Making a Truly Informed Choice: Rejecting the RH Bill (HB 4244)

Abraham Daniel C. Cruz, MD Department of Pharmacology, FEU- NRMF Inst. of Medicine Candidate, MS Pharmacology, UP Manila Associate Member, Philippine Society of Experimental and Clinical Pharmacology Member, Filipinos for Life

Fides et Ratio (Faith and Reason)

Deprived of reason, faith has stressed feeling and experience, and so run the risk of no longer being a universal proposition. It is an illusion to think that faith, tied to weak reasoning, might be more penetrating; on the contrary, faith then runs the grave risk of withering into myth or superstition. - John Paul II, 1998

Public Opinion and the RH Bill

SWS Survey (2008)
76% want family planning education in the public schools 71% favor passage of the Reproductive Health (RH) Bill

Pulse Asia Survey (2010)

69% of Filipinos support RH Bill

Public Opinion and the RH Bill

We cannot accept surveys hook, line and sinker We must always critique the methodology
Did respondents READ the RH Bill (or simply made aware of the bill)? Are the survey questions valid? Were ALL provisions included (including punitive provisions) in the survey questions? AWARENESS of the bill does not necessarily equate to knowledge of the bill

Respondents may agree with the CONCEPTS of Reproductive Health, but in actuality have not even read the RH Bill invalid respondents REMEMBER, the RH Bill is a piece of legislation with provisions and punitive clauses, and not merely a health care program

Public Opinion and the RH Bill

"Whenever you find yourself on the side of the majority, it's time to pause and reflect. - Mark Twain

Reproductive Health Bill

HB 4244
An Act Providing for a National Policy on Reproductive Health, Responsible Parenthood, and Population Development, and for other Purposes Consolidated RH Bill

RH Bills
5043, 96, 101, 513, 1160, 1520, 3387

TAKE NOTE
Broad agreement on both sides regarding most RH issues
reduction of maternal and infant mortality diagnosis and management of diseases related to the reproductive tract violence against women breastfeeding, infant nutrition care of post-abortion complications improvement of infrastructure training and deployment of skilled birth attendants, etc ***not up for a lengthy discussion

TAKE NOTE
Disagreement on:
subsidizing (i.e. using taxpayers money) and mandating contraception population control as a solution to poverty POPCOM as coordinating body mandatory sex education in grade school and high school seeming loss of parental authority in the acquisition of RH services by minors provision of RH services by employers punitive provisions which make health workers, employers, and any advocate vulnerable to prosecution

FINDING A COMMON GROUND REQUIRES DELETION OF PROBLEMATIC PROVISIONS

REMEMBER
pro-RH bill support ALL its PROVISIONS of HB 4244 anti-RH bill do not agree with SOME of the provisions of the bill
cannot support the bill that is currently being discussed in Congress

Discuss the UNAMENDED form

Still at the period of interpellation and not yet during the period of amendments Form that POGS supported when it came out with its statement
Coercive and oppressive

DO WE NEED A NEW LAW?

HB 4244 Sec. 4 Definition of Terms

80% of HB 4244 is Redundant

Section 17 of Republic Act 9710
Magna Carta of Women signed into law by Pres. Gloria Macapagal Arroyo on 8/15/2009

Specific procurement of contraceptives will be the only exception.

RA 9710 Sec. 17
Section 17. Women's Right to Health. - (a) Comprehensive Health Services. The State shall, at all times, provide for a comprehensive, culturesensitive, and gender-responsive health services and programs covering all stages of a woman's life cycle and which addresses the major causes of women's mortality and morbidity: Provided, That in the provision for comprehensive health services, due respect shall be accorded to women's religious convictions, the rights of the spouses to found a family in accordance with their religious convictions, and the demands of responsible parenthood, and the right of women to protection from hazardous drugs, devices, interventions, and substances. Access to the following services shall be ensured: (1) Maternal care to include pre- and post-natal services to address pregnancy and infant health and nutrition; (2) Promotion of breastfeeding; (3) Responsible, ethical, legal, safe, and effective methods of family planning;

