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POPULATION_ DEVELOPMENT _ REPRODUCTIVE HEALTH

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					    UP-CIDS             UNIVERSITY OF THE PHILIPPINES                                                EDITORIAL
      CENTER FOR INTEGRATIVE AND DEVELOPMENT STUDIES
                                                                                         Eliz abeth A guiling-Pangalangan
                                                                                                      guiling-Pangalangan
                                                                                         Elizabeth Aguiling-P
                                                                                                                 Executive Director

                                                                                  In 1985, then UP President Edgardo J. Angara
                                                                              established the Center for Integrative and
                                                                              Development Studies (CIDS) as a think tank of the
    OF THE NATION SERIES                                         FORUM        University. For the past 22 years, CIDS has engaged


                                                                    3
                                                                              in policy research while integrating different studies
             A CADEMIC D ISCUSSIONS ON                                        done by other units in the University. Its work has
          B URNING AND E MERGING I SSUES                                      covered a broad range of topics such as biodiversity,
                                                                              solid waste management, globalization, human
                                                                              rights, and education reform.
                                                                                   Under the present UP President, Emerlinda R.

AFORUM ON                                                                     Roman, CIDS has been reorganized and its focus
                                                                              is now on burning and/or emerging issues. Burning


POPULATION,
                                                                              issues are national or regional issues that require
                                                                              the immediate response of the University as a way
                                                                              to encourage the nation to likewise respond to

DEVELOPMENT &                                                                 these concerns. Through the CIDS fora, we tap
                                                                              members of the UP community and other


REPRODUCTIVE
                                                                              stakeholders to share their studies and strategies
                                                                              to resolve these problems.
                                                                                   On September 7, 2007, the Center held a forum

HEALTH
                                                                              on Population, Development and Reproductive
                                                                              Health, the third in its “Shame of the Nation” (SONA)
                                                                              forum series. This is indeed an apt topic, since the
                                                                              Philippines is one of the few countries still struggling
                                                                              with the question of acceptance and accessibility of
BACKGROUNDER                                                                  contraceptives in the 21st century. The right to decide
                                                                              whether to have or not to have children has been
Dr.              T. Re
Dr. Marita T. Rey es                                                          long recognized in domestic and international law,
Former UP Manila Chancellor and former Dean, UP College of Medicine           as falling within the realm of individual liberty and
                                                                              privacy. Thus, it is the duty of the State to provide
                                                                              the full range of universally accepted and scientifically
TO PUT THE DISCUSSION in context, there are two terms we                      safe family planning methods, including traditional
should familiarize ourselves with. The first is development. Development,     and modern means. This forum focuses on an issue
as defined in the column of Prof. Winnie Monsod in BusinessWorld a few        that has far-reaching implications, including in the
days ago, is “growth plus” – i.e., development is growth that is pro-poor,    fields of human rights, State obligations as a member
pro-jobs, pro-women and pro-nature. The other definition is by former         of the community of nations, economics, religion,
Senator Wigberto Tañada, as articulated during the second National Multi-     and health.
Sectoral Policy Conference on Population and Human Development. He                 The main speakers were: Dr. Ernesto Pernia, a
said that development policy must singularly focus on the economic,           distinguished UP economics professor and Dr.
political and social well-being of all Filipinos, and that national           Alberto G. Romualdez, former Secretary of Health
                                                                              and a staunch advocate of reproductive health.
development must promote human development in all aspects and
                                                                              Reactors were Mr. Ramon San Pascual, executive
dimensions of life.                                                           director of the Philippine Legislators’ Committee
    For the second term, reproductive health (RH), we borrow from the         on Population and Development Foundation, Inc.
WHO (World Health Organization) definition of health. Reproductive            (PLCPD); Mr. Tomas Osias, executive director of
health is the state of complete physical, mental and social well-being, not   the Population Commission (POPCOM); and Mr.
merely the absence of disease or infirmity in all matters relating to the     Dario Pagkaliwagan, executive director of the Lopez
reproductive system and to its functions and processes. It implies that       Group Foundation. Dr. Marita Reyes, one of the
people are able to have a satisfying sex life. It also means that people have stalwarts of the Reproductive Health Rights and
the capability to reproduce. They should have the capability to reproduce     Ethics Center for Training and Studies based in UP
or not reproduce, and the freedom to decide when and how often to             Manila, gave a backgrounder on the forum and a
reproduce.                                                                    synthesis of the points discussed. Dr. Nimfa Ogena
                                                                              of the UP Population Institute acted as moderator/
    Our sources for the reproductive health framework are three United
                                                                              facilitator. The Center thanks them and the
Nations (UN) instruments on human development. The first is CEDAW             participants for HEALTH
                              A FORUM ON POPULATION, DEVELOPMENT & REPRODUCTIVE their valuable insights.
(Convention on the Elimination of Discrimination against Women). In
 2                                                              S H A M E O F T H E N AT I O N S E R I E S


