October 6, 2011
RH bill debate highlights: October 5
Interpellations on Senate Bill No. 2865
‘National Reproductive Health Act of 2011’
Senate plenary session
Senator Ralph Recto (RR) cites differences in the three versions of the Reproductive Health (RH) bill: The House version, President’s version, and Senate version. He says the definition of ‘adolescents’ in the House version are those between 11-20 years old, which is the same as in the Executive version. Then he notes that in the Senate version, the definition is young people between 10-19 years old.
Sen. Pia S. Cayetano (PSC) answers that when the agencies that will be involved (DepED, DSWD) start defining the program and modules in RH care education, they would know the target audience. She also notes that there is a big difference between sex education and reproductive health care education
RR: To teach RH or sex education, I suppose it would be between ages of 10 to 19?
PSC: I guess the answer would be yes. But as a mother, I would say that it (RH education) actually begins as soon as the child could walk and talk. If you have a 3-year-old and you’re pregnant, your child would ask, ‘Bakit malaki ang tiyan mo?’ That is already [the start of] RH care education.
RR: But will this also be the official definition in the bill that will be carried out by DepEd, DSWD…?
PSC: I will even go younger than that for a certain reason. There’s a difference between sex education (e.g., how not to get pregnant) and RH care. Many of our young people are victims in their own homes. There are instances when the aggressor is people belonging to the family. How will we teach them that nobody has the right to touch them and they are not to undress in front of anyone? In many programs in many countries, the objective is to put the child in the defensive mode (e.g. not walking away with a stranger.) So yes, I assume that the definition of 10-19 years old doesn’t necessarily mean that a certain program will be taught to a child at age 10, but certain changes happen to a child at 10, so these need to be addressed.
RR: But the bill defines it [‘adolescent’] as 10-19 years old. Ito ang tuturuan natin. This is what is said in the bill. In the HOR version, there is age-appropriate RH and sexuality education that will be taught from Grade 5 up to fourth year high school. In the Executive version, it is Grade 6…
PSC: The objective is to provide guidelines to come up with programs. We are happy to accept any suggestions [to refine the provision on age-appropriate RH education].
RR: I don’t have a problem with the education. I only have a problem with the HOR and Executive versions which say that adequately-trained teachers will teach in public and private schools. It means there will be a common curriculum for everybody. This does infringe on the liberty of private schools…
PSC: I would like to put on record that I have not seen this Executive version. And I believe that everyone has RH needs even if they are not parents.
RR: At the age of adolescent years, ibig sabihin ba, bibigyan din natin ng contraceptives ang 10-19?
PSC: Hindi po.
RR: Malinaw ba?
PSC: Malinaw tayo.
RR: Pati bata bibigyan natin ng contraceptives? That’s how I understand it, reading the three versions. When Sen. Lapid said that when he and his wife had a child, the child had a…nagkaroon ng problema ang anak.
PSC: Sen. Lapid said his child was a blue baby.
RR: My parents didn’t give me contraceptives. I don’t think anyone in this chamber was given contraceptives by their parents [while growing up].
PSC: I am confused because that is not the Senate version his Honor was reading. The services do not have to deal necessarily with not getting pregnant. There are many elements of RH care and that does not necessarily include the problem of ‘not getting pregnant.’
RR (Cites Sec. 2 of SBN 2865 on State policies)…
PSC: We have that provision. The objective is to provide all Filipinos with RH care services as needed. So obviously the need of a sexually active adult who’s married is different from that of the adolescent.
RR: The HOR and Executive version are clear on this.
PSC: Yes, we will not give them contraceptives.
RR (On the question, ‘when does life begin?’): There will be a different set of legal contraceptives depending on how we define the beginning of life.
PSC: Currently, all contraceptives available are all those that work prior to fertilization. As we have manifested on the floor, we said that at the appropriate time, we would be happy to accept amendments to make this even clearer, even only for the purpose of the bill.
