Primary health care-based approach to sexual and reproductive health and rights

As we celebrate the 30th year anniversary of the Alma Ata declaration on Primary Health Care, and as the debate on reproductive health continues, HAIN is proud and happy to publish this material entitled, “Primary Health Care Approach to Sexual and Reproductive Health and Rights.”

The comprehensive primary health care (PHC) approach articulated at Alma Ata remains as relevant today as it was 30 years ago. Certainly, sexual and reproductive health and rights are integrated in the concepts of primary health care.

The PHC approach has provided the shift in perspective from a medicalized and biomedical framework to a more sociopolitical-cultural and biopsychosocial approach to health.

The principles of PHC clearly embody the role of social determinants in health, ie, poverty, inequity, social injustice, as factors lying outside the medical and public health services that strongly determine health. As we look at the experiences of countries, it is evident that countries which achieved the more lasting improvements in health were those with a commitment to equitable development.

It is on these premises that the focus on sexual and reproductive health should not be on population control or sex act itself (as is the direction of the current debate), but on population as it relates to poverty, environment, education and other social issues. The campaign for the recognition of sexual and reproductive health and rights should be seen in the over all pursuit of human rights, including the right to health and the right to development. These rights can only be attained if we struggle against unequal and unjust social, economic and political structures which are the root causes of poverty, ill health, and underdevelopment.

HAIN hopes that that material will provide our readers this perspective.

-- from the preface of the book by Dr. Edelina de la Paz, Executive Director of HAIN

Survey: Most Pinoys Back Reproductive Health Bill

Six out of 10 Filipino adults are in favor of the controversial bill promoting family planning and the use of contraceptives despite opposition from the Church, according to a survey released yesterday.

Pulse Asia’s October 2008 Ulat ng Bayan Survey found 63 percent of Filipinos in favor of the reproductive health (RH) bill, eight percent not in favor and 29 percent ambivalent on the matter.

The Catholic Church, which counts over 80 percent of Filipinos as followers, has said the bill, which has been pending in Congress for months, is headed for defeat after a high-profile campaign by bishops.

The country’s population now stands at around 90 million, with an annual growth rate of 2.04 percent, one of the highest in Asia and above the government’s target of 1.9 percent, officials have warned.

The Pulse Asia survey also found eight in 10 Filipinos or 82 percent think government should not only educate couples regarding modern methods of family planning but also provide them with services and materials on these methods.

The same survey showed 68 percent of Filipinos are aware of the measure and only 32 percent do not know about the bill.

The non-commissioned survey, conducted from Oct. 14 to 27, used face-to-face interviews of 1,200 adults 18 years old and above.

“Across all geographic areas and socio-economic groupings, majorities (60 percent to 89 percent) know about the proposed legislation with the highest level of public awareness being recorded in the best-off socio-economic Class ABC,” Pulse Asia said.

In contrast, lack of awareness is most pronounced in Mindanao and Class E (38 percent and 40 percent, respectively) , it said.

Pulse Asia said majorities ranging from 56 percent in the Visayas to 79 percent in Class ABC are in favor of the bill.

Eight percent are not in favor of the bill, while 29 percent are unable to say whether or not they support the bill.

Public ambivalence on the matter is more notable in the Visayas, Mindanao, and Class E (32 percent to 35 percent) than in Class ABC and Metro Manila (13 percent to 21percent), Pulse Asia said.

Among the eight percent of Filipinos who do not favor the proposed legislation, additional survey findings showed that 47 percent of them agree with the need to promote information and access to natural and modern family planning methods.

Nearly seven in 10 Filipinos or 69 percent agree with the provision of the bill recognizing the rights of women and couples to choose the family planning method they want. About the same percentages either agree or disagree (36 percent versus 35 percent) with the inclusion of sex education in school curricula.

Funding for modern family planning

Forty-four percent believe government funds should be used to support modern family planning methods. Indecision on these issues is expressed by 20 percent to 33 percent of Filipinos, while disagreement is articulated by 10 percent to 35 percent.

Public disagreement is most manifest in relation to the proposal to include sex education in the school curricula (35 percent).

Pulse Asia said most Filipinos (82 percent) think government should teach couples about modern methods of family planning (both natural and artificial methods) – a view articulated by big to overwhelming majorities (76 percent to 91 percent) in all geographic areas and socio-economic classes.

