Tag Archive | "family planning"

Come to the Family Planning Fair!


It’s World Population Day on July 11, and our friends from the UN, the European Union, and a whole host of like-minded organizations are setting up a Family Planning Fair at Manila City’s Baseco Covered Court from 8 AM to 4 PM. Free services include prenatal and medical care; and sexual and reproductive health education. A wide range of contraceptives will also be available.

Come over and celebrate the freedom to learn and to choose what’s best for our bodies and our families. Sa kalusugang pangkalahatan, family planning kailangan!

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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



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.

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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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CBCP trademarks the term “Catholic”

Manila, Philippines — In response to the existence of Catholics™ for RH (C4RH), the Catholic™ Bishops Conference of the Philippines have trademarked the term, “Catholic™.”

An official of the CBCP said Monday that the term “Catholic™” is reserved for those who obey the Pope’s teachings and are granted an official license by the Vatican through its newly formed franchising agent in the Philippines, the CBCP Commission on Franchising and Life (COFAL). COFAL recently filed a complaint with the Intellectual Property Office of the Philippines against C4RH.

“Catholics™ for RH are not authentic,” added Cebu Archbishop Jose Palma, COFAL president. “They are not recognized as Catholics™.” Last week, Archbishop Palma refused to meet members of the group unless it changed its name. “Either they change the ‘Catholic™’ part or they change the ‘for RH’ part. As it stands their name is an oxymoron, let alone illegal.”

In accordance with the guidelines of COFAL, Laguna Bishop Leo Drona, COFAL vice-president, issued a “clarificatory note for the guidance of all Catholics™ so that they may not be deceived or misled by C4RH.”

Bishop Drona added that COFAL “does not consider nor recognize this group to be an authentically Catholic™ association or group since it espouses and supports a stand contrary and in direct opposition to the magisterial teachings of the Church. Their group violates not only Canon laws but intellectual property laws as well.”

According to Drona, trademarking the term prevents the formation of other groups such as Catholics™ for Divorce, Catholics™ for Abortion, Catholics™ for Euthanasia, Catholics™ for LGBT rights, and Catholics™ for Choice.

Because of the CBCP’s recent actions, some Catholics™ said that they’d leave the Catholic™ Church and form their own.

COFAL President Palma casually dismissed these threats. “They can do whatever they want in their own church but it is useless,” said Arhbishop Palma. “The sacraments, the prayers, even the bread and wine have no holiness or power unless properly franchised by the Catholic™ Church.”

COFAL have recently filed applications to trademark the terms “moral,” “family,” and “life.”

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Atty. Jo Imbong on Imperialist, Non-Filipino RH Bill

Pre-colonial Filipino couple

The RH Bill did not come from Filipino legislators but from foreign organizations, Atty. Jo Imbong of the CBCP explained in English.

“It’s really introducing a different culture and replacing our own” — a culture which has been influenced by our Spanish, American, and Japanese colonizers — “with something else,” said Imbong.

“It is a cultural intrusion [in which] you supplant a beautiful thing with something that is alien,” said Imbong, possibly alluding to how our pre-Hispanic indigenous Malayo-Polynesian culture was supplanted with Spanish Catholicism.

Imbong and the CBCP oppose the RH Bill because it violates democratic rights — which originated in Greece — and religious freedom — which originated in Europe. They believe contraceptives are not a valid solution, let alone evil, consistent with the 1968 encyclical Humanae Vitae, which was promulgated by an Italian pope from Rome.

Instead of contraceptives, Imbong and the CBCP recommend natural family planning, a birth control method discovered and developed by individuals and institutions in the Netherlands, Japan, Austria, Australia, and the United States.

“It’s quite disturbing because our culture as it is,” said Imbong, “has very wholesome ideals, built on Christian values.” Christianity, a religion that began in Palestine, was influenced by Babylonian, Egyptian, Indian, and Chinese traditions, and was institutionalized as Roman Catholicism in Italy. It has evolved significantly thanks to theologians from all over the world, except the Philippines.

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Reproductive Health Bill Revisited

If I remember it right, it’s been already a decade of almost nonstop controversy regarding the reproductive health and contraceptives issue. The earliest that I could remember was how Mayor Lito Atienza came under fire for banning Manila public clinics from distributing free contraceptives and teaching any other methods of contraception other than natural family planning, which is the only “contraception” method espoused by his religion. Human Rights Watch HIV program research, Jonathan Cohen, even went far in saying that “the Philippines is courting an AIDS epidemic with its anti-condom approach…the casualties will be millions of people who cannot protect themselves from HIV infection“. Lito Atienza and his wife may have had pro-life projects that truly helped impoverished women, especially those who suffered from post-abortion trauma, but still, their anti-contraceptiion stance is immovable.