1979, the UN World General Assembly adopted this. It is a
human rights treaty which affirms the reproductive rights                                Population as
of women and identifies culture and tradition as influential                             Public Interest
forces shaping gender roles and family relations. This treaty
created states’ and governments’ binding obligations to                               Dr. Ernest Pernia
                                                                                      Dr. Ernes t o Pernia
eliminate discrimination and sex role stereotyping, to support                        UP School of Economics professor, V ice-chair for the Division of
women in political and public life, and support equality of                           Social Sciences of the National Research Council of the Philippines (NRCP),
                                                                                      and former lead economist at the Asian Development Bank (ADB)
women before the law and civil matters, in marriage and
family law, in access to health care, and so forth. The
Philippines is a signatory to the CEDAW.                                              THE MAIN BASIS for population being a public interest
    In 1994, 179 countries, including the Philippines, attended                       is the concept of externality. An externality is essentially a cost
the International Conference on Population and Development                            or a benefit resulting from an activity which cannot be fully
(ICPD). The ICPD recognized the interconnectedness of                                 internalized by the actor or the one responsible for the activity,




                                                                                    ○
                                                                                    ○
slowing down population growth, reducing poverty, achieving                           and the benefit or cost is transferred to others. In our case,



                                                                                    ○
economic progress, protecting the environment and reducing                            because population growth has been rapid and fertility has


                                                                                    ○
unsustainable consumption and production. We are a                                    been high for a long time, the externality has become negative
                                                                                    ○
                                                                                    ○
signatory to this. It means that we recognize the need to slow                        because it transfers the cost of childbearing, or of having many
                                                                                    ○
down population growth to reduce poverty, among others.                             ○
                                                                                    ○
                                                                                      children, to society.
    In 2000, 191 UN member-states, including the Philippines,                              The first key message is that rapid population growth
                                                                                    ○




adopted the Millennium Development Goals (MDGs.) The                                  alone cannot explain poverty. Bad governance, high income
                                                                                    ○
                                                                                    ○




MDGs are made up of eight concrete and specific targets that                          and wealth inequality, and weak economic growth are the
                                                                                    ○




should be met by 2015. Goal 1 is to eradicate extreme poverty                         main causes of poverty, but rapid population growth
                                                                                    ○
                                                                                    ○




and hunger. A mid-term report has been released by the                                exacerbates poverty.
                                                                                    ○




Philippines regarding the MDGs and apparently, there is a                                  The second is that the Philippine government’s target of
                                                                                    ○
                                                                                    ○




slight change in extreme poverty. The second goal is to achieve                       reducing the poverty rate from 30% in 2003 to 17% by 2010,
                                                                                    ○




universal primary education. Here we have a slight problem,                           which is in the Medium Term Philippine Development Plan,
because in the mid-term report,                                                                                    cannot be attained if the government
                                              Ariel G. Manuel




access to primary education came                                                                                   maintains its benign neglect of the
down from about 90 percent to only                                                                                 population issue.
about 80 percent. So it looks like we’re                                                                                Third, rapid population growth
sliding as far as universal primary                                                                                remains a hindrance to faster
education is concerned.                                                                                            economic growth, which is key to
    Goal 3 is to promote gender                                                                                    sustained poverty reduction. So the
equality and empower women. I                                                                                      great puzzle is why population growth,
think there is a slight improvement                                                                                which evidently is a public interest
here. Goal 4 is to reduce child                                                                                    issue, remains unresolved. It is only in
mortality. Again, the report says we                                                                               the Philippines where the population
                                           Women attend a seminar on population and health. Access to such
are improving. Goal 5 is to improve        information and reproductive health services remains a problem in       issue is still a burning controversial
maternal health. Here, we’ve               many parts of the country.                                              issue. In other developing countries,
reached a plateau. Goal 6 is to combat HIV-AIDS, malaria,                             even in poorer countries like Bangladesh, Pakistan and Nepal,
and other diseases. I think we are still combating HIV-AIDS                           the population issue has been resolved and they have been
and malaria, but tuberculosis (TB) is also a major concern.                           addressing it. In Bangladesh, for example, which has probably
For goal 7, which is to ensure environmental sustainability, it                       half our GDP per capita income (about 500 versus our 1200
seems that we are improving because of so many programs                               or so), the population growth is already at 1.3% per annum,
in this area, except for the Guimaras oil spill. And finally, goal                    versus our 2.36%. That’s how far behind we have been left
8 is to develop a global partnership for development.                                 behind by other Asian countries.
    We have eight more years to go to achieve our MDGs.                                    Based on surveys by Pulse Asia and SWS (Social Weather
Are we on track, despite the findings in the mid-term report?                         Station), the majority of Filipinos consider rapid population
How do we reach our development goals? What are our                                   growth as a hindrance to economic development. They believe
responsibilities? Must population, development, and                                   that it requires policy intervention, but the government has
reproductive health continue to be a shame of the nation?                             been immobilized owing to the opposition by the conservative


