No neglecting RH

That we live in difficult and troubled times is a given. Along with hard times comes the inevitability of hard choices, of sacrifices that must be made to achieve higher good. Yet time and time again, these sacrifices – of funding, of time, of attention – have come at the expense of those who can least afford it. The marginalized, the underprivileged, the underrepresented. While the emergence of COVID-19 was an unprecedented crisis that required an all-hands on deck approach – and even as it and its variants continue to  pose a dangerous threat – it is long past time that we attempt to regain ground that we may have lost on other fronts. As I wrote last year: “The need to focus on COVID-19 has meant that resources that would have been available for the fight against other health conditions have been drastically reduced… But dealing with other health conditions cannot wait until the pandemic is over. The long arm of COVID-19 casts a wide shadow – we must not forget the other dangers hiding in the darkness.”

One of the areas of health that has suffered greatly is the area of reproductive health. It should probably not come as a surprise that an area of health predominantly seen, mistakenly, as a women’s issue should be one of the first that is compromised in a battle for resources. It’s unsurprising, but that doesn’t make it any less dangerous, or any more acceptable. Last Sunday, July 11, was World Population Day and, according to the United Nations: “The pandemic has compromised health care systems particularly in the area of sexual and reproductive health. It also exposed and exacerbated gender-based inequities…” An estimated 12 million women may have experienced disruptions in access to family planning due to the pandemic, which in turn may have led to 1.4 million unintended pregnancies, according to a report from the United Nations Population Fund (UNFPA).

Here in the Philippines, the Commission on Population and Development has admitted that we must prepare for the potentially low performance of the National Program on Population and Family Planning due to the effects of COVID-19. Based on a  report from the University of the Philippines Population Institute (UPPI), the effect of the community quarantines on sexual and reproductive health, particularly that of women, is expected to be substantial. According to the Institute’s estimates, every month of community quarantine translates to an expected average increase of (1) 218,000 women with unmet need for family planning; (2) 79,000 unintended pregnancies; (3) 60 maternal deaths; (4) 17,000 cases of induced abortions and (5) the exposure of 12,000 women to intimate partner violence.

This effect of COVID-19 on our health system exacerbates the already precarious state of reproductive health in the country. The Department of Health, in its 2019 Annual Report on the Responsible Parenthood and Reproductive Health Act, noted that Filipinos still have a high unmet need for family planning, and that the number of girls getting pregnant and giving birth at a young age has increased. The spike in teenage pregnancies in the country has been especially alarming: according to a recent report from the Commission on Population, almost seven girls aged 14 and younger are giving birth in the country every day, increasing by 7 percent in 2019 compared to the preceding year. This has rightly prompted renewed calls for a full implementation of the Republic Health Act, one which fully empowers women and girls to have full bodily autonomy, in knowledge and in practice.

What does it mean to fight for bodily autonomy? It means to overturn the state of affairs where 12 percent of women believe that they do not have the power to say “no” to sex, where many cannot make their own decision as to whether or not to use contraceptives. In 2014, while affirming the constitutionality of the Reproductive Health Act in general, the Supreme Court struck down several provisions, including one which would have provided access to family planning and reproductive health services to minors who have been pregnant or had a miscarriage even without parental consent. While the rationale of the Court may be up for debate, it cannot be denied that the difficulty minors have in accessing reproductive health services directly contributes to the spike in teenage pregnancies that many consider to be one of the most pressing issues faced by women today. Similarly, the removal from effectivity of the provision which would have allowed a married individual not in a life-threatening case to access reproductive health procedures without the consent of the spouse has led to a loss of bodily autonomy that is most keenly felt by wives, who are in effect  forced to bear children solely because of the desires of the husband. This in spite of the fact that the burden of child-bearing – and the aftereffects this has on their bodies – is borne solely by women, as is much of the early care for the child.

There is much that we cannot control about the pandemic and its effects, but the neglect shown to the reproductive health of our citizens is not one of those things. We can choose to reaffirm the importance of reproductive health, not just for women, but for the betterment of the family unit that so many opponents of the RH Law claim to be desperate to protect. A family where the bodily autonomy of the wife, of the daughter, is not respected is not a family that can be considered safe, or protected.

What should be done? The Family Planning and Reproductive health programs of the national and local governments must be given the resources they need to make their services available to those most in need of them, and to any that may desire them. Data from the DOH shows that in 2019, there was a 37 percent decline in the combined 2019 budget for the implementation of the Reproductive Health Law compared to the 2018 budget allocation, and expenditures of the LGUs for family planning related programs, projects and activities decreased by about 17 percent. These trends must be reversed, even in the face of the expenditures incurred fighting COVID-19.

In hard times, we make hard choices. But if we are serious about creating a just and equal society, serious about protecting the family and the future of our youth – then the burden of these choices should not continually be borne by our women and children.

The pandemic is many things – but it is not an excuse.