(4) Family and State collaboration in youth sexuality education and health services without prejudice to the primary right and duty of parents to educate their children; (5) Prevention and management of reproductive tract infections, including sexually transmitted diseases, HIV, and AIDS; (6) Prevention and management of reproductive tract cancers like breast and cervical cancers, and other gynecological conditions and disorders; (7) Prevention of abortion and management of pregnancy-related complications; (8) In cases of violence against women and children, women and children victims and survivors shall be provided with comprehensive health services that include psychosocial, therapeutic, medical, and legal interventions and assistance towards healing, recovery, and empowerment; (9) Prevention and management of infertility and sexual dysfunction pursuant to ethical norms and medical standards; (10) Care of the elderly women beyond their child-bearing years; and (11) Management, treatment, and intervention of mental health problems of women and girls. In addition, healthy lifestyle activities are encouraged and promoted through programs and projects as strategies in the prevention of diseases.

RA 9710 Sec. 17
(b) Comprehensive Health Information and Education. - The State shall provide women in all sectors with appropriate, timely, complete, and accurate information and education on all the above-stated aspects of women's health in government education and training programs, with due regard to the following: (1) The natural and primary right and duty of parents in the rearing of the youth and the development of moral character and the right of children to be brought up in an atmosphere of morality and rectitude for the enrichment and strengthening of character; (2) The formation of a person's sexuality that affirms human dignity; and (3) Ethical, legal, safe, and effective family planning methods including fertility awareness.

General Appropriations Act of 2011

Budget for Maternal and Child Health and Population Development (DOH - Population Commission and Family Health Offices) New Appropriations: Health Care Assistance: 3,539,809,000 Implementation of the Doctors to the Barrios and Rural Health Practice Program: 123,284,000 Commission on Population Programs: 290,660,000 Public Health Development Program: 117,797,000 Health Facilities Enhancement Program: 7,116,387,000 Service Delivery Programs: Family Health and Responsible Parenting: 731,349,000 Health Promotion: 153,978,000 TOTAL: (PESOS) 12,073,264,000

2010 Budget under PNoy

932 million pesos for family planning and maternal care
800 million of which for the procurement of condoms and contraceptives

1 billion ONLY for the procurement of medicines to cure all illnesses (from infancy to adulthood)

Three billion pesos more for what???

Money is ALREADY being poured out for RH services
If services do not reach the local constituents:
Money was used for other purposes Money was corrupted

Proposed RH programs will actually cost more than P 3B scope of HB 4244 is TOO BROAD
Breast cancer chemotherapy Antiretroviral drugs for HIV Infertility diagnosis and management Medical eligibility tests prior to prescribing contraceptives (WHO requirement)

New Law: Unnecessary

RH Bill is an admission of:
incompetence in leadership in implementing laws Inability to curb corruption in the government

RH Bill will TAKE AWAY funding for basic services that have tangible impacts for the poor

Education Food security Housing Skills training, etc.

Budget Slashes
Tertiary education scholarship 1.3 billion down to 900 million TESDA 5 billion down to 700 million, Housing 10 billion down to 5 billion, Assistance to OFW 100m down to 27 million, Agriculture - slashed in half DAR slashed in half

CONTRACEPTION AND OTHER DEVICES

Issues
Sexuality
Moral issues will not be discussed

Sex + contraception + STD prevention are closely intertwined + family planning Three points to settle
when life begins mechanisms of action and failure rate of these drugs and devices State subsidy

Freedom to choose is a non-issue

Anyone can choose any method in the freedom of his/her conscience without fear of coercion

RH Bill Principal Authors

Rep. Janette Garin, 1st District, Iloilo

Rep. Edcel Lagman, 1st District, Albay

When Does Human Life Begin?

Reps. Garin and Lagman
RH Bill is not an issue of when life begins, but an issue of women s health, population and poverty alleviation Refuse to answer this question

Life issues and contraception are closely intertwined topics Definition of when life begins is NOT included in HB 4244

When Does Human Life Begin?