                                 A FORUM ON POPULATION, DEVELOPMENT & REPRODUCTIVE HEALTH
                                            S H A M E O F T H E N AT I O N S E R I E S                                            3


Catholic Church hierarchy. Yet the influence of the Catholic         those in the poorest quintile are getting about 5% or 5.4% of
Church may be highly over-rated, because surveys show that           national income or national consumption, versus Bangladesh’s
the majority of people actually favor politicians who support        9%. Bangladesh is less unequal than the Philippines, and
family planning programs. This was shown by the Pulse Asia           Thailand is also better off. In Vietnam, the poorest quintile is
Survey in March 2007, before the elections.                          also getting a bigger share of the national pie than the
     In my Development Economics class, I use this                   Philippines. The only country in the region which is worse off
development framework. We have institutions and policies             than us is Malaysia, but it is practically a developed country
that are interactive, and they impact on economic growth as          now. Usually, when economic growth is rapid, there is a phase
well as on the distribution of the benefits of economic                          when inequality worsens. I think that explains
growth. To the extent that economic growth is The majority of Malaysia’s inequality. Only 4% goes to the poorest
promoted and made rapid by good institutions, good                               quintile in Malaysia, but its GDP per capita now is
governance and good policies, and there is equitable
                                                             Filipinos           about $5,000. Malaysia has had 50 years of
distribution of the fruits of economic growth, then consider rapid independence versus our 100 years. Thailand’s case
growth becomes pro-poor. With strong pro-poor              population            suggests that population policy coupled with good
growth, the natural consequence would be rapid             growth as a           governance results in rapid economic growth and
poverty reduction. Thus, our lack of strong economic                             poverty reduction. And Indonesia, whose
growth and significant poverty reduction can be
                                                          hindrance to           governance and corruption ratings have been, until
traced to institutional performance. The only               economic             recently, worse than the Philippines, shows that
exception is the recent 7.5% second quarter growth, development.                 population policy by itself can contribute to
but even that is still open to question. So let’s hope                           significant poverty reduction.
that the economic growth can be sustained and that it impacts            Household data conform to or reinforce macro trends.
                                                                  ○




on poverty reduction.                                                Total fertility rate is a measure of the average number of
                                                                  ○




    What are the long-term population growth plans? There            children borne by women over their reproductive years. The
                                                                  ○
                                                                  ○




was 3% population growth in the Philippines in the early 1970s,      average number was 6 in the early 1970s; now it’s down to 3.5.
                                                                  ○




which slowed to 2.5% in the mid-1980s. Since then, it has been       So it has come down, but nowhere near what should have
                                                                  ○
                                                                  ○




leveling off at 2.36%, based on the census of 2000. Government       happened. Countries in Asia with lower per capita income
                                                                  ○




is now saying that it’s at 1.95%, but this is based on               and literacy have reduced fertility faster than the Philippines.
                                                                  ○
                                                                  ○




extrapolation because there was no census in 2005. That              We can say the same of Bangladesh, Pakistan, Sri Lanka, and
                                                                  ○




remains to be tested by the census that is being carried out         India’s Kerala State. The empirical data tell us that good
                                                                  ○
                                                                  ○




now. We’ll see if there was indeed a decline in population           population policy helps speed up economic development
                                                                  ○
                                                                  ○




growth from 2.36% in 2000, but I think it is unlikely.               because there is an interactive causation between population
                                                                  ○




    Indonesia’s and Thailand’s population growth rates, which        and the economy.
                                                                  ○
                                                                  ○




were similar to the Philippines in the early 1970s, are now              Those in the poorest quintile want only 4 children, but
                                                                  ○




down to less than 1% in Thailand and 1.3% in Indonesia.              they’re actually having 6 because they don’t have access to
                                                                  ○
                                                                  ○




Note that Indonesia is still considered a less developed             effective family planning methods, which should be provided
                                                                  ○




country than the Philippines in terms of GDP (gross domestic         by the government. The large income gap among the poor is
                                                                  ○
                                                                  ○




product) per capita and in terms of institutions. But Thailand       due to the high need for family planning services and low
                                                                  ○




is definitely way ahead, as its GDP per capita now is more           contraceptive prevalence rate. The poor cannot afford private
                                                                  ○
                                                                  ○




than double ours ($3,000 per annum, as compared to our               sources and often depend on government sources. The USAID
                                                                  ○