And such stance has pervaded, unfortunately, some of the country’s lawmakers. For this reason, the fate of the Reproductive Health Bill, hangs in a balance.

And unfortunately, the anti-RH force is moving heaven and earth just so that this bill will not be passed.

But what is it in the Reproductive Health Bill that has enraged the Catholic clergy?

I have actually written about this particular subject several years ago (see “What the RCC hates in the RH act“). But, since this bill has gone some revisions, we shall try to review it again, during the course of which I’ll try to dismantle the misinformation being propagated by the so-called “pro-lifers” (who have more than successfully hijacked the term just so to gain unfair advantage over their opponents).

The elements of reproductive health care that are being espoused by the bill are as follows:

    family planning information and services;
    maternal, infant and child health and nutrition, including breastfeeding;
    proscription of abortion and management of abortion complications;
    adolescent and youth reproductive health;
    prevention and management of reproductive tract infections (RTIs), HIV and AIDS and other sexually transmittable infections elimination of violence against women;
    education and counseling on sexuality and reproductive health;
    treatment of breast and reproductive tract cancers and other gynecological conditions and disorders;
    male responsibility and participation in reproductive health;
    prevention and treatment of infertility and sexual dysfunction;
    reproductive health education for the adolescents
    mental health aspect of reproductive health care.

But for this post, I shall be limiting myself in those concepts that has lighted the fire under our beloved clergy’s butts.

1) Family planning information and services

Beloved Catholic clergy did not want taxpayers’ money to fund public health clinics giving out pamphlets and lectures regarding modern artificial contraceptives. Neither does it want it to be giving away free contraceptives. The clergy wanted ONLY natural methods of family planning to be endorsed and taught by these clinics. The clergy has successfully convinced some of its members to disagree with the bill by cleverly insinuating that their taxes go to activities deemed immoral by their church (not considering that NOT everybody in this country belong to their church). And so the statements, “I will not allow the government to use my taxes to pay for your condom” and “let them buy their own condoms”. Well, the idea is to help out the impoverished who cannot afford to buy contraceptives. For those who do not know, contraceptives are considered essential medicines (see section 18, WHO list of essential medicines March 2010 update). The WHO list of essential medicines is a list of minimum medicines needs for a basic health care system. If the clergy wanted to prevent contraceptives from being able in a basic health care unit, then they are, basically, preventing the government from addressing basic health care needs.

The clergy is also frowning upon the use of IUDs and tubal ligation as contraceptive measures. What most of them are blind to is the provision in the bill that these procedures will not be FORCED upon women, but rather, it would be made available to those who may wish to have these procedures.

    SEC. 7. Access to Family Planning
    All accredited health facilities shall provide a full range of modern family planning methods, except in specialty hospitals which may render such services on an optional basis. For poor patients, such services shall be fully covered by the Philippine Health Insurance Corporation (PhilHealth) and/or government financial assistance on a no balance billing.
    After the use of any PhilHealth benefit involving childbirth and all other pregnancy-related services, if the beneficiary wishes to space or prevent her next pregnancy, PhilHealth shall pay for the full cost of family planning. 

    SEC. 11. Procurement and Distribution of Family Planning Supplies
    The DOH shall spearhead the efficient procurement, distribution to LGUs and usage-monitoring of family planning supplies for the whole country. The DOH shall coordinate with all appropriate LGUs to plan and implement this procurement and distribution program. The supply and budget allotment shall be based on, among others, the current levels and projections of the following:
    (a) number of women of reproductive age and couples who want to space or limit their children;
    (b) contraceptive prevalence rate, by type of method used; and
    (c) cost of family planning supplies.

    SEC. 24. Right to Reproductive Health Care Information
    The government shall guarantee the right of any person to provide or receive non-fraudulent information about the availability of reproductive health care services, including family planning, and prenatal care.
    The DOH and the Philippine Information Agency (PIA) shall initiate and sustain a heightened nationwide multi-media campaign to raise the level of public awareness of the protection and promotion of reproductive health and rights including family planning and population and development.

2) Proscription of abortion and management of abortion complications

As early as now, I’m going to say there is nothing (I repeat, NOTHING) in the reproductive health bill that is espousing abortion (abortion being “expulsion from the uterus of the products of conception before the fetus is viable”, according to an online medical dictionary). The bill, rather, wants to strengthen postabortion care. Now, some will say this is indirectly encouraging women to have abortion. But I’m going to stop you right there. Every woman who has had an abortion, whether spontaneous or induced, whether the abortion hurts you as a believer or not, has a right to obtain good postabortion care.

