Of 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.
[…] studies clearly show that their stance on the RH bill is simply to sit idly and allow preventable deaths day after […]
implying that the existence of contraceptives encourage sexual promiscuity is like saying the use of seat-belts encourage people to drive more recklessly… or the construction of overpasses makes people want to cross the street over and over again for no apparent reason other than the "thrill" of using the overpass.
do condoms have some mysterious erotic aphrodisiac qualities that push people to have random wanton sex with strangers? ask anyone who've used it and they'll tell you its quite the opposite. its a hassle to put on in the heat of the moment and lessens tactile sensation.
Next to pills, the most common method here is tubal sterilization. Condoms are actually at the bottom of the list. Now who would want to have their abs sliced and tubes cut or tied to have fun with strangers? Most women want to stop at 2-4 kids to simply have the time and resources to care for them.
I remember an expose by channel 2 or was it 7? where they interviewed jeepney and bus drivers. When asked what the signs on the street were… almost all of them had no idea what they were for.
all they knew was green-go, red-stop, yellow-go faster.
thus the term drive-by-instinct.
[all they knew was green-go, red-stop, yellow-go faster. ] Equivalent in sex-ed to "Yes means yes, and no means try harder." Both baaaad ideas.
28 percent of young Filipino adults thought that acquired immuno deficiency syndrome (AIDS) is curable while 73 percent thought that they are immune to human immuno-deficiency virus (HIV). two things that should be common knowledge all over the globe.
And that is normal by Church standards. Its "Natural"
I say the analogy works quite well.
It is so wrong to use the "Crossing Street" metaphor and leave out the value of discipline, of both motorists and pedestrians, and common courtesy that requires good communication between the two parties in order to reduce the incidence of accidents. Example: In the US a disciplined motorist, without the presence of a cop, would come to a full stop at an intersection that has a stop sign. He looks to his left and right, and seeing that there is a pedestrian waiting to cross, establlishes eye contact, acknowledging his presence. The pedestrian, aware that he is seen and is given the courtesy, could now safely cross the street. That scenario is realistic and is happening. What can you say about the lack of discipline of the uneducated class (acknowledging exceptions) and the educated as well, when it comes to sexual mores. It seems many just want the gratification without the responsibility that comes with the act. How does a contraceptive mentality make it easier to strengthen discipline in this specific terms, and in the much broader term of civics and cultural development of a people?
I argue that our Tiger neighbors have excelled in science and technology, becoming net producers so they become net exporters, rather than because they developed a contraceptive culture.
miguel, to use your own metaphor, a good "motorist" only becomes disciplined and capable of obeying traffic laws if he KNOWS the law. Ergo, he has to go through several sessions of driving school before qualifying for a license. I speak from experience. Even kids in the US have to sit through the occasional traffic class, as sponsored by their local police department, to ensure they know what all those signs mean.
In the same sense, discipline and the ability to make informed decisions can only be a reality if our people have access to sex education, which is one of the focuses of the RH Bill. Contraceptives are only part of the curriculum, so to speak.
[It is so wrong to use the "Crossing Street" metaphor and leave out the value of discipline, of both motorists and pedestrians,]
In the 2-part article, I had classified this as part of "making the process safer" aspect (1st article). But I agree that this was undeveloped compared to the 2 broad themes of safe maternal care and family planning. Maybe in another article…
[What can you say about the lack of discipline of the uneducated class (acknowledging exceptions) and the educated as well, when it comes to sexual mores. It seems many just want the gratification without the responsibility that comes with the act.]
You are referring to married or unmarried people? The common stereotype refers to young singles. We should be careful with the premise “many” because wide variations exist, probably cultural. In a study of 38 developing countries with DHS surveys, among never-married young women 15-24, 97% in the Philippines have never had sex. This ranks us 3rd from the top, behind Vietnam and Armenia (both 100%) The bottom 3 were Benin (49%), Mozambique (39%) and Congo (34%). Young Filipino men behave differently (75% never had sex), but this still ranks us 4th, behind Bangladesh (84%), Ethiopia (88%) and Vietnam (96%). http://www.measuredhs.com/pubs/pdf/CR19/CR19.pdf
Now Vietnam has a modern contraceptive prevalence rate of 68% compared to the Philippines’ 34% (contraception includes scientific fertility awareness methods). http://www.un.org/esa/population/publications/con….
High contraceptive rates and high abstinence rates can coexist.
To add to arm's point, areas in the United States that implemented an abstinence-only sex education program are also experiencing considerably higher incidences of unwanted teen pregnancies.
http://www.newser.com/story/103447/abstinence-onl…