$1,400 per annum). Yet we were way ahead in the 1970s                (United States Agency for International Development) has been
compared with Thailand. In terms of reducing poverty                 providing the family planning services through the government,
incidence, we are also lagging. In Thailand, poverty incidence       but that source is now drying up; it’s going to be phased out
has fallen to less than 10%; in Indonesia, its is about 16% or       next year. The problem will become worse if the government
less than 17%. Compare that with our poverty incidence,              does not step in and provide the budget for the services.
estimated from data in 2003, which is at 30% of the population           Actually, there is now P180 million budget, but that’s really
below the poverty line. We are being left miles behind by            a small amount. The UP Population Institute has estimated
Thailand, and even by Indonesia. These comparisons are               that in order to make the family planning program effective
instructive in terms of the links between governance,                in slowing down population growth or lowering fertility, we
population policy and poverty.                                       need to shift from predominantly traditional methods of
    The share of the poorest quintile of national income or          family planning to modern methods. This would cost about
consumption is a measure of inequality. In the Philippines,          1.3 billion pesos per annum.


                           A FORUM ON POPULATION, DEVELOPMENT & REPRODUCTIVE HEALTH
 4                                             S H A M E O F T H E N AT I O N S E R I E S


    The data show us that there is a consistent and
close link between poverty incidence and number               Strategic Issues in
of children at the household level. Family size is
also directly related to the likelihood of falling into
                                                              Population, Development
poverty or into exogenous shocks like typhoons,               and Reproductive Health
droughts and inflation.
                                                              Dr. Alber t o G. Romualdez
                                                              Dr. Albert       Romualdez
    Mean income per capita, expenditures, and
                                                              Director of the Health and Human Values program of the
savings are also inversely related with family size.
                                                              MTEC Hospital, Makati City and former Secretary of Health.
Expenditure, or spending per person, is also
inversely related with family size. In 2000, for
example, families with 9 children or more had a               I WILL TRY TO PUT TOGETHER a view of what our status
poverty incidence as high as 57%. For a family with           is with respect to population and what issues have led us to the sad state
only one child, it’s less than 10%. This relationship         of affairs described by Dr. Pernia, and to identify major principles behind
is consistent across quintiles as well as over time.          these issues to see if we can do something about them.
We can go back to 1985, and the relationship is still             Our population is now at 89 million. In 1975, it was less than 40 million,
consistent – very difficult to refute. As President           so it has more than doubled since then. The population growth rate is at
GMA said when she talked about the 7.5% growth                2.36%, versus an average GDP from the year 1975 of less than 4%. This
rate, figures don’t lie. We should also tell her that         means that there is a differential of only 1.4 % between the population
the figures here don’t lie.                                   growth rate and the growth in wealth. This explains a lot of the bad
    We did econometric analysis of household data.            comparisons that have been made between the Philippines and our
Econometric analysis controls for other variables             neighboring countries.
and focuses on the variable of interest. So, other                We’ve already seen that the total fertility rate is 3.5%, versus the
things being equal, what is the relationship between          desired fertility rate of 2.5%. We will certainly reach 100 million by the
poverty and fertility? An additional child has a clear        year 2015 – there’s nothing we can do about it anymore. We could have,
negative impact on household welfare, especially              if we started sometime in 1997 or 1996.
in low-income households. And the adverse                         Because of this large population, there is now a growing disparity
impact is regressive, meaning that the poorer the             between the resource requirements for development and the country’s
                                                          ○
                                                          ○




household, the larger the impact of an additional             large and growing population. In particular, social services have suffered
                                                          ○




child.                                                        from this large gap between resources and needs.
                                                          ○




                                                                  We have examples of the unequal distribution of resources between
                                                          ○




    The association between family size, poverty
                                                          ○




incidence and vulnerability to exogenous shocks is            urban and rural areas. For one, more than 60% of the budget for hospitals
                                                          ○
                                                          ○




just as strong and persistent. The demand for                 goes to hospitals in Metro Manila. This is probably historical, but it’s also
                                                          ○




additional children is lower among poorer women               because of politics, since Manila is much closer to the sources of power
                                                          ○
                                                          ○




than among richer ones. This harks back to the                where decisions are made. Another example of unequal distribution of
                                                          ○




fact that poorer families have a large unmet need             resources is in the national health accounts, which show that more than
                                                          ○
                                                          ○




for family planning services. They really want to             45% of total health expenditures – the amount of money that’s spent
                                                          ○




control family size, but they cannot do so effectively        throughout the country each year on items have to do with health,
                                                          ○
                                                          ○




because they lack access or they cannot afford to             medications, hospitalizations and so forth – goes to urban areas.
                                                          ○




buy pills or condoms. These may not be that                       In 1998, that amount was about PhP200 billion; it should now be
                                                          ○
                                                          ○




expensive to rich people, but to them, it can mean            around PhP300 to 350 billion. But what’s interesting is that 45% of this
                                                          ○




the cost of transportation or the cost of a meal.             comes from what is called out-of-pocket expenses: individuals paying
                                                          ○
                                                          ○