Human embryo at 8-cell stage

Law of Biogenesis
All life comes from preexisting life, and each species reproduces after its own kind. THEREFORE: Human beings can only reproduce other human beings, so it doesn't start out as one species and suddenly become a human being somewhere along the way

Definition of LIFE
an organismic state characterized by capacity for metabolism, growth, reaction to stimuli, and reproduction FERTILIZATION
Formation of a new cell distinct from the cells giving rise to it EMBRYO
Material composition (genetic and molecular) Developmental pathway (behavior)

Occurs in less than a second

WHEN DOES LIFE BEGIN?

Independent of ethical, moral, political or religious belief

Human embryo from the zygote stage forward are indeed living individuals of the human species HUMAN BEINGS.
Maureen L. Condic, PhD, When Does Human Life Begin? Senior Fellow, Westchester Institute for Ethics and the Human Person Associate Professor, University of Utah School of Medicine

What is Abortion?
Department of Health and Human Services, US Department of Health, Education and Welfare: All measures which impair the viability of the zygote at any time between the instant of fertilization and the completion of labor constitute, in the strict sense, procedures for inducing abortion.

Verbal Engineering
Before 1960 Fertilization = Conception 1960 ACOG definition
FERTILIZATION is the union of spermatozoon and ovum CONCEPTION is the implantation of a fertilized ovum. This definition has been selected deliberately because union of sperm and ovum cannot be detected clinically unless implantation occurs. PREGNANCY is the state from conception to expulsion of the products of that conception COMPLETE ABORTION is the expulsion of all the products of conception before the twentieth week of pregnancy.

Coincidentally made around the time the 1st intrauterine device (IUD) was sold in the market IMPLICATIONS .

Challenging ACOG definitions

Informed consent and the redefining of conception: A decision ill-conceived? 1998, Vol. 7, No. 6 , Pages 264-268 Joseph A. Spinnato, Department of Obstetrics and Gynecolog, University of Louisville School of Medicine, Louisville, Kentucky

Purpose:
assess the use of (ACOG) definitions of conception (a synonym for implantation) and the beginning of pregnancy (at implantation) in the clinical practice of its members explore the implications of differing definitions of conception and pregnancy onset for the process of informed consent.

Methodology: survey Results:

73% - conception was a synonym for fertilization 24% - conception was a synonym for implantation 50% - pregnancy began at fertilization 48% - pregnancy began with implantation Regression analysis failed to demonstrate a significant relationship to type of practice, years in practice, or the ACOG membership for these responses

Hormonal Contraception
The combinations of estrogens and progestins exert their contraceptive effect largely through selective inhibition of pituitary function that results in inhibition of ovulation. The combination agents also produce a change in the cervical mucus, in the uterine endometrium, and in motility and secretion in the uterine tubes, all of which decrease the likelihood of conception and implantation. The continuous use of progestins alone does not always inhibit ovulation. The other factors mentioned, therefore, play a major role in the prevention of pregnancy when these agents are used. - Basic and Clinical Pharmacology, 11th ed (2010, Katzung)

Hormonal Contraception
Combination oral contraceptives act by preventing ovulation. Plasma LH and FSH levels are suppressed, the midcycle surge of LH is absent, endogenous steroid levels are diminished, and ovulation does not occur. Progestin also leads to a thick, viscous mucus that reduces sperm penetration and induces an endometrium that is not receptive to implantation. - Goodman & Gilman s Manual of Pharmacology and Therapeutics (2008)

Actions of Drugs
When only one constellation of effects is wanted in a therapeutic situation, the remaining effects of the drug are regarded as limitations in selectivity (i.e., unwanted side effects).The specificity of a drug's action frequently is overestimated. This is partly due to the fact that the drug is identified with the effect that is implied by the class name..

By virtue of the ACOG/FIGO definition of conception, the post-fertilization effect of preventing blastocyst implantation does not equate to the abortifacient effect of OCPs, since abortion is defined as the termination of pregnancy from implantation before the age of viability (20wks). You cannot terminate something that hasn t even started yet.