I remember how it was in the different hospitals I have rotated before…girl coming to the hospital complaining of vaginal bleeding and by history, it was evident that she had induced abortion. Health care providers, then, would be rough and tough on her, just so she’d remember the pain and thus, “remember the lesson”. And some even threatened to be denied anesthesia during curettage, just so they’d break down and cry, the health care provider thinking she’d someday learn to keep herself from getting pregnant again, having more than 5 children or so at the tender age of 20. I remember crying at the time I assisted in the vaginal delivery of a 12-year old girl, a pregnancy that was a product of rape of her father. I remember her as a pained girl, who was so restless on the delivery table, not knowing what to do and too much in pain even to think, as the ob-gyne resident shouted down on her to keep her legs apart. “Ayoko na po! Ayoko na po!” were the words she had ceaselessly shouted until she was able to deliver her baby. I imagined it must be the same set of words that she have shouted back to her father while she was being raped.

No, I’m not saying that this girl should have outright abortion because of rape. But if reproductive health assistance are in place, she could have had proper prenatal care and a planned cesarean section would have been done, as her body frame is so small, she might be better off with a C-section rather than risking a vaginal delivery. However, she did not have prenatal care and the only consultation with a health professional that she had was when she was already in active labor. Or she could have had emergency contraception hours after the attack on her.

For you Anti-RH doctors out there, I don’t understand why you still can’t agree to pass the RH bill, with all that you’ve seen since medical school and clerkship. I bet almost everyone of you has rotated in government hospitals. You have seen the numerous poor pregnant women who have come in and out of these hospitals. You have heard their stories, of how they wanted only few children, but were stuck with 10 or more because they cannot refuse a husband asking for sex. You must have heard how most of these women would say they cannot complete their prenatal care because they’d rather spend on food and electricity than on transportation to hospital and medicines. You have seen how some of the health providers in these government hospitals have been rough and tough on these women, just so that they remember the pain and hardship enough to make them think twice before going into another pregnancy. You have seen the scope of how access to reproductive health medicines and procedures are sorely lacking in this country. How can you not agree with the passage of the bill? Because of your alma mater? Because of your religious convictions? This is not an issue of religion; this is a secular issue. Let these women have their choice!

3) Reproductive health education for the adolescents
The clergy keeps on asking, “do you want your children as young as 5 years old to learn about sex?” My answer to this is YES. Whether parents would be honest to themselves or not, one cannot deny the curiosity of a growing child. Yes, even at the young age of 5, kids do already have some questions related to gender and sex. As the kids grow older, the questions grow more mature and complicated. And it is the responsibility of parents to address these questions. But not every parent can be comfortable discussing sex with their children. Come on, be honest with yourselves. Have you ever discussed sex at any length with your mother/father? The all-too-common scenario at home is this: parent and youngster watching a movie on TV, then a kissing scene comes up. Father/mother brings up one hand to cover youngster’s eyes until the scene ended. “Don’t look, you’re too young for this!” And the youngster is either left bewildered at why he shouldn’t see those scenes or he already knows what those scenes are because he already saw movie at a friend’s house. Most Filipino parents would be just content at “screening out” the topic of sex without ever venturing into trying to give the appropriate knowledge to their kids. And unfortunately, these kids would learn about sex and reproduction through friends only. Talk about the blind leading the blind. And it is at this point that the whole barrage of misinformation and myths start and sometimes will culminate into teen pregnancy or other complications regarding relationship with another person.

And here comes the clergy telling us that only the parents should teach their kids about sex.

In the amended reproductive health bill:

    SEC. 16. Mandatory Age-Appropriate Reproductive Health and Sexuality Education
    Age-appropriate Reproductive Health and Sexuality Education shall be taught by adequately trained teachers in formal and non-formal educational system starting from Grade Five up to Fourth Year High School using life skills and other approaches… 

    …Parents shall exercise the option of not allowing their minor children to attend classes pertaining to Reproductive Health and Sexuality Education.

I’m not sure where the clergy got the idea that the kids will be forced to attend sex education classes. It is rather clear that the parents have the option to let their children attend these classes. However, in my opinion, children as young as those in the 5th grade should have these classes already. Fifth graders are usually in the age of 11-12 years old and this age is the start of puberty. With many changes in their bodies, these children should be enlightened and armed with knowledge they need to understand these changes.

There is still plenty left to be discussed regarding the reproductive health bill, now that the clergy and their loyal followers are so hell-bent on obstructing the passage of this bill into law. This has also brought out the worst in some people, even if they think they mean well and are only fighting for what they think is right. However, what we must remember that reproductive health bill shouldn’t even be an issue anymore. Every country needs a good reproductive health care available to its citizens. We have our own personal beliefs regarding it, whether it be religious or not. But reproductive health is a secular issue and citizens must decide on this with the objective that the laws to be passed should be beneficial and appropriate to EVERYONE in the country.

