Jewish traveler on the road to Jericho was attacked by bandits and left half-dead. Later, a priest saw him but decided to just pass on the other side of the road. A fellow Jew came and did the same thing. Finally a Samaritan – a member of a people in conflict with the Jews – passed, saw the stricken man and helped, and probably saved his life. In the biblical account, Jesus replied with the parable when asked, “You tell us to ‘Love your neighbor as yourself,’ but who is our neighbor?”

The RH bill is like the wounded traveler to Jericho. It has been attacked as a bringer of death, illness, corruption, immorality and all things evil. It has been on this deadly road for over 10 years now. Legislators of many congresses have studied the proposed law, or at the very least heard the pros and cons of the most publicly debated measure of recent history, only to walk away and bypass the bill without even a vote. The current congress is now nearing half of its three-year term, and 30 or so politicians are still in line as interpellators, with the obvious goal of delaying the process so that the bill gets bypassed again.

Lives and dreams are lost as the RH bill gets bypassed. While it is true that RH has unfortunately become a difficult battleground of values and beliefs, legislators can still choose. They can act like the scared, uncaring priest who failed the test of being a true neighbor despite his pious exterior and position of power within the dominant religion. Or they can follow the Good Samaritan.

 


Image above: El bon samarità by Pelegrí Clavé (1811–1880), from Wikimedia Commons

Posted in Society1 Comment

Shepherd and Sheep

Shepherd and Sheep

Democracy and with it, freedom of choice, are among the best moral ideas that we have developed, a “universal value” of the 20th century according to the economist and philosopher Amartya Sen. Poor and powerless people do not have much of both, but most will agree that having more is the right way to go. I say “most” because believers of one-man, one-party or one-religion rule do still exist and assert that orders from above work best, or that people are like sheep that constantly need a shepherd for direction. Consider this gem of such thinking from CBCP president Bishop Nereo Odchimar as told in the report “CBCP renews opposition to RH bill ahead of SONA”:

“The bill ignores moral and religious considerations in the name of democracy and freedom of choice in a pluralist society,” he said. … He said the people’s right to choose must always be guided by the Gospels and the teachings of the Church. “To ignore this principle is to ignore the light that illumines an upright conscience,” Odchimar said.

“I disapprove of what you say, but I will defend to the death your right to say it” is a popular saying that most people agree with. Both deep and practical, it is something you can repeat to yourself as you overhear your neighbor enjoying the current brain-stopper on TV, or as you read the latest inanities of anti-RH groups. Well, Bishop Odchimar just upended that guide to good-neighborliness.

We know that Catholic doctrine states that contraception is intrinsically evil. But the bishop’s statement is not about the evil of contraception anymore, but the evil of democracy. Odchimar is saying that beyond his right to proclaim his brand of morality, democracy must also give way so that only his moral choices remain. We have the freedom to choose as long as we stick to what he chooses. He must think that we really are dumb sheep.

The RH bill upholds the moral and religious views of all precisely through freedom of choice, and seeks to become law through a democratic process. Unlike Odchimar’s proposal, no one will be forced. All can live with or without RH services. Even funding will depend on people’s choices. If Catholics shift from artificial to natural family planning (NFP), then public money will also shift to funding NFP training costs.

The CBCP should be more careful about devaluing democracy and freedom of choice. Odchimar’s claim about the RH bill ignoring moral and religious considerations is false. However, the country has had plenty of disastrous experience with the reverse, when democracy and freedom of choice were ignored in the name of interests cloaked in morality and religiosity.

Spanish friars came to the Philippines and amassed wealth and power as part of conquest, colonization and Christianization. We lost 300 years of national freedom. If those events are too distant to remember, Gloria Macapagal Arroyo’s sham presidency should be memorable enough. Just two months after the May 2004 election, the bishop-friendly Arroyo was hurriedly anointed with legitimacy with these words from the CBCP:

It is the view of the bishops that the results of the elections reflected the will of the Filipino people.

Years after Arroyo’s election cheating and large-scale corruption sparked popular protests, the majority of bishops continued to prop her rule through open collaboration* or acquiescence. All in the name of her anti-RH, conservative politics.

“Ang sinungaling ay kapatid ng magnanakaw” was Susan Roces’ ringing sound bite on Arroyo’s power grab. Bishops who wish to impose their morality after inflicting a corrupt and unelected ruler on us deserve a similar rebuke: Ang kapal ninyo!

