RH law now!

Quietly, without any elaborate ceremony or flourish, President Benigno Aquino III signed Republic Act No. 10354, the Reproductive Health Responsible Parenthood and Reproductive Health Act of 2012, on Dec 21, 2012. Supporters of the RH bill, as it was then called, were jubilant. After all, it took 14 years for the RH bill to get enacted to law. That was exactly one year ago today.

The celebrations were short-lived, however. Hardly two weeks after Aquino signed the law, James and Lovely Ann Imbong, on behalf of their children and the Magnificat Child Development Center, filed a petition in the Supreme Court questioning the constitutionality of the RH law.

Then, subsequently, others filed similar petitions in the High Court. They claimed that the RH law was unconstitutional: it violated the constitutional rights to life and health, to free exercise of religion, to establish a family according to people’s religious convictions, among others. They requested the Supreme Court to issue a temporary restraining order against the implementation of the RH law.

Eventually, a total of 14 petitions were filed and each one assailed the constitutionality of the RH law.

On March 19, 2013, the Supreme Court justices voted 10-5 in favor of a status quo ante order against the RH law for 120 days. And on July 16, 2013, they voted 8-7 in favor of extending this order to stop the implementation of the RH law indefinitely.

The RH law provides information and free natural and artificial contraceptives in public health facilities, life-saving emergency obstetric and newborn care in public health facilities, and reproductive health education to young people between the ages of 10 and 19 in public schools, among others.

Meanwhile, as the decision on the RH law is still pending, the DOH and LGUs, together with community-based NGOs, are struggling to provide family planning services and health care, particularly maternal and newborn health care services, to women and their newborns.

During relatively “normal” and “peaceful” times, as women go through pregnancy and childbirth, about 15% of them experience life-threatening complications such as hypertension, hemorrhage, infections, obstructed labor, and botched abortions. Women could be saved if they immediately could access health centers or hospitals that provide quality emergency obstetric services.

As it is, during normal times, women still die, despite the existence of health facilities. The 2011 Family Health Survey shows that the country’s maternal mortality ratio increased from 162/100,00 to 221/100,000 live births between 2006 and 2011.

From 1990 to 2010, the average annual decline of maternal mortality was at about 1.1% to 1.2%. This means that far too many women, just too many women – about 50,349 to 86,221 women – have died since 1990. Outrageous.

But why do women continue to die during pregnancy and childbirth, even during normal times, when winds are still and there are no storm surges, and when no clashes or bombings occur?

The country seems to have enough health facilities that are able to provide emergency obstetric care. But do women access these health facilities? And are these facilities adequately staffed and equipped to handle emergencies?

On Oct 10, 2012, Health Secretary Enrique Ona said that out of the 283 district hospitals in the country, 187 are not able to perform operations. And if they are incapable of performing operations, then, most likely, they are not able to take care of emergency obstetric complications.

During conflicts and disasters, the situation gets far worse than what was before. Bullets or floodwaters prevent women from gaining access to health centers or hospitals, if these are not bombed or flooded. And if, by a stroke of good luck, these are still standing, they probably are not equipped or staffed.

Dr Junice Demeterio Melgar, co-founder of Likhaan whose community organizing teams are in Guiuan, Mercedes, and Salcedo, Samar, said that women asked them for contraceptives. They needed them and there just were no supplies.

According to Ernesto M. Pernia, Emeritus Professor of Economics at the University of the Philippines, Yolanda could have affected about 3.2 million girls and women of reproductive age (15-44). Of these women, Pernia estimates that about 270,000 are pregnant and 90,000 are expected to deliver in the next 3 months. If about 15% of these women acquired complications during pregnancy and delivery, it would mean that some 13,500 girls and women could die or be disabled – if they do not have access to emergency obstetric services.

During periods of conflict like what happened in Zamboanga and during extreme weather disturbances such as those brought about by Ondoy, Sendong, Pablo, the Habagat, and Yolanda, the risks of pregnancy and childbirth get amplified considerably.

Health services disappear or are disrupted. Clean water becomes scarce. Hygiene and sanitation are compromised. And as if these were not enough, young girls and women become more vulnerable to rape, sexual harassment, trafficking, and physical violence. Not only are these dehumanizing, but they are also destabilizing: they expose young girls and women to increased risks of unwanted pregnancies or HIV. What is more disruptive and damaging than these?

During times like Yolanda, the need for much more intensive reproductive health services becomes painfully acute. And it need not be. We have the RH law.

It is just languishing in the Supreme Court, held captive by 14 merciless and baseless petitions. – Rappler.com

Dr Marilen J. Danguilan is an independent health policy consultant.