Please see these related articles:

Complete Reproductive Health Bill Text http://rhbill.org/about/rh-bill-text/
Authors’ Amendments to HB 4244 http://rhbill.org/about/amendments-hb4244/

My older posts regarding the issue:
What the RCC hates in the Rh act http://prudencemd.com/?p=488
Family planning will be taught in classes in qc http://prudencemd.com/?p=428
Courting health disaster with Philippines’ anti-condom policies http://prudencemd.com/?p=396
The blog rounds: The State of Reproductive health in the Philippines http://prudencemd.com/?p=492

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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?


[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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I stand for women and oppose Ayala Alabang Barangay Ordinance 01-2011

designed by Julian Rodriguez

I come from a devout Catholic family and studied in a grade and high school that was non-sectarian (secular) but run by Opus Dei, a conservative organization in the Catholic Church. In my freshman year in high school I was taught sex education for a few weeks during Health class. The sex ed portion was eventually scrapped because of some complaints from parents.

My whole family staunchly opposes the Reproductive Health bill and wholeheartedly supports the ordinance. My mom and I both attended the public hearing last Saturday, but she was on the pro side — I was on the anti side. I’m pretty much the only one in my family that is for the RH bill and against the ordinance — and yes, it can get quite lonely.

In light of last Saturday’s public hearing on Barangay Ayala Alabang Ordinance 01-2011, I would like to share with you this letter I mailed to the barangay chairman on how the ordinance is anti-woman and supports a culture of reproductive oppression. This letter was supposed to be my 5-minute speech but the format of the hearing was changed and I could not deliver it.

21 March 2011

Barangay Ayala Alabang
Narra St, Ayala Alabang Village

Dear Mr. Xerez-Burgos,

Many women may feel the same way I do about Barangay Ayala Alabang Ordinance 01-2011 and some of them cannot speak for themselves because they are scared of how society will brand them. I am writing this letter on behalf of these women and oppose Barangay Ayala Alabang Ordinance 01-2011.

For my entire life, I have been blessed to live in a country where I can receive a university education, choose a career, and participate in elections. I can wear whatever I want and I am not required to cover myself head to toe in cloth. Arranged marriages are a thing of the past – I can actually choose my own husband and I can marry when I please. I have been so privileged compared to my female ancestors, but one thing that has not changed is that I still live in a culture of reproductive oppression.

I believe this ordinance will continue to uphold this culture of reproductive oppression instead of eradicate it. By censoring the sex education I and other residents in this village would like to receive, I will be deprived of my right to learn about my sexual rights. The first time I heard about sex was in 5th grade, in a conversation with classmates. The school I attended for my elementary and high school education forbade sex education to be taught. My mother did eventually tell me about sex, but again, it was very limited. I have learned about the process of conception but I have yet to arm myself with the right information to protect myself from sexually transmitted infections, defend myself from unwanted sex and sexual harassment, or avoid pregnancies. When this ordinance is passed, it will become illegal for me to learn about birth control – other than natural means – in the confines of this barangay. I will continue to be a victim of dishonest sex education.

In this day and age, I believe it is my right to plan my pregnancies in the way that I choose, through both natural and artificial means. Yes, I included artificial birth control because I do not share the same sentiments you have. I believe that women deserve to be in control of their bodies and to exercise their own conscientious choices when it comes to reproductive health care. We have the right to all the information we need to make decisions about sex. This barangay institution, which is meant to safeguard and provide care for its residents, will systematically block women from being fully informed.

Mr. Xerez-Burgos, what offends me the most about this ordinance is that it aims to damage my reputation when I go to the drugstore to purchase birth control and a logbook has to be filled out with my private information that is nobody’s business and certainly not the barangay’s business. I will be labeled as an abortion practitioner if I use FDA-approved non-abortive contraceptives. Is this the 17th century where my information in this logbook will essentially become a scarlet letter, a badge of shame that will be pinned on my person? And because most artificial contraceptives were created to be used by women such as birth control pills and intra-uterine devices, the reputation of all women who choose to use artificial birth control will be in danger.

This ordinance upholds a culture of reproductive oppression against anyone who can get pregnant: women. This oppression is unfortunately scarily invisible, even to us who experience it, because it continues to be normalized and institutionalized. Being raised a devout Catholic without any reliable or scientifically accurate information about birth control or sex, thereby risking my health and the health of my future children, is a form of oppression. Needing a prescription to purchase a condom, is oppression. Having my decision to use artificial birth control judged as abortion is oppression. Being treated with hostility and shame for using artificial birth control is oppression. Not being able to get proper sex education from the barangay is oppression.

I oppose this ordinance because I believe the lives of women matter.

I oppose this ordinance because women should have the right to decide when and if they get pregnant, give birth, and raise children – not the barangay, nor the Church.

I oppose this ordinance because I believe that the right to control your own reproduction is a fundamental right and is protected under the Constitution and basic human rights ideals. I believe that the fundamental right includes the right to prevent pregnancy and the right to get pregnant, whether through natural or artificial means.