    Filipino women across all socio-economic                  for their health expenditures. Yet 30% of the people can’t spend anything
                                                          ○




classes have expressed the desire for fewer                   out of their pockets, so most of the money spent on health is actually
                                                          ○
                                                          ○




children, based on the family income-expenditure              spent by rich people.
                                                          ○




survey (FIES) data or national demographic and                    Those who don’t have money have to depend on government
                                                          ○




health survey data, reinforced by surveys of SWS              expenditures, but rich people as well are served by government
and Pulse Asia. Therefore, an unequivocal and                 expenditures. Out of the more or less 50% that goes to health needs, half
coherent national population policy backed by an              of that still goes to the rich, who still share in those services. Also, less than
adequately funded family planning program would               30% of the health workforce – doctors, nurses, midwives, etc. –are
be pro-poor, pro-women, pro-children, pro-                    employed by the government sector, the Department of Health (DOH),
people and pro-quality life.                                  local governments, the military and so forth. The government system


                              A FORUM ON POPULATION, DEVELOPMENT & REPRODUCTIVE HEALTH
                                                           S H A M E O F T H E N AT I O N S E R I E S                                                     5


serves the 70% of the population that cannot afford to go to                              regulation of unhealthy activities, which includes regulating
the private sector, so it’s 30% serving 70%.                                              exploitation of the environment and air pollution, ensuring
     This type of maldistribution of resources is seen in all                             safe water, and so on. In fact, a lot of our public health
other social sectors, in education, in transportation and                                 expenditures emphasize preventive interventions that are
communications, and more. If we continue the way we’ve                                    individual in nature. This treats people individual by individual,




                                                                               ○
                                                                               ○
been going for the last 30 or 40 years, the resource gaps and                             instead of using a public health approach.




                                                                               ○
the disparities between groups, including along gender lines,                                    Finally, we have a fragmentation of health care: primary




                                                                               ○
                                                                               ○
along age lines, between disabled and non-disabled and others,                            care is isolated from secondary and tertiary care. This siphons




                                                                               ○
will continue to increase because government expenditures                                 off money from primary care, which is probably the most




                                                                               ○
                                                                               ○
on these items is continuously being reduced. In the year                                 effective kind of care. Before 1992, there was an integrated




                                                                               ○
2001, the DOH budget was PhP 11.8 billion. Last year, the                                 delivery of health services and continuity in health care.




                                                                               ○
                                                                               ○
budget of the DOH went down to approximately PhP 9.8                                      Unfortunately, the Local Government Code, without paying




                                                                               ○
billion. Now, they proudly say that they’ve restored it to                                attention to the need for integrated care, cut off the municipal




                                                                               ○
                                                                               ○
PhP11.5 billion, but the fact is that in 2000, PhP 11.8 billion                           health officers from the provincial hospitals, then chopped



                                                                               ○
could have bought more health care than the PhP11.5 billion                               off the provincial hospitals (which provide secondary care)


                                                                               ○
                                                                               ○
now. So there is a real reduction in national government                                  from the national hospitals (which are the sources of tertiary
                                                                               ○
expenditures for health.                                                                  care). Now, the Department of Health is trying to restore
                                                                               ○
                                                                               ○
     Government continues to emphasize cost recovery in                        ○
                                                                                          unity among health services.
reporting expenses. In government hospitals like the PGH                                         Because of poor prioritization, the differences in
                                                                               ○
                                                                               ○




(Philippine General Hospital), poor patients are often asked                              distribution of care, just like gender differences, are aggravated
                                                                               ○




to buy medicines and supplies. These out-of-pocket expenses                               by a lack of a reproductive health policy. The Reproductive
                                                                               ○
                                                                               ○




of the poor are not recorded as part of what they pay to the                              Health Bill has been stalled in Congress for the past four or
                                                                               ○




hospital. Thus, studies on hospital expenses do not reflect the                           five years. The national government has a tendency to point
                                                                               ○




real costs borne by the patient, a lot of which is not paid for by                        fingers at the local government, saying that they’re the ones
the government. Those who already have less access to health                              responsible for reproductive health, and doesn’t even provide
care get even less.                                                                                                     technical support. In fact, they don’t
                                         Ariel G. Manuel