There are differences in opinion on when life begins, so I don’t want to choose to have an opinion on something that even experts don’t have an agreement on. But clearly for now, the contraceptives allowed under our current system are those that have an effect only prior to fertilization.
RR: We need to have a certification from FDA (Food and Drugs Administration) on that.
PSC: We will be happy to get that from FDA [on] which of these contraceptives would have an effect prior to fertilization.
RR: There is a section in the bill that talks about full disclosure of information with regard to contraceptives. Now, we purchased a number of contraceptives and saw that they have contraindications… (enumerates contraindications, e.g. bleeding)
So once we teach these to kids and families, shouldn’t we also teach them that there are side effects?
PSC: We will not teach that to kids, Your Honor. We will not teach that to children. This will only be part of the information that will be provided by a health care provider to a patient.
As I said, it will be provided for adults and not for children. So when we provide this information to adults, we will make sure that we provide complete information. The health provider should be able to work out with the patient the appropriate contraceptive. In the US, they definitely provide this information to teenagers. But it is not the intention of this bill.
As far as I know, the HOR and Senate versions are the same in their intent on providing education and services. I would like to clarify that RH care education is not about teaching kids how to use a condom.
RR: I have no problem with sexuality education. But my problem is the ‘one-size-fits-all’ curriculum. Are we also sure that there is no barangay health center that will give contraceptives to children from ages 10-19?
PSC: Yes. But let me make clear that 18 and 19 are adults. But what do we do with 15-16-year old pregnant girls? The reality is there are so many 16-year olds who have three children. I would not be reckless as to prescribe condoms for girls with many children who are living in with the partner?
RR: I suppose education and parental guidance should answer for that.
PSC: Yes. But I stand by my question on what to do with young people who are living in with their partners and are bearing children. They are not yet adults but they are sexually active. What do we do with them?
Data from DOH say: 1 out of 10 Filipinas aged 15-19 is already a mother. This was found to be associated with low age of sexual initiation, low information, etc. It also says 33% of births of teenage mothers are unwanted…
RR: Why do we have this paragraph on prohibiting ‘knowingly withhold information …’? What is the reason for this?
PSC (cites Sec. 18, paragraph a, sub-paragraph 1): The purpose of this provision is to assure that every Filipino will have access to unbiased and correct information on RH services.
RR: That’s correct. That’s why I’m insisting that we should include side effects.
PSC: Yes, every service provider is bound to do that [full disclosure].
RR: It would appear that RH bill intends to offer RH care education for adolescents aged 10-19 and that RH services are also available to them.
PSC: No. We want to clarify that 10-year old girls would have RH care needs that have nothing to do with not getting pregnant. Thank you for asking that so we may clarify this issue.
RR: So it is clear to us that in the Senate version that: (a) We can provide RH education to ages 10-19, but not necessarily services; and (b) These services will not be available to minors in barangay centers…I have no problem with that. That is part of responsible parenthood.
PSC: Let me just throw this question to the floor: ‘What do we do when a minor comes in with a parent for services?’
RR on RH bill funding: There are so many unfunded laws in this country. There are many sections in this bill that need funding…We have Sec. 5 (employment of skilled birth attendance for 1:150 deliveries per year). How much would this cost?
PSC: This representation has a separate bill on every barangay having a midwife. This section is an improvement of the bill I have filed. The midwife is the most cost-efficient health professional that we can provide. Instead of a general statement of one midwife per barangay, we are requiring one per 150 deliveries. I specified ‘professionals’ because there may be an oversupply of nurses and undersupply of midwives.
On Sec. 5 (hiring of skilled professionals), there is a ‘wish list’ for every government agency. So this is like a wish list for DOH that we will have to consider during the budget season. As I said, we are opening the discussion on our colleagues because we intend that there will be funding for these services and I would also like to be sure that the DOH and other agencies involved will be ready for the responsibility. Offhand, with respect to the health professionals, the figure is roughly for registered nurses and midwives, the salaries amount to P4.6-P7.5 B. That is staggering. But those are the figures needed to address this concern. It’s important to put into the record how much we need. This is possible employment opportunities for our nurses and midwives. These are the ideal figures based on the need.