I oppose this ordinance because I do not believe that anyone should be legally compelled to expose their sex lives to the public.

I oppose this ordinance because I realize that my rights to birth control, to have children, and to make my own decisions hinge on my basic ability to decide when and if I reproduce.

I oppose this ordinance because I do not believe that people should be criminalized for exercising reproductive freedom and freedom of speech.

I oppose this ordinance because I am a woman and women deserve better.

Mr. Xerez-Burgos, thank you in anticipation of your kind consideration and I look forward to your reply*.

Marie Gonzalez

[*} Republic Act 9485 (2007), also known as the Anti-Red Tape Act of 2007, mandates that public officials must respond to letters of citizens within 5-10 days from receipt with a report on the action taken on the matter. This is to promote integrity, accountability, proper management of public affairs and public property.

The image used for this article was printed on shirts anti-Ordinance advocates wore at the public hearing. It was created by Julian Rodriguez.

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Do Bishops Care?

An open letter to the CBCP delivered by more than a thousand women and their supporters had this simple message: “Eleven women die every day from pregnancy and childbirth, a continuing tragedy that can be ended by the RH bill you are blocking.” To stress the point that bishops are partly responsible for these deaths, women carried streamers with this question: “Do bishops care?”

A day or two later, CBCP News published a report with a short reply and disturbing indications that the CBCP representative did not even care to read the bill.

Let us start with the most obvious error. CBCP secretary general Msgr. Juanito Figura called for more health facilities and personnel to show that they are concerned about Filipino women, evidently unaware that the RH bill has very detailed provisions on these matters.

From the past Congress to the current one, versions of the RH bill had called for the hiring of fulltime skilled birth attendants (SBA) to achieve a ratio of 1 SBA to 150 deliveries. SBAs are midwives, doctors or nurses “educated and trained in the skills needed to manage normal (uncomplicated) pregnancies, childbirth and the immediate postnatal period, and in the identification, management and referral of complications in women and newborns.” The ratio of 1 to 150 is based on the experience of successful countries like Malaysia, where the maternal mortality ratio[1] has been reduced to 50 and below since 1985, compared to the Philippines’ 162 in 2006.

Previous and current versions of the RH bill had also called for the setting up or upgrading of hospitals and other health facilities to provide emergency obstetric care (EmOC). Six lifesaving measures must be present for a facility to qualify as capable of basic EmOC; eight in a hospital tagged as comprehensive. Among these lifesaving measures are the administration of parenteral[2] antibiotics, blood transfusion and delivery by cesarean section. The RH bill also targeted a ratio of 1 comprehensive plus 4 basic facilities for every 500,000 people to ensure sufficient and well-distributed services. All of these steps come from lessons in other countries and recommendations by the World Health Organization and other international agencies.

Next, Msgr. Figura cited “social inequities” as among the reasons for the deaths and sufferings of Filipino women, especially the poor, and claimed that the RH bill “can even worsen the already real and present problems.”

Social inequities abound in health care, including reproductive health. Long queues; women due for delivery sent away to prioritize those already in active labor; two or more mothers sharing a bed—all these are common scenes in obstetric wards of public hospitals. The bishops must truly be out of touch with the lives of poor people to claim that RH measures will worsen social inequities.

In the 2008 National Demographic and Health Survey (NDHS), comparisons between the poorest and the richest quintile (20%) of women illustrate the serious inequities in reproductive health:

  • 26% of the poorest women have been managed in childbirth by a SBA, compared to 94% of the richest;
  • 13% of the poorest women have given birth in a health facility, compared to 84% of the richest;[3]
  • 1% of the poorest women have delivered via cesarean section, compared to 28% of the richest.[4]

The RH bill seeks to remedy inequities through additional funds, facilities and personnel for the public health sector frequented by poor women. If these are not done, 11 women will continue to die every day from maternal complications. More often than not, these are women who can never set foot inside the air-conditioned single rooms of private hospitals.

Next, Msgr. Figura explained that among the reasons why bishops reject the RH bill is “its overall trajectory towards population control.” Wrong again. Freedom of choice and reproductive rights are among the fundamental principles in the RH bills. Reproductive rights are human rights, and in essence guarantee the rights of couples, individuals and women to “decide freely and responsibly whether or not to have children; to determine the number, spacing and timing of their children; [and] to make decisions concerning reproduction free of discrimination, coercion and violence.” To make these principles enforceable, the RH bill prohibits public officials from forcing people to use or not use family planning services.

Surveys indicate that most women and couples want to have smaller families. Institutions and groups that wish to overturn this social trend through clandestine deals, political pressures, surprise ordinances and other undemocratic means are the ones engaged in population control.