I will not insult your intelligence.

Hormonal Contraception Failure Rates

Perfect use failure rate: 0.1% Typical use failure rate: 7.6% Pregnancies usually occur because initiation of the next cycle is delayed Factors that affect efficacy
Metabolism VARIES SIGNIFICANTLY from individual to individual, and from one population to another Strict adherence to 7-pill free days is critical to obtain contraception

Use and Implications

14 million American women annually 60 sixty million women internationally THUS, even an infinitesimally low portion (say one-hundredth of one percent) of 780 million Pill cycles per year globally could represent tens of thousands of unborn children lost to this form of chemical abortion annually

Use and Implications

Logistically and ethically impossible to determine which successful prevention of pregnancy is due to inhibition of:
Ovulation Fertilization Implantation

Rationale for scientific journal reviews to use the term no (direct) evidence.

Adverse effects
Increased risk of breast and cervical cancer (Group 1 carcinogen same level as smoking and asbestos) Strokes Thromboembolism Myocardial infarction Hypertension Osteoporosis (depo provera) Etc.

Use and Implications

TO BE PRO-LIFE MEANS TO PROTECT LIFE PRECAUTIONARY PRINCIPLE
When we are unsure of whether these drugs and devices can harm life itself, it is always better to err on the side of life, because we cannot afford to risk even one human life.

Intrauterine Device
Causes sterile inflammation of the endometrium MOA
Spermicidal Prevents implantation of fertilized ovum

Adverse effects
Uterine perforation Ascending infection

Intrauterine Device
If a woman gets pregnant with an intrauterine device (IUD) in place should the IUD be removed?
the IUD will be found between the fetal membranes and the uterus increased risk of preterm delivery 55% chance of miscarriage if the IUD is left in place risk of miscarriage is about 20% if the IUD is removed or spontaneously expelled
- Family Planning. In Stenchever MA, Droegemueller W, eds. Comprehensive Gynecology. 4th ed. St. Louis: Mosby, 2001: 341-342

Barrier Methods
Failure Rate
Condom
Perfect use - 2% Typical use - 10 18%,

Cervical cap
Perfect use
nulliparous - 9% parous:

Typical use
Nulliparous -16% parous:32%

Failure Rates Are NOT Statistics!!!

These are human lives.

We do not play Russian roulette with human lives.

THE 1987 PHILIPPINE CONSTITUTION Article 2: Declaration of Principles and State Policies SEC. 12. The State recognizes the sanctity of family life and shall protect and strengthen the family as a basic autonomous social institution. It shall equally protect the life of the mother and the life of the unborn from conception. The natural and primary right and duty of parents in the rearing of the youth for civic efficiency and the development of moral character shall receive the support of the Government.

POINTS TO PONDER
What value ought society place on human life at the earliest stages of development? Does the human embryo possess the same right to life as human beings at later developmental stages? Do we allow the government to subsidize services that put the human embryo at risk? Is our medical practice consistent with our science with regard to beginning of life issues?

HB 4244 AND ABORTION

HB 4244 and Abortion

HB 4244 DOES NOT differentiate between induced or spontaneous abortions legitimizes abortion by subsidizing the complications of a crime (if induced)

CONTRACEPTION CONTRADICTION

More Contraceptives, Fewer Abortions

Flawed because it assumes that:
Contraceptives work 100% Contraception does not alter sexual behavior/mentality

Contraception Contradiction
A couple that uses contraception establishes a contraceptive mindset, so that even if a child is conceived that child is unintended and thus unwelcome PRONE TO UNDERGO ABORTION US Supreme Court 1992 decision in upholding the right to abortion.
Planned Parenthood v. Casey In some critical respects abortion is of the same character as the decision to use contraception. For two decades of economic and social developments, people have organized intimate relationships and made choices that define their views of themselves and their places in society in reliance on the availability of abortion in the event that contraception should fail.

