reproductive health policies

Reproductive Health: Lessons from Bangladesh

The first time a coherent population policy framework linked to family planning was adopted in the Philippines was during martial law. In 1968, contraception adoption in the Philippines (measured by the ratio of married women aged 15-49 who practice or whose sexual partner practices any form of contraception) was 15%*. By 1986, that ratio went up to 44%. The average number of births per woman during this 18 year period declined from 6.45 to 4.66.

The Aquino administration upon assuming office in 1986 and heavily influenced by the Catholic bishops of the Philippines abolished the population commission set up by Marcos. Over two years, the prevalence of contraception went down to 36%. Since then it has steadily risen to just over 50% where it stood in 2008. The number of births per woman went down to 3.08 (forty years for it to halve!).

During this time, something remarkable happened in Bangladesh. With the adoption of some sensible population and health policies, they have been able to increase contraceptive prevalence from 27% in 1986 (when records were first kept) to 53% in 2008. Similarly, the number of births per woman went down from 5.4 to 2.3 in that same period. It took them just over two decades to halve their fertility rate to roughly equal the replacement rate (meaning that over the coming years their population will remain stable).

This is remarkable given that the per capita GDP (adjusted for purchasing power) in Bangladesh was in 2008 only about a third of the Philippines ($1,350 v $3,690). For those that argue that a change in fertility is affected by income, this might seem puzzling. Of course in general higher income levels lead to smaller families as demonstrated by the fact that fertility rates for both countries have been declining as incomes have risen. But policies aimed at providing options to families also play a determining role.

Continuity and stability of policy framework

Consider the different policies adopted by these two countries. I have already mentioned the almost stop-and-go nature of population planning and policy in the Philippines. In Bangladesh, they have sustained their policy framework close to forty years and have already graduated into second generation policies.

The first phase of their population policy lasted just over twenty years, from 1973 to 1996.  This phase focused on implementing programs aimed at reducing the population growth rate. These programs were centered on providing maternal and child health care services through home visitations, expanding the availability of contraceptives, multi-sectoral collaboration and encouraging the adoption of family planning services.

It took Bangladesh half the time it took the Philippines to halve its fertility rate. This is despite the fact that Bangladeshis are poorer on average than their Filipino counterparts.

The second phase began in 1997 and continues until the present. It has been more focused on integrating family planning services into a broader set of health programs affecting a wider target group.  From just focusing on reproductive and infant health it became concerned with the control of HIV/AIDS and other sexually transmitted diseases. From being home-based, the services concentrated on clinics to deliver a broad range of services.

The results speak for themselves. One area in which such programs have been effective has been in reducing adolescent fertility. In Bangladesh, the number of adolescents giving birth has gone down from 114 (per one thousand women) to just 70.5 in a span of just ten years (from 1998 to 2008).  In contrast the figure for the Philippines has hardly moved in that time moving from 47 down to 44.

This reduction in adolescent fertility might have helped Bangladesh increase the participation of women in school. In 1990, the ratio of girls to boys in primary and secondary education for Bangladesh was at 75%. By 2006, this rose to 105%. It went from 99% to 102% for the Philippines.

As a result of their integration of maternal and child health services, Bangladesh saw a reduction in the cases of infant mortality and a rise in immunization rates of infants. In 1986, infant mortality in Bangladesh was at 111 (per 1,000 live births), more than twice that of the Philippines which was at 50. By 2008, it was down to 43 for the former, while for the latter it had declined to 27. In 1986 immunization of children (between 12 and 23 months) was at a mere 3% in Bangladesh compared to 51% for the Philippines. By 2008, it rose to 89% for the former compared to 92% for the latter.

Lessons and assignments

As Father Joaquin Bernas, SJ wrote in his column for today’s Inquirer, the merits of the current RH bill must be debated on the basis of whether or not the use of state power to influence the behavior of the populace serves the public good and whether it is exercised in a reasonable manner, not coercive or oppressive.

These statistics demonstrate that the adoption of some kind of reproductive health service is defensible from a public benefit point of view. Whether the use of the public purse in providing “safe, effective and legal methods, whether the natural, or artificial that are registered with the Food and Drug Administration (FDA) of the Department of Health (DoH)” (notice how the wording avoids the use of prescriptive terms such as pill, intra-uterine device (IUD), injectables, condoms, ligation, vasectomy) is reasonable depends on the specific measures in the bill.

