Tag Archive | "inequity"

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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