————————————————-

* In 2009, Arroyo released public funds to Bishop Juan de Dios Pueblos who asked for a 4×4 vehicle as a birthday gift and to Bishop Diosdado Talamayan who asked for contributions to a clergy retirement home. A year before, the two bishops were reported to have “spent thousands of pesos for a full-page ad in a major broadsheet to express support for the Arroyo government and insist that the [bishops’] call for ‘communal action’ should not be interpreted as a call for people power.”


 

The image of shepherd and sheep above is from a public domain work of Martinus Antonius Kuytenbrouwer d. J. (1821–1897), available at Wikimedia Commons

Posted in Featured, Religion, Society14 Comments

Inglorious Gifts

Inglorious Gifts

It used to be that crimes were done in the name of God. Hand it to the inglorious Gloria Macapagal Arroyo to hit rock bottom and commit malfeasance for bishops’ birthdays. Yes, that’s birthday-plus-s because the Mitsubishi Montero gift was not a lone event. On March 9, 2006, Arroyo made a much bigger offering to mark the birthday of Pampanga Archbishop Paciano “Apu Ceto” Aniceto—policies on women and the Filipino family that, in her words, “would be the best birthday gift” she could give. Unconcerned about displaying the power of Catholic bishops during Arroyo’s rule, the Philippine Information Agency (PIA) released the following account:

[Arroyo:] “It must be providential that the birthday of Apu Ceto (her important adviser) falls within International Women’s Week when I have to make policy statements on women’s concerns and issues relating to them.”
After the concelebrated mass held in the Bishop’s honor at the Mother of Good Counsel seminary in this city, the President would attend a meeting of all female members of her cabinet in which women’s issues would be discussed.
After this, the President said she would make a declaration that “a strong family makes a strong republic”, and follow up with measures designed to further strengthen the Filipino family.
“This I think would be the best birthday gift I could give to Apu Ceto”, the President said amidst loud applause from the audience composed mostly of the bishop’s religious congregation in the province.

Strange but true. Our highest public official openly gifted someone who is not a woman and does not claim to have a wife or kids with policies on women and families. Can this be just one of those quirkiness that makes our great nation so, well… quirky? To answer this, we have to go further into the Archbishop’s background and the context when this event occurred.

Arroyo’s Gifts

Luckily, the regime then was truly indifferent about revealing Catholic church influence over governance. The same PIA piece stated that the Archbishop was the President’s adviser on “issues concerning population, family, women welfare and health” and was consulted on March 2001, just two months into Arroyo’s term, prior to her making a statement on these issues; that the President “consults with him when making a choice for a new Secretary of Health”; and that at an Interfaith Summit and the UN General Assembly in 2005, the President “brought much of the Bishop’s inputs into the statements she made in front of these prestigious international bodies”.

Dr. Manuel Dayrit—a member of Couples for Christ—became the Archbishop-and-President’s Secretary of Health in 2001. In the next few years, Dr. Dayrit created the legal basis and structures for overly expanding natural family planning (NFP) and entwining it with Catholic doctrine. He set an ambitious “mainstreaming” target—unmet up to now—to raise NFP use to 20%; created a National Natural Family Planning Committee with a Couples for Christ doctor as Chairperson and with a representative of the CBCP Family Life specified as a member; and separated NFP from the national family planning program to let the government “work more closely with groups and partners that want to promote NFP exclusively”. He even tried to ban the IUD for being an “abortifacient” but was foiled by protests done by women’s and doctors’ groups.

And what was the Archbishop’s inputs to Arroyo’s statement at the UN? The full speech was 10 paragraphs long, but these two about funding NFP exclusively in the name of Catholicism, and belittling the value of artificial contraceptives are proclamations the Archbishop would surely be proud of:

… We expect the United Nations to be sensitive to the deep Catholicism of the vast majority of the Filipino people. The funding given by the United Nations to our national Government for reproductive health will be dedicated to training married couples in a natural family planning technology which the World Health Organization has found effective compared with artificial contraceptives.
The Population Council of New York has found that artificial contraception contributes only 2 per cent to the decline of birth rates, while the combination of improving the economic condition of the family, urbanization and breastfeeding contributes 98 per cent. Thus we ask the United Nations and donor countries to direct their assistance towards the improvement of family productivity and income.