One of these provisions has to do with the way employers include such services as part of their worker’s entitlements. For Father Bernas, the specifics of the policy are worth debating, but not the policy aims. For him, you don’t “burn down an entire house to make lechon.” In other words, if there are certain objectionable parts to the Reproductive Health Bill, then these provisions should be revised, but that should not alter the need to have this all important bill passed.

The case of Bangladesh clearly demonstrates how a sustained implementation of an integrated health, family planning and population policy has had a massive positive impact on the welfare of its citizens within a generation. It should serve as a reminder to our politicians that a far-sighted policy outlook is needed in dealing with this issue.

For too long, the country has gone without a legal framework for determining its reproductive health policies. It is about time that our leaders and the public at large take a look at the proposals embodied in the reproductive health bill. Above the shrill cries of those who seem to be stuck over worries that this will lead to population control (a hangover from the 1970s’ debate) on the one hand, and on the other hand those who see in the bill a path towards the legalization of abortion, our leaders need to chart a sensible path based on reason and common sense.

* This and all other statistics cited in this article come from the World Development Indicators taken from the World Bank and available on Google’s public data explorer.

What the CBCP Assumes in the Campaign against the RH Bill

That the RH Bill is simply about contraception. It is not. It seeks to provide better training to midwives, access to basic pre-natal care services, a range of family planning methods, post-birth maternity checks, education on and treatment for fatal sexually transmitted diseases, and other basic health care rights.

That the only contraception is artificial contraception. It is not. Sec 3a. specifically states “there should be no bias for either modern or natural methods of family planning.”

That sex is a sin. It is not. Otherwise you or I will not be here today. And not every Filipino believes in the concept of sin, and not every Filipino shares the same religious values.

That contraceptives necessarily promote frivolity. It does not. The only scientific correlation between contraceptives and sex is the incidence of impregnation and disease reduces significantly with their use. It is not necessarily a license to be licentious.

That the bill is pro-abortion. It does not provide for abortion, it simply seeks to provide care for women who suffer from complications (about 100,000 per year), and from which 1,000 Filipinas die every year. And please don’t tell me that their death is their punishment for seeking an abortion. The ban on abortion, and therefore the high fatality from them, don’t change the reasons women have abortions in the first place. A lot of them more justifiable than your narrow punitive and puritan minds think.

That contraception is synonymous to abortion. It is not. The two are mutually exclusive. Contraception is to counter conception, abortion is to terminate a pregnancy which can only exist after conception. If abortion is performed, conception was not countered. Thus no contraception occurred/contraceptive was used. If contraception is used, then an abortion can never take place; that is unless contraception fails, but if it does, then the Church’s flawed argument is likewise moot.

That couples can support an infinite number of children. They cannot. And thus the Population and Development aspect of the Reproductive Health and Population Development Bill.

That couples are aware of the consequences of an infinite number of children. They do not necessarily. And thus the education aspect of the bill. Should you be punished for something you do not understand? In law, it is called mens rea or a guilty mind.

That those affected by this law, all Filipinos, are Catholic and believe in the teachings of the Church. They are not. That is why Church and State are separate. Please refer to constitution.

Most tellingly, the CBCP assumes that the Catholic Church has lost its guiding power. If the RH Bill enables health practitioners to explain both Church-approved and modern family planning methods, and who by the nature of the provisions of the bill are unable to persuade a couple from choosing one or another, and instead places the power of decision solely on the couple, then if the Church can teach right then the couple will choose the “morally superior” option (in the Church’s POV), would they not?

And if you are a Catholic, and the RH Bill is in place, then simply do not opt to use contraception if it does not sit well with you. But give others who do not share your belief the opportunity to make a decision for themselves. Do not take away their rights to control their own lives.

The Church’s adamant rejection of the bill reflects sorely on the Church’s loss of faith in themselves to properly guide its flock in the face of a “challenge” to the old ways of the Church. Its doubt in itself, its blindness to divergent beliefs, its stubborn insistence that the teachings of the Church (which after all is a religious institution comprised of mere mortals, its leadership with little to zero experience in sex, family rearing and actual economic output) are infallible and universal — all this puts in danger the health and development of an entire nation.