     The numbers of the poorest,                                                                                        even call it a reproductive health
i.e. those who cannot afford to                                                                                         policy because “reproductive
pay for their social services, are                                                                                      health” happens to be a “bad word”
likewise increasing. Their total                                                                                        among conservative circles. .
fertility rate is at 6%, while the total                                                                                    Technically, the Philippines is in
fertility rate for the richest people,                                                                                  violation of the three international
the top quintile, is 2.1%. This                                                                                         agreements that Dr. Reyes
happens to be the total fertility                                                                                       mentioned. We are certainly
rate for zero population growth,                                                                                        discriminating against women by
hence, their numbers are not                                                                                            not having a reproductive health
growing. .                               Illegal settlers around Metro Manila and other urban areas, illustrating the   policy. We are going against the
                                         impact of population growth and density on the poverty rate.
     Unfortunately, our priorities                                                                                      ICPD because we have not
are all mixed up. Based on expenditures, we place very low                                recognized the official link between high population growth
priority on health promotion activities. In the spectrum of                               rate and development, and we will almost certainly not reach
health care, there are four basic services. Health promotion                              the Millennium Development Goals.
means enhancing your health and taking measures to ensure                                        To compound all of these, we have an impending health
that you’re healthy. Preventive health means that you try to                              workforce crisis. There is very high international demand for
prevent specific illnesses, like preventing the spread of                                 nurses and care-givers. Because of this demand for
epidemics and so forth. Curative care means treatment when                                professional health services, we have been turning out low-
you’re already ill. Finally, rehabilitation is trying to restore                          quality graduates. We have staff shortages in quantity and
function after you’ve incurred some damage to your health.                                quality of nurses, doctors and midwives in provincial facilities.
     Obviously, the most effective of these four would be health                          The most severely affected right now by this impending crisis
promotion. That means educating people about health                                       are government programs, which provide the services to those
matters, advocacy of healthy lifestyles, non-smoking, lower                               who are already underserved: the poor, women, elderly and
alcohol consumption and so forth. It also involves the                                    the disabled.


                                A FORUM ON POPULATION, DEVELOPMENT & REPRODUCTIVE HEALTH
 6                                           S H A M E O F T H E N AT I O N S E R I E S


    In all social sectors, we have problems, and we need to                  Unfortunately, government is agreeing to this. And all of




                                                                   ○
                                                                   ○
address them. In education, we have to keep up with                     these are aided and abetted by a religion based on the colonial




                                                                   ○
technology. There is growing evidence that the quality of our           mindset of upper socio-economic groups.




                                                                   ○
                                                                   ○
educational system is going down. Worse, it is becoming more                 We need to regain control of the globalization process on




                                                                   ○
unequal. Graduates of private schools are able to                                   our terms. We have to reassess pro-private policies
keep up with technology, but our public schools, The differences in the social sectors and review the role of the private
especially public high schools, always get the short in distribution sector in education, especially at the university level.
end of the stick when it comes to investments in
                                                             of health care We need to restore appropriate priority-setting
improving their technology.                                                         mechanisms in the health sector to emphasize
    The old infectious diseases are still there. TB are aggravated reproductive and family health approaches. Also,
and malaria are still bad, and we’re increasingly              by lack of a         we should reestablish the primacy of the social
threatened by multi-drug-resistant forms of these             reproductive concerns of the many over the economic and
old diseases. At the same time, there are new
                                                             health policy. commercial interests of the few. This is the basis
infectious diseases. HIV and AIDS are not so new;                                   for such initiatives as the Cheaper Medicines Law.
they have been around for nearly 30 years, but the threat in                 Solutions to the reproductive health problem should


                                                                   ○
the Philippines is still there. Up to now, our epidemics are still      involve Filipinos looking for Filipino solutions to structural
                                                                   ○
                                                                   ○
characterized as low and slow. But with the growing population,         defects in our society, which have been aggravated and are
                                                                   ○
growing urbanization and evidence that sexually transmitted        ○
                                                                   ○
                                                                        still being aggravated by the evolving and complex global
illnesses are on the increase, there is no question that HIV            situation. In short, in the Philippines, we Filipinos must regain
and AIDS may not be far behind.                                         control of the effects of globalization.
    At the same time that we are still threatened by
communicable disease epidemics, we are heavily facing an
epidemic of degenerative diseases, such as cancer, diabetes,             REACTORS
and hypertension. These other diseases used to be called
“diseases of affluence,” which is not true. Recent studies show         Mr.
                                                                        Mr. Ramon San Pascual      Pascual
that, in fact, it is the poor that will suffer most from epidemics      Executive Director, Philippine Legislators’ Committee on
of these degenerative diseases, because they are more exposed           Population and Development Foundation, Inc.
to the high-risk behaviors and environment. Also, they cannot
afford the treatment.                                                   IN THE 14 TH CONGRESS , there is now a
    Finally, there is a phenomenon that is closely linked to            consolidation of the pro-life bloc. The top party-list
globalization, which is called medical tourism. Unfortunately,          contenders used to be the progressive ones: Bayan Muna,
it seems to have caught the fancy of many people in the                 Anakbayan, and even Gabriela. But in the last election in May
medical profession and in government. With medical tourism,             2007, it was the pro-life Buhay. It now has three representatives
we will effectively be causing an internal hemorrhage in the            (the highest number among the party-list groups): Rene
health sector, because people who would otherwise be trained            Velarde (son of El Shaddai leader Mike Velarde), Ma. Carissa
to serve Filipinos, will now be drawn to serve foreigners, such         Coscouella, and William Irwin Tieng.
as those who want breast augmentation jobs, nose-jobs and                    On September 4, 2007, Mike Velarde of the Catholic group
similar stuff.                                                          El Shaddai hosted a bishops-legislators meeting which included
    We have chronic under-funding. There is a near-collapse             all the “presidentiables” for 2010: Sen. Mar Roxas, Sen. Manuel
of the public sector and unregulated privatization. Donor-              Villar, and others. In that meeting, the bishops stressed that
driven international initiatives are poorly coordinated, and            the Reproductive Health Bill must be dropped. They also
such coordination is the function of the national government.           questioned the presence of the PLCPD office in Congress.
    What we are seeing is actually the end result of a 30-year          Many things have happened since then, but this incident
globalization process. Many of us actually participated in this         illustrates that the pro-life or anti-RH bloc is doing everything
process, led by the World Bank, USAID and others. These                 it can to weaken policy advocacy on population and
multilateral agencies advocate pro-private, market-oriented             development. This is an indicator of how difficult the 14th
policies. In addition, they have looked at health, education            Congress will be for population policy and reproductive health
and welfare as a set of tradable commodities, which means               advocates.
that they are all done in exchange for money. That is why less               PLCPD is made up of legislators concerned with
and less value is given to health, education and welfare in the         population policy advocacy. 47 of the 113 sponsors of the
budget and even in the people’s mindset.                                Reproductive Health Bill have been re-elected. Many PLCPD