Both are based on lies, or lapses in judgment if your prefer the colorful language of the powerful who when caught are always absolutely sorry about absolutely nothing prosecutable.

The World Health Organization (WHO) rates most artificial methods as more effective than fertility awareness methods. Moreover, limiting people to a method not of their own choosing—whether pills, NFP or whatever—will do nothing but cut sharply its effectiveness and violate fundamental human rights which the WHO promotes.

As for the Population Council, here’s what they said in an article entitled Family Planning Programs Remarkably Successful: “Decades of research show that comprehensive family planning and reproductive health services lead to sharp rises in contraceptive use that help women avoid unintended pregnancies. Over a 30-year period (1960–90), fertility declined in the developing world from more than six to fewer than four births per woman, and almost half of that decline—43 percent—is attributable to family planning programs.”

What’s the Catch?

The Population Council’s 43% became 2% at the UN speech, a remarkable manipulation of numbers to suit one’s needs. Audacious but nothing new. Just a few months earlier, Arroyo was heard in a wiretapped conversation with Comelec Commissioner Virgilio “Garci” Garcillano asking for a lead of one million votes while counting was still going on for the presidential election of 2004.

The Garci scandal and Arroyo’s no holds barred battle to cling to power set the stage for the Archbishop’s birthday gift in March 2006. The scandal erupted nine months earlier in June 2005. Despite widespread protests and calls for Arroyo to resign, the CBCP merely asked for an independent “Truth Commission”. The protests continued and on February 24, 2006, two weeks before the Archbishop’s birthday, Arroyo declared a State of Emergency to quell a supposed coup attempt against her.

The tottering Arroyo needed the bishops to survive. She bought them with various currencies, from religion-inspired policies to the glittering currency of legal gambling. To their historic ignominy, majority of Catholic bishops granted her wish.

Something died during those trying times of Arroyo’s decadent rule. Some may call it the moral authority of Church leaders. Or the principle that the end never justifies the means. Or maybe just plain honesty, fair play and decency. Whatever you call it, something is dead and rotting. And the stench is inevitably escaping.

Posted in Featured, Politics, Religion8 Comments

Crossing Streets and Maternal Death Risks (part 2)

Crossing Streets and Maternal Death Risks (part 2)

Hong Kong footbridgeOf around 3.37 M pregnancies that occurred in 2008, 17% led to induced abortions and 14% to unwanted births—more than a million pregnancies that women did not want. Some 92% of these occurred while using no method of family planning, or relying on a traditional one like the withdrawal or rhythm.

The fist half of this article likened maternal risks to similar risks when crossing busy streets. Risk reduction can be done two ways. One, make the process safer. Two, avoid it whenever possible.

Family planning (FP) is the second way. Using artificial or natural methods, it is a means to avoid unintended pregnancies. Using the road crossing analogy, effective FP methods are like overpass walkways that government builds to keep people away from harm. In turn, people need to learn and choose to use them to be of any good.

Relative Risks

An overpass is safer for most people, but is not risk-free. Nothing in life is. The overpass stairs may be slippery. Snatchers may declare the site as their emerging market. Civil engineers may have been sloppy. An earthquake, lightning or bullet from a cop’s warning shot may just strike while you’re in the middle of it. You simply compare all these with the risk of matching your footwork with running vehicles.

The same weighing of risks and benefits apply to all FP methods. For example, users of combined pills do have an increased risk of venous thromboembolism (VTE), a blood clot in veins deep inside the body that is 1–2% fatal. Anti-RH folks have often used this to scare people. What they fail to mention is that drug regulatory agencies have concluded that the increase in absolute risk is small, and that pregnancy confers higher risks of getting VTE than pill use:

Condition Risk of VTE
Not using pills, not pregnant 5–10 cases per 100 000 women-years
Using the most common pill
(low-dose ethinylestradiol + levonorgestrel)
20 cases per 100 000 women-years of use
Pregnant 60 cases per 100 000 pregnancies

 

Contraindications

Using an overpass is also not safe for everyone. Someone on wheelchairs who will try the atrociously steep ramp at the Quezon Avenue-EDSA overpass will probably careen down and break more bones. Urging someone with fear of heights or an asthmatic attack to climb up is courting trouble. Other more sensible methods should simply be made available.

For FP methods and all other medicines, the user may have a condition which makes the drug or procedure riskier than usual. If the risks outweigh the benefits, the medicine is contraindicated, meaning not recommended for use. Since people have unique genetics, medical histories and current conditions, the decision can only be done on a case to case basis.