Finally, Msgr. Figura said that bishops reject the RH bill because it intends to “use public funds to subsidize contraceptives and sterilization services.” The 2008 NDHS shows that among married women, 54% do not want to have any more children, and 19% want to delay the next birth by two or more years. If these women can avoid pregnancy, then they would not be in any danger of maternal death. If the government will help them use a method of their choice—whether artificial or natural family planning—then taxes would have been used to prevent maternal complications and deaths.

In a pluralistic and secular society, contraception and sterilization are not self-evidently objectionable. The CBCP’s short reply noticeably dropped any mention of Humanae Vitae or the natural moral law that usually underpin its opposition to contraception and sterilization. This is a good sign. Now if they would just read the bill.


Signed letters sent to the bishops:

Bukas na Liham sa CBCP Hinggil sa RH

An Open Letter to the CBCP Regarding RH


[1] Maternal deaths per 100,000 live births, a standard measure that represents the risk of dying once pregnant

[2] Intravenous or intramuscular

[3] The recommended level is not less than 15% should give birth in an EmOC-capable health facility, based on the estimate that at least 15% of all pregnancies lead to serious maternal complications that need emergency obstetric care.

[4] The recommended level is 5-15%. Rates below 5% indicate that women who need cesarean section delivery to survive are not getting it. Rate above 15% suggest an overuse of elective cesarean operations.

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Talking to Death

A fictional face-off between Aquino and bishops

A fictional face-off between Aquino and bishops

The common sexist notion is that women talk too much. But on the issue of reproductive health, a bachelors’ club and a bachelor president may well be gearing up to talk each other to death.

I’m talking of course about the CBCP bishops and President Aquino. Listen to the palace’s spokesman and pray tell if you can detect any sense of urgency: “As you know we still have a dialogue with the bishops on the end of February. We committed to propose a responsible parenthood bill with inputs from the dialogue. … The President will limit his power to certify measures as urgent based on what is stated in the Constitution. It refers only to emergency cases. So most likely, [the RP bill] will not be certified as urgent.”

But really, what can these bachelors with palaces talk and agree about?

The bishops are sworn to obey the pope and Humanae Vitae—they can’t agree to any law that includes artificial contraception as a choice, even if it’s called “The Most Sacred, Blessed and Responsible Parenthood Within Holy Matrimony Act.”

The president has sworn to a Constitution where human rights and Church-and-State separation are fundamental principles. His idea that informed choice must be central to family planning is a mere reiteration of constitutional tenets. He cannot endorse the bishops’ NFP-only doctrine without junking his “daang matuwid” (honourable path) and following his predecessor’s hobby of trashing our basic law.

And so we had mighty men glaring at each other the last few months. A tense deadlock, dramatically broken when the most powerful of them all decided… to talk some more.

Poor mothers and infants die each day, half from pregnancies unplanned, others due to simple RH services unavailable. Will bachelors with palaces notice or care?

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Ten Good Reasons to Pass the RH Bill Now

Just a few years ago, say “RH” in ordinary talks and you’ll get blank looks. Now, most Filipinos know that RH is reproductive health. It has entered presidential debates, topped the news, been surveyed to death. Moreover, majority have plainly said their piece: “We support RH.” Why? Loads of reasons—from the practical “We need help” to the proud “It’s my choice!” But 10 good ones should be enough to convince rational people and thoughtful policy-makers. So here are our top picks.

1 RH will: Protect the health & lives of mothers

The WHO (World Health Organization) estimates that complications arise in 15% of pregnancies, bad enough to hospitalize or kill women. From the 2 million plus live births alone, some 300,000 maternal complications occur yearly. This is 7 times the DOH’s annual count for TB, 19 times for heart diseases and 20 times for malaria in women. As a result, more than 11 women die needlessly each day.

Enough skilled birth attendants and prompt referral to hospitals with emergency obstetric care are proven curative solutions to maternal complications. For women who wish to stop childbearing, family planning (FP) is the best preventive measure. All these are part of RH.

2 Save babies

Proper birth spacing reduces infant deaths. The WHO says at least 2 years should pass between a birth and the next pregnancy. In our country, the infant mortality rate of those with less than 2 years birth interval is twice those with 3. The more effective and user-friendly the FP method, the greater the chances of the next child to survive.

3 Respond to the majority who want smaller families

Times have changed and people want smaller families. When surveyed about their ideal number of children, women in their 40s want slightly more than 3, while those in their teens and early 20s want just slightly more than 2.

Moreover, couples end up with families larger than what they planned. On average, Filipino women want close to 2 children but end up with 3. This gap is unequal, but shows up in all social classes and regions. RH education and services will help couples fulfill their hopes for their families.

4 Promote equity for poor families

RH indicators show severe inequities between the rich and poor. For example, 94% of women in the richest quintile have a skilled attendant at birth, while only 26% of the poorest can do so. The richest have 3 times higher tubal ligation rates. This partly explains why the wealthy hardly exceed their planned number of children, while the poorest get an extra 2. Infant deaths among the poorest are almost 3 times that of the richest, which in a way explains why the poor plan for more children. An RH law will help in attaining equity in health through stronger public health services.