RR: Thank you for your honesty.
PSC: Thank you for acknowledging that. Because that is one trait that I’m proud of and I’m not planning to deceive anyone with this bill.
RR cites Sec. 10 (procurement of family planning supplies): How much will this require? How will the DOH implement this? Are we going to increase taxes for this purpose? Are we going to increase contributions in PhilHealth?
PSC: There are five million women with unmet family planning needs. So if we are to estimate, that would be 5 million women x P365 pesos. That would be P1.8 billion pesos. This is given by the DOH.
RR: What about the males?
PSC: Yes, but we need to emphasize family planning [are primarily] the needs of women. Because most of the time, it is the women who take on the task of planning the family.
RR: When you say 5 million unmet need, how did the government come up with the figure?
PSC: It is NSO (National Statistics Office) who does this survey.
RR: You are asking the LGU to purchase, and is there a formula given based on women of reproductive age and the need? This P1.8 B is very small. Where is the mandate for LGU?
PSC: The computation is based on ‘unmet needs of women.’ Also, it is the DOH that will lead the procurement of supplies. The intention is for DOH to take the lead in procuring.
RR (cites Sec. 9 on Family Planning Supplies as Essential Medicines): So kasama ang barangay health center? There are so many mandates. It will be very costly and hard to implement. Would the DOH have the number for this as well? (Reads Sec.7, on Access to Family Planning)
PSC: This is precisely why we would like to include appropriation for the purchase of necessary products, because we will put it upon the national government to provide and procure.
RR: There are many mandates here with regard to duties of LGUs. So how much is this going to cost? Are you going to take it from other programs? Or would we require more contribution (like taxes)?
PSC: On the mandate, we make it very clear that the objective of this measure is for every Filipino who has RH needs to have access to services.
RR: Yes, I think we should pass something on RH. But is this really the way we should help the poor?
PSC: When it comes to who will spend, it is the national government that will spend for this. Where will it (money) come from? Paano naman ang ibang sakit? We work with health professionals. We have two former secretaries of health (present in the gallery). No one of them chooses one health concern over others, but they acknowledge that this RH need has not been addressed. We have a big budget for DSWD’s CCT, etc.
RR: Between CCT and UHC, we are buying contraceptives. Why not let them buy it for themselves? I am not against RH, but to push for contraceptives…Is it the best way to help the poor?
PSC: Again, let me say that RH needs don’t always mean contraceptives. These are real needs of women. We have to address these issues. And yes, it is one of the best ways to help the poor. I am not saying that we remove services for others in order that we provide RH services. But as I said yesterday, balanced planning.
RR (cites Sec. 12 Mobile Health Care Service): It’s like we are pushing contraceptives.
PSC: The mobile health care unit is not a contraceptive ice cream truck. I am offended that we continually try to create an impression. This is not true.
If his Honor would like to clarify, we would welcome amendments. The objective of this section is to address the fact that we are archipelagic. We hear stories that many mothers die because of problems in transportation.
With respect to funding, yes, this will be funded.
RR: We have to have a reasonable budget for this and all other projects of the government…
RR: Are there certain NGOs pushing for contraceptives?
PSC: Those (NGOs) I’m working with, their concerns are way beyond contraceptives. RH is much more beyond contraceptives.
RR: In the Senate version, there is no section on ‘Ideal Family Size.’ Can I get the assurance of the sponsor that this section found in HOR version will not find its way in the final version of the bill?
PSC: I have always been candid in my position that couples have the freedom and responsibility to choose the size of the family that they can support. #
Note: This post merely serves to summarize the main points that were raised at Wednesday’s interpellations and not as a transcript of the said proceedings.