Recognizing the Language of Abortion

KNOW WHAT YOU SUPPORT

DR. JUNICE MELGAR, LIKHAAN Eventually, we give them information about safe abortion. We also warn them about unsafe pregnancies. We tell them But do you know of service providers, safe service providers who would look after these poor women and give them a proper abortion? Yes. I think most women s NGOs have contacts. If you really are pro women, you will have contacts to these services that are underground. http://www.youtube.com/watch?v=z
QrR-uYoKh8&feature=related

REDUCING MATERNAL MORTALITY

Maternal Mortality and HB 4244

Good provisions

Improving and increasing access to infrastructure Mobile health care services improving prenatal care training and deploying more skilled birth attendants

Questionable
advocating contraception in this situation Rationale: multiparity apparently increases the risk of uterine atony, hemorrhage, other complications lead to maternal death

To reduce the number of maternal deaths, we should prevent women from getting pregnant???

Reducing Maternal Mortality

a key common factor in the trends in maternal mortality, both globally and in the United States, is access to good basic and comprehensive obstetrical care (prenatal postnatal care) Countries with substantial increases in maternal mortality health systems have been decimated by war or internal conflict
Congo and Somalia ; Small improvement s - Liberia, and Guinea Bissau, showed only very small improvements),

extremely high HIV infection rates

South Africa, Botswana, Swaziland, Lesotho, Kenya, Zimbabwe , Zambia Direct effect HIV-positive women are more likely to die from opportunistic
infections, postpartum sepsis, and hemorrhage

Indirect effect
stresses on the health system and loss of physicians and nurses to death and migration

Reducing Maternal Mortality

POPULATION DEVELOPMENT AND POVERTY

Guiding Principle

Population Development, Poverty, and HB 4244

Population Development, Poverty, and HB 4244

Ideology Remains the Same

Too much people make a country poor We need to reduce the number of people because we have limited resources Numerous economic studies have shown that there is no correlation between poverty and population.

Population Density vs Absolute Numbers

Population and Poverty

There is insignificant empirical association between population growth rates and output per capita (economic growth) it is the rate at which technology grows and the ability of the population to employ these new technologies efficiently and widely that permit economic progress. provide laws and opportunities that will provide stable, secure, well-paid jobs with good benefits and higher education.
Simon Kuznets Nobel Prize Winner

GABRIELA, Population and Poverty

Rep. Luzviminda Ilagan and Rep. Emmi De Jesus Section 12 should be removed These provisions must be deleted in the RH bill. Otherwise, the long saga of blaming the population, and specifically women s wombs, for the rising poverty in the country continues. This wrong notion is made to persist while government and big business interests escape responsibility for the poverty they have caused this country for decades, and the ailing Philippine health system that the government has turned its back on.

Root Causes of Poverty

wrong economic policies poor governance human greed systemic corruption

It is a poverty to decide that a child must die so that you may live as you wish. - Blessed Mother Teresa of Calcutta

Demographic Winter

-cannot support dependents through taxes and product consumption - Not easy to reverse because mentality has been changed (Russia, Korea, Singapore, Japan, China) despite incentives

Racism, Eugenics, Population Control and Contraception

Margaret Sanger Founder, Planned Parenthood and Birth Control Review Eugenics
belief in the possibility of improving the qualities of the human species by discouraging reproduction by persons with presumed genetic defects We don t want word to get out that we want to exterminate the Negro population.

NSSM 200
"Populations with a high proportion of growth. The young people, who are in much higher proportions in many LDCs, are likely to be more volatile, unstable, prone to extremes, alienation and violence than an older population. These young people can more readily be persuaded to attack the legal institutions of the government or real property of the establishment,' imperialists,' multinational corporations, or other-often foreign-influences blamed for their troubles" [Chapter V, "Implications of Population Pressures for National Security].