And lest you need reminding, CBCP, GOD GAVE US FREE WILL. Let us have it.

Marie Claire in 2008 launched an ad campaign supporting the RH Bill.

“The Marie Claire Mouths”

"Women should represent themselves."

"Don't less someone else speak for you."

"Don't let someone else decide for you."

The Moral Dimensions of Family Planning

President Aquino’s recent announcement that he would be pushing forward with the reproductive health (RH) bill has set off a firestorm of reactions from various sectors, including the Catholic Bishops’ Conference of the Philippines (CBCP), a representative of which has threatened Aquino with excommunication.

What follows is the text of a keynote address delivered by former First Lady Imelda Marcos on January 7, 1974, at the First Asian Regional Conference on Family Planning. Pro Pinoy is posting the speech in the hope of stimulating discussion not only on the current controversy, but also on the history of population control in the Philippines. It may be of interest to note that Mrs. Marcos, a Catholic who led the move toward population control during the Marcos regime, has yet to be excommunicated.

The Moral Dimensions of Family Planning

It is my pleasure to keynote this Asian Regional Conference on Family Planning of the Medical Women’s International Association. I can think of nothing more appropriate and timely to usher in World Population Year 1974 than a regional conference on family planning. Allow me therefore to welcome to Manila our neighbors from the Asian region and our distinguished guests and speakers to this inaugural activity of our world population year program. I hope you will find your stay both fruitful and pleasant.

The Malthusian solution to its own nightmare was—after abstinence—war, famine, and pestilence. We know now that this is no solution at all, as war, famine, and pestilence are the consequences of the population explosion.

Our modern technological civilization has, therefore, devised the technique of planning and control.

We are moved, as B. F. Skinner has said, to depend on our strength, which is technology. Thus population planning and control originated as a proposition from among the rich nations of the world, nations which have benefited and are benefiting most from technology.

Some cynic has said that population planning and control is advocated for the poor peoples by the world’s rich in order to preserve their stability and insure their comforts. For if the world’s poor were to increase beyond measure, the rebellion of the poor will explode and imperil the security and well-being of the world’s rich.

And, going farther, not us but the philosophers of the technological civilization have pointed out that a shift in the thinking of rich nations can, without great effort, convert their resources and technology for feeding, clothing, and housing all the peoples of the world. The expenditure in arms and space technology could have been, it is said, redirected to the welfare of all mankinds [sic] on earth.

For developing nations like the Philippines, the planning and control of population is of fairly recent awareness. For nations such as ours have experienced the painful reality of economic growth being cancelled out by a high rate of population increase. Our rate in the Philippines is among the highest in the world. It is for this reason that we have taken the Western proposition for our own fundamental end—that of survival. As President Ferdinand E. Marcos has emphasized again and again, we need to depend on ourselves.

And so we pursue our population programme with enthusiasm and vigor, aware nevertheless of traditional ways and mores of our people.The main thrust of our programme is education, basically the re-orientation of our people to the complexities of modern life. Only in the Philippines do you find a tri-partite cooperation among the government, the private sector, which includes the religious organizations, and international agencies concerned with population control. We have adopted the technique in order to avert diffusion of time, effort, and resources.

Education, not just pills and other palliative measures, is the crying immediate need. Government alone cannot succeed. The help of the private sector, specially of the religious organizations, is most critical.

In a week we inaugurate the Population Center building where such cooperation of hte private with the religious, government, and international organizations involved in population control will be formalized and housed.

We must say that for the most part it is the Filipino male in the Philippines who holds the key to family planning. Traditionally, the Filipino looked to the child-bearing of his wife as a matter of prestige or male pride, while both husband and wife looked to many children as an assurance for their old age. And so children were born in expectation of a form of bondage, for in exchange for their rearing they should take care of their aging parents.

I hold no strong brief against this attitude. It is one of the charms and proof of compassion of Filipino family life. But it is anachronistic in an age of social security.

We need to understand now that we bear and raise children because we love them, not for any economic or selfish reason.

Thus, if there were in the West political, social, and economic considerations in advocating population control for the poor peoples of the world, for us, in the Third World, the primary consideration is moral.