5 Prevent induced abortions

Unintended pregnancies precede almost all induced abortions. Of all unintended pregnancies, 68% occur in women without any FP method, and 24% happen to those using traditional FP like withdrawal or calendar-abstinence.

If all those who want to space or stop childbearing would use modern FP, abortions would fall by some 500,000. In our country where abortion is strictly criminalized, and where 90,000 women are hospitalized yearly for complications, it would be reckless and heartless not to ensure prevention through FP.

6 Support and deploy more public midwives, nurses and doctors

RH health services are needed wherever people are establishing their families. For example, a report by the MDG Task Force points out the need for 1 fulltime midwife to attend to every 100 to 200 annual live births. Other health staff are needed for the millions who need prenatal and postpartum care, infant care and family planning. Investing in these core public health staff will serve the basic needs of many communities.

7 Guarantee funding for & equal access to health facilities

RH will need and therefore support many levels of health facilities. These range from health stations that can do basic prenatal, infant and FP care; health centers for safe birthing, more difficult FP services like IUD insertions, and management of sexually transmitted infections; and hospitals for emergency obstetric and newborn care and surgical contraception. Strong RH facilities can be the backbone of a strong and fairly distributed public health facility system.

8 Give accurate & positive sexuality education to young people

Currently, most young people enter relationships and even married life without the benefit of systematic inputs by any of our social institutions. We insist on young voters’ education for events that occur once every few years, but do nothing guiding the young in new relationships they face daily. The RH bill mandates the education and health departments to fill this serious gap.

9 Reduce cancer deaths

Delaying sex, avoiding multiple partners or using condoms prevent HPV infections that cause cervical cancers. Self breast exams and Pap smears can detect early signs of cancers which can be cured if treated early. All these are part of RH education and care. Contraceptives do not heighten cancer risks; combined pills actually reduce the risk of endometrial and ovarian cancers.

10 Save money that can be used for even more social spending

Ensuring modern FP for all who need it would increase spending from P1.9 B to P4.0 B, but the medical costs for unintended pregnancies would fall from P3.5 B to P0.6 B, resulting in a net savings of P0.8 B. There is evidence that families with fewer children do spend more for health and education.

You may want to copy this (or expand the list) and send to family, friends and acquaintances until it reaches our legislators. We need the support of everyone we can reach and convince.

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Sex: Control and Consequences

“It’s good if the man agrees with you—then he controls himself.” (Maganda pag ok ang lalaki—siya na ang nagkokontrol.) Were the men controlling their sex drives? Or controlling their orgasms so as not to come inside their wives? I was struck by the language used by a group of urban poor women as our team of community researchers analyzed a video of a focus group discussion last week. The women were all non-users of modern contraception despite their desire to stop childbearing altogether.

pregnant bishopI think they meant both types of control. About half were doing rhythm, and the rest were on the withdrawal method. Almost all were keenly aware that their methods were not so reliable (hindi safe). One woman narrated how a severe hypertensive disorder (eclampsia) during her last pregnancy forced her to stay a month at a hospital to recover.

Men are in control. Women bear the consequences.

Will our society ever put an end to this glaring inequity? I think there is hope. When the group was asked if they thought it was a woman’s right to use contraceptives, all said “Yes!” in unison. None fingered the husband as the reason for non-use.

Gender equity and equality in the bedroom or banig are still far-off, but there are signs of progress. The 1987 Constitution vowed for the first time to “ensure the fundamental equality before the law of women and men.” Forcing sex on one’s spouse became an offence in the Anti-Rape Law of 1997. Women with college education have narrowed the gap between the number of children they want (average of 1.9) and the number they end up with (2.3), according to a 2008 survey. The 2009 Magna Carta of Women has mandated the State to “take all appropriate measures to eliminate discrimination against women in all matters relating to marriage and family relations.” Reproductive Health bills based on the principles of human rights and reproductive rights have won broad public support in recent years.

There is hope. Except perhaps for the Catholic Church.

Popes, bishops and priests still lord over Catholic sexual moralities with strange antiquated rules. A man may spill his seed anytime with his wife, but not anywhere: rhythm method is moral, withdrawal is not.

The scientific stance about rhythm and withdrawal methods are way easier to comprehend and judge for truthfulness: both are more effective in preventing pregnancy than no method at all, but are less effective than modern methods like condoms, pills, injectables, IUDs, vasectomy and tubal ligation.

If women could become priests, bishops and popes, or if women could participate at the highest level of policymaking, would the Church remain so harsh and dogmatic about contraceptive methods? I suspect the answer is no, but I figure changes like these would take generations or centuries to occur.