NSSM 200
"We must take care that our activities should not give the appearance to the LDCs of an industrialized country policy directed against the LDCs. Caution must be taken that in any approaches in this field we support in the LDCs are ones we can support within this country. "Third World" leaders should be in the forefront and obtain the credit for successful programs. In this context it is important to demonstrate to LDC leaders that such family planning programs have worked and can work within a reasonable period of time." [Chapter I, World Demographic Trends]

NSSM 200
"In these sensitive relations, however, it is important in style as well as substance to avoid the appearance of coercion."

WOMEN S RIGHTS AND FREEDOM OF CHOICE

The Universal Declaration of Human Rights

Article 25 (1) Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control. (2) Motherhood and childhood are entitled to special care and assistance. All children, whether born in or out of wedlock, shall enjoy the same social protection. Are these rights/choices being curtailed?

Upholding your freedom of choice does not require the government to make your choices free.

Where Should Your Taxes Go?

Top 10 Causes of Morbidity
Diarrhea Bronchitis Pneumonia Influenza Hypertension TB Diseases of the heart Malaria Measles Chicken pox

Top 10 Causes of Mortality

Diseases of the heart Pneumonias Accidents Cancer Pulmonary tuberculosis Renal failure Diabetes mellitus Asthma peptic ulcer Liver cirrhosis

Contraceptives and Kenya

"... Malaria is epidemic in Kenya. Mothers die from this disease every day because there is no chloroquine, when instead we have huge stockpiles of contraceptives. These mothers come to me and I am helpless..." - Dr. Stephen K. Karanja,
M.B.CH.B.M.MED O/G - Consultant Obstetrician/Gynaecologist
http://pop.org/content/population-control-the-kenyan-perspective-895

Contraception is an INDUSTRY
1963 US annual sales
$200 million in hormonal contraception $80 million in diaphragms, jellies and other feminine hygiene products $85 million in prophylactics for men (condoms, spermicides)

Imagine how much they are earning TODAY Oddly enough, they also count on a population that is steadily rising, despite their efforts, to give them new customers.
http://www.time.com/time/magazine/article/0,9171,829935,00. html#ixzz1PV7vGPS5

FREEDOM OF CONSCIENCE AND RELIGIOUS EXPRESSION

Living the Faith

it is important to make it understood that being Christian is not a sort of uniform to wear in private or on particular occasions, but is something alive and allencompassing, able to take up all that is good in modernity.

Pope Benedict XVI on Promoting the New Evangelization

Implications
80% of Filipinos are Catholics Do they accept, live and express this faith? What does this mean to our Catholic President? Teaching on artificial contraception, on sexual intercourse being always open to life in the context of marriage, on sex education as the primary role of parents, and on responsible parenthood these ARE Catholic teachings concretely expressed One CANNOT be Catholic and be pro-RH. It is an OXYMORON. The freedom of conscience as well as freedom from coercion in religious expression must be guaranteed by the State.

Separation of Church and State

Violations in freedom of conscience

COERCIVE HB 4244 PROVISIONS

THE 1987 PHILIPPINE CONSTITUTION Article 2: Declaration of Principles and State Policies SEC. 12. The State recognizes the sanctity of family life and shall protect and strengthen the family as a basic autonomous social institution. It shall equally protect the life of the mother and the life of the unborn from conception. The natural and primary right and duty of parents in the rearing of the youth for civic efficiency and the development of moral character shall receive the support of the Government.

SEXUALITY EDUCATION: AN ISSUE OF CONTENT

OTHER COERCIVE PROVISIONS

LAST WORDS

Purple Ribbon Movement Launch: Crowne Plaza May 13, 2011

March for Life, Quirino Grandstand, March 25, 2011

THE TRUTH DOES NOT NEED CELEBRITY ENDORSERS

Reproductive Health and Responsible Parenthood

the love between husband and wife, love for children and family that is the fruit of that love, and ultimately the love of God that forgives us and that enables us to be faithful to the Word in spite of our sinfulness and scarce resources. This is a beautiful message and the Church should not be ashamed of it.
Dean Tony La Via Ateneo School of Government

THANK YOU FOR LISTENING!!!