[Dash of SAS] When you run out of birth control pills

Ana P. Santos
[Dash of SAS] When you run out of birth control pills
President Duterte’s signing of EO 12 is a step in the right direction, but the Supreme Court still has to lift its TRO

Sometime last year, my usual trip to the pharmacy to refill my medicine cabinet became a cause for worry. My birth control pill was out of stock.

We hear “out of stock” or “not available” a lot in various situations such as in a restaurant, for example, but in this case, the availability problem could not be solved by ordering something else on the menu.

The first time it happened, I still had back up stock to fall back on, but when I was down to my last box of pills and only got another apologetic, “Sorry po” from the pharmacist, my anxiety morphed into panic.

My choices were limited to buying a more expensive brand or risking an unplanned pregnancy. But since I also use the pill for hormone regulation, I had to buy another brand – one that was four times more expensive than the brand I had been using for years.

The incident brought to mind all the community women I had talked to who had to resign themselves to the possibility of another pregnancy all because the rural health clinic in their village had run out of contraceptives or did not stock up yet.

As it turns out, this erratic supply of contraceptives is likely to continue or become even worse under the Supreme Court’s temporary restraining order (TRO) on the implementation of the Reproductive Health Law (RH Law).

The RH Law was passed last December 2012 but in the four years since then, its full rollout has been aggressively blocked by opposition from groups bent on keeping the law from being implemented. (READ: RH Law: The long and rough road)

Last year, the health department’s contraceptive budget was cut and the Supreme Court issued a TRO on the government procurement and distribution of Implanon and Implanon XT, matchstick-like rods that are inserted in the upper arm that offers three years of contraceptive protection.

The Supreme Court first issued the TRO in June 2015 before the DOH had procured 400,000 contraceptive implants for release and distribution to poor communities. The implants are expected to expire in 2018.

When the DOH appealed for the lifting of the TRO, the Supreme Court rejected the motion in August 2016 and issued new orders to the Food and Drug Authority (FDA) and the DOH.

Penned by Associate Justice Jose Catral Mendoza, the SC order directed the FDA to do the following:

  1. Come up with rules and procedures for registration and recertification of contraceptive commodities to determine whether they are abortifacients or non-abortifacients.
  2. Allow opponents of the RH Law to participate in the processing of registration and certification of contraceptives through public hearing.

“The wording of the decision seems to have declared previous decisions of the FDA as contraceptive registration as void and seems to have expanded the prohibition from only Implanon and Implanon NXT to other contraceptives,” said Elizabeth Angsioco, national chairperson of women’s health group Democratic Socialist Women of the Philippines and part of the RH Law National Implementing Team (NIT).

In her column on January 14, Angsioco explained, “Decisions of the FDA are now appealable to the Court of Appeals…The FDA is a regulatory body and its decisions were deemed final. The Courts had nothing to do with the performance of its responsibilities as this office is supposed to decide based on scientific evidence and medical findings.”

Gradual phaseout

Under the TRO, either commodities themselves expire or certifications that allow for their sale and distribution lapse. The total effect is the gradual phasing out of contraceptives from government clinics and pharmacy shelves as the registration/certification of new contraceptive brands and recertification of existing brands is suspended until the FDA can comply with the SC’s demand to come up with rules and procedures for registration and recertification of contraceptives.

According to data provided by the DWSP and Commission on Population (Popcom), 31% (or about 15 brands) of contraceptive certifications expired as of December 2016.

“Another 31% will expire in 2017, 29% in 2018 for a total of 91%. By 2020, only 2% of certifications will be valid. That is the schedule of the gradual elimination of contraceptives from both government clinics and commercial drug stores as a result of this TRO,” said Dr. Juan Antonio Perez, Popcom executive director.

Perez noted that one progestin-only pill brand usually prescribed for breastfeeding mothers who want to space their pregnancies has been affected by the TRO.

“Pharmaceuticals who sell contraceptives will lose their license to sell and can no longer import these commodities anymore. There will be nothing to sell,” added Perez.

Women who freely buy their contraceptives at the local drug store will not be able to buy them because they will no longer be available.

The Supreme Court through, spokesperson Theodore Te, insisted that there is no TRO on the RH Law and the government’s implementation of the law.

In a statement released to the media, Albay Representative Edcel Lagman, one of the principle authors of the RH LAW answered, “While there is no direct injunction against the implementation of the RH Law, the Supreme Court has pierced the heart and soul of the RH Law by making the certification, procurement and access to contraceptives more difficult and cumbersome. When the Supreme Court halted the certification and re-certification by the FDA…the Supreme Court practically derailed the enforcement of the RH Law so much so that by 2018 contraceptive supplies are expected to dry up,” 

Duterte’s EO

But what about the executive order that the President just signed?

President Duterte’s signing of the EO 12 calling for the full implementation of the RH Law is a step in the right direction that serves several purposes but the fact remains that the only way the RH Law can fully be rolled out and for thousands of Filipinos who to benefit from its promise of enabling them to plan their family size is for the TRO to be lifted.

“The President signing the EO sends a policy message and a clear endorsement of the the RH Law. Helping the poor with their family planning needs, along with job creation and economic growth is outlined as a key strategy to reduce poverty,” said Rom Dongeto, Philippine Legislators’ Committee on Population and Development (PLCPD) executive director. 

“The EO also supports the NEDA and DOH’s lobby to call for the immediate lifting of the TRO,” said Dongeto.

The phasing out of contraceptive supplies will not eliminate the need for birth control. The continued demand for birth control will fuel the supply for it through the black market where buyers risk buying counterfeit contraceptives of dubious formulation. Those with resources will need to secure their supplies from overseas.

Support for the RH Law and demanding that its provisions be carried out is needed now more than ever. Advocates have started an e-signature campaign calling for Supreme Court to lift the TRO on the RH Law and is planning for other initiatives in the coming months.

“All of us must raise our voices and let the Supreme Court know that we want the justices to respect reproductive rights and lift the TRO. All of us who have a voice must continue to do this for ourselves and those among us who have no voice until we are heard,” said former DOH secretary and chairperson of RH NIT Esperanza Cabral.

– Rappler.com

Ana P. Santos is Rappler’s sex and gender columnist and Pulitzer Center grantee. In 2014, the Pulitzer Center on Crisis Reporting awarded her the Persephone Miel fellowship to do a series of reports on Filipino migrant mothers in Dubai and Paris.

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