For example, natural family planning (NFP) is effective for motivated couples. If one or both do not want to use it, the method is contraindicated. The risk of pregnancy would be too high. If the husband is violently uncooperative, the woman gets no benefit at all while risking a whole range of harm. Using the same principles, combined pills are not prescribed to women with pre-existing hypertension because of increased risk of heart attack and stroke; or to women with pre-existing breast cancer because both natural and synthetic estrogens stimulate the proliferation of breast cells.

Policy Choices

“An ounce of prevention is worth a pound of cure” is something we learn in elementary school. When anti-RH folks profess to support safety through maternal care services and in the same breath denigrate the value of family planning, I yearn for the simple lessons of our grade school teachers. The anti-RH position is akin to banning overpass walkways, insisting that people rely on the natural ebb and flow of traffic to safely cross streets, and allaying their fears by saying there will be more hospitals to save and mend broken bodies.

The RH bill’s safe motherhood proposal is simple. Women who are pregnant by choice or circumstance should get the standard care that has made maternal deaths a rarity in many parts of the world. Women who do not want more children or want to postpone the next pregnancy should get the family planning method of their choice to avoid maternal risks altogether.

Make the process safer. Avoid risks whenever possible. Both are needed, both should be done.

Posted in Featured, Society10 Comments

Crossing Streets and Maternal Death Risks

Crossing Streets and Maternal Death Risks

Busy street in ManilaCrossing 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).

Lifetime risk of maternal death

Source: World Health Organization, UNICEF, UNFPA and The World Bank,
“Trends in maternal mortality: 1990 to 2008”, Annex 1 & Appendix 14, 2010.

 

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).

Percentage use of SBA, Philippines

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).

Percentage use of SBAs, selected countries
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.

Part 2: Family Planning and Reducing Exposure to Risks

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Lying for a Cause (part 2)

Lying for a Cause (part 2)

Cherry pciking image from http://outofthestormnews.com/2010/07/22/louisiana-continues-to-improve-punts-cherry-picking-restrictions/The article “Lying for a Cause” generated a response from the creator of the anti-RH video, the core paragraphs of which are as follows:

In the said article, they accused us of purposely lying because in the video was a picture of a small kid being vaccinated. The video subtitle said it was sterilization and they point out that the picture was taken from another article regarding swine flu (?) and they go on ranting about this mistake, and how sterilizations are about vasectomy and ligations. They therefore concluded that we lied.

First of all, it is a given that I used pictures from all over the internet. Is this how Freethinkers are supposed to think? Cherry-pick on a small issue that is virtually a non-issue? That’s just shows the intellectual void between your ears. By focusing on that small point, they missed the larger point of the video. You miss the forest for the trees. But hey, let’s not stop them from doing their thing. They’re freethinkers after all. That is how they think.

Lastly, the article pointed out vasectomies and ligations as ways of sterilizations. Haven’t they heard of vaccines that were deliberately sterilized people? Try visiting this and read up: http://www.whale.to/m/sterile.html

Anti-RH groups have consistently hammered on artificial contraception as their main issue against reproductive health. Female sterilization is the most popular method of artificial contraception worldwide (20% use) and ranks second here in the Philippines (10% use). Opponents of RH should know what they are opposing. Sterilization, tubal ligation and vasectomy are not esoteric procedures. If the video’s creator thinks that not knowing what he is opposing is “virtually a non-issue”, I do hope responsible members of his group will tell him otherwise.

Besides the cherry-picking defense, the video’s creator came up with a bolder counterpoint: that there are vaccines that deliberately sterilize people. This claim is dangerous to infants and mothers and deserves a longer response.

First let’s tackle the source. Whale.to is a conspiracy theory site. It gave rise to Scopie’s Law which states: “In any discussion involving science or medicine, citing Whale.to as a credible source loses the argument immediately, and gets you laughed out of the room.” Others have written extensively on the website which you can read here and here, or you can simply browse www.whale.to and judge for yourself the general credibility of the site. This article’s point is more on the anti-RH video, specifically these two contradictory claims:

Anti-RH video says: “In 1916, Margaret Sanger formed Planned Parenthood. She believed in racial purity and targeted Black People. Adolf Hitler eventually adopted Sanger’s Eugenics… and killed more than 4 million Jews.”