Pulse Asia said exactly the same percentage says that it is the government’s duty to provide the people with knowledge, services, and materials on modern methods of family planning. This sentiment is expressed by 78 percent to 87 percent across all geographic areas and socio-economic groupings.

Less than one in 10 Filipinos (six percent to eight percent) disagree with either view, while indecision on these matters is expressed by 10 percent to 13 percent of Filipinos, Pulse Asia said.

The survey also revealed that about four in 10 Filipinos (44 percent) say the government should pass a law specifying the number of children couples may have.

“Thirty-six percent are not inclined to do the same,” Pulse Asia said. “Almost two in 10 (19 percent) are undecided on the matter.”

Across geographic areas and socio-economic classes, big pluralities to small majorities (45 percent to 58 percent) in Metro Manila, the Visayas, Mindanao, and Classes D and E favor the idea of government passing a law on the number of children couples may have, Pulse Asia said.

In contrast, a near majority (47 percent) of those in the rest of Luzon do not think government should pass such a law while in the poorest Class E, almost the same percentages express either agreement or disagreement (42 percent versus 40 percent) with this proposal.

Religious influence

While 49 percent of Filipinos say couples should follow what their religion tells them about family planning, 44 percent are ambivalent as regards the possibility of their church or religion influencing their vote for a candidate advocating modern family planning methods.

“Big pluralities to sizeable majorities (41 percent to 68 percent) across all geographic areas and socio-economic groupings are of the view that couples should follow the dictates of their religion when it comes to the issue of family planning,” Pulse Asia said. “This sentiment is most manifest in the Visayas and least pronounced in the rest of Luzon.”

On the other hand, around the same percentages of Filipinos are either ambivalent on the matter or do not agree that couples are obliged to abide by the teachings of their religion on family planning (27 percent against 23 percent).

When it comes to the impact of their church or religion on their decision as to whether or not to vote for a candidate supporting modern family planning methods, indecision is the predominant public sentiment at the national level (44 percent) and particularly in the rest of Luzon, the Visayas, and Classes D and E (42 percent to 52 percent), Pulse Asia said.

In contrast, 34 percent of Filipinos say there is a big possibility their vote would be influenced by their church or religion while 21 percent express a contrary opinion.

Pulse Asia’s survey has sampling error margins of plus or minus three percent at the 95 confidence level.

Bill advocates rejoice

A pro-reproductive health bill advocate said yesterday that the latest results of the Pulse Asia survey had only reinforced their stand that a majority of Filipinos support the bill.

“The survey had only reiterated what other surveys have said – that most of the Filipino people want the bill passed. I hope that those opposing this will listen this time,” said Beth Angsioco, secretary-general of the Reproductive Health Alliance Network (RHAN).

Angsioco also urged the Catholic hierarchy to keep an open mind on the bill.

Akbayan Rep. Risa Hontiveros, one of the main authors of House Bill 5043, or the “Reproductive Health, Responsible Parenthood and Population Development Act of 2008,” said this only proves even more the need to pass such an important law.

“It’s another win for the RH bill. Majority of the respondents, and we presume many of them are Catholics, want the government to spend for this. Majority of them says that this is a political issue,” she told the media in a briefing

Hontiveros, along with the other RH bill authors, are likewise hopeful that Catholic bishops would finally hold a dialogue with them on the issue, and that the “heart” of the measure – providing a free and responsible choice for couples – would not be sacrificed.

Another RH bill main author, Rep. Edcel Lagman of Albay, highlighted the “persistent negative reports that 11 Filipino women die daily” due to pregnancy and childbirth as one of the reasons for the immediate passage of the bill.

Such a statistic, according to him, makes the Philippines among the worst performing countries in improving maternal health care.

The House leadership decided December last year to defer deliberations on the reproductive health bill until they resumed their sessions yesterday, owing to fierce debates that sometimes got too personal.

GMA firm on stand, but…

Malacañang reiterated that the position of President Arroyo remains the same on the issue of birth control but said she would take into consideration the different sentiments of all sectors.

Deputy presidential spokesperson Lorelei Fajardo said the opinion of the people, including that of respondents in the surveys, would be taken into consideration by the President if and when the reproductive health bill is passed by Congress and reaches her office for her signature.

Mrs. Arroyo has always supported natural family planning as a means of birth control and has advocated this through the various government agencies. – With Sheila Crisostomo, Delon Porcalla, Marvin Sy


Source: Phil. Star 20 January 2009