Thursday, October 07, 2010

Healthcare as a matter of right

After a year of refuge in Baguio City from the first shock of martial law imposed by Ferdinand Marcos in 1972, our young family decided to leave the mountain retreat and return to the confines of old Manila. Actually, with another child coming, I needed to look for work to support my growing family. Two years later, I would find a job with the Population Centre Foundation, a private organization established to promote and fund family planning programs and research as part of the New Society’s population control initiative. The Foundation was bankrolled by huge grants from the Rockefeller and Ford Foundations and the USAID.

Here it was one late sultry afternoon when the chairperson of the Foundation, the First Lady of the land, Imelda Romualdez-Marcos, made a surprise visit along with her retinue of friends and foreign visitors, among them Van Cliburn, the celebrated American pianist. She wanted to show the new building and its modern facilities to her guests. For the first time, I got up close and personal with the dictator’s better-half, even shaking her soft and silky hands that exuded a fragrance totally foreign to my native nose buds. Mesmerized for some reason, I didn’t wash my hand that night to keep the bouquet as fresh as possible. My right hand was also a bit swollen, almost crushed, when I shook hands with the famous Van Cliburn, whose fingers were so large they could run the full length of two baby grands.

By that time, the Population Commission, the government office in charge of family planning on a national level, was already distributing free condoms, contraceptives and other birth control devices in health centres throughout the country. Their offices were also housed in the Foundation’s new edifice which was part of the tour that I conducted for the heavily-scented First Lady and her guests. The tour ended in the ultramodern kitchen where someone from the group started asking whether there was any food they could nibble before they left. It was fortunate that the canteen concessionaire had a whole apple pie left and the guests, including the wife of the New Society helmsman, digged at it as if they had not eaten for days. Well, the guests loved the lip-smacking apple pie. My boss, the executive director of the Foundation and Madame Imelda’s gynaecologist, took me aside and whispered if I could ask the concessionaire to send another pie to Malacanang Palace where the First Lady and her husband lived. Mrs. Marcos would really appreciate it, he added. His total obeisance jolted me from my bad dream. I quit my job soon after, promising myself not to kowtow again to the infamous occupants of the Palace by the Pasig River, and never to eat an apple pie when our starving people couldn’t even afford to smell or buy a real apple.

More than 35 years have passed and now the country’s Roman Catholic Church is being threatened by a Reproductive Healthcare bill in Congress. For some, it would have been better without such a law since the Catholic Church never protested against family planning and birth control during the Marcoses’ halcyon days. Was it also because the Church lost its voice during the twenty years of iron rule by the Marcoses? Others rue that Church hierarchy waited it out till after the EDSA People Power Revolution drove the Marcos family out of the country. Yes, from all indications, the hierarchy’s reaction was far and between a little bit too late.

Promiscuity, among the young especially, had become permissive. New social values and sexual norms have sprung up and eroded the modesty and temperance of the old generation. The fact is that the Church had slept and almost by default allowed the forces of progress to march onward along with birth control devices. Except for its unflinching stand against abortion, the Church has lost this fight a long time ago.

Truth is, the proposed reproductive healthcare law is not all about birth control as the Church and other opponents of the bill would like to portray it. It only became a family planning issue after President Benigno Aquino III during a recent visit to the United States said that he would extend assistance to couples planning to limit the number of their children by using artificial contraceptives. According to the Church, contraception is a type of abortion and it is a grave crime and banned by the Constitution.

Arguments over the proposed reproductive health law range from whether population control will actually alleviate poverty or whether the law is moral or immoral. Oftentimes, our leaders and policy makers blame overpopulation as the root cause of poverty. That kind of argument goes far back to the Middle Ages which echoed the plaint raised by an Italian priest and diplomat by the name of Giovanni Botero, who said that population cannot increase beyond its food supply.

There are other countries and cities in the world which are much more crowded than Manila or the entire country, yet they have a higher gross domestic product per capita. Accepting that a manageable population of healthy, educated and productive citizens is key to sustainable human development, population control is not an assurance of genuine development.

Poverty in the Philippines is not caused by overpopulation but by farmers’ problems of landlessness, workers’ lack of jobs and low wages, and government policies that favour big business interests over people’s welfare. An inequitable concentration of wealth in the hands of the richest 10 per cent of the population also reinforces widespread poverty.

Any effective reproductive healthcare law must address issues beyond population control—not just about the use of pills, injectibles, condoms and cycle beads. It must focus on making reproductive healthcare services accessible to all women, particularly indigent and poor women workers who have long been excluded from healthcare. It’s the woman’s health, stupid, to borrow from James Carville’s famous epithet.

The poor, particularly women, have always been at the losing end of this debate about population control. Take abortion on demand, for example. Criminalizing abortion has forced pregnant women who do not want to give birth to seek clandestine options. A recent study made by the New York-based Centre for Reproductive Rights found that over half of all pregnancies in the Philippines are unintended and one-third of these pregnancies end in abortion. The same report also said that because of various reasons including rape and dire socio-economic consequences, half a million Filipino women are choosing abortion with more than 1,000 women dying and 90,000 being hospitalized for complications from unsafe abortion.

Making abortion illegal does not stop abortion; it only makes it more dangerous for the health and lives of Filipino women. The Philippines, which owes its Roman Catholic faith to Spain, makes abortion criminal by lifting directly from the old Spanish Penal Code of 1870. Because of high rates of death from unsafe abortion due to its illegality, Spain has already reconsidered its restrictive law and, since 1985, has allowed abortion on certain grounds. In February 2010, Spain went even further in liberalizing abortion by allowing the procedure without restrictions up to 14 weeks and by giving 16- and 17-year-olds the right to have abortions without parental consent.

Other predominantly Catholic countries like Belgium, France, Italy, Poland, Hungary, Colombia, Mexico and Portugal have all also allowed abortion on certain grounds.

Whether to allow women to abort is a hot issue that will linger, perhaps even forever. Those who believe in the sanctity of human life in accordance with the teachings of their religion will never be deterred in championing the pro-life cause. Pro-choice activists will do the same. Bridging this great divide will require a rational understanding of social evidence that more and more women today die from unsafe abortions. In the end, the real issue is whether we should deny healthcare as a matter of right to these unfortunate women.

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