Whale.to says: “There isn’t any evidence for homicidal gas chambers, only gas shelters or disinfection chambers to kill lice that spread Typhus (hence the use of Zyklon B), a major cause of death at the time and the reason for all the bodies seen in the mass graves at Belsen, that were used to convince people of Nazi ‘death camps.’ The gas chamber myth can easily be seen in the absurdity of the morgues that are passed off as gas chambers at Auschwitz I and Auschwitz II, and in the actual mechanics of using gas to kill humans (see Mechanics of Gassing Gas chambers). There also isn’t any written evidence for a policy of genocide known as the ‘Final Solution’.”

If the video’s creator thinks whale.to is credible enough to support his bold claim on vaccines that sterilize people, will he also believe the site’s extensive denial of Nazi death camps and drop his Sanger-Hitler-genocide argument? Or will he just admit his mistake on the sterilization-vaccination link? (Before answering, he may also want to examine first articles in the site that touch on Catholicism such as this one The Homosexual Colonization of The Catholic Church and this page Popes.)


This photo was used in the anti-RH video with the caption “…and killed more than 4 million Jews.” On the other hand, whale.to claims in the photo caption that these are victims of typhus and starvation.


Caption of the anti-RH video: “The rest of the world have adopted an RH bill in one form or another. These countries eventually embraced abortion and the culture of death.” At the whale.to site where this photo is also posted, the topmost part of the page says: “Belsen photographs … Typhus victims were stripped after death in order to burn the clothing and destroy the typhus-bearing lice.”


Now on to the video’s message that contraception leads to genocide or is genocide. One test of this claim is to look at the Jewish people—the victims of Hitler’s genocide—and their current handling of contraception.

Genocide is punishable with death in Israel. Similar to the 1948 Convention on the Prevention and Punishment of the Crime of Genocide, Israel defines the crime as “any of the following acts committed with intent to destroy, in whole or in part, a national, ethnical, racial or religious (hereinafter referred to as ‘group’), as such:

(1)   killing members of the group;

(2)   causing serious bodily or mental harm to members of the group;

(3)   inflicting on the group conditions of life calculated to bring about its physical destruction, in whole or in part;

(4)   imposing measures intended to prevent births within the group;

(5)   forcibly transferring children of the group to another group.”

Yet, despite Act number 4 above being defined as genocide, contraception is legal and practiced in Israel, with 30% using IUDs, 13% pills, 4% condoms and 5% other modern methods. The key word in Act number 4 is “imposing”—making people use birth control against their will. Contraception based on free choice is legal and accepted.

Another test of the contraception-leads-to-genocide claim is to look at disparities in the use of modern methods in the Philippines. If less powerful groups are being targeted for destruction through contraception as part of a eugenics agenda, then we should see higher rates of contraceptive use among these groups. But the opposite trend is quite apparent—more powerful groups use more contraceptives (see table below). Instead of evidence of genocide, what we have are signs that marginalized people do not have equitable access to contraception.

Percentage Current Use of Modern Contraceptives
Richest region (NCR) – 32% Poorest region (ARMM) – 10%
With college education – 36% With no education – 9%
Highest wealth quintile – 33% Lowest wealth quintile – 26%
Highest wealth quintile
using female sterilization – 12%
Lowest wealth quintile
using female sterilization – 4%
Source: 2008 National Demographic and Health Survey, p. 56

 

Forcible sex is rape. Forcing others to follow your sexual practices violates a host of civil rights. Sex between consenting adults is accepted by society. Similar norms are applicable to contraception. Imposing birth control is genocide. Imposing Vatican-approved methods—as was done in Manila by ex-mayor Lito Atienza of Pro-Life Philippinesis a violation of human rights. The freedom to choose a family planning method and government services to realize the choice is a fine policy, and is at the core of the current Reproductive Health bill.

(Next: Erroneous claims on vaccines and abortion/sterilization and the deadly consequences for infants and women)

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Lying for a Cause

Lying for a Cause

A video entitled “RH BILL – Filipinos For Life Oppose the RH Bill!” uploaded by www.filipinosforlife.com on YouTube made a hilarious mistake about a contraceptive method (or so I thought at first). The video claimed:

In 1974, Henry Kissinger and the United States saw the need to curb the population of 13 developing countries including ours. Planned Parenthood and UNFPA went to these countries and in exchange for foreign aid… sterilizations, condoms, intrauterine device and oral contraceptives.