                            A FORUM ON POPULATION, DEVELOPMENT & REPRODUCTIVE HEALTH
                                             S H A M E O F T H E N AT I O N S E R I E S                                             7


members (which include some 80 legislators) were also re-             of Action, which emphasized reproductive health and
elected, and some of them are heading important committees            reproductive rights. In 1991, the Local Government Code (RA
that may be of help in passing laws on population and                 7061) took effect and devolved family planning to local
development. One is the Committee on Population and                   government units (LGUs).
Family Relations. Its jurisdiction includes matters directly and          During Pres. Joseph Estrada’s administration, the
mainly relating to population growth and family planning,             population program focused on unmet needs in family
census and statistics, rights and responsibilities relating to        planning. It was under the Estrada administration that the
family relations, enhancing the quality of family life, and care      Contraceptive Independence Initiative (now Contraceptive
of the elderly. It has a membership of 25 legislators, and the        Self-Reliance) saw its beginnings. There was a budget for
chairperson is Rep. Nanette Daza.                                     contraceptive self-reliance, but the program was not realized.
     Another important committee is the Committee on Health,              The Arroyo administration treats family planning as a
with Rep. Arthur Pinggoy as chairperson. In the Senate, there         component of women’s health and as a means to achieve
is the Committee on Health and Demography, with Sen. Pia              couples’ desire fertility. The DOH embarked on a campaign
Cayetano as head. Possible approaches we can use are the              for fertility awareness. According to the President, we have
budget and legislation, both on national and local levels. I          been emphasizing and promoting artificial methods for almost
think it is up to us to tap Congress as a pathway to clarify and      35 years. So this time, to level the playing field, let us try to
push population and development issues.                               work on fertility awareness and the promotion of natural
                                                                      family planning (NFP) and responsible parenting.
Mr. Tomas Osias
Mr. Tomas                                                                 On January 25, 2005, we signed our Statement of Support
                                                                      for ICPD and its implementation. Pres. Arroyo also stressed
Executive Director, Population Commission
                                                                      that we would like to achieve a 1.9% population growth rate
                                                                      by 2010, consistent with the poverty reduction and sustainable
ESSENTIALLY, WE NEED accessible, affordable and                       development objectives of the government. She also stressed
quality population, RH and family planning information and            that it shall be the responsibility of the local government units
services. Regarding the opposition of the Catholic Church, do         to provide information and services on RH and family planning
we want to address head-on the religious sector or would we           to their constituents.
like to find out areas where we can work together? I will try to          So what do we see as our policy agenda? First, accelerate
address this in my presentation on population policies and            family planning use to contribute in reducing maternal deaths.
programs from 1969 to the present, including a policy agenda          This includes establishing and upgrading facilities to provide
and call to action.                                                   Basic Emergency Obstetric Care (BEmoC) and
    In 1967, President Ferdinand Marcos, together with 17             Comprehensive Emergency Obstetric Care (CemoC).
heads of state, signed the UN Declaration on Population,                  Two, improve health facilities, obstetric, maternal and
which precipitated the provision in the Constitution saying           infant logistics and skills at the barangay level, and capability-
that it is the State’s responsibility to achieve and maintain         building for service providers and nationwide advocacy for
population levels conducive to national welfare. Also during          contraceptive self-reliance.
the time of Marcos, the POPCOM was created. At that time,                 Third, we have to segmentize the health market. We have
the focus was on the implementation of the national family            to encourage those who can afford to go to private clinics to
planning program.                                                     do so. Only the poor shall be subsidized by the government.
    During the time of President Corazon Aquino, the                  We will also work for the inclusion of family planning supplies
emphasis was on the right of couples to determine the number          in the Botika sa Barangay.
of children. Essentially, the responsibility of the State to              Four, intensify the promotion of the responsible parenting
maintain and manage the population level was transferred to           movement, which will encourage a shift from traditional
the couples, and family planning was packaged as a form of            methods to scientific natural family planning methods, and
health intervention. Also, POPCOM was transferred from                strengthening the participation of NGO-based organizations.
NEDA (National Economic and Development Authority) to                 This is one area where we feel we can work with the Catholic
the Department of Health (DOH).                                       Church, because the Church endorses only natural family
    During President Fidel Ramos’ time, it was again                  planning methods.
emphasized that rapid population growth was constraining                  For adolescent reproductive health needs, we stress the
socio-economic progress. The population-resources-                    strategy of a parent education program. This is also an area
environment balance was very strongly advocated. It was also          where the Church can work with us, because they would like
under Ramos that the Philippines signed the ICPD Program              parents to be the teachers to their adolescent children when it