Large families living in squalor strain the moral sense. Our experience of greed, graft, and corruption has largely been the consequence of large or even many families. Numbers have ethical implications: the qualitative change in the moral perceptions of a man who proceeds from three children to ten or more is rather evident. Aggression comes from pressure and population pressure, indeed, arouses the aggressive instincts of men.

But more than this negative moral sanction is the positive one. To plan, to abstain properly, or to take measures breeds discipline and manifests maturity. Though we may learn that creature comforts await us at the end of the discipline, we are more exhilarated by the fact that we accept the responsibility for our own lives, that every step we take is the result of ethical deliberation.

The boons of population discipline will take, at least, a generation or two to be felt and enjoyed by all. But the spiritual well-being that comes from the knowledge of self-abnegation and planning is immediately felt. Thus, we say that family planning leads to other forms of planning—to economic, social, and even political planning.

We are at present involved in making a new society, a society that is compassionate no less than disciplined and progressive.

We are aware that family planning is one of the pillars of the new society, undertaken not because we want to protect the wealth of the few against the explosion of the poor, bunt undertaken because we do not want to condemn unborn generations to misery and servitude.

We want children because we love them, and because we love them, we want, as far as possible, the best for them, spiritually no less materially. But too many of them will surely diminish our love and deflect our attention: too many of them will strain our moral capacities. This I feel is the moral dimension of family planning in the Philippines.

On this note, I welcome all of you to our country and may your seminar prove fruitful, may your discussions bring forth new insights and new ways of promoting the great moral change that will protect mankind from unregulated fertility.

To all of you, thank you.

Mulat Pinoy's Pop Media Fellows announced

Mulat Pinoy’s Pop Media Fellows announced

Population affects people in different ways. From a housewife allotting a daily budget to feed a family of seven, to a fresh graduate seeking employment, or a doctor experiencing a particularly toxic shift at a public hospital– a nation of 90 million has a wealth of stories to be told.

Four such stories will get the spotlight in the coming months, thanks to the Mulat Pinoy media fellowship. Run by the Probe Media Foundation and Philippine Center for Population and Development, the media fellowship aims to encourage both traditional and new media practitioners to turn their critical eye on issues of population and development. The fellowship was open to all traditional media, and also included categories for new media initiatives like blog posts, podcasts, and infographics.

The Mulat Pinoy Media Fellows are: Renato Ilupa, DXSO Radyo ng Bayan Marawi; Gideon Isidro, Philippines Daily Inquirer-2BU; Antonio Manaytay, Zamboanga Sibugay Tribune and Inside Mindanao; and Ana Santos, (SAS) and Integrated Regional Information Network (IRIN). [Ana Santos also happens to be a contributor to Pro Pinoy – editor]

The fellows’ projects will focus on various aspects of population and development. Santos touches on reproductive health policies and its implications for women, while Manaytay probes into the lives of coal miners in Mindanao. Meanwhile, Ilupa and Isidro will use multiple media to share their population stories. Isidro talks about youth issues via print and video, while Ilupa’s feature on RH for Muslims will be presented via print and radio. Fellows are expected to work on–and publish–their stories in time for the culminating workshop on November 6.

Mulat Pinoy media fellows were selected by a panel of seasoned journalists and popdev experts, including: Prof. Melba Orense, UP Diliman College of Mass Communication; Jaileen Jimeno, Philippine Center for Investigative Journalism; Rose Marcelino, NCR director of the Philippine Population Commission; Jay Jay Orense, TV5 News and Public Affairs program manager; and Dr. Zelda Zablan of the UP Population Institute.

– – – – – – – – – –

Contact: Mulat Pinoy: Popdev and Social Media
Telephone Number: (02) 433 04 56
Email: [email protected]

About Probe Media Foundation:

The Probe Media Foundation, Inc. (PMFI) is a non-stock, non-profit organization dedicated to improving the quality of media in the Philippines and in the Asia-Pacific region through training of professional and aspiring media practitioners.

About PCPD:

The Philippine Center for Population and Development, Inc. (PCPD) believes that a better understanding of the relationship between population and development will empower Filipino families to make informed decisions and actions that will result in an improved quality of life.  The Center, a private, grant-making foundation supports research, advocacy and model projects on population and development in the Philippines.