With the word “sterilizations“, the video showed a picture of kids in line and a young girl screaming and being given an injection (see screen capture below).

A young girl forcibly sterilized to curb population growth—who would not be furious at this scene? Except that a minimal effort at research will show that sterilizations in family planning refer to tubal ligation for women and vasectomy for men, done through surgical procedures and not through injections.

Where did the photo come from? How can this anti-RH group make such a silly mistake? With the obvious guess that the photo is about vaccination for kids, I found the source of the photo with a single Google image search.

After seeing that the source of the photo has the word “vaccination” in the article’s headline, I have to retract my initial “silly mistake” reaction. The group behind the video wants to shock and anger its audience into an anti-RH position, and simply lied to further its cause. Now let’s wait and see if they will change their video and stick to speaking the truth.

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Fudging Numbers

Fudging Numbers

Anti-RH groups will hold what they call the “grandmother of all rallies” against the RH bill. I hope the attendance numbers will not be fudged again just to promote their cause.

Fudged again? Here’s a chronicle of the numbers game that took place for a similar show-of-force attempt last month (all underscoring supplied):

2/11/2011 – press release by Human Life International, 100,000

On Sunday, February 13, 100,000 pro-life activists will march through Manila in opposition to a so-called “Responsible Parenthood” bill that has been repackaged to appeal to the pro-life majority of Filipinos.

2/12/2011 – news report on an anti-RH rally in Cebu, 1 million

… Dr. Rene Josef Bullecer, Human Life International director, said the bill, which is being readied for deliberations, is the same as the previously filed proposals that aimed to make way for abortion and other ways that hamper human life. … On Sunday, around one million people are expected to attend a rally against the RH bill in Manila.

2/13/2011 – website post by YouthPinoy, an anti-RH Catholic youth alliance, 5,000

Of the estimated 5,000 people at this pro-life rally mainly organized by Pro-Life Philippines and the CBCP Commission on Family and Life, there are several thousands of young people who have chosen to spend their Sunday protesting against the highly-controversial RH Bill or the Responsible Parenthood Bill.

2/14/2011 – news report by Malaya, 5,000

Organizers said the rally which was participated in by some 5,000 would be the first in a “show of force” events.

2/14/2011 – news report by CBCP News, 10,000

“We stand with you for life,” said Lanao del Norte 2nd District Rep. Fatima Aliah Dimaporo, a Muslim, told the around 10,000 protesters.

2/15/2011 – news report by PNA, 5,000

“We stand with you for life,” said Lanao del Norte 2nd District Rep. Fatima Aliah Dimaporo, a Muslim, told some 5,000 protesters who joined the rally at the PICC complex.

2/18/2011 – news report by LifeSiteNews.com, over 50,000

Over 50,000 pro-life Filipinos gathered in opposition to the so-called reproductive health (RH) bill last Sunday at the Philippine International Convention Center in Pasay City.

Anti-RH groups predicted two attendance figures: 100,000 and 1 million. Then they reported three figures for actual attendance: 5,000, 10,000 and over 50,000. Two news sources gave the same attendance estimate: 5,000.

Who’s telling the truth? I think you can figure that out for yourself. (Kudos to YouthPinoy!)


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Taxes for RH: Public Funding for a Public Good

Taxes for RH: Public Funding for a Public Good

Imagine if advocates of laissez-faire capitalism say to Congress, “Our taxes pay for government agencies that regulate our businesses and impose labor standards. But we are fundamentally opposed to such regulations and labor standards! Forcing us to pay is unjust and oppressive.” Should Congress cave in and eliminate these tax-funded measures that anger preachers of laissez-faire and objectivism? I think majority will say no. Most people want the goals of regulations and standards—like safe products, honest services and decent pay for employees and workers—and view them as established rights that must be protected.

Preachers of Catholic fundamentalism say something eerily similar about reproductive health (RH): “Our taxes will pay for artificial contraception. But we are fundamentally opposed to such services! Forcing us to pay is unjust and oppressive.” Should Congress heed this argument?

Public acceptability

It is true that Humanae Vitae forbids Catholics to use artificial contraception. But majority of Filipino Catholics do not believe or follow this papal encyclical. According to a 2010 SWS survey[1], 69% of Catholics favor access to all legal means of family planning in government health facilities. The 2008 NDHS[2] survey of 13,594 women—80% of whom are Catholics—shows that some 60% of currently married women had “ever used” a modern family planning method disapproved by Vatican. Another 38% had tried withdrawal[3], a traditional method similarly banned by Vatican. In addition to Catholics who do not follow Humanae Vitae, other Filipinos have religions or norms that view artificial contraception as moral, and government will violate their freedom of religion and thought if such methods are singled out and excluded from public health services.