Secular structures move faster. Filipino men approved women’s right to vote in a plebiscite in 1937. Less than eight decades later, we have had two women presidents. There are women in the Senate and House of Representatives; women justices of the Supreme Court; women governors and mayors; women managers of enterprises; women in practically all professions. Heck, even elementary pupils elect girls as classroom presidents! In this great social tide of building more egalitarian institutions, the Catholic Church stands firm resisting change.

In matters of sex, the Filipino family and the Church are quite similar. Men are in control. Women bear the consequences. But unlike the Church, each of us can change the family we belong to, or the one we plan to build and nurture.

The Church may be hopeless, but there is hope.


The operations research of Likhaan Center for Women’s Health is ongoing at a large urban poor community in Letre, Malabon. Why some women like those in the focus group discussion (FGD) are not using contraceptives, and what can be done to help them are the key questions we hope to answer and share with you by year’s end. Nene facilitated the FGD I narrated above. Eric, Lina, Iday, Miriam and I are part of the team. Thanks to Monk for the idea on blurring the lines. Any and all errors in this article are of course mine.

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Killing Babies

Hardcore opponents of contraception just love incendiary language. They repeatedly equate artificial family planning methods with killing babies or the extermination of millions of unborn children, toying around with the conscience of contraceptive users. Babies are cute and cuddly. Who would support treating them like vermin? Well, current medical evidence say that not practicing proper birth spacing leads to more infant deaths. So in the spirit of tit for tat, tell this to the moral crusaders: your obstruction of contraceptive choices kills real babies.

Thirty seven international experts convened by the World Health Organization (WHO) reviewed several studies in 2005 and, in the usual objective and non-fiery style of scientists, made the following recommendation:

Individuals and couples should consider health risks and benefits along with other circumstances such as their age, fecundity, fertility aspirations, access to health services, child-rearing support, social and economic circumstances, and personal preferences in making choices for the timing of the next pregnancy. … After a live birth, the recommended interval before attempting the next pregnancy is at least 24 months in order to reduce the risk of adverse maternal, perinatal and infant outcomes.

What are the adverse outcomes associated with birth spacing of less than two years? Infants 0–12 months old face increased risk of death. If women and couples are assisted in having the most effective method of contraception that suits them—a core content of reproductive health bills in Congress—infant deaths will be reduced. Simply put: family planning saves babies.

One of the Millennium Development Goal targets is to lower the Philippines’ infant mortality rate (IMR) to 19 deaths per one thousand live births by 2015. The National Demographic and Health Survey of 2008 showed that those with previous birth intervals of three years have already met this target with a measured IMR of 18, while those with intervals of less than two years have almost twice the death rate at 35.

Poor access to contraception kills infants. And these are deaths among real babies with bodies you can caress and faces you can touch, not the conjectured unimplanted fertilized eggs that anti-contraception advocates scream about. The WHO has firmly stated in 2006 that hormonal contraceptives and IUDs “cannot be labelled as abortifacients,” that doing so “contradict both WHO’s evidence-based international standards on the mechanisms of action and the drug and device labelling in the WHO Model List of Essential Medicines.”

Around 52,000 babies were estimated to have died in the Philippines in 2008. If Humanae Vitae was made into law, and if the Catholic Church fails to shift millions of couples to its approved natural family planning methods, how many more babies would die? I think anti-contraception advocates should appraise the evidence and do the math. Then perhaps they would reexamine their conscience and their moral compass, and at the very least drop the incendiary language.

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Now Who’s Being Unreasonable?: Carlos Celdran, the Catholic Bishops, and the Failure of Reason.

I sympathize with the folk who find Carlos Celdran’s actions offensive and unreasonable. I can see where you’re coming from. But let me suggest, too, that there’s enough unreasonableness to go around, and maybe it didn’t start with Carlos shouting in Manila Cathedral.

All this arguing about RH aside, we’ve quite forgotten that a reasonable accommodation already exists. It is this: allow government health offices to offer both artificial and natural family planning resources; permit anybody, of whatever faith, to choose the family planning resource that they need. The Catholic Church is absolutely free to pressure its believers to make a choice consistent with its dictates – but cannot pressure the government to limit its offerings only to that choice consistent with Church teaching.

But apparently, for the bishops, this accommodation is simply not reasonable enough. And it is only the Church hierarchy and their stalwarts who have rejected this reasonable middle ground.

After decades of the Philippine media and politicians indulging the Catholic bishops’ threats, tantrums, and drama, it’s easy to overlook the accommodation that’s been under our noses all along – and the bishops’ unreasonable refusal to join the rest of us in compromise.

“We’ve tried reasoning with the bishops, and it didn’t work. Now let’s try plan B.” It could be that Carlos was the very first person who came to this conclusion. He certainly won’t be the last.

Originally published as a note on Facebook.

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