                              A FORUM ON POPULATION, DEVELOPMENT & REPRODUCTIVE HEALTH
 8                                              S H A M E O F T H E N AT I O N S E R I E S


comes to reproductive health and sexuality matters.                          Aside from these, we also try to participate in various
   We should provide appropriate information, education                   advocacy campaigns on the national and regional scale.
and counseling strategies as well as push for men’s
involvement. We can do all this through a grand partnership
with the different sectors, an advocacy which will come up                SYNTHESIS
with measures that will take into account population and
development concerns in international, national and local                 Dr. Marita Re y es
                                                                          Dr.        Re
development priorities.                                                   Former UP Manila Chancellor and former Dean,
                                                                          UP College of Medicine

Mr. Dario Pagk aliwagan
Mr.        agkaliw
          Pagkaliwagan
Executive Director, Lopez Group Foundation
                                                                          WE HAVE LEARNED                      many things through this
                                                                          forum. Our speakers, using figures that do not lie, have shown
                                                                          that rapid population growth is a hindrance to sustained
WHAT DOES THE Lopez Group do in population and                            economic growth and that it exacerbates poverty. They also
development? At the work places, we strengthen their                      have shown that the impact of rapid population growth is
reproductive health program. At the site level, we assist the             aggravated by many things like poor prioritization,
communities; and at the regional and national levels, we                  globalization and an imbalanced role of the private sector.
advocate, initiate, encourage and take action.                                  There are social challenges including poverty, urbanization,
    We surveyed our employees and found out about their                   environmental degeneration and globalization that impact
family planning needs. The program rolled out and more                    on education, on health and social welfare. Fortunately, there
than a thousand employees participated in the different                   are solutions. One is pushing for a national policy on
seminars we conducted. Then, we had the system installed.                 reproductive health, population and development. Despite
    We provide supplies and services; we have training on                 the strong lobbying efforts of the pro-life bloc, there is hope
modern family planning methods. We have four doctors within               because PLCPD has already identified new members who
the company who are trained in non-surgical vasectomy. Four               can help in coming up with legislation on population and
employees came and became the spokespersons for the                       development.
companies. We have a program in place, and it is now being                      We need to regain control of the globalization process so
monitored. This is part of the corporate planning process and             that we are able to reassess priorities, such as the role of the
is part of the annual budget cycle. Materials are sourced,                private sector in health, social services and education.
given and discussed on occasions when the employees                       Education, too, can be part of a very basic, but not completely
convene.                                                                  curative, solution to our population and development
    We aligned with NGO partners with expertise in these                  dilemma.
areas, like Friendly Care, the Family Planning Organization of                  We are happy to note that POPCOM is trying to weave its
the Philippines (FPOP), the Philippine Center for Population              way through some very strong influences within its board.
Development, and the PBSP (Philippine Business for Social                 They have a strong advocacy for contraceptive self-reliance,
Progress).                                                                reducing maternal mortality, responding to the reproductive
    In one program in Jaro, Iloilo, we aligned with the FPOP              health needs of adolescents and young people, and involving
and connected with communities to initiate a contraceptive                men. But these will just be mere words if there is no real
self-reliance program. We organized volunteers among                      national policy that is supported by a budget.
women who became the advocates for the use of                                   Most important, we are happy to note that the private
contraceptives. We gave them supplies, and they now do it on              sector, especially big business, can also do something to help
a working capital basis. The barangay captains were very                  fill in what may be lacking from government. The Lopez Group
receptive. This is a sustainable program that is ongoing in               of Companies has shown that in fact, promoting family
their barangays.                                                          planning is good for business as well as for the country.


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