Thankfully, Catholic voices of reason and moderation are also being heard. Among them is Fr. Joaquin Bernas, Dean Emeritus of Ateneo Law School, who wrote the following in his blog:

The official Catholic teaching is that artificial contraception is immoral. Other religions believe in good faith otherwise. Seeking to impose Catholic belief and practices on non-Catholics and others violates freedom of religion. Freedom of religion does not merely mean freedom to believe. It also means freedom to act or not to act according to one’s belief.

Religious objections

Using taxes for purposes that some people oppose on religious grounds is neither new nor unique to RH. Both Muslim and Jewish communities forbid drugs derived from pigs, yet example products like heparin (a drug for preventing blood clots) and MMR (measles, mumps & rubella) vaccines are in the Philippines’ core list of essential medicines, available in public health facilities and reimbursable through PhilHealth. Members of the Jehova’s Witness oppose medical blood products, yet we spend taxes for blood transfusion and organ transplant services. To manage these religious objections, individuals are simply allowed to refuse drugs and treatment and seek out alternatives.

Catholic bishops oppose the mere reading of Jose Rizals’ two novels, as expressed in the following statement they issued in 1956:

… [Noli Me Tangere and El Filibusterismo] have included such substantial defects in their religious aspect as to render them objectionable reading in such sense that only with due permission obtained from ecclesiastical authority may these books be read by Catholics.  This permission, however, is readily granted for a justifiable reason, whenever the person concerned has sufficient knowledge of the Catholic doctrine in question.

Despite the bishops’ opposition, we spend taxes teaching Rizal’s novels in public schools as mandated by Republic Act No. 1425.

Cost effectivity

Finally, some people fear the tax burden of RH, especially the cost of supporting contraception. The fear is unfounded. Local and international studies by the Guttmacher Institute show that voluntary contraception will reduce total health costs by lowering the maternal and newborn care spending that come with unintended pregnancies.

In the Philippines, providing modern contraception to all women who need them[4] would increase the total public and private spending from P1.9 billion to P4.0 billion[5]. However, the increase would be offset by contraception’s impact on health spending for unintended pregnancies, which would fall from P3.5 billion to P0.6 billion. In sum: family planning costs would rise by P2.1 billion; medical costs for unintended pregnancies would fall by P2.9 billion; a net savings of P0.8 billion would be realized.

The details of the estimate are available online, but the following scenario may help explain the projected savings in public health. A woman belonging to the poorest 20% of families would, on the average, plan for three children but end up with five. If she has been enrolled in PhilHealth as required by regulations, the state health insurance agency would have to spend P6,500 for each normal childbirth; around P17,800 for each caesarean delivery; and P1,000 for each infant given a newborn care package. Two unplanned births would therefore cost P15,000 to P37,600. Around half would be paid for by PhilHealth[6] and the rest shouldered by the woman or, if not yet depleted, by the public hospital’s funds for indigent patients. In comparison, PhilHealth spends only P4,000 for each tubal ligation or vasectomy, and less than P500 for a copper-IUD that could last for up to 10 years.

Public goods deserve public funding. Reproductive health is a public good with a wide range of benefits. It is understood and supported by most people. For the minority with objections on religious or other grounds, the freedom to use or not use such services should suffice. And on top of all these, RH services saves money. What more can anyone ask for?

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[1] Social Weather Station

[2] National Demographic and Health Survey

[3] Some “ever users” of artificial contraception had also used withdrawal, so the two percentages cannot be added.

[4] Specifically “women who are at risk for unintended pregnancy”: married or unmarried and sexually active (within the past three months), are able to become pregnant, and do not want any more children or do not want a child in the next two years.

[5] Some people will not use any modern method of family planning for various reasons, so this scenario represents the highest possible level of use. The Guttmacher study calculated costs for other scenarios. In addition, the largest share of health spending—some 54%—come from private, out-of-pocket sources, according to the latest government figures. All of these factors will peg the cost to the public sector at a figure lower than P4.0 billion.

[6] Which currently has a benefit ceiling of 4 live births

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