Returning priorities

As nations around the world, including our own, contemplate a restructuring of COVID-19 protections in view of lower COVID case counts, it’s important to remember two things. The first of these is that COVID-19 is still very much among us, and that lower case counts point to the success of protections and not that they are no longer needed (especially to protect the most vulnerable). Second is that in assessing how to reallocate government resources to areas other than COVID-19, we must prioritize fundamental services and those that disproportionately impact the vulnerable. In both aspects, reproductive health must be put near the top of the list.

When COVID-19 had just emerged on the scene and lockdowns beginning, experts warned about the drastic consequences many necessary restrictions would have on reproductive health, particularly for women and girls. Our country already faced many maternal and reproductive health challenges even before the pandemic began. As I mentioned last year, in the Department of Health (DOH)’s 2019 Annual Report on the Responsible Parenthood and Reproductive Health Act, the DOH noted that Filipinos that year still have a high unmet need for family planning, and that the number of girls getting pregnant and giving birth at a young age had been steadily increasing since 2011.

The UN Committee on the Elimination of Discrimination against Women (CEDAW) had also previously expressed concern over the way the Responsible Parenthood and Reproductive Health Act (The RH Law) has been implemented – or rather, inconsistently implemented – in the country. Once quarantines were imposed, experts raised the alarm that the measures taken by the government to respond to COVID-19, while necessary in most cases, would hurt the ability of Filipinos to access reproductive health services. Health systems that needed to focus on COVID-19 cases would have fewer resources, if any, to devote to family planning or pre- and ante-natal services.

This is compounded by mobility restrictions, both mandated by the government and self-imposed due to the fear of catching the virus. The United Nations Population Fund in the Philippines (UNFPA) raised the possibility that the annual total of Filipinas of reproductive age (15-49 years of age) who do not use any contraception, though they do not want to become pregnant, could also increase by 2.07 million, a 67 percent increase from 2019.

Worldwide, experts predicted there would be 48.6 million women with an unmet need for modern contraceptives, 56,000+ more maternal deaths and 7 million additional unintended pregnancies due to the major global disruption of reproductive health services. The UP Population Institute estimated that every month of community quarantine in the country could potentially lead to: 218,000 women with an unmet need for family planning; 79,000 unintended pregnancies and 60 maternal deaths, amongst others.

In 2022, there is not yet much in the way of concrete data on what the actual effects of the pandemic have been on the reproductive health of the Filipino people, but what data exist seem to fall in line with the predictions of the experts. In its 2020 report on the implementation of the RH Law, the DOH noted that reimbursements for reproductive health services decreased significantly by 12 percent from 2019, and noted that there was a higher number of “dropouts” from family planning services, likely because of the difficulties in accessing such services because of pandemic restrictions.

DOH listed the following as challenges it faced in the implementation of the RH Law during the pandemic: (a) insufficient human resources; (b) limited facilities due to the conversion of some into dedicated COVID hospitals; (c) misconceptions and fears concerning immunization, family planning side-effects, HIV stigma; (d) increased barriers to health care-seeking behaviors due to mobility restrictions and fear of the disease; (e) record-keeping, surveillance and reporting measures were hampered as existing resources were redirected towards COVID-19-related tasks. All of this, while working with a budget that was 29 percent lower than that given the year before.

A study by the UNFPA also gave credence to the impact of the pandemic on reproductive health, particularly for women, as significant proportions of respondents in a 2021 study reported both sexual activity during the pandemic and a disruption or delay in their ability to access reproductive rights and services in the same time span. Only 10 percent of women reported to have continuous access to reproductive health services, and many were unaware if birth centers were open at all.

What does all this data mean? That the reproductive health rights of Filipinos, particularly women, are in dire straits. With public and private resources now being freed up due to the decrease in COVID case counts and easing of alert levels, there must be an active and conscious push to direct a significant portion of these to increasing awareness and accessibility of reproductive health services across the board. Converted facilities should be returned, if possible, to their RH focus; staff must also be allowed to return to RH focused duties and information must be disseminated not only regarding the return of these services, but the steps being taken to reassure Filipinos that health protocols are in place to keep their visits safe.

What is really required is not merely a return to the previous status quo – which, as I already mentioned, was rife with challenges to reproductive health – but an improvement and evolution of the same. Many of the work-arounds and innovations developed during the pandemic to remotely provide RH services to the public – such as hotlines/helplines, an active presence on social media, remote consultations, even online chatbots – have proven to be helpful and should be scaled upwards.

There should be a renewed push to review and repeal discriminatory laws and ordinances, and to clarify the right of the Filipino people, particularly women, to information about reproductive health, including modern contraceptives. Above all, there should be a recommitment to the idea of bodily autonomy – that we have a right to make decisions when it comes to sexual relations, to childbearing and to the respect of our own bodies.

A reprieve in the battle against COVID-19 does not mean it is time for complacency, either in our defenses against the virus or in our progress on other vitally important fronts. It’s time to renew our commitment to bodily autonomy and renew our commitment to reproductive health.